Nurse Practitioner Specialties and The Versatile Role of The Family Nurse Practitioner (FNP)

This blog has been updated on March 22, 2023

In 2022, the percentage of nurses graduating with a Bachelor of Science degree in nursing (BSN) or higher stood at about 59%, according to the Campaign for Action 2022. Less than a decade earlier, the Institute of Medicine released the landmark report 'The Future of Nursing', calling for doubling the number of U.S. nurses with doctoral degrees by 2020. The number of nurses with a doctoral degree increased from just over 10,000 in 2010 to over 33,000 in 2018, and continues to grow.

What these figures prove is that more nurses are pursuing advanced degrees to further their careers, based not only on the increasing number of students, but the programs, schools, and new NPs entering the field. Nursing is now the nation's largest healthcare profession, with more than 3.8 million registered nurses (RNs) nationwide. Of all licensed RNs, 84.5% are employed in nursing. Employment of RNs is also projected to grow 15% from 2016 to 2026, much faster than the average for all occupations.

Nurse Practitioners (NPs) are an essential component to the delivery of health care to patients across the lifespan. As of November 2022, according to the American Association of Nurse Practitioners (AANP) there are over 355,000 NPs licensed in the United States and this is projected to grow over the next 10 years.

There is a physician shortage, especially in primary care, and NPs are able to help fill this void by delivering excellent care to their patients. 

"NPs are stepping up to meet some of the big challenges that we're seeing in healthcare today. But, still, over 99 million Americans lack access to primary care. Waiting times in hospitals are longer than ever before. NP is a top job choice because I believe it offers more opportunity to achieve work-life balance. Now we have to work on getting more people to pursue this career option." April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, AANP President

What is a Nurse Practitioner?

Nurse practitioners are advance practice nurses who have completed a master's or doctoral degree program and have advanced clinical training beyond their initial professional registered nurse (RN) preparation. NPs blend clinical expertise in diagnosing and treating health conditions with an added emphasis on disease prevention and health management. 

As such, NPs play a large part in ensuring the health care needs of millions of Americans are met every year. The care is delivered in various settings, including inpatient, outpatient, and even home health. Nurse practitioners may work in private practice or work for large health care organizations. Nurse practitioners can even open, manage, and work in a clinic independent of physicians in some states. Not all NPs can practice independently as the NP practice environment varies from state to state. For more information, visit your state board of nursing.

The care provided by a nurse practitioner is unique in that it focuses on the holistic health and wellbeing of the patient. The goal is to view every patient as an individual, focusing on the whole person and not just one specific diagnosis or problem. This is achieved through assessment, diagnosis, treatment, and evaluation. Based on their patient's assessment, the NP can:

• Order and interpret diagnostic tests, including laboratory, diagnostic imaging, and preventative screenings
• Diagnose the patient based on these findings
• Initiate treatment, including prescribing medications
• Evaluate the patient as needed to ensure the treatment plan is working

The NP also collaborates with other health care providers and the interdisciplinary team to ensure all patient health needs are met. This may include consulting with other providers and health care specialties as needed. The NP will also work with physical therapy, occupational therapy, care management, social work, and others to provide comprehensive care. Lastly, the NP includes the patient in the decision-making process, emphasizing education and health counseling to ensure the patient understands agreement with the plan.

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Nurse Practitioner Specialties

According to the American Association of Nurse Practitioners (AANP), there are 11 NP specialties that a nurse practitioner can be certified in. 

• Family
• Adult
• Adult-Gerontology Primary Care
• Psychiatric/Mental Health
• Acute Care
• Pediatrics—Primary Care
• Adult-Gerontology Acute Care
• Women's Health
• Gerontology
• Neonatal
• Pediatrics-Acute Care 

Over 69% of practicing NPs are certified in family practice, followed by 10.8% certified in adults and 7% in adult-gerontology. Each NP specialty is important to meeting the health care needs of patients, and it is not uncommon to have collaboration between multiple NP specialties to ensure the best care possible for the patient. For that reason alone, as the population continues to grow and the aging population lives longer, the need for NPs of all specialties will be significant to ensure we can meet the health care needs of all patients. 

Once you have decided to advance your nursing degree, the next step is choosing a path. As stated above, there is a growing need for all types of nurse practitioners. Various paths offer different opportunities, flexibility and environments. Some NP specialty tracks provide more flexibility, such as family practice, adult-gerontology, and psychiatric/mental health. Other types of nurse practitioners provide a more adrenaline-filled day, such as the neonatal or acute care track. It is essential to determine the environment you wish to work in first before choosing a specialty.

It is also important to consider additional certifications needed for a particular path. For example, if you want to work in acute care and are a board-certified family nurse practitioner (FNP), you will most likely have to obtain an acute care certification, which better prepares you to care for those in an acute care setting.

For those who are unsure or prefer to keep the door open to numerous opportunities, including the environment and population served, family practice is a great fit.

Why Choose Family Practice?

Almost all NPs (89 %) are prepared in a primary care focus such as adult, family, gerontological, pediatric or women's health. Family focus is the most prevalent category, at 49.2 %. This preference may be due to the flexibility with the job, the broad population served, and a wide range of practice settings available. Here are some common questions about FNPs and what they do.

