It may surprise some to discover that, with 3.8 million registered professionals in the US alone, nursing is not only a huge profession but an extraordinarily multifaceted one, with multiple specialisms and excellent opportunities for career progression.
In this essay, however, we’ll “zoom in” on one of these specialisms – the family nurse practitioner – and show how sought-after and respected this high-status and many-sided clinical profession actually is.
What are ‘Nurse Practitioners’?
Nurse Practitioners or ‘NPs’ are healthcare professionals who have pursued advanced clinical training after gaining their Bachelor of Science in Nursing (BSN) degree and obtaining their Registered Nurse (RN) license (which is granted upon passing a licensure exam). Upon qualification as an NP, these senior professionals are designated as ‘APRNs’ – Advanced Practice Registered Nurses.
This means that NPs have, in total, successfully completed six or more years of a formal academic and clinical study, with the NP training at a substantially higher level than the BSN degree.
In other words, these specialized health professionals are usually already experienced and qualified nurses. Still, they have progressed beyond entry-level qualifications (the BSN) to obtain graduate-level qualifications and expertise (i.e., a master’s or a doctoral degree). Their Nurse Practitioner training also requires them to acquire advanced clinical skills and knowledge during the course of their high-tier graduate academic studies.
This advanced training equips NPs to perform myriad primary and specialty care functions, a set of competencies that became acutely important during the Covid-19 pandemic of 2020-22. NPs “stepped into the breach,” as it were, to increase access to primary care during significant shortages of doctors and other healthcare professionals. Forbes reports that this, in turn, has led numerous state lawmakers in the US to introduce new legislation removing all remaining hurdles to patients requiring high-quality primary care from a Nurse Practitioner. Twenty-six states (and climbing) have now agreed to grant “Full Practice Authority” to NPs, meaning that they are no longer required to conduct their operations under physician supervision but are recognized as fully independent healthcare providers in their own right.
Is a Family Nurse Practitioner the same thing?
The short answer to this question is “Yes and No.” Family Nurse Practitioners, or FNPs, are registered APRNs, meaning they have completed the requisite advanced academic and clinical training described earlier for this senior tier of the profession.
FNPs represent one of the specialisms of the Nurse Practitioner field. Like all qualified Nurse Practitioners, FNPs are authorized to:
- Examine, evaluate, and diagnose patients
- Craft treatment plans, including pharmaceutical treatments and follow-up clinical appointments
- Order and interpret diagnostic tests, including advanced imaging interventions like MRI scans, laboratory analyses of blood or tissue samples, or order a range of therapies
- Prescribe medications
- Refer to other clinical specialists or other providers if appropriate
The other specialisms NPs can choose from are Adult-Gerontology (primary or acute care), Women’s Health, Pediatrics (primary care), Neonatal Care, and Psychiatric/Mental Health care.
Returning to FNPs, these highly-credentialled and clinically highly competent professionals offer care for all ages, from newborns right through to the most elderly of senior citizens. Of all the APRN specialisms, this is the most well-established and widely distributed, with the first FPNs graduating in 1965.
Today they can be found in hospitals, community health clinics, and private medical practices, where they serve as primary healthcare providers for individuals and families alike. Many (like family physicians) treat the same patients from one decade to the next, obtaining a deep and personal understanding of their medical conditions but also of their personalities, and lives.
The tasks of the Family Nurse Practitioner
At the heart of FNP practice is the delivery of high-quality, expert primary care to patients of all demographics and ages. That means they’re academically and clinically competent to diagnose and treat a whole gamut of conditions, from urinary tract infections to upper respiratory illnesses, obesity to diabetes, and conduct routine health check-ups and clinical follow-ups to injuries arising from accidents and much else besides.
A good deal of an FNP’s daily work consists in liaising closely with colleagues from other healthcare disciplines, from nurses to lab technicians, physicians to radiologists, and specialists like oncologists, cardiologists, orthopedic surgeons and, where relevant, colleagues in mental health services (psychologists, psychiatrists, mental health nurses, counselors/psychotherapists).
