Introduction
Along with other medical professionals, a nurse practitioner (NP), sometimes also referred to as advanced practice registered nurses (APRNs), plays a critical role in the healthcare sector. These registered nurses (RNs) gain additional education, namely, master’s degree, to provide high-quality care for individuals and public health in their area of specialization. In particular, in contrast to usual nurses, they are trained to interpret and establish a diagnosis and deliver coordination of care and disease prevention, among others. Thus, this research paper aims at examining specific elements of a nurse practitioner’s career, including job description, education, career opportunities, professional activities.
Job Description
The Scope of Practice
NPs with a graduate degree perform many duties and tasks and are involved in various specialties such as primary care, cardiology, pediatrics, geriatrics, oncology, psychiatry, women’s health, and others. Their activities typically comprise performing physical exams and overall diagnosis, document patients’ histories, and prescribing tests, interventions, and procedures. Furthermore, NPs can coordinate referrals, deliver patient education on self-care, healthy lifestyles, and disease prevention, and conduct complicated procedures, including lumbar puncture and a bone marrow biopsy (“Nurse practitioner (NP),” n.d.). Besides, these nurses should be knowledgeable in a variety of chronic, degenerative, and acute illnesses and give accurate clarification about health problems. They also participate in public health promotion, especially by participating in different prophylactic programs and research.
It is worth noting that the scope of practice and privileges granted to NPs significantly depends on the regulations and laws of a particular state they operate. In some states, practitioners can work autonomously, while in others, they should closely collaborate with another healthcare provider or be under a doctor’s supervision. Specifically, according to the American Association of Nurse Practitioners (AANP), states are divided into three categories, that is, full practice (Oregon, Minnesota), reduced practice (New York, Utah), and restricted practice (Texas, California) (Staff Writers, 2021). The first provision implies NPs’ ability to evaluate patients’ conditions, order diagnostics, and provide treatment under their local state board of nursing. The second demands tight cooperation with other professionals such as physicians, whereas the final requires supervision of at least one area of NP’s practice. Additionally, the core distinction between nurse practitioners and physicians is that the former should adhere to the responsibilities within their medical specialty, while the latter can prescribe any diagnosis and treatments.
Code of Ethics
The ethical actions and decisions of NPs should be grounded on the American Nurses Association’s (ANA) Code of Ethics, providing general instructions for appropriate professional behavior to promote the quality nursing practice. This moral code contains four main principles, such as beneficence, non-maleficence, autonomy, and justice. Beneficence means that NPs prefer medical procedures and interventions that favor patients’ best interests and wellbeing and cause minimum possible harm (Haddad and Geiger, 2020). Providing necessary medications in a due manner, accompanying patients while performing difficult tasks, or psychological support of individuals belongs to widespread instances of beneficence. Non-maleficence requires nurses to avoid deliberate harm to patients. For example, some doctors willfully prescribe drugs that can cause durable addiction or provoke suicide intentions if taken inappropriately, which is categorically forbidden.
Autonomy is tightly connected with respect for patients’ preferences, values, beliefs, and needs and their engagement in the decision-making process. In particular, according to this principle, persons and communities have a right to waive treatment, medications, surgery, or other medical procedure even if they can bring substantial benefit to their health. Finally, justice assumes equal and fair attitudes towards all people irrespective of their income and racial, social, and sex affiliations. This principle plays a vital role in an equitable distribution of medical resources, including workforce, medications, tests, or vaccines, among the whole population. Besides, NPs should give the first priority to patients in an acute and urgent position.
History
Although NP is a relatively modern profession, its history goes back over 55 years, the times when healthcare experiences noticeable transformations. Specifically, in 1965, Loretta Ford, EdD, in partnership with Henry Silver, MD, established the first NP program at the University of Colorado. Despite its initial certificate status, the NP program acquired a master’s degree program at Boston College in 1967. In 1973, the United States could already offer over 65 NP programs, expanding into many medical fields, including adult acute care and women’s health (Brennan, 2020). By 1985, such magisterial organizations as the Council of Primary Care Nurse Practitioners and the American Academy of Nurse Practitioners were founded. In the following decade, namely, in 1994, Mary O’Neil Mundinger first set a clinical nursing doctorate in the USA at the Columbia School of Nursing. Since then, the specialization began to gain exponentially increasing popularity and authority, having already above 270,000 legal members (Brennan, 2020). Nowadays, APRN is regarded as an honorable profession immensely contributing to the development of healthcare and the wellbeing of diverse populations.
