In the press of caring for patients, family nurse practitioners (FNPs) must tend to a patient’s physical well-being and mental health. Caring for a patient’s mental status can be vital to meeting healthcare needs.
As primary care providers, FNPS play a significant role in tending to mental health concerns. The American Association of Nurse Practitioners (AANP) reflected that 88% of the nation’s NP workforce are certified in an area of primary care, with over 70% delivering primary care services, notes LaMicha M. Hogan, PhD, APRN, FNP-BC, associate dean/department chair for APRN Programs for the Texas Tech University Health Sciences Center School of Nursing-Graduate Program.
In this article, we’ll offer ways to ensure you’re attending to your patient’s mental health needs and touch on how FNP programs should educate students about mental health.
Great Impact
Though stigmatizing societal attitudes regarding mental healthcare have improved, a patient’s initial encounter with a healthcare provider will likely have the most significant impact on self-perception of a mental health complaint as well as willingness to seek continued treatment, notesHogan.
Early detection and intervention lead to the best outcomes, in conjunction with a trusting, collaborative rapport between the patient and FNP to reduce stigma present with having a mental health condition, according to Hogan. FNPs must be aware that a patient’s mental health status has a greater impact on chronic physical health conditions if undiagnosed or left untreated, she notes.
It’s imperative for FNPs, especially those in primary care settings, to prioritize the screening of conditions such as depression and anxiety, notes Amanda Ringold, DNP, FNP-BC, CRNP, SANE-A, assistant professor at the University of Pittsburgh School of Nursing. “To ensure effective mental health assessments, FNPs must address and overcome organizational barriers, including time constraints, a lack of a universal screening policy, and providers’ feelings of inadequacy in conducting mental health screenings. FNPs are poised to take on leadership roles within clinical settings to address and mitigate these challenges,” she explains.
Screening Strategies
Various strategies exist for dealing with mental health during patient care visits. For instance,
Ringold notes that not every screening needs to be done face-to-face with the FNP. Instead, screenings can be conducted with pen and paper in the waiting room or via an app before the appointment. She notes that other team members, including nurses or medical assistants, can be trained in administering the screenings.
Lisa Johnson, DrNP, CRNP, ACNP-BC, associate professor and DNP/NP Program Coordinator at Gwynedd Mercy University, agrees that patients can complete questionnaires in the waiting room or before the visit. However, “we have to be cautious not to fatigue patients with questionnaires and to ascertain their reading level and primary language prior to requesting a mental health assessment be completed by the patient,” she warns.
In an interview, Irene W. Bean, DNP, FNP/PMHNP-BC, FAAN, FAANP, FNAP, CEO of Serenity Health Care, P.C., and Tennessee State Rep for AANP, says to pay attention to a patient’s body language once in a patient encounter. Watch for poor eye contact or note whether a patient has been crying.
She says to pay attention to slurred speech and be aware of signs such as a patient who typically speaks loudly suddenly speaking in a whisper or a normally talkative patient now being reserved.
FNP Programs
Johnson says NP educational standards emphasize assessing mental health in varied patient populations. Healthcare providers and institutions of higher education need to focus on the cultural considerations of mental health disorders and further emphasize collaborative communication between primary care and mental health providers, she notes.
Hogan says clinical competencies are best attained via a competency-based educational model throughout the FNP curricula. Specialized courses on mental health, simulation training, interprofessional education, and clinical rotations in primary care settings can develop competence. She says that after graduation, FNPs should maintain continuing education specific to FNP’s scope of practice and evidence-based care for mental health concerns.
Ringold notes a growing trend of students at the University of Pittsburgh School of Nursing opting for dual FNP-PMHNP degrees.
Scope of Practice
While FNPs can treat mental health conditions such as basic anxiety and depression, they need to be mindful of their state’s scope of practice, says Bean. For patients with conditions such as bipolar disorder or schizophrenia, you may be stepping outside your practice scope and may need to refer the patient to a specialist, Bean says
“One thing that I would stress, and I stress to my students, is that you want to protect your license. You want to ensure the patient is safe while protecting your license,” Bean says.
Calling on Compassion
When you realize your patient is anxious, depressed, or dealing with a mental health issue, “What you don’t want to do is rush that patient from that conversation,” says Bean. “You’re going to miss a lot of things when you rush patients who have a mental health crisis through your clinic,” Bean says.
