Family Nurse Practitioner: Everything You Need to Know

The role of a family nurse practitioner (FNP) is one of today’s fastest-growing professions. FNPs are increasingly recognized for their critical contributions to modern health care, and the rise of the FNP specialization is helping to shape the future of patient care. The Walsh University Master of Science in Nursing: Family Nurse Practitioner program equips nurses for the tremendous opportunities in the field. 

A Big Picture Look at the FNP Role

Family nurse practitioners serve as primary care providers for patients across the lifespan, and they often develop long-term relationships with families. Offering holistic care, the FNP focuses on health promotion, treats illnesses and injuries and educates patients and families.

An FNP is qualified to provide many of the same services as physicians and may work autonomously or under the supervision of a physician if required by state regulations. An FNP is trained to work in outpatient settings such as primary care, retail health clinics, student health, public health clinics and outpatient specialty care.

Currently, approximately 65% of nurse practitioners are certified as family nurse practitioners. The demand for FNPs is quickly expanding due to demographic shifts and changes in the health care field.

The high quality of service provided by nurse practitioners has been carefully documented over many years. The American Association of Nurse Practitioners (AANP) tracks the research and recently issued an update on findings for nurse practitioner care. According to the AANP, “the overwhelming majority of studies that compare NP care to physician care in the U.S. continue to find no significant differences in outcomes.”

How the FNP Role Has Developed Over Time

Since the emergence of the nurse practitioner role around 50 years ago, the profession has continued to develop, with increasing levels of influence in health care. Let’s take a look at where FNP practice started and its progression over the years.

In the 1950s and 1960s, physicians had been collaborating with and mentoring registered nurses with clinical experience. There was also increasing specialization in the medical field, creating a lack of primary care physicians. Leaders agreed it was time to expand the nurse’s role.

According to a historical timeline from the American Academy of Nurse Practitioners (AANP), formal educational structures began taking shape in the mid-1960s and 1970s. In 1965, the University of Colorado introduced the first nurse practitioner program, developed by Dr. Loretta Ford, a nurse, and Dr. Henry Silver, a physician. By 1973, the United States had over 65 university nurse practitioner programs. As nurse practitioners had proven their care to be highly effective, in 1971 the University of Washington opened the PRIMEX program, one of the first to educate family nurse practitioners.

In the 1980s, the AANP was formed and in 1993 established the American Academy of Nurse Practitioners Certification Program. During that time, the number of nurse practitioner educational options increased significantly, primarily at the master’s or post-master’s level. Meanwhile, the federal government had begun investing millions of dollars in NP education, and the number of nurse practitioners continued to steadily increase.

In the early years, the NP practice was limited by a requirement for physician supervision. As NPs have proven their capability of producing high-quality patient outcomes over several decades, state boards of nursing have gradually granted them more independence and a broader scope of practice. This movement has opened many more primary care provider options for patients.

The Job Outlook for Nurse Practitioners Today

With heightened recognition for quality of care, nurse practitioners are moving to the forefront of contemporary primary care and rapidly growing in number. The profession has become one of today’s most desirable careers.

By 2020, there were more than 290,000 licensed nurse practitioners in the United States. The Bureau of Labor Statistics projects that the number of nurse practitioners will increase by a massive 52% from 2019-2029. By comparison, the number of positions for registered nurses is only expected to grow by 7% in the same time period, while the total number of jobs for all professions is projected to increase by 4%.

Not only are nurse practitioners in extraordinarily high demand, but the profession also reports some of the highest satisfaction ratings of today’s career fields. U.S. News and World Report rankings currently list nurse practitioner in third place for the “100 Best Jobs'' and second place for the “100 Best Health Care Jobs.”

Along with appealing job opportunities, nurse practitioners also enjoy far above average compensation, with median wages of $109,820 in 2019. This compares to median wages of $73,300 for registered nurses in 2019 and median annual wages of $39,810 for all occupations.

The Rising Prominence of the Family Nurse Practitioner in Primary Care

A number of factors are converging to create the exceptional demand for nurse practitioners in today’s health care landscape. The needs for FNPs are particularly crucial due to an aging population accompanied by a shortage of primary care physicians and inadequate health care resources in underserved areas.

