How to Become a Family Nurse Practitioner: The Complete Guide

Two FNP students examining a female patient
Two FNP students examining a female patient

Few career paths have grown as exponentially in recent decades as family nurse practitioners (FNPs). This rapidly increasing health care field provides advanced practice registered nurses (APRNs) with high salaries and strong job security. With our aging population, the Bureau of Labor Statistics predicts a steep 52% employment rise for nurse practitioners within the ten-year period between 2020 and 2030.

Many nurses and nursing students may have questions about how to become a family nurse practitioner. In this overview, you’ll discover everything from what a family nurse practitioner does to what an FNP earns. You’ll also find a summary of relevant state laws and discover the exact steps you need to follow to become an FNP.

 

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What Is a Family Nurse Practitioner?

A nurse practitioner is an advanced practice registered nurse who has a master’s of science in nursing (MSN), followed by an FNP certification. This extra preparation gives nurse practitioners broad knowledge to perform exams, order lab work and prescriptions, diagnose common primary care and medical problems, and authorize treatments. A nurse practitioner is a licensed nursing professional with responsibilities for treatment and diagnosis beyond the level of a registered nurse. 

A family nurse practitioner (FNP) is a nurse practitioner who delivers health care across a wide range of age demographics. FNP practice covers infants to adolescents, young adults to seniors—similar to family physicians. There are many specialty certifications for nurse practitioners, but FNPs are the largest group accounting for 65.4% of nurse practitioner certifications.

 

History of the Family Nurse Practitioner Role

In 1965, the Medicare Act created a new surge of older and low-income patients seeking health care. This greater patient demand resulted in lower physician availability, and nurses stepped in to fill the gap. That same year the nurse practitioner role was born.

The first nurse practitioner curriculum was launched at the University of Colorado as a certificate program to bring primary care to children. Though it began as a certificate program, it would become a master’s program by the 1970s. The focus expanded from pediatrics to families, adults, gerontology, women’s health, neonatology, and other specialties.

By 1973, more than 65 nurse practitioner programs were available in the United States; by 1980, that number had swelled to 200. That same year, the Nurse Practitioner Association for Continuing Education (NPACE) was established. In 1985, the American Association of Nurse Practitioners (AANP) was formed.

The nurse practitioner profession has escalated steadily both in available programs and in numbers of nurse practitioners. Today, more than five decades later, 355,000 nurse practitioners practice in the U.S. 

As one scholarly journal noted, “the rapid growth of NPs since the initial certificate program has been astounding.” The AANP predicts that the aging population and the number of people living with chronic diseases will continue to drive the demand for nurse practitioners.

 

What Does a Family Nurse Practitioner Do?

For those wondering how to become a family nurse practitioner, a natural question is what does an FNP do? A family nurse practitioner provides care for patients of all ages, from babies and adolescents to young adults and seniors. An FNP is equipped to serve patients across their lifespans.

FNP care may include performing exams, diagnosing and treating illness, ordering lab work and tests, and prescribing medication. They also deliver health education to patients.

 

The FNP Role: Duties & Responsibilities

Family nurse practitioner duties and responsibilities go beyond monitoring patients to managing patient care. A nurse practitioner’s responsibilities may comprise developing treatment plans that include:

  • Creating or contributing to patient care plans
  • Offering health education and patient counseling
  • Recommending lifestyle changes to promote health
  • Performing physical exams
  • Evaluating and interpreting findings
  • Prescribing medication
  • Ordering lab and diagnostic tests
  • Writing admission, transfer, and discharge orders
  • Referring for consultation

With the appropriate educational background, an FNP may perform such complex procedures as bone marrow biopsies, lumbar puncture, fine needle aspiration, and suturing. FNPs must also be able to interpret and communicate clinical data effectively.

FNPs may also serve as preceptors in postgraduate programs, helping to guide the education of nurse practitioner candidates, or they may conduct research on topics of particular interest, such as working conditions for nurses or the implementation of health policies that affect whole communities.

