Nurse practitioners (NPs) are essential healthcare providers who are excellent, skilled clinical resources for newborns and elderly patients. While there are many available NP career choices, the family nurse practitioner (FNP) is a trendy option among nurses seeking to become primary care providers with the authority to diagnose illnesses, order diagnostic tests, prescribe medications, and manage the care of patients across the lifespan.
If you’re a nurse who wants to become a family nurse practitioner, what does that avenue look like, and what hoops do you need to jump through to achieve your goal? And if you’re not a nurse, what additional work must be done to get there? Let’s examine the landmarks along the way to becoming an FNP.
Why Become an FNP?
Becoming an FNP has pros and cons, so considering the many possibilities available in advanced practice nursing, it’s prudent to do your due diligence.
PROS:
Earning power: According to the U.S. Bureau of Labor Statistics (BLS), nurse practitioners, nurse midwives (CNMs), and nurse anesthetists (CRNAs) earned a median annual salary of $125,900 in 2022, with a mean hourly wage of $60.53. While the much higher salaries of CRNAs may admittedly skew the numbers higher, there’s no arguing that NPs are doing well for themselves.
Job growth: As another incentive for those considering the NP path, the BLS projects 38% job growth for NPs through 2032. When weighed against projected job growth of 6% for RNs and 3% for MDs, the attractiveness of a career as an NP can appear exceptionally bright.
Full practice authority: The state practice environment for NPs is improving slowly. The American Association of Nurse Practitioners (AANP) reports that in the states where full practice authority has been granted, “state practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing. This is the model recommended by the National Academy of Medicine, formerly called the Institute of Medicine, and the National Council of State Boards of Nursing.”
CONS:
Future license portability: At some point in the future, the APRN Compact will become a reality like it is for millions of registered nurses. However, more states still need to sign on to begin implementing even a fraction of a potential compact.
Stress and burnout: Recent statistics show a high level of burnout, depression, and anxiety among NPs, primarily due to workplace stress, overwork, perceptions of lack of respect from colleagues and patients, and insufficient salaries.
The 15-minute visit: Since most FNPs work in a clinic or office setting, the now common 15-minute office visit can starkly contrast with the relational aspects of bedside nursing that many nurses enjoy as RNs.
The FNP Career Pathway
For Non-nurses:
For non-nurses wanting to secure their future by becoming a family nurse practitioner, the first step is to become an RN through an associate degree in nursing (ADN) program or a bachelor of science in nursing (BSN) program.
Alternatively, a non-nurse can also pursue a direct-entry MSN program, an accelerated path where the student simultaneously earns a BSN and an MSN. Specific direct-entry programs bypass the BSN entirely. Most of these programs will require the completion of prerequisites that will likely include some combination of anatomy and physiology, biology, chemistry, nutrition, sociology, psychology, statistics, and microbiology.
For Registered Nurses:
Registered nurses with an ADN who want to pursue a career as an FNP will want to complete an RN-to-BSN bridge program and then apply to an MSN program with an FNP track. Registered nurses can also consider an RN-to-MSN program, which allows students to take core BSN courses while completing their MSN.
Potential MSN and FNP students should know there is a strong movement afoot to make the Doctorate of Nursing Practice (DNP) degree the entry-level requirement for becoming a nurse practitioner. While a goal of 2025 has been set, this change has yet to be codified as an absolute requirement, but the day for such a requirement is fast approaching.
Students can expect to be tested regarding aspects of assessment, diagnosis, planning, and evaluation of patients across the lifespan in areas of knowledge that include:
Health assessment
Pathophysiology
Therapeutics
Evidence-Informed Practice
The Life of the FNP
Licensed and certified family nurse practitioners can work in a wide variety of settings, including but not limited to:
FNPs can earn additional postgraduate certifications in areas like psychiatric/mental health. APRNs can also become eligible for leadership positions in many clinical settings.
While those considering FNP certification may be worried about the limits of the increasingly common 15-minute patient visit, FNPs can find plenty of practice areas with other types of structures for patient interaction.