An Aging Population

In what the U.S. Census Bureau describes as “the graying of America,” the proportion of older adults in the United States is expanding more than ever. Baby boomers are reaching retirement age, and thanks to advances in general health, people are living longer.

By 2030, the population of older adults is expected to reach 21%, up from 15% in 2018. By 2060, it is projected that approximately 25% of the U.S. population will be in the 65-or-older category. At the same time, the number of people over 85 is likely to triple.

Family nurse practitioners will be a vital source of primary care for the burgeoning community of seniors. Providing whole-person care, the FNP can advise patients regarding physical and emotional well-being. Qualified to treat common illnesses and chronic medical conditions, a family nurse practitioner will often be the primary source of care as physiological challenges of aging surface.

Not only are FNPs qualified to treat many health concerns that accompany aging, but they are also uniquely equipped to help patients prepare for aging. Because a family nurse practitioner cares for people of all ages, patients may rely on the primary care of one provider for many years.

As a patient ages, the FNP can offer credible information and insights about what the patient should expect in coming years. Preventative care and health promotion will be essential components of a plan for maintaining optimal vitality in the senior years. An FNP who has cared for a patient throughout life stages will also have a strong understanding of the individual’s state of health and specific concerns that will relate to the aging process.

Physician Shortages

At the same time the population of older adults is rising, large numbers of physicians are reaching retirement age themselves. These two factors leave the medical community with a significant shortage.

A recent report from the Association of American Medical Colleges (AAMC) projects a deficit of up to 139,000 physicians by 2033. The needs are especially high in primary care, accounting for approximately 40% of the shortfall. Trained to provide many of the same services as medical doctors, family nurse practitioners are positioned to help fill the gap in primary care.

Underserved Areas

Another factor signaling a greater need for primary care is the lack of adequate medical resources for underserved communities, particularly rural areas and locations with high numbers of minority residents.

Rural Challenges

The National Rural Health Association (NRHA) highlights the disproportionate access to medical care in remote locales. While urban areas benefit from 31.2 physicians per 10,000 people, rural areas average 13.1 physicians for 10,0000 people. Rural areas also have larger percentages of older adults and higher poverty levels compared to urban areas.

Rural residents often drive long distances for specialized medical care and hospital services, and they rely heavily on primary care clinics for general medical treatment. According to the NRHA, family physicians provide more than 40 percent of care in rural areas, compared to only 15% overall across the nation.

Family nurse practitioners fill a tremendous gap in these areas by providing preventative services, routine care, and treatment of illness and injury. The American Association of Nurse Practitioners (AANP) reports that nurse practitioners are more likely to live in rural settings, and they make up approximately one-fourth of providers in rural locations.

Urban Challenges 

Health care inequity is not limited to rural life, however. Another disparity gaining attention is the inequity of resources for minority populations, often clustered in urban centers. The COVID-19 crisis has brought to light underlying issues, as infection rates and deaths from the virus have disproportionately hit minority groups.

Julia Raifman, assistant professor of health law, policy and management at the Boston University School of Public Health, co-authored a report on ethnic disparities in health care reported by U.S. News & World Report. Identifying high levels of disease risk related to race and ethnicity, Raifman cites persistent imbalances in education, living conditions and employment opportunities.

A study of the Social Determinants of Health by the U.S. Department of Health and Human Services identifies domains of factors affecting health and proposes interventions. Considering the area of health and health care, the initiative proposes that “expanding access to health services is an important step toward reducing health disparities.” 

Again, family nurse practitioners will be a vital part of the solutions in establishing greater health care equity. FNPs who work in urban clinics can serve as health care promoters and caregivers for underserved populations, meeting crucial needs toward healthy communities.

Family Nurse Practitioner Job Description

FNPs are trained to provide the same level of care as primary care physicians, including diagnosis and treatment of common illnesses and injuries. A family nurse practitioner typically serves in an outpatient setting to provide high quality primary care to patients and families.  

What Does a Family Nurse Practitioner Do?

