Pursuing a career as a family nurse practitioner

For those who are passionate about health, fitness, and wellbeing, pursuing a career in the medical field might feel like a logical step. For those who might not have the time or finances to pursue a physician role, a nursing position may be a better fit. There are many different types of nursing roles, ranging from nursing assistants who help with personal care for patients, to advanced practice registered nurses who sometimes have similar responsibilities to a physician. 

According to US News & World Report, the Nurse Practitioner (NP) role is the best job in healthcare. The median salary for this role is $120,681 in 2021, and chances for upward mobility are high. The job market for nurse practitioners is also very good. The Bureau of Labor Statistics (BLS) cites less than 0.4% unemployment, over 30,000 openings each year, and the number of positions available is predicted to increase 40% by 2031. 

As the demand for healthcare rises, the US faces a shortage of qualified physicians. Particularly in rural areas, nurse practitioners may serve as the only primary care provider, which allows them a high level of autonomy and responsibility. Family Nurse Practitioners (FNPs) have an even greater level of influence over patient care; whereas nurse practitioners train only in a particular age group or type of care, FNPs care for patients throughout their lifetime. They also have greater flexibility in terms of where they work, which could include locations as diverse as primary care, hospitals, urgent care, schools, or hospice care. The scope of practice (SOP) for FNPs is also varied, with specialties such as geriatrics, pediatrics, acute care, and mental health.

What is the scope of practice?

Scope of practice is a term referring to the activities that a medical professional is allowed and expected to complete based on their knowledge, training, and skills. It is something that can evolve over time, as a person gains more experience, and it also varies depending on the rules and laws in each state. Staying within the scope of practice is an important consideration, as it ensures the best care for the patient and avoids nurses losing license. When a patient’s illness progresses beyond a healthcare professional’s SOP, they should be referred to someone with a greater scope.

What is the SOP for family nurse practitioners?

Each state has restrictions in place around the scope of practice for FNPs, though states generally fall within one of two categories: full practice or either reduced or restricted practice.

Full practice

According to the American Association of Nurse Practitioners, states with full practice environments “permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing.” As of 2023, the following states are considered full practice: Alaska, Arizona, Colorado, Connecticut, Florida, Hawaii, Idaho, Iowa, Maine, Maryland, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, South Dakota, Vermont, Washington, and Wyoming.

Reduced or restricted practice

In states with a reduced or restricted practice environment, at least one of the responsibilities in full practice states cannot be freely performed; a physician must supervise or collaborate this element of patient care before it can be implemented. As of 2023, the following states are considered reduced or restricted practice: Alabama, Arkansas, California, Delaware, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, Mississippi, Missouri, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Wisconsin, and West Virginia.

Despite restrictions put in place by the state, the scope of practice for FNPs is broad and varied. They care for patients throughout their lifetime, starting at birth to geriatric care. In areas where there are no physicians, or in primary care settings, an FNP may be the first and only healthcare provider with whom a patient will interact. Increasingly, the SOP for FNPs also includes mental healthcare, due to shortages of trained providers.

When interacting with a patient, FNPs have many roles. The SOP allows them to assess a patient’s situation and symptoms, diagnose illnesses, and establish a course of action based on their clinical judgment. As mentioned above, this may require physician supervision or collaboration in certain environments. However, FNPs are often enabled to order tests or procedures that will assist with diagnosing patients. With the appropriate educational and training background, FNPs can interpret diagnostic tests, write prescriptions, offer low-level counseling, and provide information to patients about disease prevention, therapeutic interventions, and general wellbeing. FNPs are also responsible for referring patients to specialized services in the case of more severe illnesses.

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FNPs’ role in person-centered care

Many prominent medical organizations now promote the use of Person-Centered Care (PCC), due to its correlation with treatment engagement, improved recovery rates, and better health outcomes. In summary, PCC means that the patient is involved in their own healthcare decisions, they are made aware of and informed about their treatment options, and care is provided holistically— taking into consideration a person’s spiritual, emotional, cultural, and psychological values, among others. With PCC, the patient is empowered through looking at the experience of the illness and customizing treatment so that quality of life is minimally impacted.

Within their role as primary care provider, FNPs are at the core of PCC. FNPs often interact with patients more than any other clinician. This allows them to establish a close rapport with patients and understand their symptoms, problems, values, and hopes better than anyone else. Such understanding is crucial when the FNP is coordinating a patient’s care. This can allow them to provide personalized treatments that are holistic and customized based on a patient’s particular needs and limitations. The relationships they build with their patients give them unrivaled insight to providing the best possible care.

Where do family nurse practitioners work? 

Because the scope of practice for a family nurse practitioner is so broad, they can work in many different settings. They may work in an inpatient setting, such as at a hospital, an emergency room, a surgical unit, or a critical care unit, for example. Specialized training may require an FNP to visit inpatient and clinical settings to monitor a patient’s progress, even if they are based in private practice. In some states where the scope of practice is freer, FNPs can have their own practice. Another alternative may be to work in a community setting, such as part of an outreach or public health program. Regardless, there are a large variety of employers and choices for an FNP.

Many educational programs have links to the clinical community to help with placements during the course of the program. For example, Texas Woman’s University (TWU) offers clinical placement services for their Master of Science students helping them learn from practical settings and develop confidence to provide care after graduation. But where do Family Nurse Practitioners work ? By developing their medical knowledge and skills through advanced programs like the MSN – FNP from TWU, nurses will be able to work in diverse environments such as outpatient hospital clinics, private practices, urgent or immediate care clinics, rural health clinics, corporate clinics, specialty clinics, and even in telemedicine services. 

