Family Nurse Practitioners Education, Schools and Career Overview

A family nurse practitioner (FNP) is a highly trained nursing professional that has demonstrated advanced clinical knowledge and is qualified to be a first-contact or direct care provider. An FNP may be a registered nurse with a Master of Science or other advanced degree in nursing who has selected a specialty, completed a rigorous clinical rotation, passed a national examination, and received the appropriate license from his or her state of residence.

The advanced education and thorough clinical training an FNP graduate receives allows them to work and deliver care much more independently than either an licensed vocational nurse (LVN) or a registered nurse (RN). LVN’s work under the general supervision of a registered nurse. Registered nurses work more independently than LVN’s, but still work under the direction of a physician. RN’s can deliver care, but they are generally not in a position to direct it.

In contrast, family nurse practitioners typically work collaboratively with doctors, and in most states they are licensed to order tests and prescribe medication and other treatments. A family nurse practitioner directs the care that his or her patient receives, and in some cases the patient may have no need to see a doctor at all unless their condition is complicated enough that it should be referred to an MD specialist.

A family nurse practitioner studies aspects of health, wellness, illness and injury management for a full array of ages and conditions. An FNP is prepared to manage the care of patients both young and old, and takes special consideration to the relationships between patient and caregivers. FNP’s are considered generalists, meaning they have a broad knowledge base to offer care to a very broad demographic.

Family Nurse Practitioner Duties

More and more, FNP’s are becoming first-contact providers. This means that when someone goes to a doctor’s office for a visit, they may actually be seeing the family nurse practitioner first. The education and training an FNP receives qualifies them to treat many conditions and make decisions with regard to the appropriate treatments, tests or medications a patient may need. A case will be referred to a physician or specialist if it is complicated or resistant to normal treatments, but it is possible that an FNP will direct the care from start to finish.

In addition to being extremely qualified care providers, the philosophy of nurse practitioners is to create a framework of overall health. This includes treating illness and injury, but also involves teaching a positive approach to prevention, wellness and a healthy lifestyle. While an FNP may be the first clinical contact for someone who needs medical attention, the FNP’s overall approach to health care delivery includes a holistic approach to maintaining health and wellness in the long term. This means that an FNP may spend equal time treating a condition and providing education by being an advocate for preventive care and general health and wellness.

Family Nurse Practitioner Specializations

There are many settings where family nurse practitioners might work, from freestanding clinics to hospitals.

It is very common to find a family nurse practitioner working in a physician’s office as part of a team that creates a successful family practice. An FNP may see patients in the office, or visit patients in hospital on physician’s behalf. A family nurse practitioner might work in a public health clinic helping care for patients who need access to health care despite having limited access to insurance. FNP’s might also work for insurance companies as part of wellness education programs, or providing claims oversight.

How to Become a Family Nurse Practitioner

A family nurse practitioner needs to have a master’s or doctoral degree in nursing from a program that offers preparation for the family nurse practitioner specialty. While most master’s programs are oriented towards the eventual completion of a nurse practitioner specialty, there are programs that offer the Master of Science in nursing (MSN) with an orientation toward being a nurse educator or administrator.

The coursework in an FNP program is geared towards creating an exceptionally well-qualified nursing professional. Courses are challenging, and many include lab-work to teach beyond textbooks. FNP programs should also ensure that the population specialty coursework required by the American Nurses Credentialing Center (ANCC) is incorporated into the curriculum.

Core courses in anatomy, physiology, pharmacology and health care principles will be included in the FNP program for a student newly entering the field, or will be built on for students who already have nursing degrees. Many classes in an FNP program are progressive and build on earlier coursework. Assessment courses, for instance, advance throughout the curriculum, as do theory and practice courses.

Classes in a family nurse practitioner program may include:

• Advanced health assessment
• Legal and ethical considerations in nursing care
• Principles in primary care
• Pharmacology
• Geriatric medicine
• Pediatric medicine
• Community health principles
• Advanced nursing theory

Family nurse practitioner degree programs

It is not uncommon for students to work their way up the nursing ladder, so to speak, and become a nurse practitioner in smaller increments. Student could complete courses of study to become LPN/LVNs and then start working, furthering their nursing education while they work in the field. LPNs could get their bachelor’s degrees in nursing and become RNs, then continue working towards their family nurse practitioner certification while employed as RNs. 

While this does prolong the education process, it allows a nurse to earn an income while getting a more advanced degree. It also gives an FNP candidate valuable work experience, and in some cases existing work settings can be used to complete clinical hour requirements.

If a student with an LVN or RN level education is interested in becoming an FNP, there are specialty programs designed to make this happen without duplication in education or clinical training. Sometimes called “bridge” programs, these programs are crafted to build on existing coursework to advance knowledge, not repeat it.

For individuals who want to pursue careers as FNPs and who already have baccalaureate degrees, there are accelerated MSN programs. Existing degrees held by would-be FNPs don’t necessarily have to be in nursing in order to meet eligibility requirements for accelerated programs, but if the bachelor’s degree is in a non-science or allied health field, there will likely be some pre-requisites in the area of biology, anatomy and physiology that need to be completed. 

The accelerated degrees fit four years worth of bachelor’s and master’s degree nursing-specific education into three years. These programs are very aggressively paced, and they often schedule classes year-round. They include the same high quality coursework and demanding clinical rotations that a regular program does. 

