Pathway from Registered Nurse to Nurse Practitioner

By Lee Nelson

Nurse.org, October 7, 2017 —

As a registered nurse, sometimes you just want to do more in your profession. That’s why so many are heading towards earning an advanced degree to become a nurse practitioner.

In fact, more than 20,00 students comopleted their academic programs in 2015 in the United States, according to the American Association of Nurse Practitioners (AANP).

“Many times, the average nurse practitioner student has been practicing as a registered nurse for 10 years or so,” says Ken Miller, president of the AANP. “They just get to a point in their career that they want more autonomy. There is just such a need for this profession because of the Affordable Care Act.”

Miller says that between 30 and 40 million more people have been added to the primary care system after finally getting health insurance.

“But no single discipline can handle that. So, the nurse practitioners are picking up a lot of that primary care that needs to be done,” he said. “They also can own their own clinics. In fact, there are 250,000 nurse-owned and managed clinics across the country.”

It’s such a good job that U.S. News & World Report ranked it #2 Best Health Care Job of 2017 and #2 in the 100 Best Jobs overall in 2017.

Advantages of being a nurse practitioner

“Once you become a nurse practitioner, the increase in salary is tremendous,” Miller says.

For instance, a licensed practical nurse makes an average of $43,000 annually, while a registered nurse earns $67,490. But nurse practitioners average $104,740 year.

“Those who work in acute care, start out even higher. In many places, their salaries are $150,000 a year,” he says.

Nurse practitioners can prescribe medications in all 50 states. Florida is the only state that won’t allow them to prescribe narcotics.

Nurse practitioners can also own their own clinics, can treat patients and order tests. Registered nurses can order tests but they have to call a NP or doctor to get an order for that test, Miller says. A nurse practitioner works closely with patients. No matter what the specialty, he/she will spend the majority of time at work assessing, examining, diagnosing and treating patients.

They can diagnose patients with diabetes or high blood pressure and then help them manage it. They can order and then interpret laboratory tests and X-rays. They also are there to educate and support patients’ families through the bad moments.

In some states, nurse practitioners are required to have a supervisory contract in place with a physician. But in many, they do have the authority to work independently.

The opportunities abound for this profession. Nurse practitioners have a chance to work in all types of settings including hospitals, doctors’ offices, urban and rural clinics, college campuses and within corporations.

Timeframe for transitioning from RN to nurse practitioner

A nurse practitioner degree can take two to four years depending on the program and whether or not the participant is full-time or part-time, Miller says. Some programs even offer an accelerated program that takes less than 16 months or less to complete. This is for those with a bachelor’s degree already.

These are called Direct Entry MSN programs. The National League for Nursing (NLN) said that these programs that build avenues within nursing education “facilitate and inspire the seamless academic progression of nursing students and nurses. Our common goal is a well-educated, diverse nursing workforce to advance the nation’s health.”

“Most nurse practitioner candidates do their schooling part-time while they work. Many are either single parent families or have small children. Those who go full-time usually have a spouse who is working and can take care of the bills,” Miller says.

Most schools require a nurse to have been working one to two years before they get their advanced degree.

“You need that foundation,” he explains. “There is a movement afoot that believes an RN can go directly to earning a Doctor of Nursing Practice (DPN) and bypass the master’s degree.”

According to the American Association of Colleges of Nursing (AACN), there are more than 250 schools nationwide offering DPNs. Of those schools, 30 percent offer nurses the chance to skip the master’s degree and jump from a BSN to a DPN.

Miller states that there are 200 some programs out there offering this so far. But he says that there isn’t enough data on whether that idea will fly with everyone. The usual timeframe for someone to become a nurse practitioner includes:

Earning a bachelor’s degree in nursing. Those who have a bachelor’s degree in another subject can take the fast-track option to a master’s degree.

Be state licensed as a registered nurse.

Choose a specialty – Many nurse practitioner graduate programs require applicants to have at least one to two years of experience working as an RN in a chosen specialty. Nurse practitioner specialties include such things as family practice, midwifery, acute care, mental health, anesthesia, pediatrics, gerontology and women’s health.

Complete a master’s degree in a nurse practitioner program or a doctorate degree.

Take the nurse practitioner certification exam for your practice specialty.

Obtain a nurse practitioner license.

Program options and Getting a Doctorate

Depending on where you choose to do your course work to become a nurse practitioner, the options are varied. Programs across the country offer full-time, part-time and online choices. Some take one year full-time, others can go for years with part-time classes and clinic work.

Many of these programs provide a pathway to becoming a nurse practitioner for a variety of nurses who may have different levels of prior experience including those who are already RNs, BSNs and MSNs. For working nurses, online nurse practitioner programs allow students to choose their own pace and work around their busy nursing schedules to complete training are a convenient option.

As of 2015, the American Association of Colleges of Nursing (AACN) will require that anyone seeking training as an Advanced Practice Registered Nurse (APRN) will be required to complete coursework necessary for a Doctor of Nursing Practice (DNP) degree. Until 2015, only a master’s degree was required. However, adoption is not yet mandatory. So, many nurse practitioner programs already in place still allow the candidate to earn a Master’s degree and not a doctoral degree.

When and if the DNP becomes the prevailing way of doing things, then that will increase coursework and longer training to become a nurse practitioner.

Some of the Best Programs

Here are a few of the top nurse practitioner programs across the country including their cost, according to U.S. News & World Report:

#1 – John Hopkins University, Baltimore: $37,056 per year

#2 – University of Pennsylvania, Philadelphia: $39,552 per year

#3 – University of Washington, Seattle: $25,575 (in-state), $$39,048 (out of state) per year

#4 (tie) – Duke University, Durham: $36,058 per year

#4 (tie) – University of California, San Francisco: $17,339 (in-state), or $32,433 (out-of-state) per year

#6 – Vanderbilt University, Nashville: $1,434 per credit hour

About 62 percent of those who become nurse practitioners work in the family practice area of healthcare, Miller says. And about 24 percent of all nurse practitioners are men, and those numbers are growing each year.

“But you can be a nurse practitioner any place, and the pay is very good,” he says.

No two days will be alike as a nurse practitioner. That’s why so many people love the job. You are working one-on-one with patients helping them understand their newly diagnosed disease or counseling a family whose young child is in ICU. The next day, you order tests for a man with heart problems and help him understand what procedures are needed to save his life. The job will challenge you and hopefully inspire you for a very long time.