Because of their long-term and in-depth knowledge of their patients, they also serve as a crucial hub for communications with other professionals and specialists involved in each patient’s care. That unique, in-depth knowledge of specific patients also helps them to craft uniquely individualized treatment plans; their entire approach to healthcare revolves around their enduring, personal connection with their patients.
Are there specialisms within the specialism of Family Nurse Practitioner?
While it’s certainly the case that FNPs have earned a well-deserved reputation for handling anything that comes before them clinically, they may also tailor their training in favor of some specific nursing practitioner specialties within the FNP role – Spring Arbor University has several courses that can help nurses find their niche.
Before listing them, a word or two about the training may be relevant here. While there is much emphasis in the formal training on taking a broad-based and holistic approach to healthcare, there are also options to sub-specialize during the advanced training program in particular areas of interest to them.
For nurses considering progressing their careers by entering this versatile and rewarding role, the good news is that getting credentialed no longer means having to give up work to “go back to school,” as it were. Well-established campus-based universities of high academic repute, like Spring Arbor, are offering complete FNP programs online to nurses with a BSN degree and registered nurse license (RN). This enables them to study around their existing work and family commitments without sacrificing either. For RNs who have not yet graduated with a BSN, this particular program offers an online RN-MSN (Master of Science in Nursing) bridge program in preparation for the FNP training, which includes attaining a bachelor’s degree in the process.
Back to the sub-specialties available within the FNP profession. Depending on interest, FNP students can opt to include an extra focus in their training in any of the following areas:
- Cardiology
- Emergency medicine
- Endocrinology
- Geriatric care
- Oncology
- Surgery
These sub-specialties open doors to qualified FNPs to include areas of specific special-interest expertise within their general daily practice.
Healthcare settings where FNPs are to be found
For the vast majority of Americans, their first point of entry into the healthcare system when an illness or malady strikes is the family doctor’s office’s most widely used primary care setting. For that reason, most FNPs tend to be mainly based there.
However, as their training covers such diverse medical fields and grants them particularly in-depth knowledge in their chosen sub-specialties, other FNP roles can be found in various settings, including outpatient surgery clinics and hospital emergency rooms. The majority of FNPs, however, tend to choose to work in primary care clinics and family doctor’s offices.
What is the scope of practice for FNPs?
This varies from state to state in the US. Qualified to work with any patient population as advanced-level primary healthcare professionals, their exact range of duties is defined by individual state law.
Essentially there are three tiers of practice that FNPs fall into, depending on which state they’re located in. These are:
Full Practice Authority, wherein they have the authority to independently evaluate, diagnose, and treat patients without supervision by a physician. As mentioned earlier, this level of authorization has been adopted by more states in the wake of the Covid-19 crisis, when Nurse Practitioners helped ease the pressure placed on other medical professionals. In these states, FNPs may open their own practices.
Reduced Practice Authority, wherein FNPs are able to evaluate, diagnose and treat patients provided their practice is overseen by a physician who must approve of their proposed interventions.
Restricted Practice Authority, wherein FNPs are obliged to be supervised by a physician who is required to sign off on all proposed FNP treatment plans before they are implemented. Physicians are also required in these states to write all prescriptions.
Conclusion
While this role is often challenging, it’s also one of the most endlessly exciting and rewarding specialisms in the nursing profession. It’s also a role that has become so well-established since its “debut” in 1965 that handsomely remunerated FNP jobs can be found just about anywhere in the country.
And a crucial part of what makes this specialism so rewarding for its practitioners is that they have vastly more authority over their interventions than they ever did as BSN-credentialled RNs. For this reason, most RNs tend to prefer to work in states where they are legally granted Full Practice Authority – but the number of states adopting this policy is now rising swiftly in the wake of the global health crisis of 2020-22.
It should perhaps be pointed out that two levels of post-BSN qualification for these roles are available: the Master of Science in Nursing (MSN) or the more advanced and in-depth Doctor of Science in Nursing (DSN).
The advantage of master’s programs is that they’re faster (and less costly) to complete than Doctoral programs. But the trend seems to be that most prospective FNPs prefer to take the DNP route, not least because of the added depth of academic and clinical knowledge they offer – and the doors they open to high-salary leadership and management roles.
Whichever route a future FNP takes, however, a richly rewarding career awaits upon completion.