 

Family Nurse Practitioner Skills

The family nurse practitioner role is significant in health care and requires robust skills. The AANP, AACN, and the National Organization of Nurse Practitioner Faculties have identified core skills necessary for all FNPs. Some essential nonclinical FNP skills include:

  • Critical thinking
  • Compassion
  • Leadership
  • Technological literacy
  • Policy understanding
  • A strong scientific foundation
  • Collaborative skills for working in teams
  • Communication skills
  • Proficiency in managing health care delivery systems
  • Expertise in health care practices
  • Aptitude in the practitioner-patient relationships
  • Competence in clinical and independent practices
  • Strong core ethics

Nurse practitioners should also be detail-oriented and cope well with occasional stress.

 

Why Become a Family Nurse Practitioner?

Every nurse has a different reason for considering why and how to become a family nurse practitioner. The field of family nurse practitioners offers rapid job growth with almost 17,000 jobs added each year. It also offers strong monetary compensation, with average six-figure salaries.

Beyond financial security, FNPs can know they are filling a critical need for patients in health care. They want to serve others to improve the health of diverse populations globally. In 2021, about 89% of NPs went into primary care programs, while only 12% of physicians entered a primary care residency.

NPs provide more than “355,000 solutions to the primary care shortage facing Americans today.” As AANP notes, nurse practitioners are “more than just health care providers; they are mentors and educators.” FNP students can know they are not only investing in their careers but providing care where it may otherwise be limited and good patient outcomes.

 

Becoming a Family Nurse Practitioner: Step-By-Step

The process of how to become a family nurse practitioner involves several simple but essential steps. Someone wishing to become a nurse practitioner must:

  1. Obtain a license as an RN in their state. Candidates must apply to their state licensing agency to take their licensing exam. All 50 states have the same standard for passing the licensing exam.
  2. Earn their Bachelor of Science in Nursing (BSN) degree. Completing a registered nursing program can take two to four years. During this time, a student will learn about disease prevention and physical examination.
  3. Earn a Master of Science in Nursing (MSN) in an accredited program with a focus on preparing graduates for national certification as family nurse practitioners. Gaining an MSN will involve both classroom education and clinical hours working with patients.
  4. (An alternative path for RNs with a BSN wishing to become an FNP involves completing a doctor of nursing practice (DNP) degree. Programs designed for this group incorporate master’s-level work in the doctoral program, streamlining the educational experience.)
  5. Pass a national certification exam. Common certifications for nurse practitioners include the American Nurses Credentialing Center (ANCC) certification and the American Academy of Nurse Practitioners (AANP) certification.
  6. Finally, when certification is achieved, candidates must apply for their FNP license in their state, the final step to becoming a family nurse practitioner.

Many, but not all, graduate programs require experience as a registered nurse for one or two years prior to enrollment.

 

BSN-prepared nurses can earn an MSN and FNP certification in tandem

Coursework in an accredited MSN-FNP program will equip you to provide sound family health care. It will also prepare you for the national certification exam you must take. A combination of classroom experience, laboratory experience, and clinical experience are all part of becoming a family nurse practitioner.

Coursework commonly covers:

  • Pathophysiology
  • Pharmacology
  • Health care analysis
  • Leadership and ethics
  • Population health
  • Primary health care
  • Models of delivering care
  • Physical health assessment and diagnostics
  • Health care policy

Marymount’s Master of Science in Nursing Family Nurse Practitioner coursework covers each of these areas in depth. The coursework, which focuses on the intellectual, ethical and spiritual development of the student, is framed within the American Association of Colleges of Nursing’s Essentials of Master’s Education in Nursing and the National Organization of Nurse Practitioner Faculties' Criteria for Evaluation of Nurse Practitioner Programs.