Where Does the FNP work?

The FNP primarily works in the outpatient setting and a family practice clinic. However, the FNP may also work in various other locations, including urgent care, minute clinics, and even the emergency department in some hospitals. The FNP may also work for sub-specialties, including orthopedics, pulmonary, cardiology, palliative care, wound care, and many more. The FNP may work in women's health, pediatric clinics, internal medicine clinics, long-term care organizations due to their education preparing them to deliver care to all age groups.

Population Served

The FNP can care for patients of all ages, from newborns to older adults.

Scope of Practice

The scope of practice for the FNP prepares them to deliver care to patients across the lifespan—this includes newborns to older adults/gerontology. The FNP can practice autonomously when delivering care and provides care to patients with acute, chronic, and complex health problems. They also perform annual wellness exams, health promotion, and disease prevention, including ordering preventative screenings as indicated. The FNP will assess, diagnose, treat and evaluate the patient by ordering diagnostic tests, interpreting these tests, and treating the patient based on the findings. Treatment consists of both pharmacologic and nonpharmacologic management, and the FNP can prescribe both controlled and non-controlled substances as needed.

As of September 2021, the scope of practice for the NP varies state by state. Refer to your state board of nursing for specific information regarding the scope of practice for the NP.

How is FNP different from other NP specialties?

The FNP track for a nurse practitioner is different from other NP specialties in several ways. The FNP's role provides holistic care and promotes health and wellness to patients across the lifespan, from the newborn to the aging adult. No other NP specialty prepares you for this breadth of care. Most, if not all, specializations will require you to be dual certified to provide care to a specific range of patients. FNPs can work with other health care providers (such as MDs, PAs, and NPs) and interdisciplinary teams to ensure their patient receives the best care possible. The FNP also emphasizes caring for the whole individual with a focus on health education and counseling.

Quick Comparison of the FNP with other NP Specializations

Here is a quick comparison of the FNP to seven other NP specialties. 

NP Specialty	Brief Description	Education Requirement	Population Served	% of Practitioners*
Family Practice	Deliver primary care/health care to patients across the life span. Provide treatment and management of both acute and chronic problems and focus on preventative and annual wellness exams.	Minimum of an MSN degree with FNP specialization, and completion of FNP board certification exam.	All populations including newborn to older adult.	69.7%
Adult	Provide health care/primary care to the adult population focusing on the treatment of acute and chronic illness as well as preventative screenings and annual wellness exams.	Minimum of a FNP or adult-gerontology MSN degree and completion of FNP or adult-gerontology board certification exam.	18 years of age and older.	10.8%
Adult-gerontology Primary Care	Provide health care/primary care to the adult population, focusing on the treatment of acute and chronic illness and preventative screenings. This specialty is similar to the adult NP.	Minimum of an adult-gerontology NP MSN degree and completion of the adult-gerontology board certification exam.	18 years of age and older, with emphasis on the older adult population.	7%
Pediatrics—Primary Care	Provide health care/primary care to the pediatric population including diagnosing and treating acute/chronic illness. They also focus on primary care and preventative health through wellness visits.	Minimum of a family practice or pediatrics NP MSN degree and completion of either the FNP or pediatric NP board certification exam.	Newborn to 18 years.	3.2%
Women's Health	Deliver health care to women throughout their lifespan. Their focus is on gynecological, obstetrical, and reproductive health and preventative screening and wellness exams for women.	Minimum of a FNP or Women's Health MSN degree and completion of the FNP or Women's Health NP board certification exam.	Primarily adolescent females through older adults.	2.9%
Psychiatric/Mental Health	Provide care to meet the mental health needs of patients. This includes assessing, diagnosing, and treating as indicated.	Minimum of a FNP or preferably a PMHNP MSN degree and completion of FNP or PMHNP board certification exam.	Pediatrics (usually beginning early adolescent) through the older adult.	4.7%
Neonatal	Deliver health care to the neonate population in the hospital/NICU setting. This includes both pre-term and full-term babies. You do need neonate experience before pursuing this NP degree.	Minimum of a neonatal NP MSN degree and completion of a neonatal NP board certification exam.	Neonate.	1%
Acute Care	Deliver health care to the adult patient in the acute care setting. This is done through assessment, diagnosis, and treatment. There is no follow up with the patients after discharge as that is the responsibility of the primary care provider and/or specialists consulted.	Minimum of an MSN degree and completion of board certification exam.	18 years of age and older.	4.1%

*Per the AANP website and based on the National NP survey completed in 2020. The sum of all percentages is greater than 100% because some NPs have more than one certification.

What is the Next Step for Aspiring Nurses?

If you are interested in providing care to a wide population range, completing your FNP degree or certification is the most flexible route in advancing your nursing education. If you are ready to take the next step in your career, please visit the Carson-Newman University website and learn about our online MSN-Family Nurse Practitioner program. You can receive your free FNP program guide and connect with an enrollment advisor who can further answer questions about the FNP program.

If you already have an MSN degree, consider the Post-Master's FNP Certificate to advance your nursing career. This program will provide you with the skills necessary to be a successful FNP.

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