Amen Eguakun, MSN, RN, FNP, considers himself blessed. Working at a church-sponsored clinic in Nashville, he provides primary care to minority and disadvantaged patients battling HIV and AIDS. He works independently and can devote as much time as he needs to each of his patients.
Eguakun credits it all to three coveted initials: FNP (family nurse practitioner). “If I were still a registered nurse, I could not be doing this,” he says. “Becoming a nurse practitioner gave me [advanced] training and expanded my knowledge of medical treatment. Now, I can combine that with the skills I had as a nurse.”
Today, many other nurses are choosing to become nurse practitioners. According to the American Academy of Nurse Practitioners (AANP), there are more than 106,000 NPs in the United States. This represents a threefold increase since 1990. Even with this growth in numbers, NPs are in demand in virtually every part of the country.
Nurse practitioners perform many functions usually associated with physicians. They diagnose illnesses by performing physical exams and by ordering needed lab tests or other diagnostic tools. They also prescribe treatment. This often includes writing prescriptions for medicine as well as ordering treatments like physical or occupational therapy. Because NPs are able to provide basic primary care, some minority health experts believe that increasing the number of minority nurse practitioners could make a major difference in the war against racial and ethnic health disparities.
What nurse practitioners do is regulated by state laws, so their responsibilities can vary depending on their geographic location. Health care facilities further define what nurse practitioners do within their organizations, which means the functions NPs perform can also vary from one hospital, physician’s office or other practice setting to another. While nurse practitioners typically hold a graduate degree, a few states allow them to practice without one, but only after completing one or two years of intensive training.
Why Become a Nurse Practitioner?
Many nurses who decide to continue their education and pursue a nurse practitioner license cite such benefits as higher salaries, expanded job opportunities and increased job security. Those are certainly very valid reasons for becoming an NP, but many practitioners say the real benefits are intangible.
“My job as a nurse practitioner is rewarding financially,” says Eguakun. “But spiritually, I’m a millionaire because I have the opportunity to make a real difference.”
Eguakun, a native of Nigeria who is now a U.S. citizen, began to dream about becoming a nurse practitioner while working in a hospital as an RN. “Most of the ailments we were dealing with were expensive to treat,” he recalls. “I realized that I could do more if I was involved in primary care and could prevent people from going to the hospital. If more people were involved in preventive care, maybe we would not have to spend so much time and money on hospital care.”
He also realized that minorities, particularly those with HIV and AIDS, often have a very difficult time getting primary care. “In the hospital, I saw many African Americans with HIV and AIDS. They were dying. I learned that everything has to do with prevention,” he says.
Now, as an FNP, Eguakun has the time and the authority to treat the entire patient. Many of his patients like to refer to him as a doctor, but he quickly corrects them. He is proud to be a nurse practitioner and declares, “I want my profession to get the credit.”
Of his work at the First Response Clinic, he says: “We take care of patients with HIV and AIDS, but we also provide primary care. This population is very hard to reach. We want to give them all the treatment they need in one location. That relieves some of the patients’ problems in accessing care, like getting from one clinic to another.” He has even visited patients at home when they couldn’t make it to the clinic.
First Response Clinic, operated by the Metropolitan Interdenominational Church, receives federal funding but is operated solely by the church. Eguakun believes that gives him a better chance of reaching many patients, providing treatment for those afflicted with HIV/AIDS and helping those who are still healthy avoid the deadly disease.
“In the Southeast, religion and the church are big factors in people’s lives,” he explains. “The religious community has also been seen as a problem in reducing the occurrence of HIV in minorities, because the issue is not discussed in churches. [The church that runs our clinic] is actually in the forefront of disseminating information about preventing the disease.”
That close relationship with patients is what drives many nurse practitioners, according to Kenneth Miller, PhD, RN, CFNP, FAAN, president-elect of the American College of Nurse Practitioners (ACNP) and professor and associate dean for research and clinical scholarship at the University of New Mexico Health Sciences Center, College of Nursing.
“The biggest reward is having the time to do what we were educated to do: talk to patients about disease prevention and health maintenance,” he says. “Most physicians don’t have the time to do that. [Compared to doctors], we do a lot more education and discussion with patients.”
Welcoming Diversity
Here are a few quick facts about nurse practitioners from the AANP: The average annual salary of full-time practitioners is $73,620. Nearly half of the country’s NPs (41%) specialize in family medical care, 19.5% specialize in adult care, 11% in women’s health and another 11% in pediatrics.
Miller also expects rapid growth in two other specialty areas: acute care and gerontology. “The hottest specialty right now is acute care. Residents have a limited number of hours to work in the hospital and someone has to pick up that slack. There’s a demand for acute care nurse practitioners all over the country.
“The group we really need to start focusing on for the future is geriatric patients,” he continues. “Nurse practitioners can provide the type of care that senior citizens are going to need.”
Over 95% of nurse practitioners are female, although high-profile male NPs like Miller hope to draw more men to the field. The NP profession is also very open to racial and ethnic minorities. According to the most recent National Sample Survey of Registered Nurses, published by the Health Resources and Services Administration, Bureau of Health Professions, Division of Nursing, approximately 11% of nurse practitioners are nurses of color–and that figure is expected to increase.
