Family Nurse Practitioner Scope of Practice: What You Need to Know?


Written By: Jennifer Schlette MSN, RN

So, you finally have decided to take the plunge. You have decided that now is the time to start that advanced practice nursing degree and become a family nurse practitioner, but you are not entirely sure what a family nurse practitioner can do. What falls into the scope of practice of a family nurse practitioner? Well, you are in luck! Keep on reading to find out.

There are various paths that a registered nurse seeking an advanced practice degree can choose to take. There are many different programs that will help facilitate how you can reach this goal. Let’s take a look and see all the important details about a family nurse practitioner from how to become one, to examining the scope of practice and finally finding out how and where you can use this advanced degree. Knowing how to achieve your goals is always important, but with equal importance is what your work environment will look like as a family nurse practitioner, because this will be a big part of your life. You will need to understand the family nurse practitioner scope of practice in order to create a safe environment for you and your patients. The information you will find in this article will hopefully alleviate any lingering questions you may have.


How to Become a Family Nurse Practitioner?


So, before we can talk about the scope of practice of a family nurse practitioner, we should discuss how you can become one. In order to become a family nurse practitioner, you would be required to obtain an advanced practice nursing degree. This essentially means you as a registered nurse would need to obtain a graduate-level nursing degree or higher in your desired field of study. Once you have obtained this degree from an accredited graduate or doctoral nursing program, then you as an advanced practice nurse must successfully pass an exam specifically for the family nurse practitioner in order to gain a license to practice in your new role. This exam will test your clinical knowledge and the application of that clinical knowledge to the patient across the lifespan. In order to practice as a family nurse practitioner, you would also be required to become certified through an examination by an accredited certifying body such as the American Academy of Nurse Practitioners National Certification Board and American Nurses Credentialing Center to name a few. If you wish to become a family nurse practitioner who specializes in a particular area, then you would be required to become certified in that specialty area by taking an exam. An example of a specialty area is critical care.

Some people may decide as they complete their coursework that one particular area really interests them and stands out over the rest. These family nurse practitioners may choose to concentrate in certain areas such as cardiology, oncology, women’s health, or emergency medicine as examples. In order to concentrate in these specific areas, additional training and education may be required. Keep in mind, you would need to check with the state you plan on practicing in regarding their rules and regulations since education and certification requirements can vary by state.


What is the Scope of Practice of a Family Nurse Practitioner?


The family nurse practitioner (FNP) scope of practice includes caring for patients across the lifespan, but what does that really mean? What is a lifespan? Across the lifespan essentially means that you as the family nurse practitioner can care for patients from birth to geriatrics. The family nurse practitioner assumes the role of the primary health care provider. The FNP scope of practice enables the health care provider to assess, diagnose, and treat their patients as they see fit based on their clinical judgment. The family nurse practitioner scope of practice authorizes the nurse practitioner to order test and diagnostic procedures in order to aid in the diagnosis of their patient. An FNP also has the education in order to interpret these findings to direct the best care for the patient and guide their treatment plan. The scope of practice for family nurse practitioners will allow for the health care provider to write prescriptions and therapeutic interventions for their patient while guiding the patient on health promotion and disease prevention through education.

One thing that can impact the family nurse practitioner scope of practice is the practice environment allowed by the state the healthcare provider chooses to practice in. The state that the FNP chooses to practice in dictates the amount of autonomy or independence from a physician the FNP will have. The scope of practice for family nurse practitioners will be impacted by the restrictions the state has set. You as the family nurse practitioner could be working in a state that is full practice, reduced practice, or restricted practice. So, what does that mean in terms of what I can do?

Full Practice States: Well, in a full practice state, you as the family nurse practitioner can assess the patient, diagnose the patient, order and interpret any diagnostic test that you feel is indicated in order to adequately treat your patient. You would also able to initiate treatment modalities for the patient as you feel is indicated including prescribing medication as well as controlled substances without the collaboration or supervision of a physician. The family nurse practitioner is able to practice this way under the authority of the state board of license in the state they practice in. Arizona and Connecticut are examples of full practice states.

Full Practice States
Alaska Arizona Colorado Connecticut
Hawaii Idaho Iowa Maine
Maryland Minnesota Montana Nebraska
Nevada New Hampshire New Mexico North Dakota
Oregon Rhode Island South Dakota Vermont
Washington Wyoming
(Source: aanp.org)


Reduced and Restricted Practice States: The FNP scope of practice is limited in reduced and restricted practice states. The limitations in reduced and restricted states will vary to different degrees. If you were to work as a family nurse practitioner in a reduced practice state, you would be required to have a life-long collaboration or be supervised by a physician for the duration of your career. This means that you as the family nurse practitioner can diagnose and treat your patients, but when it comes to writing prescriptions, the collaborating physician would need to oversee you. Pennsylvania and New York are examples of reduced practice states for family nurse practitioners. In states such as California and Texas, you as the health care provider would need to have a physician oversee your diagnosis and treatment plans for the patient including the writing of prescriptions. This type of environment is known as restricted practice and is the strictest.

Reduced Practice States
Alabama Arkansas Delaware Illinois
Indiana Kansas Kentucky Louisiana
Mississippi New Jersey New York Ohio
Pennsylvania Utah Wisconsin West Virginia
Restricted Practice States
California Florida Georgia Massachusetts
Michigan Missouri North Carolina Oklahoma
South Carolina Tennessee Texas Virginia
(Source: aanp.org)


Regardless of the type of practice state the family nurse practitioner works in, if there is a collaborative physician overseeing the family nurse practitioner, then a collaborative practice agreement must be entered into by both parties. This agreement will detail the working relationship between the family nurse practitioner and the physician as well as the protocols that should be followed in regards to caring for the patient.


Where do Family Nurse Practitioners Work?


The scope of practice of a family nurse practitioner would enable you to function as the primary care provider in many different settings. Some of the settings that a family nurse practitioner can work in can be inpatient in a hospital such as in an emergency room, a medical-surgical unit, or a critical care unit to name a few. A family nurse practitioner’s scope of practice also allows for them to work with specialties such as orthopedics or oncology and see patients in the hospital or clinic setting. Some of these specialties may require additional training and education so just keep that in mind when you are trying to decide where you want to work. Other employment options for family nurse practitioners could be to work in a primary health care setting such as doctor’s office. If your scope of practice does not restrict you and you work in a full practice state, then you as the FNP could have your own practice. Maybe you can see yourself working in urgent care or even in a community outreach program. There are so many options that you can explore once you become a family nurse practitioner in order to decide where you want to work.


Conclusion


The role of the family nurse practitioner can enable an advanced practice nurse an abundance of career choices within the world of nursing. Once you have completed the requirements for the advanced degree, licensure and certification by an accredited body, there are numerous settings you can work in. The family nurse practitioner scope of practice does vary from state to state regarding what the advance practice nurse can do with or without the supervision of a physician. It is very important to know what your state of employment will allow in terms of your autonomy as a family nurse practitioner. I personally feel that when you are deciding the path that you want to take in your advance nursing career, you should carefully examine what your comfort level is with the type of independence you will have in treating patients in your state of employment as the primary care provider.

Becoming a family nurse practitioner will give you the opportunity to help all kinds of patients throughout the lifespan. You may find that you really enjoy working with children or you may really enjoy working with the geriatric population. Remember, regardless of the path you choose, we have a duty to our patients to do the best for them.


Jennifer Schlette MSN, RN
Jennifer Schlette is a registered nurse in pediatric critical care in New York City. She is the former Director of Undergraduate Nursing at a college located in New York. After obtaining her BSN from the College of Mount Saint Vincent, she went on to complete her MSN.