Is becoming a nurse practitioner right for me?

Author(s): Deborah Becker, PhD, ACNP, BC, CHSE, FAAN

This advice will help you make an informed decision.

When I ask nurses why they want to be a nurse practitioner (NP), many struggle to find an answer. Before applying to graduate school, do your homework. Research the knowledge and skills needed, the role activities, and the level of responsibility required to perform the essentials of the position. Start by understanding the basics, review the answers to the following frequently asked questions, and then ask yourself if this role is for you and whether you have the attributes for success. (See NP basics.)

NP Basics

Nurse practitioners (NPs) are licensed healthcare providers who work independently or as part of a team to:

diagnose and treat patients with acute, episodic, and chronic illnesses
promote healthy behaviors and prevention
prescribe pharmacologic and nonpharmacologic therapies
order, perform, and interpret diagnostic tests
develop treatment plans and evaluate progress.

What does an NP do?

NPs obtain patient histories, perform physical examinations, and order and interpret diagnostic tests, including laboratory studies, 12- lead electrocardiograms, and x-rays. They analyze the data collected, create a list of potential diagnoses, and then make a diagnosis and develop a treatment plan (including pharmacologic and nonpharmacologic therapies) in collaboration with the patient. NPs also provide patient education and counseling.

Where do NPs work and with what types of patients?

NP work settings include primary care offices or clinics, specialty care offices, small and medium-sized community and urban hospitals, and large academic health centers. NPs must choose a specific patient population for their practice. Population choices are pediatrics, adult gerontology, women and individuals with gender-related issues, neonates, patients with psychiatric issues, and patients and families across the lifespan. The pediatric and adult gerontology populations are further divided by the level of care they require—primary or acute care.

How do I decide which NP I want to be?

This decision is yours to make. Ask yourself what patient age group you’re interested in caring for. Patients from birth to 21 are within the pediatric NP’s purview. Patients ranging from age 13 through death can be cared for by adult-gerontology NPs. If you see yourself treating newborns up to 1 year old and premature babies, you may enjoy being a neonatal NP.

A significant shortage of psychiatric providers exists, so if you’re interested in helping individuals across the age continuum manage mental health issues and disorders, this role may be for you. If you’re interested in treating women and individuals with gender- related issues (and their partners), then consider a women’s health and gender-related role. If you like the idea of managing patients and their families across the lifespan, then family practice NP may speak to you. If you’re considering focusing on either pediatric or adult through gerontology patients, you’ll need to choose between acute or primary care. If you’re drawn to patients who have acute or critical illnesses, want to restore their health or help them obtain the highest level of independence possible after recovery, then acute care is for you. If you want to focus on preventing illness, encouraging heal thy behaviors, delivering preventive care, and managing chronic illness and lower acuity episodic issues, then choose primary care.

Whichever population you choose, you’ll need to review your personal attributes, learn about the NP program requirements, and how to choose the best program for you.

What personal attributes do NPs need?

NP responsibility, accountability, and autonomy are greater than that of a nurse. You want to make sure you have the attributes that will help you succeed and provide the best patient care possible. (See Do you have what it takes?).

What are the NP program application requirements?

Candidates applying to NP programs must be BSN-prepared or have completed a second degree program that meets the requirements for licensure. You must have an active nursing license in the state where you’re employed or where your graduate school is located so that you can participate in clinical rotations. You’ll be required to submit official transcripts from your undergraduate program; if your grade point average doesn’t meet the programs’ requirement, you may need to take an entrance exam such as the Graduate Record Examination. Performance on this exam provides an objective parameter for determining admission eligibility.

Most applications also require an essay to evaluate writing ability and letters of recommendation from previous instructors and supervisors.

Do you have what it takes?

Nurse practitioner (NP) success requires certain characteristics and attributes. Do you already have them, or do you need to develop them before embarking on your NP education?

Caring and compassionate. Patients are coming to you for answers, and they’ll share more if you are authentic with them.

Attentive. Patients want you to listen to their concerns and offer solutions. If you let phone calls, staff and provider interruptions, and documentation requirements distract you, patients won’t feel heard or valued.

Positive. Provide a positive attitude about patient concerns and options for reducing or eliminating them. Equally important is maintaining emotional equanimity—being appropriately empathetic, but not criticizing or joining in the anger a patient feels about another provider’s decisions.