An FNP provides primary care for patients of all ages, either autonomously or under the supervision of a physician, depending on state regulations. Family nurse practitioners excel in providing compassionate, attentive care that considers multi-faceted aspects of wellness. They often serve entire families through progressive life stages.

An FNP is highly skilled and knowledgeable concerning medical tests, procedures, and medications. A day-in-the-life of a family nurse practitioner will include responsibilities such as:

• Conducting a patient history and physical 
• Ordering diagnostic tests and interpreting the results
• Diagnosing conditions and illnesses
• Developing treatment plans
• Prescribing medication
• Counseling patients about health concerns
• Providing preventative health services
• Promoting health through social and environmental interventions
• Offering patient education about the health problem and plan

Family nurse practitioners streamline medical services by serving as the central point of care for their patients. FNPs are qualified to:

Care for minor injuries

• Provide infants and children with health and wellness care
• Manage health and wellness for women, which includes initial prenatal and preconception care
• Coordinate care with other specialists
• Treat chronic conditions and illnesses

What Are Essential Traits of an FNP?

Beyond high levels of competence in nursing science, family nurse practitioners are known for providing attentive care and developing trust with patients. Let’s look at some of the most essential qualities of a successful FNP.

Compassion

Nurses deliver healing to hurting people—hour after hour, day after day. A family nurse practitioner, like all nurses, is motivated by compassion for patients that drives an eagerness to serve. 

In providing primary care, an FNP will encounter a broad range of difficult situations, calling for multi-faceted responses. Each patient will face different issues—whether illness, infertility, debilitating injury, learning difficulties, or even the emotional ups and downs of family and career changes—that will affect how health care is delivered. The wide-ranging complexities of primary care require consistent compassion.

Effective Communication

FNPs are gifted communicators, both in listening and in conveying information and insight. The FNP-patient relationship is built on trust, and a successful practitioner proactively engages the patient in wellness and care planning.

Family nurse practitioners are trained to ask questions in assessing a patient’s health. Beyond rote questionnaires, an FNP gleans insights from active listening and tailors a discussion to a patient’s individualized needs.

An FNP is also skilled in presenting knowledge and application points with clarity and in ways that will motivate patients to take action.

Team Leadership

Moving from the role of registered nurse to an FNP position is a step into leadership. Family nurse practitioners coordinate patient care and serve as leaders within teams, in both informal contexts and in structured frameworks.

An article by LinkedIn Talent Solutions outlines a series of interview questions for nurse practitioner candidates to guide in identifying essential soft skills. One set of suggested questions asks about work within medical teams to identify leadership qualities. The article explains that the demonstration of strong leadership skills is critical because leading a team is a “big leap” for nurses. Successful nurse practitioners have developed a trait for team leadership through experience and training.

How Does Scope of Practice Vary by State? 

Across the United States, each state sets its own regulations for nurse practitioner scope of practice. These regulations determine the degree of autonomy for family nurse practitioners and the extent of services an FNP may provide to patients.

Currently, 23 states and Washington, DC, allow full practice. In a full practice environment, a nurse practitioner operates exclusively under the licensure authority of the state board of nursing to provide these services:

• Evaluate and diagnose patients
• Order and interpret tests
• Manage treatments and prescribe medications

As of 2021, the full practice list includes:

• Alaska
• Arizona
• Colorado
• Connecticut
• District of Columbia
• Hawaii
• Idaho
• Iowa
• Maine
• Maryland
• Massachusetts
• Minnesota
• Montana
• Nebraska
• Nevada
• New Hampshire
• New Mexico
• North Dakota
• Oregon
• Rhode Island
• South Dakota
• Vermont
• Washington
• Wyoming

Currently, 16 states operate with reduced practice for nurse practitioners. In this model, nurse practitioners have limited authority in one or more aspects of nurse practitioner practice. The nurse practitioner is required to have a regulated plan of collaboration with another health provider (most commonly a physician), or one or more aspects of practice are limited.

