Should I Become a Nurse Practitioner?
This question comes up all the time – whether you are currently a nurse, considering a career in nursing, or contemplating a switch in careers.
There are many things to consider when pursuing a career as a nurse practitioner (NP). Let’s address some frequently asked questions.
What is a nurse practitioner?
Nurse practitioners are registered nurses with additional education and nursing experience who provide a wide range of health care services to people at every stage of life (1). Nurse practitioners are licensed, independent practitioners who practice autonomously and in coordination with other health care providers (2).
How many countries have nurse practitioners as part of their workforce?
According to a 2018 study on health workforce planning, eight countries were identified as having NPs including Canada, the United States, Australia, Finland, Ireland, Netherlands, New Zealand, and the United Kingdom (3).
What can a nurse practitioner do?
The scope of practice of an NP differs depending on the country in which an NP is licensed. Let’s touch briefly on the general scope of practice in the 8 countries listed above.
Canada: NPs autonomously diagnose and treat illness, order and interpret diagnostic tests, prescribe medications, consult and refer to specialists, and perform medical procedures (1). Each province and territory have individual NP legislation and scope of practice in place (1).
United States: 50 states have NP licensure with either full, reduced, or restricted practice. Full practice permits all NPs to evaluate patients, diagnose and interpret tests, and initiate and manage treatments (including prescribing medications and controlled substances) (4). Reduced practice requires a career-long collaborative agreement with another health provider in order for an NP to provide patient care, or it limits one or more element of NP practice (4). Restricted practice requires career-long supervision, delegation of tasks by another care provider, and restricts certain aspects of NP practice (4). Check out this helpful practice map from the American Association of Nurse Practitioners.
Australia: NPs are registered nurses with authority to diagnose and treat patients of all ages. Similar to Canada and the U.S., NPs require master’s level of study and must be certified through the Nursing and Midwifery Board of Australia. Nurse Practitioners can diagnose, order and interpret diagnostic tests, initiate treatments, prescribe medications, and refer to other health care providers (5).
New Zealand: NPs have a broad scope of practice similar the above countries and have the same prescribing authority as physicians (6). To become an NP, one must be a registered nurse, have four years of clinical experience, complete an approved clinical master’s degree, and pass a competencies assessment by an approved panel (6).
United Kingdom: NPs can prescribe and practice autonomously, however it is not a formally regulated profession (7). You need a master’s degree approved by the Royal College of Nursing. The Royal College of nursing has proposed implementing a national certification to provide regulation and consistency for a standard scope of practice (7).
Netherlands: NPs provide advanced assessment, diagnosis, treatment, have full prescriptive authority within specialization, can perform certain medical procedures, can facilitate referrals to specialists, and can autonomously practice without supervision. To become an NP you need a 2-year dual master’s degree similar to other countries (8).
Finland: NPs are autonomous providers that assess patients, establish treatment plans, and monitor acute and chronic health conditions. They have partial prescribing authority. To become an NP you need a master’s degree and certification. The role is not nationally regulated; therefore scope varies according to organizational oversight (9).
Ireland: NPs provide assessment, diagnosis, establish treatment plans, and have prescriptive authority. Similar to other countries, you need at minimum a master’s degree in advanced practice nursing (10).
BOTTOM LINE: The NP profession is growing, with 8 countries incorporating NPs into their projected healthcare workforce.
What education do I need to become a nurse practitioner?
Generally speaking, you need to have a license as a registered nurse, gain experience as a registered nurse, complete a nurse practitioner master’s degree, and attain a license as a nurse practitioner. If you want to read more about this specific question, check out these posts:
How long does it take to become a nurse practitioner?
You need a registered nursing degree and license first (usually a 4-year bachelor’s degree in nursing), plus nursing experience in the workforce (most NP master’s programs have a specific clinical hour requirement for admission). Then at minimum you need to complete a 2-year NP master’s degree (either full or part-time).
Every person’s NP journey varies. You may decide to do the minimum number of hours required to get into an NP master’s program, or you may take your time and get more experience as a nurse before deciding to pursue a career as an NP (which can be helpful for you to decide which areas of health care you are passionate about). Many programs offer part-time study options.
What jobs can I get as a nurse practitioner?
Nurse practitioners work in many settings – community clinics, health-care centers, home health settings, long-term care homes, hospitals (outpatient clinics, inpatient, emergency rooms), public health settings, private clinics, NP-led clinics, and more. You can work in rural or urban settings.
Will I get a Job as a nurse practitioner?
Many countries are facing provider shortages and imbalances in primary healthcare due to the rise in chronic disease and multimorbidity (11).
The USA has the highest absolute number of NPs and rate per population, followed by the Netherlands, then Canada (11).
Canada, the U.S., and the Netherlands are incorporating NPs in healthcare workforce planning (3). In Canada, NPs have increased in numbers in recent years, and integration into healthcare varies depending on the province in which you work. For example in Ontario, NPs have been incorporated into several multidisciplinary team models (e.g. family health teams, community health centers) as well as NP-led models (nurse practitioner-led clinics) (3). In 2022, 7,113 NPs were employed in direct patient care in Canada, with a growth rate of 10% between 2021 and 2022. This represents the largest percentile increase compared with other regulated nursing types (12).
In the U.S., according to the Bureau of Labor Statistics, NPs are one of the fastest growing jobs. Overall employment of nurse anesthetists, nurse midwives, and NPs is projected to grow 38% from 2022 to 2032 (13). NPs and physician assistants are being included in health workforce planning in an effort to reduce projected primary care physician shortages (3)
In general, it shouldn’t be difficult to find work as an NP, especially as demand for healthcare services continues to rise.