Educational and certification requirements

The educational and training requirements for nurse practitioners are greater than that of registered nurses. The American Association of Nurse Practitioners outlines the typical path an aspiring FNP might take:

  • Qualify as a registered nurse (RN).
  • Complete a Bachelor of Science in Nursing (BSN).
  • Complete a nursing practitioner-focused graduate nursing program.
  • Pass a national nurse practitioner board certification exam.
  • Apply for nurse practitioner licensure in the state of practice.
  • Complete regular renewals of certification and state licensure.
  • Pursue continuing education as per regulations and to understand new technical knowledge.

The curriculum for an FNP will be varied and comprehensive, since they are expected to work with patients across their lifespan. Coursework might include topics such as epidemiology, pharmacology, health policy, communication skills, clinical assessment and diagnostics, disease prevention, family theory, primary care, and pediatric care. FNPs will also be expected to develop specific skills so that they can work with electronic health records, establish a rapport with patients, develop good oral and written communication skills, and work with equipment such as nebulizers or cardiac monitoring devices.

Areas of specialty

Though their training exposes them to knowledge about all stages of a person’s life and a general understanding of all types of illnesses, FNPs can choose to specialize in areas related to a specific function of the body, such as the following:

  • Cardiology – assisting people with cardiac diseases, such as coronary artery disease, congestive heart failure, arrhythmias, heart disease, or myocardial infections.
  • Dermatology – assisting people who have conditions involving hair, skin, or nails. This may include skin cancer, psoriasis, acne, rashes, or mole removal.
  • Endocrinology – assisting people who have disorders related to the glands or endocrine system, such as diabetes, thyroid disorders, infertility, pituitary issues, or hormonal imbalances.
  • Nephrology – assisting people who have kidney diseases or injuries.
  • Orthopedics – assisting people who have disorders related to the musculoskeletal system, such as broken bones, joint replacements, torn tissue, or genetic abnormalities. 
  • Urology – assisting people with issues related to the urinary tract system, kidneys, bladder, and urethra, such as UTIs, incontinence, or prostate cancer.
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Alternatively, FNPs may specialize broadly in another area rather than focusing on a specific organ or area of the body. These specializations may include the following:

  • Addiction care – assisting with people who have a history of drug abuse, have substance abuse problems, struggle with addictions, or are in treatment or recovery for addiction.
  • Aesthetics – assisting with people who are receiving cosmetic or skin health procedures, such as plastic surgery, chemical peels, micro needling, or dermal fillers.
  • Emergency medicine – assisting with people who have minor injuries within an emergency department setting.
  • Gerontology – assisting with people over the age of 65, studying age-related issues such as decreased respiratory strength, low bone density, and increased likelihood of infection. 
  • Mental health care – assisting with the psychiatric and physical health needs of people suffering from mental illness or disorders.
  • Oncology – assisting with people who are at risk for or have a cancer diagnosis.
  • Palliative care – assisting with people who have life-threatening illnesses and/or illnesses that cannot be cured.
  • Pediatrics – assisting with the care of children, from infancy to early adulthood.
  • Rehabilitation – assisting people with chronic illness or disability to attain more independence, health, and function in terms of self-care and quality of life. 

Specializing is not essential, but many FNPs choose to because it allows them additional opportunities to care for their patients. Specialties may also give FNPs skills and experience with new types of technology or equipment that can aid diagnosis and treatment of their primary care patients. Each specialty has its own requirements for credentials and licensure, so FNPs should research what their state’s standards are before pursuing any course of study.

Growth opportunities

Specializing is one way FNPs can find new opportunities for growth and advancement. Other options may be less intense: workshops and continuing education can help an FNP stay up to date about a topic. This can help an FNP understand the limits of their scope of practice better, so that when an illness is progressing, they know when and how to refer it to a specialist.

One possibility for career advancement is for an FNP to pursue a nonclinical occupation. Experienced nurses are needed to educate the next generation of practitioners, and an FNP could take a professorship at a university or within a nursing education program. FNPs can also take on consulting roles, whether it be regarding the information technology nurses use, healthcare policy on any level, medical research, or the operations of a medical institution. Finally, there are also administrative and leadership roles within the clinical settings that an FNP can work; they can manage the nursing teams, set institutional policy, and handle operations, for example.

FNPs who are interested in high-level policymaking, research, and leadership, might pursue a Doctor of Nursing Practice (DNP). The skills learned at this level differ from that of a master’s, and emphasize topics such as conflict management, data analysis, developing institutional strategy, managing healthcare teams, mentoring nurses, and healthcare business. An education like this allows an FNP to look beyond ensuring good patient outcomes and work to support the entire nursing profession. A DNP is qualified to teach, advocate, and influence the future direction of healthcare services. 

Conclusion

With unrivaled levels of growth, numerous educational and employment opportunities, and the potential to significantly influence patient health outcomes, the FNP role is an excellent career choice for many. There are several different routes an FNP can take to specialize their skills and knowledge for their patient base and expand their scope of practice. Considering the increasing shortages of medical professionals across the country, FNPs’ influence and impact on healthcare will only grow.

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