Education, Registration, and Certification
Requirements
In the United States, the process of becoming a nurse practitioner is a challenging way demanding necessary education, experience, and skills. The first step to NP’s career is obtaining credentials as an RN by mastering Bachelor’s Degree in Nursing (BSN) program, a diploma nursing program, or Associate Degree in Nursing (ADN) provided by accredited higher institutions. Compared to the associate’s degree that requires two years of studying, the BSN can be completed only in four years. Most nurses choose ADN programs to commence their career sooner and gains some valuable experience, but then usually enroll in the BSN (“How to become a nurse,” n.d.). A bachelor’s degree is a critical milestone in a route to a post-graduate career in nursing, equipping nurses with essential skills such as communication, management, research, supervision, community health, and others. It is worth noting that graduates of nursing programs should pass the National Council Licensure Examination (NCLEX) to receive the license.
Another vital component for obtaining an NP is gaining at least one year of experience. Although the tendency to skip this step is currently increasing, working on the front lines of healthcare is highly beneficial before seeking certification as an APRN. In the context of the COVID-19 pandemic, establishments cooperating with the National Certification Corporation require a minimum of 500 supervised hours during the NP program (“Statement,” 2021). Preceding practice helps nurses learn various skills and knowledge and acquire the general picture of the medical environment.
The next phase is enrolling in a nursing graduate program called a Master of Science in Nursing (MSN), also regarded as an inferior limit of the educational requirement for NPs. Many organizations offer RN-to-MSN or ADN-to-MSN programs for registered nurses without bachelor’s degrees (“Nurse Practitioner,” 2020). Besides, some nurses pursue Doctor of Nursing Practice (DNP) programs, the highest level of available nursing education to be an expert in healthcare administration or research. It is worth indicating that graduate studies entail both classroom or online education and intensive clinical training, taking from 18 to 24 months of full-time studying for MSN. The ultimate stage is earning an advanced practice nursing license by observing the state’s specific licensing requirements and obtaining the respective score on a national certification examination.
Two Institutions
The first institution is Binghamton University, located in Vestal, the state of New York. This public educational establishment provides the Master of Public Health (MPH) program offering full-time and part-time study and primarily covering five courses, including biostatistics, health policy, epidemiology, environmental health, and others. The program lasts one year and costs $6,170 for in-state students and $17,810 for out-of-state applicants (“How to become a nurse,” n.d.). To enroll in the program, applicants need to have a bachelor’s degree from a regionally or nationally accredited college institution. Besides, the student can have both online and on-campus styles of studying.
The second higher school is Indiana Wesleyan University situated in Marion, the state of Indiana, which offers a Family Nurse Practitioner specialization in Primary Care Nursing. The online MSN program comprises 700 hours of supervised practicum and the attendance of onsite courses (“Online family,” n.d.). The cost of the program accounts for $24,102 for both in-state and out-of-state applicants and lasts around one year (“How to become a nurse,” n.d.). The admission requirements include a Bachelor of Science degree and at least one year of professional practice.
Employment
Nurse Practitioners possess vast employment perspectives with the opportunities to work in hospitals, community health centers, or other healthcare settings. According to the United States Bureau for Labor Statistics (BLS), job availability for NPs currently consists of 211,300, as of 2019, and will achieve 322,000 by 2029, demonstrating a 52% growth (“Nurse Anesthetists,” 2021). In particular, over the decade, NPs are projected to have approximately 24,200 new vacancies on average every year. For example, in Indeed, a worldwide employment website, as of June 01, 2021, 1,193 jobs are posted in Florida with an average salary of $80-120 per hour (“Nurse practitioner: Florida,” n.d.). The most promising states by employment include California, Texas, New York, Florida, and Ohio. Outpatient care centers, general medical and surgical hospitals, offices of physicians belong to the industries with the highest employment and wage.
In addition, as the BLS states, the typical educational entry-level for this occupation is a Master’s degree; work experience and on-the-job training are not compulsory (“Nurse Anesthetists,” 2021). The average annual salary for NPs amounts to $114,510; hospitals and outpatient care centers have the best pay rates (“Nurse Anesthetists,” 2021). NPs with experience of less than one year, three to five years, and over ten years earn nearly $99,000 per year, $120,000, and over $123,000 accordingly (“How much,” 2021).
