Guest post by Dr. Rachel Silva DNP, APRN, NP-C, FNP-BC, RNC-OB
Dr. Silvas answers the question “How do I become a Nurse Practitioner?”
Dr. Silva works clinically as a Family Nurse Practitioner, is CEO of Accessible Healthcare Institute™LLC, Host and Producer of The Nurse Practitioner Show™, and Assistant Professor of Graduate Nursing at Felician College.
She’s also a profound social media influencer and can be found on Facebook, Twitter, Google+, Instagram, and her newsletter.
How Do I Become a Nurse Practitioner?
I remember the first day I saw a nurse practitioner. I was confused how someone that wasn’t a member of the elite paternalistic medial profession could prescribe orders to me as the registered nurse caring for the patient.
I had so many patients on the medical-surgical floor I was working on that day, and I didn’t have much time for discussion. I saw the charge nurse and inquired “Who is the lady writing orders in the patients’ charts?”
The charge nurse answered, “Oh, she’s a nurse practitioner. She’s like a physician, but not a physician. She’s a RN who went back to school to be a nurse practitioner (NP).”
Puzzled, I continued asking questions, “How do you go from an RN to an NP? What do you have to do in order to be an NP?” How do I become a nurse practitioner??
She answered,”Oh honey, you have to get your master’s degree!”
My short-lived dream of only one minute was shattered. I would never be a nurse practitioner. I was 18 years old and it was the mid-1990’s. Across the street from the hospital was the college that I received my associate of science in nursing (ADN) in order to be licensed as a registered nurse (RN).
I thought about all the sleepless nights I had studying, going to sleep at 4am, and tears running down my cheeks at 7am in the shower wondering how I would survive another day of nursing school.
I couldn’t imagine repeating that torture for four more years. I lived in a rural area in South Carolina. That NP was a rarity I convinced myself. No one seemed to understand her role or easily accept her position.
I was 18 years old, working as an RN, had just bought my dream red convertible car and was buying my first home. Although before starting nursing school at 16 years of age, I prayed I would be able to earn a doctorate in nursing before I turned 40 years old, I had better things to do than contemplate enduring more torture of what I had just survived.
Fast forward a little over a decade, and I was working in The Big Apple at New York University Medical Center. I was surrounded by some of the most fabulous nurses from across the country. The hospital was Magnet certified by the ANCC, nursing education was paramount to the clinical ladder and expected of the nursing staff.
Within the hospital, 92% had earned an BSN degree and approximately 35% of nursing staff had earned an MSN degree. I was fascinated with their NYC attitude and uncompromising expectations for evidenced-based practice. If patient outcomes did not meet their expectations, no worries, it would be discussed in meetings.
These nurses told nursing leadership what policies needed to be changed based on their scholarly literature findings. Nurses developed plans to improve patient outcomes and meet expectations of their profession providing healthcare.
Unknowingly, these nurses empowered and motivated me to pursue continuing my nursing education as a nurse practitioner.
Best of all, I did earn my doctorate in nursing before my 40th birthday, after all.
So, how do you become a nurse practitioner?
What Is a Nurse Practitioner?
The history of the nurse practitioner profession began with the two pioneers and founders of the nurse practitioner profession: Dr. Loretta Ford, a nurse, and her colleague Dr. Henry Silver, a pediatrician.
There was a strong demand and need within society for primary care services. Understanding this need within public health and the nursing profession’s ability to meet the need of access to primary care services led to development of the nurse practitioner role and the first NP program in 1965.
Many refer to the physician shortage as prompting the growth of NP programs. However, Dr. Ford has clarified the NP role was developed to meet society’s need for primary care services, and the physician shortage simply provided the opportunity for nurse practitioners to meet a public health need within their capability.
NPs are advanced practice nurses. They have received an undergraduate baccalaureate degree and licensure as a registered nurse. In addition, a nurse practitioner has received advanced graduate education.
In order to become a nurse practitioner, one must have earned a Master of Science in Nursing (MSN) specializing as a nurse practitioner. Many NPs have also earned doctoral nursing education, primarily with either a clinical doctorate as a Doctor of Nursing Practice (DNP) or with a research doctorate as a Doctor of Philosophy (PhD) in nursing. NPs have completed graduate education, achieved licensure and credentialing beyond their roles as registered nurses.