“You have to have compassion for patients dealing with a crisis. Their crisis may not be something you feel is a crisis, but to them, it’s everything. You can’t discount their feelings, and you can’t discount what you’re seeing in that patient.”
The family nurse practitioner (FNP) credential is a popular choice for nurses considering the right academic path to becoming nurse practitioners.
While nurses can choose a route that addresses more specific populations, such as a pediatric NP, a psychiatric NP, or an adult-gerontology NP, the FNP offers an opportunity to treat patients across the lifespan—from infants to centenarians.
The appeal of the FNP is rooted in both the patient care opportunities and the professional autonomy the FNP offers. “The premise behind the FNP is to provide holistic care for all individuals,” says Julia M. Steed, PhD, APRN, FNP-BC, CTTS, academic director of the Family Nurse Practitioner Specialty and assistant professor at Vanderbilt University School of Nursing. She says that FNPs focus on an approach that emphasizes health prevention and promotion appropriate for different lifestyles and cultures. It’s an approach that’s useful in many healthcare settings.
Nurses choose a path for many reasons, often based on a mix of personal and occupational experiences, says Tearsanee Carlisle Davis, DNP, FNP-BC, PMHNP-BC, FAANP, the director of Clinical Programs and Strategy at the University of Mississippi Medical Center (UMMC) Center for Telehealth and an associate professor at UMMC. “Originally, I entered a nurse educator program because of my love for teaching,” Davis says. “However, after the first day, I knew I loved patient care more. I switched programs and became an FNP. One of the main reasons for my choice was my hometown and the needs of the people there. I knew that nurse practitioners were the answer, and I was excited to become a part of something that could change people’s health.”
Jo Loomis, DNP, FNP-C, CHSE, CLC, ANLC, NCMP, CNL, associate professor in the School of Nursing and Health Professions at the University of San Francisco, realized that her original midwifery plan would better serve her if she could do what she found was pulling at her—being able to care for the whole family. Nursing students, she says, can keep an open mind as they are moving through clinical settings that will include other NP areas, such as pediatrics or women’s health, and can pay special attention to the especially appealing areas—or notice if they all are.
Loomis says that as an FNP, a nurse can have a broad scope of everything that may contribute to a patient’s health. They focus on the tenets of health promotion, risk aversion, and disease prevention. “They take it all into consideration,” Loomis says, including that other factors might influence a care plan or other people involved. She says the role consists of listening to the patient’s health concerns and what is happening in their lives.
The FNP is an excellent choice for many nurses, but not all. If nurses are trying to decide the best credential, Davis says to remember what is truly important. “I believe [nurses] should answer their ‘why’ for advancing their education first,” she says. They will be more successful if they can prioritize what makes them tick. “I believe that by knowing their reason for choosing a path, they will understand the responsibility that comes with it,” she says. The FNP, says Steed, includes a little bit of everything, which gives an FNP the ability to adapt to different patients and settings. Steed has used her FNP as a practicing nurse in areas ranging from chiropractic to urgent care to weight loss.
Finding the right academic program to earn an FNP is essential to a nurse’s success. Many factors influence the decision, and each nurse will have different priorities. The final decision includes determining what will work for course delivery (online or on campus), cost, location, and the length of the program. However, while the school’s reputation and the strength of the faculty are top-of-the-list fundamentals, a flexible approach will be helpful. Automatically thinking the shortest program is the best can be detrimental. “It takes time to learn the role and become fully equipped as an NP,” says Loomis.
Steed also recommends that nurses look into the student support available. Supports include all the assistance a grad student needs, including library help, career coaching, and even grad services counseling. Assessing what kind of research the school’s faculty members are working on and possibly reaching out to them individually also offers insight into what opportunities will be available as an FNP student.
Davis, who has used her FNP in settings as diverse as private practice, community health, emergency medicine, and academia, recommends putting in some work before making a decision. “I think they should study it and talk with others who have been successful on the journey,” she says.
This crucial role allows nurses to make meaningful and measurable changes for families in their communities. In practice settings, the FNP, with a broad understanding of all ages and health conditions, is an expert in triaging what is within their scope to treat and what might need additional expertise or specialists.