NPs with MSN usually pursue family practice, acute care, pediatric and neonatal care, mental health, pain management, or nursing education. DNPs can specialize in highly qualified areas, including nurse anesthesia, pediatric endocrinology, clinical research, or psychiatric nursing. They also may take leadership and top-level roles in large medical organizations, supervising clinical teaching and research. Moreover, DNPs can instruct at the graduate level or even in MSN programs at different universities. Besides, nurses with DNP degrees gained $10,000 more per year compared to their colleagues with MSN degrees in 2017 (“Nurse practitioner salary guide,” 2020). Altogether, job opportunities for APRNs will be in immense demand, especially in underserved regions, such as rural areas and inner cities.
Professional Activities
Organizations and Journals
Nurse practitioners as elite healthcare professionals can participate in numerous international, national, state entities directly related to nursing practice. These organizations typically provide members with access to up-to-date professional information, annual conferences, job listings, and even a continuing education library. The libraries contain various comprehensive research, in-depth case studies, and interactive, useful videos and presentations. The most prominent national healthcare organizations include the AANP, American Nurses Association (ANA), Doctors of Nursing Practice, National Organization of Nurse Practitioner Faculties, and Gerontological Advanced Practice Nurses Association (GAPNA). The international establishments comprise the International Council of Nurse Practitioners, Australian College of Nurse Practitioners, or Canadian Association of Advanced Practice Nurses. Finally, the state of Florida also multiple medical organizations promoting and supervising NPs’ practice and workflow. Central Florida Advanced Nurse Practitioner Council, Florida Association of Nurse Practitioners, Florida Coalition of Advanced Practice Nursing, Florida Chapter of GAPNA, and Florida Chapter of NAPNAP belong to the most substantial of them.
The membership cost of the associations significantly varies and also depending on the nurse’s status. For instance, GAPNA offers flexible annual membership dues, from $100.00 for a one-year subscription to $285.00 for a three-year subscription (“Membership information,” n.d.). The annual dues of the Florida Association of Nurse Practitioners comprise $100 for NP members and $50 for NP students or retired NPs (“Select your member type,” n.d.). Furthermore, many organizations have different discounts ranging from 10 to 20 percent or include specific savings on insurance and other benefits.
In addition, NPs have the opportunity to join different interesting journals that bring substantial benefit to their everyday practice. Examples include The Journal for Nurse Practitioners (JNP), The Journal of the American Association of Nurse Practitioners (JAANP), or Nurse Practitioner. The JNP is located in John F. Kennedy Boulevard, Philadelphia, and its personal subscription costs $99.00 (“Subscription options,” n.d.). These periodicals discuss and investigate the broad spectrum of medical issues related to nursing activity, individual health and wellbeing, specific illnesses, medications and innovative interventions, and public concerns.
Continuing Education Unit
Continuing education unit (CEU) is an educational measure employed in continuing education programs to help medical providers maintaining their professional competence and license. Besides, CEU refers to a particular type of professional development that aims at keeping nurses updated about medical issues, laws, and rules, and the healthcare environment. Continuing Education Requirements differ depending on states and are controlled by the related Board of Nursing. In Florida, APRNs should complete 24 hours of CE every two years, 12 of which should be continuing nursing education, and the rest is continuing medical education (“Mandatory Continuing Education Requirement,” n.d.). Specifically, these 24 hours should include medical error prevention, the laws and rules in Florida, human trafficking, one hour devoted to HIV/AIDS, impairment in the workplace, and domestic violence. However, it is worth noting that hours related to identifying impairments in the workplace are to be performed every four years.
Nurse practitioners can choose different methods, including programs and virtual courses, to meet the CE requirements. The best CE organizations comprise the Advanced Practice Education Associates (APEA), AANP, or Nurse Practitioner Associates for Continuing Education (NPACE). For instance, (NPACE) possesses online courses and live workshops; AANP and APEA also have comprehensive libraries with books and videos. In addition, nurses can attend free sessions provided by such authoritative companies as PRIME Education, NursingCE, or Pri-Med. Finally, NPs can visit various conferences that can provide necessary CE credits, such as National Conference for Nurse Practitioners. The given conference is usually held twice per year; this year, it will occur July 8-11, offering more than 40 CE hours and containing about 100 sessions and workshops (“2021 The National Nurse,” 2021). Thus, presently, nurses are equipped with diverse interesting and helpful instruments to renew their license and receive valuable knowledge.