NPs are independently licensed practitioners who provide high-quality and cost-effective care. NPs practice as either primary healthcare providers or specialty healthcare providers in ambulatory, acute and long-term care settings. The scope of practice for NPs provides blends nursing and medical care for individuals, families and groups.
NPs are well-known for their focus on health promotion and disease prevention. In addition, NPs diagnose and manage both acute and chronic health conditions, prescribe medications and non-pharmacologic therapies, order, conduct, supervise and interpret diagnostic and laboratory tests.
They serve as health care researchers, interdisciplinary consultants and patient advocates.
To learn more about the role of nurse practitioners, read the AANP Policy and Position Statements.
The Nurse Practitioner Journey
Step 1: Earn undergraduate degree Bachelor of Science in Nursing (BSN). Ensure the program you select is an accredited program through either:
- Commission on Collegiate Nursing Education (CCNE)
- Accreditation Commission for Education in Nursing, Inc. (ACEN), formerly knowns as the National League for Nursing Accrediting Commission (NLNAC).
Step 2: Receive state licensure as a registered nurse (RN).
Step 3: Determine your purpose in continuing graduate nursing education. Is it to continue academic education as an advanced practice to nurse with the goal of diagnosing, managing acute and chronic diseases with prescriptive authority?
Step 5: Select your population focus as a nurse practitioner: neonatal, pediatric, adult-gerontology, family, women’s health, psychiatric mental health, or acute care nurse practitioner. Become familiar with curriculum standards and expectations of graduate nursing programs.
Step 6: Complete and submit the application to your desired college of nursing and nurse practitioner program.
Step 7: Confirm support from your family and friends. There is no way you can complete a NP program without support. If you have children, you need to know who can step in to lend a helping hand over the next two years.
What if you can’t leave NP clinical in time to go to Johnny’s parent-teacher conference? Who can pick-up your daughter from daycare those days? You have research you have to complete for your capstone paper that is due in three hours, but there aren’t any clean clothes to wear and not one clean dish in the house.
My word of wisdom is to forget housework, there is no way you can work as an RN, take care of a family, go back to school to be a nurse practitioner and manage everything you did before. If there is anyway you can hire someone to help around the house it will save your sanity.
Step 8: Locate potential nurse practitioner clinical preceptors. This is the hard part. Don’t wait until the clinical semester starts. Don’t expect people to jump at the opportunity to precept a student for free.
Generally, NP preceptors are not financially compensated for their preceptorship. Most likely, this can involve making “cold calls” to offices in order to speak with a nurse practitioner regarding this opportunity. There are several strategies to locate NPs that could be potential preceptors:
- NPfinder.com by the American Association of Nurse Practitioners
- Find an NP Preceptor by eNP Network
- Search provider lists in Medicare and private insurance directories
Step 9: Excel at organizational skills. Most NP students are working as RNs and have family responsibilities. Coordinating and managing personal responsibilities with academic responsibilities is imperative.
Step 10: Discover helpful clinical resources. Throughout your NP curriculum you will learn what is referred to as the “3 Ps,” advanced physical assessment skills, advanced pharmacology, advanced pathophysiology, as well as research findings and national guidelines to translate into evidence-based practice in the clinical setting.
Along with required textbooks and readings, utilize handy mobile reference tools. My top two choices would be Epocrates®+ and UpToDate®. Both of these require purchasing a subscription, and UpToDate® is expensive.
However, UpToDate® does give a great discount for students and Epocrates® does offer college institutions discounts. In addition, with UpToDate® you accumulate continuing education credits, as it tracks time you spend using the service and accumulates as contact hours.
Family Practice Notebook is an excellent resource that just released a mobile app, and it’s free. To ensure your research papers are formatted correctly in American Psychological Association (APA) format, use software such as PERRLA or Mendeley.
