Career profile: the nurse practitioner
Nurse practitioners are skilled postgraduate qualified nurses who can assess, diagnose and treat patients. What is the scope of their work and how much money can a nurse practitioner expect to make? Sarah Harrop reports.
First things first, what exactly are nurse practitioners?
They’re nurses with postgraduate education and training in nursing. In the US, they are mid-level practitioner healthcare providers, which means they have the training and qualifications to assess, diagnose and treat patients. In a similar way to a doctor, they can diagnose and treat acute conditions by prescribing medications; order diagnostic or laboratory tests such as X-rays or blood tests; manage a patient’s overall care; and specialise in a broad array of healthcare areas from urgent care to oncology, mental health to neonatal health.
"We can pretty much do anything that a doctor can do with the exception of performing surgical procedures independently," explains Sylvia Estrada, a nurse practitioner at the Cedars-Sinai Medical Center in California.
While nurse practitioners are less extensively trained and educated than doctors, the nurse practitioner training covers basic disease prevention, coordination of care, and health promotion. The nurse practitioner role is part of the US and Australian healthcare systems, although the scope of their practice varies at the US state level, and in Australia it is guided by health organisation policy and the individual nurse’s competency.
The UK NHS equivalent of nurse practitioners are referred to as advanced practice nurses or advanced nurse practitioners. This is slightly different to US and Australian nurse practitioners because rather than it being a defined role, in the UK advanced practitioner status is a level of practice. Advanced practitioners are therefore not only nurses but also pharmacists, occupational therapists, paramedics, midwives and other healthcare professionals. All are educated at master’s degree level and assessed as being competent in practice, using expert knowledge and skills gained through years of experience.
According to the Royal College of Nursing, advanced nurse practitioners “have the freedom and authority to act, making autonomous decisions in the assessment, diagnosis and treatment of patients.”
What’s a typical day like for a nurse practitioner?
Hours for a nurse practitioner can vary according to work situation. For those working in hospital, shifts could vary each week and there may be frequent night and weekend work, for example. A typical day for a US nurse practitioner might include:
Admin tasks: a nurse practitioner’s day will usually begin with checking messages, patient records and test results on the electronic medical records system, and end with reviewing patient records and ordering lab tests. Other administrative duties include filing patient information, organising records, creating staff schedules or ordering new supplies, or training and supervising other team members to do these tasks.
Seeing patients: visiting and examining patients to assess their conditions is a key part of the role, including talking with patients about their health. In a busy location, a nurse practitioner could see tens of patients in a single day. They’ll also take observations of blood pressure, temperature, heart rate etc and review patients’ charts.
Diagnosing: nurse practitioners rely on their training, education and experience to determine the most likely cause of a patient's symptoms, often discussing them with other nurses or doctors, to help them make an accurate diagnosis.
Coordinating treatment plans: following diagnosis, nurse practitioners work with the patient, their families and a wider team of medical professionals to make sure they get the care they need. They’ll decide how to manage the disease, such as recommending lifestyle changes, prescribing medicines or referring the patient on to the relevant specialist.
Training and guidance: training new nurses, answering their questions and supervising procedures or admin tasks may also form part of a nurse practitioner’s day.
At the end of the working day, nurse practitioners typically prepare for the next day by creating a schedule and ordering lab tests such as blood tests.
What kind of skills and qualities should a nurse practitioner have?
Focus: it’s essential to be attentive to what patients tell you and what you notice when you examine them; otherwise you may miss essential clues as to the cause of their symptoms.
“Try to focus on what the patient or the family is telling you. Additionally, do not make assumptions. Assumptions are one of the critical factors that limit a provider’s attention. Keep several differential diagnoses in mind to avoid tunnel vision during your physical examination” says Andrea Mosher, a primary care paediatric nurse practitioner.
Compassion and empathy: this a core skill for all nurses – it is essential to be concerned about a patient and what they are going through and to let them know that you care and want to support them.
Integrity: establishing a patient’s trust by being honest and upfront with them is key to getting the critical information from them that is needed for their care.
Competence and skill: the job comes with responsibility for patients’ health, so proficiency and conversely being aware of the limits of your knowledge and when to defer to specialists is important.
Being a good communicator and listener: nurse practitioners have to be able to communicate with their patients, colleagues, and upper management, expressing themselves clearly and concisely and actively listening to what others are saying.
Tenacity: a nurse practitioner has to persevere and come up with alternate plans to help their patient. Creating these plans may take some out-of-the-box thinking.
“Not all patients are the same, nor will they respond the same way to the same treatment plan. If a diagnostic test or a treatment option doesn’t go to plan, you are not allowed just to give up. This is someone’s health or potentially their life we are talking about!” says Mosher.
Good organisation skills, including time management: managing busy workflows is an essential part of the job to keep things running smoothly and avoid delays, as well as adequate preparation before seeing a patient to take in their medical history and charts.
Analytical skills: every patient has a different body and mind, set of circumstances and medical history, so strong analytical thinking skills are essential to gathering appropriate data, solving complex problems, and making rational decisions.
What do nurse practitioners typically earn?
According to a nurses.co.uk estimate in January 2023, the average nurse practitioner salary in the UK is between £35,000 and £40,000 a year. Within the NHS, salaries can start as a Band 6, which was £33,706 a year as at January 2023. However, nurse practitioner jobs are often advertised at Band 7 (starting at £41,659) or even higher up the NHS pay scale. Starting salaries in the private sector are more difficult to estimate but are anecdotally said to be upwards of £40,000 per annum.
In the US, nurse practitioners make an average annual salary of $121,610, according to the US Bureau of Labor Statistics (BLS). However the salary range can vary widely between different US states: nurse practitioners in Tennessee earn an average of $99,330 while their peers in California earn an average of $158,150 and somewhere in the middle is Massachusetts where the average is $138,700.
Regardless of which state a nurse practitioner works in though, several factors have a strong influence on pay. Level of education is one of them, with nursing practitioners with a doctorate normally earning more than those with a master’s degree. Travelling nursing practitioners will often earn more than those working in one location as will career NPs employed by a facility, who will often have a generous benefits package.
What nurse practitioner specialty is the highest paid?
According to the US Bureau of Labor Statistics, in 2022, the highest paid specialty for nurse practitioners was $145,000 per year for a Psychiatric Nurse Practitioner, followed by $135,000 for a Neonatal Nurse Practitioner. At the lower end of the scale were Women’s Health and Adult-Gerontology Nurse Practitioner jobs, whose average salaries in 2022 were $99,495 and $96,198, respectively.
In the UK, the NHS has a consistent payscale for nurses and varies across the UK, however as mentioned above, nurse practitioner posts in the NHS are not always advertised at the same pay band, with some at Band 7 and others at Band 8a or higher.
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