Reflection and the Personal Career Plan
The healthcare environment has always been demanding, requiring substantial efforts, active attention, and close interdisciplinary collaboration to ensure the appropriate quality of care. Despite the recent remarkable advancements, especially in the technological sphere, medical providers still face numerous severe problems in their daily workflow. The COVID-19 pandemic, its aftermath, aging population, and increase of many co-morbid chronic diseases demonstrate the array of formidable challenges emerging before the full range of professionals and policymakers. In these serious contexts, I firmly believe that nurses play one of the most critical roles in providing a timely and due response to these issues since they are at the forefront of care delivery.
In particular, from childhood, I strive to help people and enhance the surrounding environment by participating in various community-strengthening events and activities vigorously. Working as a nurse will give me vast opportunities to improve somebody’s life and make a personal contribution to the wellbeing of our country. Herewith, studying at Miami Dade College helps me realize that this profession requires profound knowledge, versatile skills, substantial diligence, and a proactive position to correspond to the high standards of nursing practice. Although I have no experience yet, I will try to be committed to essential nursing values and principles such as respect, integrity, benevolence, non-maleficence, equity, responsibility, and honesty while performing my duties. Such understanding and approach to my occupation have become the core reasons urging me to pursue a career as a nurse practitioner who should be a real expert in their occupational field. I believe that obtaining a MSN will supply me with the necessary knowledge and leadership skills and assist me in advocating for patients’ and communities’ needs and rights.
Concerning my short-term goals, I aim at receiving a Family Nurse Practitioner specialization or the Master of Public Health, preferably via live studying. In this regard, I consider several opportunities, including the universities indicated above and local institutions such as Florida International University or Barry University. It is worth adding that the MPH primarily attracts me by the upcoming incremental demand in nurses because of both the current pandemic and future challenges. Besides, I would like to improve the wellbeing of our communities by helping prevent different chronic and infectious illnesses and providing education, examination, and counseling. Undoubtedly, after graduating, I plan to devote my effort to refine the population health of Miami or at least Florida. However, I also understand that the healthcare sector experiences an acute deficit in specialists, and therefore, I am ready to serve where I may be needed.
Long-term objectives are much more difficult to project. Definitely, after acquiring some experience, for instance, 3-5 years, I would like to obtain DNP to be able to take a leadership role in one of the healthcare organizations and promote public health through research and best prophylactic practices. In addition, I consider perspectives of teaching or instructing in various organizations, including educational establishments. I also plan to broaden my knowledge by visiting some online workshops intended to learn specific skills both related to nursing activities and administrative functions.
Interview
A nurse practitioner N. with seven-year experience has been interviewed about the main aspects of her career, namely, its advantages, challenges, and problems. In particular, the primary advantage connected with a NP’s specialization is that they always feel that their service is highly needed for sick individuals and mostly bring noticeable benefit for patient’s wellbeing. Moreover, in daily practice, nurses have excellent opportunities to develop personally and professionally and acquire diverse knowledge, which also gives much pleasure. However, almost all nurses face overload because of different causes, including understaffing, intense working periods, and demanding patients, supervisors, or situations. Besides, various issues associated with protected health information (PHI) also can place some pressure. She said that one worker was even dismissed for posting a photo with a patient. Overall, the interviewee concluded that, although this profession is engaging and multi-faceted, it also entails significant responsibility, attention, and caution.
Conclusion
In summary, the paper has investigated the specific aspects of a nurse practitioner’s career, including job description, education, career opportunities, professional activities. NPs can perform many functions and responsibilities and work in various healthcare sectors, including cardiology, pediatrics, or primary care. Based on state regulation, APRNs are engaged in full practice, reduced practice, and restricted practice. NPs’ code of ethics revolves around four main principles, such as beneficence, non-maleficence, autonomy, and justice. The path to a NP’s specialization typically lies through credentials as a RN, obtaining reliable experience in the chosen field, and graduating from a MSN. Employment presents tremendous opportunities for NPs since the demand for medical professionals constantly increases. After receiving a MSN, nurses can join different related organizations or journals to promote their career and professional developments. Overall, NP is a demanding but exciting occupation replete with ample opportunities, interesting challenges, and responsible tasks that eventually can help me grow as a personality.
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