Nursing Wiki

Nurse Practitioners

The nurse practitioner is the largest of the four advanced practice roles and the fastest-growing occupation in American healthcare of any size. About 336,300 people held nurse practitioner jobs in 2025, with a median wage near $132,300, and employment is projected to grow 41 percent through 2035 — roughly 137,800 additional positions.

Nurse practitioners diagnose and treat. They take histories, examine patients, order and interpret tests, prescribe, and manage conditions over time. Whether they may do any of that without a physician's involvement depends entirely on the state. See nurse practitioner practice authority.

Where the role came from

It began as a response to a shortage. In 1965, as Medicare and Medicaid were about to expand coverage without expanding the supply of primary care physicians, Loretta Ford, a public health nurse, and Henry Silver, a pediatrician, built a pediatric nurse practitioner programme at the University of Colorado. The premise was that experienced nurses could be prepared to deliver primary care to children in communities that had none, and that this was an extension of nursing rather than a junior version of medicine — a distinction Ford insisted on for the rest of her career.

The programme was small. By 1972 it had produced 64 pediatric nurse practitioners. Sixty years later the role has 336,300 jobs and its own licensure category in every state.

Role and population, not specialty

Advanced practice licensure is not organized around clinical specialties the way registered nurse certification is. Under the Consensus Model adopted in 2008, a nurse practitioner is licensed for a role — nurse practitioner, as opposed to nurse anesthetist, nurse-midwife, or clinical nurse specialist — and for one of six population foci:

  • family and individual across the lifespan
  • adult-gerontology, split into primary care and acute care tracks
  • pediatrics, also split into primary and acute care
  • neonatal
  • women's health and gender-related
  • psychiatric-mental health

Education, national certification, and the state licence must all match on both role and population. This is the rule that surprises people: a family nurse practitioner is not credentialed to work in an intensive care unit, and no amount of experience there substitutes for the acute care preparation. Moving between populations means going back for a post-graduate certificate and sitting a different examination.

Sub-specialty practice — oncology, dermatology, cardiology, emergency, occupational health — sits on top of a population focus rather than replacing it, and is recognized by additional certification rather than by licensure. See scope of practice and nursing specialties.

Who certifies

Certification is mandatory here, unlike at the registered nurse level, because state licensure depends on it. Several boards divide the field:

  • The American Academy of Nurse Practitioners Certification Board certifies family, adult-gerontology primary care, and emergency nurse practitioners.
  • The American Nurses Credentialing Center certifies family, adult-gerontology primary care, adult-gerontology acute care, and psychiatric-mental health nurse practitioners.
  • The Pediatric Nursing Certification Board certifies pediatric primary and acute care nurse practitioners.
  • The National Certification Corporation certifies neonatal and women's health nurse practitioners.
  • The certification arm of the American Association of Critical-Care Nurses certifies adult-gerontology acute care nurse practitioners.

Where two boards certify the same population, as with family practice, the examinations differ in emphasis — one weighted toward clinical management, the other including professional and regulatory content — and both satisfy state licensure. Candidates generally pick on exam style rather than on any difference in what the credential permits.

Education

Entry is a graduate degree: a master's in nursing or a doctor of nursing practice, with supervised clinical hours in the population focus. Programmes require a registered nurse licence, and most expect clinical experience first, though direct-entry routes exist for people with a degree in another field.

The doctorate has been pressed as the entry requirement since 2004, when the American Association of Colleges of Nursing took that position, and the organization representing nurse practitioner faculty set 2025 as the target date. Neither is a law. No state board requires a doctorate for licensure, master's-prepared nurse practitioners continue to be certified and licensed, and the deadline passed without regulatory effect. What has changed is supply: many universities converted their programmes anyway, so the doctorate is increasingly the only option on offer rather than the only option permitted.

Where they work and what it pays

Physician offices employ about 46 percent of nurse practitioners, hospitals about 25 percent, outpatient care centres about 9 percent. The concentration outside the hospital is the mirror image of the registered nurse workforce and reflects what the role was designed for.

Pay varies by population focus, setting, and state, and the national median of $132,300 conceals a wide spread — psychiatric-mental health and acute care roles generally sit above it, primary care below. Full practice authority states tend to pay somewhat more, though the effect is confounded with geography.

What limits the role in practice

Three things constrain nurse practitioners independently of state law, and all three are commonly mistaken for it.

Payers set their own credentialing and reimbursement rules, and may pay a percentage of the physician rate for the same visit. Hospitals grant privileges under their own medical staff bylaws, and can require physician co-signature in a full practice state. And where a collaborative agreement is required, its price is set by a private market — physicians charge for the signature, and the fee is a fixed cost of operating. See collaborative practice agreements.

Sources

Find your next nursing job here

100% free for nurses. New jobs every day. Travel, per-diem, and permanent positions nationwide.

See something out of date? Sign in to suggest an edit.