Critical thinking. NPs must sift through information that the patient provides, uncover what’s relevant, and critically analyze exam and test results to develop a diagnosis and treatment plan. Healthcare is always evolving, so you must commit to life-long learning and professional development.

Responsible. NPs are responsible for a wide range of tasks. You’ll need to provide accurate and timely information to the patient, follow-up on pending diagnostic tests, review consulting reports, and evaluate patient treatment response. That requires being organized, detail-oriented, and willing to admit when you don’t know something (but reassure the patient that you’ll get answers as quickly as possible).

Able to prioritize. Patients usually have several co-morbidities along with their current complaint. You must be able to recognize which problems require immediate attention and which can wait. You’ll also need to reassure the patient by clearly communicating your reasoning.

Communication skills. Communication is essential to your success and good patient care. Translating medical jargon into language that your patient can understand helps the patient participate in care and understand the reasons behind prescribed treatment. You’ll also need to communicate with other providers involved in your patient’s care, with staff who are collecting samples and performing diagnostic tests, and with nurses who implement the plan of care, assess patient responses, and relay their findings back to you.

Physical endurance. Many NPs work 50 to 60 hours per week, and most of those hours are spent standing and walking. Depending on your employment agreement, you may be required to do on-call hours or work night shifts. The longer hours and the change in routine may put more strain on your health.

Stress management. Being an NP can be highly stressful. You must have effective ways to deal with and diffuse stress.

How do I decide whether to apply to a master of nursing or a doctor of nursing practice program?

NP programs are offered at both the master’s and doctorate level. Master’s programs, which typically are 2 to 3 years, focus on providing the required coursework and the number of clinical experiences and hours needed to meet the NP competencies and the certification exam eligibility criteria. Completing a doctor of nursing practice (DNP) program frequently requires additional years of study. The curriculum provides advanced coursework on leadership, quality and safety, informatics, healthcare economics and policy, and evidence-based practice (EBP). Many DNP programs have an EBP project as a graduation requirement. The American Association of Colleges of Nursing has recommended that NPs be prepared at the doctorate level, and the National Organization of Nurse Practitioner Faculties has committed to move entrylevel NP education to the DNP level by 2025. One option could be to obtain a master’s degree with the plan to return to school later to pursue a DNP.

Make an informed decision

Determining what you want to do for the next phase of your career is an important decision. Take the time to explore your options and do the research so that you’re fully informed about NP role responsibilities and expectations. You also want to understand the educational requirements, how long it will take to complete your education and training, and what the financial implications are. Your road to success as an NP should be paved with all the information you need to make the right decision for you.

Deborah Becker is a practice professor of nursing and director of the adult gerontology acute care nurse practitioner and streamlined post-MSN certificate adult gerontology acute care NP programs at the University of Pennsylvania School of Nursing in Philadelphia.

Selected references

American Association of Colleges of Nursing. AACN position statement on the practice doctorate in nursing. October 2004. aacnnursing.org/Portals/42/News/Position-Statements/DNP.pdf

American Association of Nurse Practitioners. All about NPs. aanp.org/about/all-about-nps

American Association of Nurse Practitioners. Student resources. aanp.org/student-resources

Consensus model for APRN regulation: Licensure, accreditation, certification & education. July 7, 2008. ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf

Fitzpatrick JJ, Ea EE, Bai LS. 301 Careers in Nursing. New York: Springer Publishing Company; 2017.

Hooker RS, Brock DM, Cook ML. Characteristics of nurse practitioners and physician assistants in the United States. J Am Assoc Nurse Pract. 2016;28(1):39-46.

National Organization of Nurse Practitioner Faculties. The doctor of nursing practice degree: Entry to nurse practitioner practice by 2025. May 2018. cdn.ymaws.com/ www.nonpf.org/resource/resmgr/dnp/v3_05.2018_NONPF_DNP_Stateme.pdf

Santana N. The Ultimate Nurse Practitioner Guidebook: A Comprehensive Guide to Getting into and Surviving Nurse Practitioner School, Finding a Job, and Understanding the Policy that Drives the Profession. New York: Peter Lang; 2018.

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