BOTTOM LINE: Think about whether this career path is a good fit for you. Do you feel like your career has plateaued? Do you want to challenge yourself professionally and personally? Do you like working with people? Are you up for a steep learning curve and a fair amount of self-directed learning?
What is the average nurse practitioner salary?
NP salaries vary significantly depending on where you work (country, province/state, organization). Unfortunately there is a lack of standardization for salary, as many NP jobs are non-unionized. You can review primary health care NP wages in Canada here. You can review NP wages in the U.S. here.
How does a nurse practitioner differ from a physician assistant (PA)?
Several countries are incorporating PAs as part of the healthcare work force (3). Physician assistants practice medicine on teams with physicians and other health care workers. A key difference between an NP and a PA is that PAs work under the supervision of a licensed physician, however, also possess the autonomy to perform a wide range of clinical tasks and procedures. Another key difference is the training model. Generally speaking, to be a PA you require an undergraduate degree followed by a PA master’s degree (educational pathways vary). Similar to NPs, PAs work in a variety of health care settings within interdisciplinary teams. There are several online resources to read more about this career path.
How does a nurse practitioner differ from a physician?
There is a significant difference in the training model and educational pathway. To become a physician in Canada and the U.S., you require an undergraduate degree, medical school training, and successful completion of a residency program to become a physician within a speciality. Physicians have exposure to more clinical time during training. For example family physicians gain clinical experience in medical school in addition to 2+ years of full-time residency. There are several online resources to read more about this career path.
In summary, NPs are a rapidly growing workforce with potential to fill gaps in our healthcare system. Don’t get me wrong – it isn’t an easy career to pursue. Expect a steep learning curve, develop a healthy relationship with diagnostic uncertainty, and comfort with making autonomous decisions that impact the health of patients. If you enjoy autonomy and working with people, and are looking for ongoing professional and personal growth, this might be a path worth considering.
The whole purpose of this blog is to raise awareness for the NP role, to help prospective NPs gain a better understanding of what the role entails, and how to prepare for the steep learning curve ahead. If you know of anyone who may benefit, please share this resource!
References/Readings:
1. Canadian Nurses Association. Canadian Nurses Association [Internet]. Canada. [2024; Feb 19 2024]. Available from https://www.cna-aiic.ca/en/nursing/advanced-nursing-practice/nurse-practitioners
2. American Academy of Nurse Practitioners. AANP [Internet]. United States of America; 1993. [2022; Feb 19 2024]. Available from https://www.aanp.org/advocacy/advocacy-resource/position-statements/scope-of-practice-for-nurse-practitioners
3. Maier CB, Batenburg R, Birch S, Zander B, Elliott R, Busse R. Health workforce planning: which countries include nurse practitioners and physician assistants and to what effect? Health Policy. 2018 Oct;122(10):1085-1092. doi: 10.1016/j.healthpol.2018.07.016. Epub 2018 Aug 11. PMID: 30241796.
4. American Academy of Nurse Practitioners. AANP [Internet]. United States of America. [2023; Feb 19 2024]. Available from https://www.aanp.org/advocacy/state/state-practice-environment#:~:text=State%20practice%20and%20licensure%20laws,the%20state%20board%20of%20nursing
5. Australian College of Nurse Practitioners. Australian College of Nurse Practitioners [Internet]. Australia [2024; Feb 19 2024]. Available from https://www.acnp.org.au/aboutnursepractitioners
6. Manatu Hauora Ministry of Health. Manatu Hauora Ministry of Health [Internet]. [2024; Feb 19 2024]. Available from https://www.health.govt.nz/our-work/nursing/nurses-new-zealand/nurse-practitioners-new-zealand#:~:text=Nurse%20practitioners%20provide%20a%20wide,same%20authority%20as%20medical%20practitioners
7. Kruth T. International Advanced Practice Nursing [Internet]. 2022. [2022; feb 19, 2024]. Available from https://internationalapn.org/2022/06/19/united-kingdom/
8. Kruth T. International Advanced Practice Nursing [Internet]. 2022. [2022; feb 19, 2024]. Available from https://internationalapn.org/2022/07/01/netherlands/#:~:text=The%20scope%20of%20practice%20for,within%20specialization%20(Maier%2C%202019)
9. Kruth T. International Advanced Practice Nursing [Internet]. 2022. [2022; feb 19, 2024]. Available from https://internationalapn.org/2022/05/17/finland/
10. Nursing and Midwifery Board of Ireland. Nursing and Midwifery Board of Ireland. [2024; Feb 19, 2024]. Available from https://www.nmbi.ie/Registration/Add-New-Division/Advanced-Practitioners
11. Maier CB, Barnes H, Aiken LH, Busse R. Descriptive, cross-country analysis of the nurse practitioner workforce in six countries: size, growth, physician substitution potential. BMJ Open. 2016 Sep 6;6(9):e011901. doi: 10.1136/bmjopen-2016-011901. Erratum in: BMJ Open. 2016;6(9):e011901corr1. PMID: 27601498; PMCID: PMC5020757.
12. Canadian Institute for Health Information. CIHI [Internet]. [2023; Feb 19, 2024]. Available from https://www.cihi.ca/en/nurse-practitioners#:~:text=In%202022%2C,growth%20rate%20of%2010%25
13. U.S. Bureau of Labor Statistics. U.S. Bureau of Labor Statistics [Internet]. [2023; Feb 19, 2024]. Available from https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm#tab-6