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The nurse practitioner (NP) profession evolved from the need to fill a void in the primary care workforce more than 50 years ago. Today, nurse practitioners remain a vital component of the primary care workforce, although their roles have diversified to include specific patient population focus areas. Today’s nurse practitioners serve the specialized needs of distinct patient population groups by concentrating their graduate education and becoming nationally certified in one or more patient population foci – family/individual across the lifespan, women’s health, adult-gerontology acute or primary care, neonatology, pediatrics or psychiatric/mental health.
Further, NPs can elect to pursue additional training and education to provide care in a number of sub-specialties like haematology/oncology, urology, orthopaedics, gastroenterology, neurology, cardio-pulmonary, dermatology, allergy and immunology, endocrinology, emergency medicine, occupational health, or sports medicine.
Graduate level education and national board certification are now standard, ensuring a high-level of quality care, both in primary and acute care settings and across the age spectrum. Clinical competency and professional development remain hallmarks of the nurse practitioner role.
Although far more nurse practitioners work in primary care than in any other area (about 49 percent), jobs for NPs in non-primary, specialty areas are expected to increase dramatically during the projection period leading up to 2025 due to a lack of specialty physicians in the workforce.
Nurse Practitioner Job Description
According to the American Association of Nurse Practitioners (AANP), nurse practitioners provide high-quality primary, acute, and specialty care health services across the lifespan and in diverse settings. Although an NP’s job description would differ slightly based on the population they serve and the setting in which they work, all NPs have a number of things in common:
- NPs are licensed, independent practitioners that practice in ambulatory, acute, and long-term care settings as primary and/or specialty care providers.
- NPs may work autonomously or in coordination with other healthcare professionals.
- All NPs possess advanced clinical training and competency to provide care beyond the scope of registered nurses.
- All NPs possess a graduate education, possessing a Master of Science in Nursing (MSN) or higher.
- NPs diagnose, treat, and manage acute and chronic illnesses.
- NPs focus on health promotion, disease prevention, and health education and counseling.
- NPs order, conduct, supervise, and interpret diagnostic and laboratory tests.
- NPs prescribe pharmacological agents and non-pharmacologic therapies.
- NPs help patients make better lifestyle and health choices.
- NPs also often serve as healthcare researchers, consultants, and patient advocates.
According to a 2012 National Survey of Nurse Practitioners conducted by the Health Resources and Services Administration (HRSA) Bureau of Health Professions National Center for Health Workforce Analysis, nurse practitioners reported that they were “most likely” to perform the following direct patient care services:
- Counsel and educate patients and families: 85.6 percent
- Conduct physical examinations and obtain medical histories: 83.9 percent
- Prescribe drugs for acute and chronic illnesses: 80.4 percent
- Order, perform, and interpret lab tests, x-rays, EKGs, and other diagnostic studies: 75.4 percent
- Diagnose, treat, and manage acute illnesses: 68.3 percent
- Diagnose, treat, and manage chronic illnesses: 60.9 percent
- Provide preventive care, including screening and immunizations: 55 percent
- Provide care coordination: 53.3 percent
- Make referrals: 46.1 percent
- Perform procedures: 26.2 percent
Standards of Practice for Nurse Practitioners
The American Association of Nurse Practitioners’ (AANP) describes the standards of practice for nurse practitioners as encompassing these processes, priorities and responsibilities:
Process of Care: Nurse Practitioners use the scientific process and national standards of care as a framework for managing patient care. This includes:
- Making an assessment of a patient’s health status
- Making a diagnosis
- Developing a treatment plan
- Implementing a plan that is consistent with the appropriate plan of care
- Following up and evaluating the patient’s status
Care Priorities: Nurse practitioners follow an established practice model, which emphasizes:
- Facilitating a patient’s entrance into the healthcare system
- Patient and family education
- The facilitation of patient participation in self-care
- The promotion of optimal health
- Continuity of competent care
- Promoting a safe environment
Interdisciplinary and Collaborative Responsibilities: Nurse practitioners participate as a team leader and member of the healthcare/medical team.