With predictions for astronomical job growth and opportunity in the years to come, family nurse practitioners will undoubtedly be in great demand nationwide. Pursuing the career path of the FNP is not for everyone, but the plethora of potential opportunities will attract students from all walks of life far into the foreseeable future.
Cultural competence and cultural safety are crucial to delivering effective care. They are also key to creating working environments where everyone feels valued and able to function at the highest level. If we invest time and energy in understanding and implementing these concepts, the dividends can be invaluable, both individually and collectively.
Defining Cultural Competence and Cultural Safety
Dr. Raj Sundar is a physician, community organizer, and the Healthcare for Humans podcast host. As a healthcare leader, Dr. Sundar uses various platforms to bring a human scale to care delivery. In his view, the importance of cultural competence and safety cannot be overstated.
“Understanding cultural competence and safety is crucial when working with diverse cultures,” Dr. Sundar shares. “However, the definitions of cultural competence have evolved from diverse perspectives. One definition that’s commonly used is the following: having the capacity to function effectively within the context of diverse cultural beliefs, behaviors, and needs, as highlighted by the CLAS Standards (culturally and linguistically appropriate services).”
He continues, “On the other hand, cultural safety goes beyond individual competency, focusing on creating environments where everyone feels safe and respected, particularly addressing historical and structural causes of inequity. It builds upon cultural humility, which involves recognizing personal biases while understanding and respecting others’ perspectives.”
Where Does Cultural Competence Fall Short?
However well-meaning cultural competence initiatives can be, they don’t always hit the mark. Dr. Sundar explains, “Competence-focused approaches can sometimes overlook individual differences, leading to stereotyping and neglecting unique experiences.” He continues, “Additionally, while cultural competence training is valuable, it often emphasizes surface-level cultural differences, neglecting deeper issues such as systemic biases and power dynamics.”
Sundar uses his cultural background and experience to illustrate how cultural competence can fall short. “My identity as an Indian-American from North Carolina who likes lacrosse, sweet tea, and country music illustrates the complexity [of individual experience] beyond cultural identity. Individual differences always matter, but my history and values are deeply connected to my Indian ancestry.”
“A plethora of training is designed to expose providers to different cultures and expand their understanding of the beliefs, values, and behavior, thus achieving competence. Although this intention is commendable, training providers to become competent in various cultures presents the risk of stereotyping, stigmatizing, and othering patients and can foster implicit racist attitudes and behaviors.
“Further, by disregarding intersectionality, cultural competence training tends to undermine provider recognition that patients inhabit multiple social statuses that potentially shape their beliefs, values, and behavior.”
Parallel Concepts
When it comes to other concepts that parallel cultural competence, Sundar adds that two other terms to be familiar with are cultural humility and responsiveness.” He describes them thus: “Cultural humility is an attitude or mindset characterized by an ongoing willingness to engage in self-reflection, self-critique, and lifelong learning about one’s own cultural biases and the cultural backgrounds of others. It emphasizes recognizing the limitations of one’s perspective and being open to learning from diverse experiences and perspectives.”
He states, “Cultural responsiveness involves recognizing, respecting, and integrating individuals’ cultural backgrounds, values, and beliefs into designing and delivering services and interventions. It goes beyond cultural competence by emphasizing the importance of engaging with communities, co-creating solutions, and adapting practices to meet diverse populations’ specific needs and preferences.”
Strategies and Tools for Increasing Cultural Competence
There are many strategies and tools for increasing cultural competence. Dr. Sundar shares, “While insufficient, cultural awareness training can be essential opportunities to connect with peers to reflect on conflicts, tension, or care pathways that can be improved.” His examples include asking questions like:
Why does our Russian community have the lowest mammogram rate?
When a Jehovah’s Witness refuses blood in a life-threatening situation, are we all aware of what to do and have the support we need?
When families come together to care for an individual, can we navigate that context in our highly individualistic environment?
Sundar adds, “It’s often essential to have cultural liaisons, which allows for collaboration with community leaders and organizations serving diverse populations.” This strategy can provide insights into cultural norms and various practices and behaviors that community members engage in when seeking healthcare.”