States with reduced practice regulations are:

• Alabama
• Arkansas
• Delaware
• Illinois
• Indiana
• Kansas
• Kentucky
• Louisiana
• Mississippi
• New Jersey
• New York
• Ohio
• Pennsylvania
• Utah
• West Virginia
• Wisconsin

In the remaining 11 states, nurse practitioners have a restricted scope of practice. In these scenarios, nurse practitioners are restricted in at least one aspect of NP practice. Supervision, delegation or team management by another health provider is mandatory. The states with restricted practice are:

• California
• Florida
• Georgia
• Michigan
• Missouri
• North Carolina
• Oklahoma
• South Carolina
• Tennessee
• Texas
• Virginia

Over time, more states have expanded the scope of practice for nurse practitioners. The National Academy of Medicine and the National Council of State Boards of Nursing recommend a full practice environment. Leading organizations such as the Robert Wood Johnson Foundation advocate for removing restrictions for nurse practitioners in an effort to expand access to quality care for more people.

How to Become an FNP

To become a family nurse practitioner, a nurse is required to hold a valid registered nurse (RN) license and complete advanced graduate level education and certification requirements. An FNP must be nationally certified and hold a state license to practice as a nurse practitioner.

Education Requirements for a Family Nurse Practitioner

To become a family nurse practitioner, BSN- or MSN-prepared RNs are required to attain a Master of Science in Nursing (MSN) or a DNP through an accredited program. FNP education includes rigorous academic coursework and clinical practice.

Because an FNP cares for patients of all life stages, clinical experiences typically include time in the following clinical areas:

• Primary care/internal medicine
• Women’s Health
• Pediatrics
• Families in Primary Care
• Becoming Certified as a Family Nurse Practitioner

All nurse practitioners are required to attain certification from either the American Nurses Credentialing Center (ANCC) or the American Academy of Nurse Practitioners (AANP). Certification for family nurse practitioners is awarded based on a competency exam for clinical aptitude in health care for families and individuals of all ages. Test questions cover major areas of nurse practitioner care including assessment and diagnosis. 

Certification as an FNP calls for extensive knowledge across the spectrum of primary care. Some examples of testing areas include:

• Anatomy and physiology
• Diagnostic tests
• Pharmacology
• Epidemiology

Walsh University’s Online MSN: Family Nurse Practitioner Program

The Walsh online MSN-FNP program is accredited by the Commission of Collegiate Nursing Education (CCNE), and the university is also accredited by the Higher Learning Commission. Walsh University is ranked by U.S. News & World Report as a Top 50 Midwest Regional University.

Completing your Family Nurse Practitioner degree online is a flexible, convenient way to advance your career. By taking two classes at a time, you can earn your degree in as few as two-and-a-half years while you continue working . Keep in mind that work schedule flexibility is needed to accommodate clinical hour requirements because most outpatient clinics tend to operate under traditional business hours. The Walsh MSN-FNP program is now available in these states.

Coursework in the online MSN-FNP program thoroughly prepares students with the knowledge and skills for career success as a family nurse practitioner. Clinical hours with a skilled preceptor allow for hands-on application of academic coursework. Two intensive experiences provide hands-on instruction in a dynamic workshop format and help prepare you to begin your clinical rotations. 

Here is a look at a few of the classes you will take:

• NURS 610 – Advanced Pathophysiology: Explores interrelationships of human biological systems, biochemical, genetic and cellular concepts.
• NURS 614 – Advanced Health Assessment: Incorporates theory and research-based methodologies and skills to evaluate the health of individuals across the lifespan.
• NURS 642 – Clinical Pharmacology: Comprehensively reviews specific requirements, responsibilities, interprofessionalism and concerns in prescribing medication.

Designed for working nurses, the Walsh MSN-FNP program equips you to achieve your career goals. Significant features include:

• Flexible Access—Log in any time, from anywhere.
• Clinical Placement—Clinical sites and preceptors are provided for all clinical courses.
• Expert Faculty—Actively practicing nurse practitioners, most DNP-prepared, engage personally with students. 
• Dedicated Support—One-on-one coaching is available throughout your program.
• Affordability—A tuition rate of $725 per credit hour keeps costs reasonable.

Your Future as a Family Nurse Practitioner

Get more information about Walsh’s Online MSN-FNP program and take the next step in your career path.