Accurate Documentation of Patient Status and Care: Nurse practitioners maintain accurate, legible, and confidential records.
Responsibility as a Patient Advocate: Nurse practitioners act as advocates of health policies that benefit communities and individuals at the local, state, national, and international levels
Quality Assurance and Continued Competence: Nurse practitioners participate in continued learning throughout their career as it pertains to evolving standards, their particular patient population and specialty niche, ethics and pharmacotherapeutics.
Adjunct Roles of Nurse Practitioners: Nurse practitioners serve as mentors, healthcare providers, researchers, managers, and consultants.
Research as Basis for Practice: Nurse practitioners support research that supports evidence based practice specific to their patient population focus, as well as in the areas of pharmacology, disease prevention, epidemiology, medical technology and more.
Areas of Specialized Care and Work Settings for Nurse Practitioners
The 2012 National Survey of Nurse Practitioners also revealed the settings in which nurse practitioners work and the type of care they provide.
Nurse practitioners surveyed reported providing patient care within five distinct specialty areas:
- Primary care: 48.1 percent
- Internal medicine subspecialties: 13.3 percent
- Surgical specialties: 8.8 percent
- Pediatric subspecialties: 3.1 percent
- Psychiatry/mental health: 5.6 percent
- No specialty: 1.3 percent
The majority of nurse practitioner jobs (56.7 percent) were found in outpatient settings:
- Private physician offices: 31.6 percent
- Federal clinic: 6.7 percent
- Private NP office/practice: 4.1 percent
- Community clinic: 2.9 percent
- Retail-based clinic: 2.2 percent
- School/college health service: 2.2 percent
- Urgent care clinic: 1.8 percent
Still, a significant proportion of nurse practitioners (31.6 percent) worked in hospital settings, followed by:
- Long-term and elder care settings: 4.7 percent
- Public or community health settings: 2.1 percent
- Academic education programs settings: 3.1 percent
- Occupational employee health settings: 1.1 percent
Although a nurse practitioner’s work setting and area of specialized practice would contribute significantly to their job duties, their chosen patient population focus remains the biggest determinant for the types of patients they treat and the duties they routinely perform:
Family/Across the Lifespan: This patient population focus involves preventive healthcare, as well as the assessment, diagnosis, and treatment of chronic and acute illnesses and preventive healthcare for individuals and families across the lifespan. NPs working with this patient population group demonstrate a commitment to family-focused care and have an understanding of common health issues that arise at different ages and stages of life.
Neonatal: Neonatal nurse practitioners provide healthcare to neonates, infants, and children up to two years of age.
Paediatric Acute Care: Acute care pediatric nurse practitioners care for children with complex acute, critical, and chronic illnesses across the entire pediatric age spectrum, from birth to young adulthood.
Paediatric Primary Care: Primary care pediatric nurse practitioners provide care to children from birth to young adulthood. The primary services that paediatric primary care NPs provide includes well childcare and prevention/management of common pediatric illnesses and conditions.
Psychiatric-Mental Health: Psychiatric-mental health nurse practitioners focus on the mental health needs of individuals across the lifespan, from infancy through old age, as well as families and populations across the lifespan. Patients of psychiatric-mental health NPs include those at risk for developing and/or possessing a diagnosis of mental health or psychiatric problems.
Women’s Health/Gender-Related: Women’s health/gender-related nurse practitioners provide primary care to women across the lifespan, with an emphasis on conditions unique to women, from adolescence through the remainder of their lifecycle. Women’s health/gender-related NPs consider the interrelationship of gender, social class, culture, ethnicity, sexual orientation, economic status, and socio-political power influences.
Adult-Gerontology Acute and Adult-Gerontology Primary Care: Adult-gerontology acute and primary care nurse practitioners provide acute or primary healthcare services to young adults (including late adolescents and emancipated minors), adults, and older adults. Their scope of practice is not setting-specific but rather based on patient care needs.