As a community organizer, Sundar has other recommendations. “Building relationships with your community is helpful. Part of my podcasting journey with Healthcare for Humans is building relationships with local immigrant and refugee communities, amplifying their voices, and caring for them in the way they want in the context of their history and structural inequities.”
Patients’ perspectives must also be taken into consideration. “It can be beneficial to actively seek patient input about cultural preferences, needs, and concerns,” Sundar advises. “Take time to listen attentively and respectfully to patients’ perspectives and incorporate their feedback into your approach to care. Ask, ‘How can I be a better advocate and caregiver for your community?’”
Dr. Sundar reminds us that we must also reflect on our cultural biases, assumptions, and privileges. “If we consider how these factors influence our interactions with patients and colleagues from diverse backgrounds, that self-awareness is a step toward becoming a more culturally aware healthcare professional.”
A Learning Process
In the end, Dr. Sundar has specific recommendations for nurses.
“Nurses should recognize cultural awareness as a continual learning process rather than a static achievement. For example, it’s been a journey for me to realize how to incorporate the values of the Native Hawaiians and Pacific Islander community in my care. I have had to be intentional about how I say hello and talk about suffering to meet the community where they are. It takes time and building relationships to realize this.”
Dr. Sundar believes that achieving health equity requires ongoing self-reflection and that we remain open to diverse perspectives.
“Health equity is the idea that everyone should have the same opportunities to be as healthy as possible, regardless of their circumstances, and we must be committed to it. Doing this work isn’t always easy, but it’s worth the effort and will always be needed in our diverse world.”
When you earn a nursing degree — an ADN, BSN, MSN, or beyond — you signal to the world that you’re a professional who values education and advancing your career. Consistently reaching for increased expertise is a goal for individuals working in almost any discipline, and nurses are no exception.
Beyond your formal education, you have other opportunities to expand your knowledge, and certifications are one such avenue for demonstrating dedication to having the most up-to-date, evidence-based information possible in your area of nursing practice.
Why Get Certified?
If you haven’t yet pursued nursing certifications, now may be the time to consider the possibility. Certification can serve many purposes, each of which holds value for you and your career.
Validated commitment to mastery: Your potential capacity to grasp the subtleties of your chosen nursing specialty is limitless. There’s no end to how much you can learn by digging deeper and deeper into the nuances of a particular branch of nursing and the clinical judgment that comes with it. Many certification processes are no walk in the park, and if you want validation of being the best you can be, certification can accomplish that goal.
Enrich your marketability and earning potential: In the job market, you need every advantage to stand out from the crowd. Certification shows a potential employer that you’re serious about your career and have gone above and beyond. Being certified could be the thing that gets your resume noticed. You may also enjoy increased earning potential.
Augment your sense of pride and empowerment: Some nurses rest on their laurels, others keep learning, and your accomplishments say a lot about your ambition to be the best you can be. As you gain knowledge, skill, and expertise, you can be proud of who you’ve become, and having those extra letters after your name is something you earned by going the extra mile.
Other benefits of certification include the respect of your colleagues and the benefits experienced by patients in the care they receive.
Popular Certifications
There’s an enormous and growing list of certifications available to nurses. Remember that to sit for certification exams, you’ll need to have logged a certain amount of clinical experience in that specialty, so research is essential.
Here are a few popular certifications for your consideration:
Pediatric Advanced Life Support (PALS) can be attained through the American Heart Association, the Red Cross, and several other organizations.
Certified Emergency Nurse (CEN)is available through the Board of Certification for Emergency Nursing (BCEN). Two years of emergency experience is recommended but not required.
Critical Care (CCRN) from the American Association of Critical Care Nurses (AACN) is geared towards those working as intensive care and critical care nurses. There are specific clinical hour requirements in direct critical patient care before sitting for the exam: 1,750 hours during the previous two years, with 875 of those hours in the most recent year, or 2,000 hours in the last five years, with 144 of those hours in the most recent year.
Oncology Certified Nurse (OCN) requires a minimum of 2,000 hours of adult oncology nursing practice (clinical, administration, education, research, or consultation) in the previous four years, two years of experience as an RN, and 10 hours of continuing education in oncology in the last three years.