 

BSN-prepared nurses may also consider a DNP degree

If you are a licensed RN with a BSN degree, you may consider becoming a family nurse practitioner with a doctor of nursing practice (DNP) degree. The DNP is one of two terminal degrees in nursing, the other being a Ph.D. in nursing. The Ph.D. programs tend to focus on advanced research in nursing, as well as academics. The DNP was established as a practice-oriented doctorate, building on the master’s-level education in evidence-based practice, quality measures, and systems leadership.

At Marymount University, you can enroll in a DNP-FNP program that incorporates master’s-level and doctoral coursework in a single educational experience.

Another consideration is the continued push for advancing the education of nurses in every role. The National Organization of Nurse Practitioner Faculties (NONPF) is advocating for the DNP to be the minimum degree requirement for nurse practitioners by 2025. 

 

Nurses with an MSN can opt for a post-master’s certificate

If you have completed an MSN with a specialty other than family care and you would like to expand your practice population, you can enroll in a post-master’s FNP certificate program that will give you the education you need to be certified as an FNP. Coursework and clinical hours will prepare you to deliver primary care to patients across the lifespan, with the knowledge to treat acute and chronic illnesses. 

An online FNP certficiate program from Marymount University is flexible enough that you can continue to work and study part-time, and finish in 20 months.

 

How Long Does It Take to Become a Family Nurse Practitioner?

The length of time it takes to become an FNP depends on whether you already have your RN license or BSN degree. Here is the time involved in each step:

  • Completing a Bachelor of Science in Nursing degree and getting your RN license can take 2 to 4 years.
  • Once you have your BSN and RN, obtaining your master’s degree (MSN) through an MSN-FNP program can take 2 to 3 years.
  • If you have a BSN and RN license and decide to pursue a DNP, the program will take a little over three years. 
  • If you have an MSN that is not focused on family practice, you can earn a post-master’s FNP certificate in 20 months.
  • FNP exams are given on a rolling basis.

The general time range is six to eight years to complete all degrees and certifications.
 

Family Nurse Practitioner Clinicals

Clinicals are an indispensable part of the education of a family nurse practitioner. They enable you to apply your classroom knowledge in a clinical setting by working directly with patients at a health care site. Generally, students will experience about 500–700 clinical hours on the path to their FNP, equipping them for real-life, advanced practice nursing.

 

FNP Preceptors

As part of your clinical experience, you will be mentored and evaluated by an experienced clinical preceptor. Your preceptor may be a nurse practitioner, a physician’s assistant, or a physician.

At Marymount, the FNP program team works with students to ensure robust clinical placement and a strong preceptor.

 

Family Nurse Practitioner Certification & Licensure

Before you can become licensed as an FNP, most states require you first to get your FNP certification. Certification follows your master’s degree and culminates your rigorous preparation and training. As AANP notes, “Certification formally recognizes all you’ve learned along your journey to becoming an NP.”

Two nationally recognized certifications are AANP certification and ANCC certification:

 

AANP Certification

The American Association of Nurse Practitioners Certification Board awards this AANP certification. The AANP is multiple-choice, competency-based, and has 150 exam questions over 3 hours.

They offer a range of nurse practitioner certifications, including the Family Nurse Practitioner Certification (FNP). The FNP certification tests clinical knowledge in family and individual care and is valid for 5 years before renewal is required.

 

ANCC Certification

The American Nurses Credential Center offers numerous nurse practitioner certifications, including the Family Nurse Practitioner Certification (FNP-BC). The ANCC exam offers 175 questions over 3.5 hours and includes healthcare policy and theory questions. The FNP-BC also tests clinical knowledge in family and individual care and is valid for 5 years before renewal.

At Marymount, 100% of 2019 graduates passed their certification exam on their first attempt.

Once you have your certification, you may apply to your state board of nursing for your license—the final step in becoming a family nurse practitioner. Each state has individual licensing requirements.