Step 11: Upon graduation and earning your Master of Science in Nursing (MSN), become nationally certified as a nurse practitioner. The organization you will need to contact for registration of the national certification exam is dependent upon your population focus as a nurse practitioner:
- American Association of Nurse Practitioners (AANP)
American Nurses Credentialing Center (ANCC)
- American Association of Critical Care Nurses (AACCN)
- National Certification Corporation (NCC)
- Pediatric Nurse Certification Board (PNCB)
To study for the NP national board exam, access NP certification examination review resources. These resources are also excellent study companions during NP school, as well as after passing NP boards:
- Fitzgerald Health Education Associates (FHEA) with Dr. Margaret Fitzgerald
- Advanced Practice Education Associates (APEA) with Dr. Amelie Hollier
- Barkley & Associates, Inc.
- Maria Leik Intensive Nurse Practitioner Review
Step 12: Receive state licensure as a nurse practitioner. Upon graduation and receiving national certification as a nurse practitioner, complete the application process with your state’s Board of Nursing to receive licensure to practice as a nurse practitioner.
The American Association of Colleges of Nursing (AACN) Consensus Model endorses the licensure title of Advanced Practice Registered Nurse (APRN). However, states differ on the state licensure titles, it may be
- Advanced Practice Registered Nurse (APRN)
- Advanced Practice Nurse (APN)
- Advanced Registered Nurse Practitioner (ARNP)
- Nurse Practitioner (NP)
- Certified Nurse Practitioner (CNP)
- Highest educational degree/s: academic title of highest level of nursing education is to be listed first. If applicable, to be followed by the academic title of highest level of non-nursing education. If you have a master’s degree or doctoral degree, it is not necessary to list the corresponding baccalaureate degree unless the baccalaureate degree is in a different academic field.
- State licensure title: such as APRN or APN. If one is an advanced practice nurse such as APRN or APN, it is not necessary to also list the RN state license, as it is understood one is licensed as an RN in order to be an APRN
- National certification title/s: with highest academic certification titles listed first
- Awards and honors: such as Fellow of American Association of Nurse Practitioners (FAANP) or Fellow of American Association of Nurses (FAAN)
- Other non-nursing certifications: such as Emergency Medical Technician-Basic (EMT-Basic)
For example, Mary Smith DNP, MBA, APRN, FNP-BC, RNC-OB
Step 13: Apply for a National Provider Identifier (NPI) number, Drug Enforcement Administration (DEA) license through the federal government. Some states may require an NP to have received a Controlled and Dangerous Substance (CDS) state license before eligibility for a DEA license through the federal government.
Step 14: Join your state and national professional nurse practitioner associations, if you haven’t already.
The American Association of Nurse Practitioners is the largest full-service national professional membership organization for NPs of all specialties. I
Step 15: Maintain professional liability insurance as a nurse practitioner. This includes understanding the differences between the two types of malpractice coverage: claims-made liability coverage versus occurrence liability coverage. For additional information, read The Nurse Practitioner’s Business Practice and Legal Guide. 4th edition, authored by nurse practitioner and healthcare attorney, Carolyn Buppert JD, MSN, ANP-BC.
Step 16: As you proudly search for your first NP job, realize you will never know it all. The field of nursing, advanced practice nursing and healthcare is continually evolving with new research discoveries. Endeavor in lifelong learning as a nurse practitioner and be proud of the difference you make in the lives of your patients and your community.
Also read Become a CRNA
Until next time friend,
Come visit me at Ask Nurse Beth career column at allnurses.com for all kinds of entertaining and informative career questions and answers, and to submit your own question 🙂
Additional Nurse Practitioner Resources
If you’d like to hear personally from some AANP leaders, you can hear interviews featuring the AANP Past President Dr. Angela Golden, AANP President Dr. Cindy Cooke, as well as AANP Health Policy Fellow and NP Student Amy Rose Taylor, and AANP member Dr. Monica Alleman on The Nurse Practitioner Show™. The AANP provides members with a student resource center, as well as information for nurse practitioners beginning their practice with interview skills, contract negotiation skills, and salary expectations. Your active membership helps support our nursing organization as they legislate on our professional behalf, and ultimately impact access to care for all.