Certified Diabetes Care and Education Specialist (CDCES) is a specialization that gives the successful applicant the tools to work with patients facing the challenges of life with diabetes. Applicants must have two years of RN experience, at least 1,000 hours providing diabetes care and education in the previous five years, with 20% of those hours in the most recent year.
At this point, it’s important to note that all areas of advanced nursing practice (family nurse practitioner, pediatric nurse practitioner, adult-gerontological nurse practitioner) are considered specialty certifications, and NPs trained in one area of practice can take an exam and receive post-graduate certification in another advanced practice discipline at their discretion.
Since many certifications require significant experience in the designated specialty to sit for the exam, some employers will support and pay their nurses to become certified once they have sufficient experience. Certain employers may even make pursuing certification within a set period a part of your contract.
Of course, paying for your certification and recertification is a significant benefit, although paying for the process yourself wouldn’t be the end of the world. Nothing stops you from getting the certification if you want to demonstrate your commitment and sharpen your expertise. Train yourself in the interest of your professional development and career.
The nursing certifications list is long, and you can decide what makes sense for you. The validation of your expertise that certification confers is real, as is the increased marketability. Certification is a powerful avenue to accomplishing that goal if you take pride in your nursing specialty and want to take your knowledge and skill as far as you can.
Throughout history, new technologies have always sparked legitimate fears that some jobs will be radically changed or eliminated due to innovation. The telegraph, the telephone, the tractor, the steam engine, the internet, robotics, artificial intelligence — each of these developments has brought some form of change in the job market, the viability of particular professions and skills, and how things get done.
When it comes to nurses and the nursing profession, innovative technologies might give us pause to consider what nurses do, how they perform specific tasks, and if the profession might stand to lose something.
While medication-dispensing robots, telemetry, electronic fetal monitoring, artificial intelligence, and other technological advances have altered our work as nurses, fears that robots will replace us and send nurses into the historical career dustbin are likely unfounded. New opportunities are being created as nurses embrace emerging technologies and become educated and trained in valuable 21st-century skills.
The Human Touch
Nurses are the most trusted profession in the United States because they touch patients literally and figuratively daily. The trust between nurses and their patients is born mainly from the human-to-human interactions that make nursing a compelling combination of an art and a science.
No matter how efficient a robot may be in doling out medications and how powerful artificial intelligence and machine learning may become, the absolute humanity of nursing care would be impossible to replace with a machine entirely.
The physical assessment of a newborn, the expression of empathy, and the practice of hospice nursing are just three areas that come to mind where the human side of nursing care is so utterly crucial. While an immersive virtual or mixed reality application could be utilized to educate a patient about dialysis or provide basic diabetic teaching, no application can take the place of a nurse sitting on the edge of a patient’s bed, holding their hand, and providing emotionally intelligent supportive counseling as the patient mentally prepares for surgery.
The human side of nursing is the art that maintains the sacredness of the nurse-patient bond. Nursing may be partially driven by plans of care developed within the parameters of the nursing process, but where the rubber hits the road is where person-to-person interaction informs the patient experience and the nurse’s calling.
Nursing Embracing Technology
Rather than considering how technological advances might cause nurses to be replaced by machines, the more likely new reality is that of nurses embracing technology in the interest of their careers.
Nursing informatics has opened new career paths for nurses interested in computers, data management, and analytics. Nurses who master their facilities’ electronic medical records can make themselves invaluable as super users capable of training other nurses and staff in using an EMR.
Nurses pursuing master’s and doctoral degrees in informatics can pursue previously closed opportunities, including positions such as Chief Nursing Informatics Officer (CNIO). For nurses who can find such opportunities, companies creating new bedside technologies and digital interfaces will need skilled clinicians who can act as consultants on testing devices and applications that have yet to be ready for prime time.
The Robots Won’t Be Replacing You
Although science fiction could tell an entirely different story, the reality is that we won’t be seeing autonomous robot nurses speeding from room to room, providing hands-on patient care without ever needing a break for dinner or the bathroom, at least not anytime soon.