Family nurse practitioner schools

The American Nurses Credentialing Center requires attendance at an accredited program in order to be eligible to take the national certification examination. The agencies that accredit family nurse practitioner programs are the National League for Nursing Accreditation Commission (NLNAC) and the Commission for Collegiate Nursing Education (CCNE). Additionally, in order to become licensed in your state of residence, the program must be approved by your state’s Board of Nursing. Being state approved and being accredited by the NLNAC or CCNE are not the same thing, so make sure that the program you select meets both of these requirements.

For individuals who already have a bachelor’s degree, there are online programs where the coursework, examinations and homework are offered through web-based platforms. Accelerated versions of online programs are also available, and these maintain the same condensed coursework schedules as the traditional campus-based programs do. Online accelerated programs are most often scheduled, while some other online programs may allow a student to self-pace. Due to the demanding coursework and the sheer volume of information that must be taught, tested and built upon, the online accelerated programs often set a schedule that the student must keep pace with.

Clinical contact hour requirements are the same in an online program as they are in a campus-based program. Most online programs will have a coordinator available to help students find local medical facilities in which they can meet their practical contact requirements through clinical exposure to family nurse practitioner jobs.

FNP training

Nursing is a hands-on profession. While a tremendous amount of information can be learned in lectures, labs and from books, the application of that knowledge always takes the form of working with actual patients in a clinical setting. Family nurse practitioner programs establish very thorough clinical rotations for their students. Additionally, the ANCC sets a 500 clinical hour requirement in order to be eligible to sit for the national examinations. 

Career advancement for FNPs

The BLS shows that the best job opportunities for nurse practitioners could be available to those willing to work in underserved or rural areas. While opportunities for advancement will naturally occur as a result of other NPs retiring from the job, NPs also could find advanced job opportunities by seeking certification, such as in adult or family care. Certification can be sought through organizations such as the American Nurses Credentialing Center or the Pediatric Nursing Certification Board and shows that NPs have gone through a rigorous testing process and met specific qualifications to reach the certified level.

NPs also can specialize in a wide range of health care fields, varying from pediatric to adult-gerontology care. The specific fields are diverse, and nurses usually specialize at the master's degree level. The most recent salary information from the American Academy of Nurse Practitioners (AANP) shows, however, that out of the various fields, NPs specializing in acute care are among the highest paid. This may suggest that this could be the best NP field as far as potential for salary advancement.

FNP certification and licensure

Certification ensures that a candidate possesses a standardized body of knowledge. Family nurse practitioners have broad responsibilities with regard to their patients’ care and passing the certification exam ensures that FNP’s possess the knowledge and skills that their profession will demand of them.

Licenses are issued by each state, as each state establishes exactly what a health care professional can and cannot do. Licensure demonstrates to the state’s population that an FNP holds the proper certification and knows what his or her scope of practice is. 

In order to be an FNP, you must have a master’s or doctoral degree from a qualified nursing program, have family nurse practitioner certification from the American Nurses Credentialing Center (ANCC) or other certification agency, and be licensed by your state of residence.

FNP certification

The ANCC certification process involves meeting the educational criteria necessary to be eligible to sit for the national certification examination, and then passing the examination itself. To be eligible to sit for the examination, you must:

• Be a licensed RN in your state of residence
• Hold a master’s or doctoral degree from a family nurse practitioner school accredited by the National League for Nursing Accreditation Commission (NLNAC) or the Commission for Collegiate Nursing Education (CCNE)
• Have completed course content in areas specific to the FNP certification, including advanced health assessment, advanced pharmacology, advanced pathophysiology, health promotion, disease prevention and differential diagnosis
• Have completed at least 500 hours of faculty supervised clinical hours

Once these requirements are demonstrated, a candidate can schedule the examination. The exam is computer based. The ANCC offers classes and study groups to help a candidate prepare for the test.

The ANCC requires that a certification applicant already possess the title Registered Nurse, which includes passing the National Clinical License Examination (or, NCLEX).  Then, there’s the ANCC certification exam for family nurse practitioners. Once this examination has been passed, the candidate holds the title FNP-BC, or Family Nurse Practitioner – Board Certified.

FNP licensure

Licenses are issued by the Board of Nursing in each state (specific department names vary). All states in the US require a practicing FNP to have a license. Most states require that a candidate attend a Board approved nursing program and hold certification issued by the ANCC.  The licensure process typically involves applications and proof of eligibility, and may involve fingerprinting and background checks.

It is important to note that some state requirements may differ from those established by the ANCC. For example, some states may require education in ethics; some may have more demanding clinical hour requirements. Most family nurse practitioner programs ensure that graduates meet both the ANCC and state of residence requirements.

Salary and Career Outlook for Family Nurse Practitioners

Many jobs in the health care industry are expected to fare well in coming years, as an aging population lives longer, as people look to live healthier lives, as medical conditions in need of treatment persist, and as advancements in medical technology are made.

However, in general job growth and salary figures for family nurse practitioners will vary based on factors like location, education level, and experience. Here’s an idea of what career outlook and pay could look like for nurses in the coming years:

Sources:

1. May 2014 National Occupational Employment and Wage Estimates United States, Occupational Employment Statistics, May 2014. http://www.bls.gov/oes/current/oes_nat.htm
2. Nurse Practitioners, Bureau of Labor Statistics, Occupational Employment Statistics, May 2014. http://www.bls.gov/oes/current/oes291171.htm
3. Nurse Practitioners, Bureau of Labor Statistics, Occupational Outlook Handbook, Jan. 8, 2014. http://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm
4. 2011 AANP National NP Compensation Survey, American Academy of Nurse Practitioners, 2012. http://www.aanp.org/images/documents/research/2011AANPNationalNPCompensationSurveyPreliminary.pdf