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Nurse Types / Nurse Practitioner / Scope of Practice

There are currently 27 states, along with Washington, D.C., that grant nurse practitioners (NPs) full practice authority. This means that NPs in those states can perform many of the same tasks as physicians, including prescribing medications, ordering physical therapy, diagnosing and treating medical conditions, and interpreting diagnostic tests.

Some people think that nurse practitioners as less experienced or that their care is inferior to that provided by physicians, but that’s not true. Numerous studies have shown that, in many ways, nurse practitioners provide the same level of care as physicians.

In this post, we will explore the following: 

• Nurse practitioner scope of practice by state
• The meaning of ‘scope of practice’
• Why nurse practitioners are growing in demand

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Nurse practitioner scope of practice by state

Every state has different specifications for what nurse practitioners can and can’t do. Some states are more restrictive than others. For example, in Florida, nurse practitioners cannot diagnose or treat patients without a physician available, while in Washington state, nurse practitioners are able to diagnose, treat, and prescribe medications, including medical marijuana.

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What is ‘scope of practice’?

For nurse practitioners, “scope of practice” refers to the responsibilities and duties they can perform based on their state licensure, as well as their professional qualifications. For example, a nurse practitioner has a broader scope of responsibilities than a registered nurse but they generally have a smaller scope of practice than physicians.

There are three different levels of practice that a nurse practitioner can have in a given state. These levels are full practice, reduced practice, and restricted practice. 

Full practice 

In a full practice state, nurse practitioners can evaluate patients, diagnose illnesses, order and interpret diagnostic tests, and prescribe medications. They are granted permission to perform these tasks through their state’s board of nursing.

Reduced practice

Reduced practice means that nurse practitioners can participate in at least one element of NP practice. Elements of practice that may be restricted include prescribing certain medications or performing certain medical procedures. Reduced practice also means that nurse practitioners must enter into a regulated collaborative agreement with a physician in order to provide patient care. Each state’s board of nursing outlines its NPs’ scope of practice, which varies from state to state.

Restricted practice

The main difference between reduced practice and restricted practice is the amount of oversight that a nurse practitioner is required to be under. In states with restricted practice, nurse practitioners cannot engage in at least one aspect of NP practice. Restricted practice state laws require that NPs work with a physician throughout their careers in order to provide patient care.

Why are nurse practitioners in such demand?

There are many reasons for the increased demand for Nurse Practitioners, but there are two that stand out above all others. One reason is that the expanded access to care created by the Affordable Care Act has insured 20 million more Americans. This expanded access has made it necessary for more physicians and nurse practitioners to enter the field. 

Additionally, America’s population continues to age, and that means that people will require more medical care. By 2025, the population that is over the age of 65 will grow by 41%, while those younger than 18 will increase by only 5%. 

According to the Association of American Medical Colleges, the projected shortage of nurse practitioners will be between 61,700 and 94,700. This leaves an enormous vacuum for nurse practitioners to fill, and tremendous opportunity along with it.

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Nurse Types / APRN vs NP

Exploring a career in nursing? One of the first things you’ll notice is the wide range of options available. There’s a hierarchy of nursing positions,  ranging from Certified Nursing Assistants (CNAs) to the Chief Nursing Officer (CNO), and somewhere between the two, you’re sure to find a particular category or specialty of nursing that most fits your goals and your interests.

In this article, we’re going to look at Advanced Practice Registered Nursing. We’ll explore:

• What ARPNs are
• Common types of APRNs
• Differences between APRNs and NPs
• How to become an APRN/NP
• APRN and NP job and salary outlook

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What is an APRN?

Advanced Practice Registered Nurses (APRNs) are near the very top of the nursing ladder. In fact, the only nursing positions that rank higher are Doctor of Nursing Practice (DNP) nursing professionals and Chief Nursing Officers.

An APRN is a licensed Registered Nurse (RN) who has earned a master’s level or doctorate level degree in a nursing specialty. Once they complete their education and become certified, APRNs are able to assess, diagnose, and manage patient problems at a much higher level than they could when they were a registered nurse. They have the authority to order diagnostic tests and procedures and prescribe medications – including controlled substances – in all states and territories within the U.S.

The nursing scope of practice outlines all the duties that licensed APRNs can undertake. They can work in health clinics or hospitals, helping with all aspects of patient care for adults, children, or both. While most states allow APRNs to work independently, some require supervision from a physician. APRNs should check with their state licensing boards to determine whether their state of practice allows full autonomy.

Common types of APRNs

As previously mentioned, there are several APRN specialties from which to choose when pursuing an education. Each has its own specific curriculum, clinical practice hours required, and certification requirements.