“All of the programs [that train practitioners] are trying to recruit more minorities,” Miller comments. “Here [at the University of New Mexico], we are trying to make sure that the composition of our class meets the cultural diversity of the state where we live. [NP] programs want to make sure there is equity in terms of the composition of classes that are admitted so that our practitioners can better serve the minority populations.”
Eguakun says he’s never felt that his race or gender were obstacles in becoming or practicing as a nurse practitioner. “I actually saw it as a plus,” he maintains. “I was working as the sole nurse practitioner at a clinic in a housing development. Some people argued that we might lose women coming in for Pap tests because I was a man, but the number actually increased.”
He has also found that being an African American male gives him the opportunity to build relationships and trust with other black men. “The majority of women are wonderful about seeking health care, but men do not seek it,” he says. “I can reach out to young males and talk to them about getting medical care.” He spends one day a month walking around housing projects, passing out condoms and business cards and connecting to young men in the community.
Choosing an NP Program
So you’ve decided that an advanced practice career as a nurse practitioner is right for you. Where do you go from here? If you’re already an RN, your first step will most likely be to go back to school and earn a graduate degree.
Some experts estimate that at least 50 new nurse practitioner training programs have opened since 1995. They range from intensive, on-site full-time programs to accelerated “fast-track” programs to those offered entirely online through distance education. Before you decide which program to apply to, first think about your passions and then imagine what you want your life to be like after your training.
“It’s always good to work as an RN for a few years,” Eguakun advises. “That will guide you to what you like and don’t like and can help you decide on a specialty. In my case, I knew I wanted to work with disadvantaged populations and HIV/AIDS. My training, everything I did, was geared toward that. The preceptorships that I did were designed to reflect my needs and my goals.”
Once Eguakun was in graduate school, faculty members looked at his goals and introduced him to people who still serve as mentors, providing advice and information on new developments in his field. “Those relationships become very important,” he emphasizes. “The individuals you’ll meet have been in the field. They’ll continue to guide you and expose you to new resources. Plus, you’ll learn how to be a mentor to the next generation of minority nurse practitioners, and that’s very important.”
Miller recommends that nurses who are considering becoming practitioners first spend a couple of days shadowing a working NP. “You have to understand the role nurse practitioners play,” he explains. “The best way to do that is to spend two or three days with a nurse practitioner, just to get a feel for whether this is something you want to do.”
He also reminds would-be NPs that graduate school will be very different from their undergraduate nursing education. “The most difficult thing in terms of becoming a family nurse practitioner is having to think outside the box,” he says. “Many nurses have been educated in a disease mode. They learn about a disease and then they look for signs and symptoms. Nurse practitioners look at the total picture, using the patient’s history and physical condition.”
While all nurses are involved to some extent in diagnosis, NPs are able to diagnose and prescribe treatment independently because of their advanced education, Miller explains. “Graduate programs that train nurse practitioners are two years in length and have 600 to 1,000 more clinical hours beyond the bachelor’s degree,” he says. “Nurse practitioners have advanced skills. They function at a level that allows them to practice independently and they’re able to make more decisions about what is best for the patient.”
Finding the Right Practice Setting
Once you’ve completed your educational and clinical practice requirements and become licensed as a nurse practitioner, your next decision is choosing where you want to practice. NPs can work in a wide variety of practice settings, including hospitals, clinics, physician’s offices, public health departments, HMOs, home health care agencies, hospices, private practice and more. Once again, it’s important to think about what your needs and goals are in order to choose the setting that’s the right fit for you.
“In some offices, nurse practitioners see patients every 10 minutes. You need more time than that to do a good job of diagnosing and treating a patient,” Miller says.
On the other hand, some NPs are able to find workable solutions for providing effective care despite these tight time constraints. Miller says he knows a nurse practitioner who walks into a patient’s room with two assistants. As she’s examining the patient, one assistant is writing down her notes. The other follows through on her treatment plan. “When she leaves the room, she’s finished with that patient,” Miller explains.
But if spending only 10 minutes with a patient isn’t your style, be careful in selecting your first job after adding “NP” to your signature. “When you get out of school, don’t just settle for any job,” Eguakun cautions. “Find a practice group where you really want to work.”
He warns future NPs to do their homework about a practice or health care facility before accepting a position there. “How a nurse practitioner practices depends on the philosophy of the organization,” he says. “If you are in a private practice as an NP, your paycheck may be based on how many patients you see. There’s pressure to get patients in and out quickly.”
Organizational policies can also influence the amount of independence an NP has, Eguakun adds. “I worked in a hospital setting after I graduated. I was a nurse practitioner, but the physician had to see everything [I did] and sign off on every prescription. It wasn’t productive and I knew it wouldn’t work for me. I wanted to have a physician who saw me as a collaborator. I wanted to have some independence and control over what I did.
“Now, the physician I work with is a collaborator. We are a team and we act as a team. He’s accessible to me 24 hours a day.”
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