 

Where Do Family Nurse Practitioners Work?

Nurse practitioners have a range of possible work environments, depending on their focus of practice. An FNP may work in independent practice if their state permits. Or FNPs frequently work with a team of specialists to provide preventive and diagnostic care. About 73% of nurse practitioners deliver primary care and approximately 24% work in private practice. But they also practice in:

  • Private and public general medical and surgical hospitals
  • Specialty hospitals
  • Outpatient care centers
  • Private and public colleges, universities, and public schools
  • Offices of other health practitioners
  • Community housing and emergency relief services

 

Family Nurse Practitioner Work Hours

FNP hours vary with their work environment. When working in a family practice office, FNPs usually work normal business hours. Hospitals and 24-hour clinics may require shifts, including working nights, holidays, or weekends.

FNPs average seeing 18 patients a day.

 

Family Nurse Practitioner Salary: How Much Do FNPs Earn?

According to the U.S. Bureau of Labor Statistics (BLS), FNPs’ median pay in 2021 was $120,680 per year. Contrast that with the median salary for registered nurses, which was $77,600.

FNP salaries tend to vary based on the region and practice setting. The range varies from $79,470 in the lowest 10th percentile to $163,350 in the 90th percentile.

 

Family Nurse Practitioner Job Outlook

As the demand for primary and family practice care increases, so will the need for nurse practitioners. The Association of American Medical Colleges predicts a shortage of nearly 122,000 physicians in the next 12 years. Further, BLS notes that nurse practitioners can perform many of the duties of physicians and thus may help reduce health care costs.

BLS predicts the demand for nurse practitioners will grow 52% over a decade. “About 16,900 job openings for nurse practitioners…are projected each year, on average.” In concrete numbers, that translates to 189,100 nurse practitioners who were employed in the U.S. in 2018 and 242,400 needed by 2028.

In 1996, seven nurse practitioners worked at the National Institutes of Health, the largest biomedical research agency in the world. Currently, over 200 do.

 

Family Nurse Practitioner Job Satisfaction

Few jobs promise greater opportunities and satisfaction than that of a nurse practitioner. U.S. News & World Report places nurse practitioners as the No. 1 job in health care and No. 2 in the Top 100 Jobs in the U.S., ranked on such elements as 10-year growth and salary. The profession earned this ranking thanks to:

  • A high median salary
  • A low unemployment rate (1.2%)
  • The high 10-year growth volume

Nurse practitioner is also ranked #2 among the best STEM jobs. Because of the overwhelming need for primary care providers for the general population, 69.7% of nurse practitioners train in the area of family care.

 

Family Nurse Practitioner Scope of Practice

The scope of practice indicates the services that a health professional is allowed to perform based on their certification. Family nurse practitioners provide an expansive scope of practice to families across the span of their lives. Many NPs enjoy the role and the independence and autonomy they have to make care decisions for their patients.

 

State Practice Environment for FNPs

Each state has individual laws regarding the scope of practice for family nurse practitioners. These laws are divided roughly into three groups:

  • Full practice authority – These states allow all FNPs to evaluate patients, prescribe medication, and manage treatment.
  • Reduced practice authority – These states limit at least one element of FNP practice. This means the state requires a transition time to independent practice or prescribing authority.
  • Restricted practice authority – These states restrict at least one element of FNP practice. This means the state requires the FNP to maintain a working relationship with a physician over the entire course of their career.

The following states, territories, and the federal district grant full practice authority to FNPs:

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

The following states and territories grant reduced practice authority to FNPs:

  • Alabama
  • American Samoa
  • Arkansas
  • Illinois
  • Indiana
  • Kansas
  • Kentucky
  • Louisiana
  • Mississippi
  • New Jersey
  • Ohio
  • Pennsylvania
  • Puerto Rico 
  • Utah
  • U.S. Virgin Islands
  • West Virginia
  • Wisconsin

The following states grant restricted practice authority to FNPs:

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

Organizations such as the Institute of Medicine advocate for FNPs to practice “to the full extent of their education and training” to meet the demand for care. Learn more about the specific laws in your state.