Once nurses are in practice as FNPs, they are often rewarded with seeing the change that comes from their work. “For me, it was the satisfaction of knowing I was meeting a real need in the community. Nurses are often the ones who connect with the patients and family. As an NP, I felt better prepared to educate and provide care. My FNP experience opened many doors for me, many of which I could have never imagined,” Davis adds.
So, you’ve decided it’s time to further your education? Or maybe you haven’t decided yet because you are unsure what to do. So many questions are swimming through your mind: Are all FNP programs the same? How much will it cost? Can I still work as an RN while I’m in school? How will I know which program is right for me? Well, never fear; you may find the answers you need here.
Are All FNP Programs the Same?
The short answer is no, and that can be a good thing. All accredited FNP programs in the United States must follow the standards of their accrediting bodies, both for nursing and their university at large, governmental regulations, licensure standards, and other guidelines. However, the standards can be arranged in several different ways. This allows nursing colleges to offer programs that fit various student needs.
The FNP curriculum is typically offered in three different formats: online, traditional face-to-face, or a hybrid of online and traditional. Online programs have made educational experiences more accessible to students who would not otherwise have the opportunity to further their education or who prefer the flexibility of online learning. When considering online learning, ask whether the classes are presented in synchronous, asynchronous, or a combination of formats.
Synchronous delivery typically means having online classes with a live instructor at specific times, discussions with other students, and opportunities to ask questions and receive feedback. Asynchronous classes usually consist of recorded content, allowing students to access their learning experiences at any time of the day or night, with scheduled opportunities to interact with instructors. Combination formats are just that, a combination of the two.
Traditional programs provide face-to-face learning with an experienced instructor, and hybrid programs offer a taste of both in-person and online learning. So, determining which of the program types is right for you may take some self-evaluation. Some students need the structure of being required to show up in person at a specific date and time, and some are more self-regulated. Neither is right, and neither is wrong. Just make sure to think it through to set yourself up for success.
Another similarity between FNP programs is the requirement for hands-on patient care in clinical settings with properly vetted preceptors. Make sure to inquire about preceptor policies when considering a program. Some programs arrange clinical experiences for their students. However, the vast majority of programs require students to arrange their own clinical experiences. So, the time to start networking with FNPs in your area is now. Most programs allow students to learn from physicians for some required hours.
However, the majority of hours should be spent learning from an experienced nurse practitioner. Because the FNP scope of practice encompasses patients across the lifespan, students will likely be required to have preceptors in differing specialties: pediatrics, women’s health, primary care, and urgent care. Many programs also allow preceptorships within sub-specialties such as aesthetics, dermatology, podiatry, cardiology, urology, etc. Think outside the box. It never hurts to ask whether your favorite practitioner could be approved for a clinical experience.
A couple of words to the wise concerning preceptorships:
Some preceptors require payment for their services, and some do not. Some colleges allow paid preceptors, and some do not. Make sure to ask about this before you enroll in a class that requires a preceptor.
Contact your state’s Board of Nursing (BON) to ensure they allow clinical experiences while you learn from another location. The college you apply to should provide this information, but it always helps to check it out yourself.
How Much Will an FNP Program Cost?
According to Nurse.org, the range for graduate credit hours is approximately $500 to $2000. Required credits usually range from 46 to 54, but there are variations. So, look at the program curriculum and do the math. Also, don’t forget to ask about fees, books, supplies, etc., and start thinking about scholarships, grants, and financial aid now.
Please consider your time cost as well. Colleges and universities must calculate in-class time, expected out-of-class work time, clinical time, lab time, etc. So, think of solutions ahead of time for things like childcare, vacations, practice, and life in general. While graduate school is temporary, it will likely mean change for the whole family. So, make sure to talk it through with all of those important people in your life. After all, people can do just about anything for a while, as my Nana always told me.
Can I Still Work as an RN While I’m in School?
Most people do work while in graduate school. However, this may factor into your decision about the type of program you want to attend. An asynchronous program may work better if your practice site requirements conflict with traditional or synchronous course requirements. Or your practice site may be willing to accommodate the changes you need. It never hurts to ask. Just remember, a practice site is a great place to make contacts for clinical preceptors.