Rather than considering how the robots may be coming for your nursing job, perhaps it’s best to focus on how you can embrace them and leverage these new developments to the advantage of your nursing career.
Don’t worry — the robots won’t be rolling into town next week to staff the ICU. But if you’re a nurse wondering how the tech revolution could revolutionize your nursing career, there’s much to learn and new opportunities just around the corner.
In the world of nursing, certifications and their corresponding designations carry with them the concepts of excellence, professionalism, and focused dedication to career growth. Not all nurses pursue certification during their years of service in healthcare, but many hear the call and take inspired action to achieve such a goal.
Making an effort to become certified in your nursing specialty is like doubling down on your skills and knowledge. Doing this takes discipline and forward-thinking, demonstrating that you care enough to show the world that nursing excellence and professional mastery matter.
Every year on March 19th, we celebrate National Certified Nurses Day to honor the nurses who take their careers to the next level by becoming certified. This celebration encourages us to take a moment to acknowledge the role that certification plays in strengthening the nursing profession while improving care and patient outcomes. Being certified is meaningful, and we make meaning by pausing for the cause of reflection and recognition of the nurses who choose this path.
Nursing Certification 101
According to the American Association of Critical Care Nurses (AACN), the first nursing certification was issued in 1945 to recognize nurse anesthetists. Certification boards began to be created in the 1960s, and the number of available nursing certifications continues to grow to this day.
Many nurses choose to pursue certification of their own volition, while some employers may encourage or even require nurses in specific specialty areas to become certified. Having your employer pay for and support your certification goals can be a desirable benefit, especially if your certification process has a financial cost you’d rather not bear yourself.
A 2021 Journal of Nursing Administration study states, “Nurse specialty certification is ’a mechanism for validation or formal recognition by documenting individual nurses’ knowledge, skills, and abilities specific to their specialty’. It is a form of individual credentialing above and beyond entry-level education and licensing. By pursuing specialty certification, nurses exhibit a commitment to professional growth and lifelong learning while establishing competency in a specialized area of care such as oncology or medical-surgical nursing. The intended outcome of certification in nursing is to improve safety, quality of care, and health outcomes for those using healthcare services.”
No matter what certification you choose to pursue, rest assured that being certified is something to be proud of and to clearly and proudly document on your resume as a mark of nursing distinction and professional mastery.
Why Should You Consider Becoming a Certified Nurse
As mentioned above, certification is a demonstration of dedication to your area of specialty nursing practice. Being certified can serve many purposes and brings with it a variety of benefits, including:
Marketability: Being certified can make you a stronger candidate in the job market, especially if it sets you apart from non-certified applicants for the same positions.
Career mobility: Some employers may value nursing certifications very highly, with certified nurses more likely to advance on the organization’s clinical ladder or into positions of greater responsibility, including nursing leadership.
Respect and recognition: Certification can elicit in others a sense of respect for and recognition of your professionalism, expert knowledge, and skill.
Personal/professional pride: Certification may elicit pride in your expertise, mastery, and accomplishments as a dedicated nurse.
Certification is a feather in your nurse’s cap. It marks you as a nurse focused on career growth and expert skill and knowledge. By being certified, you benefit not only your career but also inspire others to follow in your footsteps and contribute to the improved quality of patient care, not to mention strengthen your employer’s organizational profile.
Certification Speaks Volumes
Having one or more nursing certifications speaks volumes about your professionalism and desire to develop yourself as a nurse of integrity and mastery. Being certified says a great deal about you, and your certifications can enhance your ability to advance your career in any direction you’d like to go.
Some nurses may sit on their laurels and do the bare minimum, while others may seize the day and take every opportunity to develop themselves professionally. Only you can decide if the path to certification is right for you based on your perception of the benefits of certification and the value of that process to your career.
In recognition of Certified Nurses Day, let’s acknowledge those nurses who’ve stepped up to the plate and taken on certification as a prospect worthy of their attention and hard work. And if you’re already certified, give yourself a pat on the back for going the extra mile and showing the world that you’re a nurse who wants to be the best you can be.