 

Can Family Nurse Practitioners Prescribe Medication?

Yes, nurse practitioners “hold prescriptive privileges, including controlled substances, in all 50 states and D.C.” Additionally, “95.7% of NPs prescribe medications, and those in full-time practice write an average of 20 prescriptions per day.” The scope of their prescriptive authority varies, however, depending on the state.

  • Some states imbue FNPs with full prescriptive authority, able to prescribe without physician oversight.
  • Others require that an FNP complete a certain number of hours with a physician before they transition to prescribing medication independently.
  • Finally, some states require the FNP to maintain a relationship with a physician to prescribe medicine.

 

Family Nurse Practitioner vs Registered Nurse: What’s the Difference?

While family nurse practitioners and registered nurses both provide dedicated care for patients, there are several key differences:

 

Family Nurse Practitioner vs Nurse Practitioner: What’s the Difference?

The term nurse practitioner applies to one segment of advanced practice registered nurses, the other two being nurse-midwives and nurse anesthetists. Before completing their master’s program, nurse practitioners must select a patient population group and modality (primary care or acute care) for which they focus their education and certification. Here are the specialty areas for nurse practitioners:

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

With 69.7% of nurse practitioners certified as family nurse practitioners, it is the largest specialty group by far. That being said, nurse practitioners can seek certification in another specialty group once they have completed the required education and examination. 

 

Family Nurse Practitioner vs Physician: What’s the Difference?

Nurse practitioners' and doctors’ roles overlap in several areas—they each diagnose illness, prescribe medicine, and make patient treatment plans. But key differences exist:

  • An FNP holds a master’s at a minimum, while a doctor must complete medical school and a residency.
  • An FNP has 6 to 8 years of postsecondary education, while a doctor has an average of 11.
  • An FNP’s ability to prescribe medicine and diagnose illness independently varies by state. Doctors can prescribe independently in all 50 states.
  • An FNP’s median salary is $120,680, while a doctor’s mean annual wage is $208,000.
  • Both professions have a positive job growth rate, according to the BLS. But the 52% projected rate of growth for NPs far outpaces the 3% growth rate for doctors, which is slower than the average for all jobs.

 

Family Nurse Practitioner vs Physician’s Assistant: What’s the Difference?

Family nurse practitioners and physician’s assistants are both non-physician roles that are growing quickly in medicine. Here are some basic similarities and differences:

  • Both an FNP and a Physician’s Assistant (PA) require master’s level education.
  • PAs are required to work under the supervision of a physician. NPs may operate an independent practice in states that allow full practice authority.
  • The median pay is quite similar, at $120,680 for an FNP and $121,530 for a PA.

 

Family Nurse Practitioner Organizations

Many national and regional organizations support nurse practitioners in their work. Some keep their members informed of upcoming changes or potential changes in the field while others advocate for reform. You may be able to attend meetings or conferences they sponsor for networking and career growth. Among these are:

See here for a list of regional nurse practitioner associations around the U.S.

FNP students in a clinical setting learning how to become a family nurse practitioner


Your Next Step in Becoming a Family Nurse Practitioner

Are you ready for the next step in learning how to become a family nurse practitioner? There has never been a better time.

Marymount’s FNP programs are CCNE accredited, and 100% of 2019 Marymount graduates passed their certification exam on their first attempt. The program also takes the stress out of finding a clinical placement by matching candidates with high-quality experiences.

Marymount students are guided by Catholic traditions, focused on intellectual curiosity, service to others, and a global perspective.

Join the growing body of professional nurses making a difference with an online FNP degree from Marymount University. If you’re interested in becoming an FNP at Marymount, contact one of our admissions advisors to discuss which pathway is right for you.

 

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