How Will I Know Which Program is Right for Me?
Consider the things above and talk to people that you trust. Ask them to tell you about their experiences. Then, consider what they say with your perspective in mind. Ask good questions and do your homework in examining available programs. You must consider your learning style, non-negotiable responsibilities, resources, and your family’s willingness to be flexible for a little while. When considering a program, you need to know about the format, the college’s accreditation status, the program’s success in licensure pass rates and graduate placements, the length of the program, the cost in money and time, the program’s preceptor requirements, and whether your BON allows learning from the college’s state. Then, choose wisely and GO FOR IT!
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.
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.
Are you the tech-savvy nurse on the unit? Do your colleagues seek you out with questions about the quirks of your electronic health record (EHR)? If so, consider turning that know-how into a career in nursing informatics.
A background at the bedside is critical for a successful nursing informatics role. “There’s typically some kind of clinical experience involved before jumping into an informatics role,” said Christy St. John, MSN, RN, NI-BC, CPHQ, president of the American Nursing Informatics Association (ANIA), in an interview. “To come straight from your studies into informatics is fairly rare.”
A combination of clinical nursing experience and education in informatics is essential, according to Melinda L. Jenkins, PhD, FNP, associate professor and director, nursing informatics specialty, Rutgers School of Nursing. Experience with patient care in the clinical setting is essential to the nursing informatics role because this role is the connection between the clinical setting and the technology piece of healthcare, says Lori Martone-Roberts, DNP, RN, CHSE, director of simulation and professor of the practice of nursing, Wheaton College.
Although training and hands-on experience with technology is important, Michael Mickan, chief nursing informatics officer at Memorial Hermann Health System, looks for experience using the tools on hand and a natural curiosity that leads to self-teaching. He feels that a nurse with that kind of informal experience is usually more successful as a nurse informaticist than those who wait to be formally trained before exploring a new technology.
Range of Skills
You’ll need to bring many skills to a nursing informatics role. Mickan outlines a variety of abilities:
Communications: Nurse informaticists must be able to provide “translation” of patient care, and clinician needs to technology partners as well as technology concepts and requirements to clinical users and communicate with various disciplines.
Problem-solving: Informaticists must be able to identify the real problem with astute observation and critical thinking encompassing people, processes, and technology.
Change management: Nurse informaticists must understand change management strategies and be comfortable facilitating, guiding, and managing change.
Project management: Often, a nurse informaticist facilitates collaboration between clinical and technology partners to solve problems and support the optimal use of technology. To do this effectively, proficiency in project management is a must.
Data analytics: Nurse informaticists must have a solid grasp of the data that validates the problems to be solved and provides the baseline for measuring progress.
Day-to-Day Projects
What kind of work will you do on a daily basis? An example, notes Martone-Roberts, could be to evaluate workflows or improve usability and streamline processes, leading to improved functioning and efficient data capture.
She notes that nurses in the nursing informatics role will work with EHRs in various ways, including managing information and troubleshooting issues when healthcare professionals use the system. Other projects involve training, validating, and reporting data and ensuring the collected data is useful.
She suggests that one example of a project could involve using chatbots to keep a patient engaged and decrease re-hospitalization. Similarly, Mickan outlines workflow analysis and optimization projects, working with clinical decision support systems and EHR implementation and optimization.
Growing Field
When it comes to future demand for nursing informaticists, “I see it as a growing sector,” says St. John.
“I think sometimes it’s a matter of being a little bit more broad in the way we think about nursing informatics,” she notes. Instead of simply searching for the term on a job site, a job search can be more about “opening my eyes to things that might include AI, analyst, or health informatics roles. I think nurse informatics roles will be more in demand in the bigger picture of health technology.”
Education and Certification
According to Martone-Roberts, you’ll need an RN and BSN to serve in a nursing informatics role. Also, she says, a nurse with a master’s degree in healthcare informatics, nursing informatics, or data management will be better positioned to succeed.
Although one of the more technical roles in nursing, nursing informatics still has patient care as the end goal. “At the end of the day, what we’re after is better outcomes for the populations that we’re serving, whether that’s in the inpatient setting, whether that’s in an ambulatory setting, whether that’s in our communities,” says St. John.