Family Nurse Practitioners (FNPs)

The APRN title that’s chosen most frequently is Family Nurse Practitioner (FNP). FNPs work with patients of all ages, emphasizing wellness and prevention programs. They treat patients in much the same way as physicians do. FNPs are qualified to assess patient health, diagnose conditions, and prescribe medication when appropriate.

There are three types of practice environments where you’re likely to find FNPs working: full practice, reduced practice, and restricted practice. The National Academy of Medicine and the National Council of State Boards of Nursing recommend FNPs work in a full practice environment.

Adult-Gerontology Acute Care Nurse Practitioners

Acute Care NPs work in healthcare environments that serve patients who need immediate medical treatment because of illnesses or injuries. Since some states allow APRNs to work without direct supervision, they can help alleviate crowded emergency rooms and trauma centers where patients who require immediate assistance go for treatment.

Neonatal Nurse Practitioners

Neonatal NPs care for newborns who are born prematurely, are injured after birth, or who develop a serious illness. They provide advanced care for neonatal patients, including assessing a newborn’s physical condition and prescribing medical interventions such as incubators and prescription medications.

Women’s Health Nurse Practitioner

Women’s Health NPs focus on the healthcare needs of women. They work in doctors’ offices, hospitals, and clinics that provide gynecological, obstetric, and reproductive health services to women patients.

Certified Nurse Midwife

A Certified Nurse Midwife is specially trained to care for pregnant mothers, helping them throughout the reproductive process from preconception through the labor process and after delivery.

Certified Registered Nurse Anesthetist (CRNA)

Certified Registered Nurse Anesthetists (CRNAs) administer anesthesia before and during medical procedures. They are among the highest earning of all Advanced Practice Registered Nurses.

APRNs vs NPs

Nurse Practitioners are one type of Advanced Practice Registered Nurse. There are similarities and differences between APRNs and NPs. Let’s take a look at some of the most common.

	Nurse Practitioner	Advanced Practice Registered Nurse
Minimum education	Master of Science in Nursing (MSN)	Master of Science in Nursing (MSN)
Duties	Assess, diagnose, and treat acute and chronic illnesses. Act as a primary care medical provider (in some states). Provide referrals for specialized care.	APRN duties vary depending on the specialty chosen.
Common practice settings	Ambulatory clinics Community clinics Long-term care facilities Private medical practice	APRNs can work in any healthcare setting, including hospitals and private medical practices.
Licensing & certification	Certification varies depending on nursing specialty. Nurses can seek appropriate credentials through the American Nurses Credentialing Center (ANCC) or the American Association of Nurse Practitioners (AANP). All NPs must seek licensure from the Board of Nursing in their state of practice.	APRNs must hold a valid RN licensure from their state of practice. In addition, they must seek certification from the ANCC or other certification bodies that align with their chosen nursing specialty.
Continuing education requirements	NPs must renew their certification every five years. To qualify for recertification, NPs must have 1,000 hours of clinical practice within 5 years and 75 contact hours of continuing education that is relevant to their nursing specialty.	Continuing education requirements for APRNs depend on their chosen specialization.
Prescribe medications	Yes, but the type of medications and the level of supervision is determined by the Board of Nursing or other licensing agency for the NP’s state of practice.	Some APRNs have prescriptive authority depending on the states where they are licensed and their specialization.

How to become an APRN/NP

To become an APRN, candidates must first earn an advanced nursing degree. They can choose to complete their Master of Science in Nursing (MSN) education all at once or first become a licensed RN with either an ADN or a BSN and then go on to earn their advanced degree on a full time or part-time basis. There are several high-quality bridge programs that minimize the time required to complete APRN educational programs:

• Bachelor of Science in Nursing (BSN) – 3-4 years
  BSN-to-MSN bridge program – about 2-3 years

• Master of Science in Nursing (MSN) – 6 years
  RN-to-MSN bridge program – about 2 years

After earning an MSN, candidates must complete the clinical hours required for their specialty and then pass a national certification exam. Several national accreditation organizations offer APRN certifications.

The final step is applying for licensure in the state where you intend to practice as an APRN. Requirements for APRN licensure vary by state, so check with your state’s licensing agency to ensure you’ve met all of its criteria.

APRN and NP job and salary outlook

APRNs earn an average annual salary of $125,900, depending on where they work, their role, and their level of experience. There is a significant difference between the $200k median annual wages that a Certified Registered Nurse Anesthetist makes and the $115k that a nurse midwife makes; similarly there is a big difference between the median annual wages that all APRNs earn at hospitals ($133,030) and the median annual wages for APRNs who work in educational settings ($110,260).

According to the U.S. Bureau of Labor Statistics (BLS), demand for APRNs will increase by 40% from 2021 to 2031, which is significantly faster than the national average for all other occupations.

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