Registered Nurse vs. Nurse Practitioner: What's the Difference?

09/30/2020

Nurse Practitioners: Look at the Differences from RNs

By Debra Wood, RN, contributor

In the past seven years, the nurse practitioner workforce in the United States has more than doubled, with salaries increasing and demand remaining high for both registered nurses (RNs) and nurse practitioners (NPs), according to a study in Health Affairs.

David I. Auerbach, MS, PhD, an external adjunct faculty member at the Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, in Bozeman, and lead author of the 2020 study, said the growth of nurse practitioners will change the way people receive care. 

The American Association of Nurse Practitioners (AANP) reports millions of patients receive care from nurse practitioners, with 1.06 billion visits taking place annually with NPs. 

The Auerbach study reported an increase from 91,000 nurse practitioners in 2010 to 190,000 in 2017. The number of RNs also increased 22 percent. Yet more NPs are not adversely affecting the RN ranks. 

“There has been no link established between pursuing the NP and an RN shortage,” said Tracy Klein, PhD, FNP, ARNP, FAANP, FRE, FAAN, associate professor at the College of Nursing at Washington State University Vancouver.

RN vs. nurse practitioner 

Although both professions, registered nurses and nurse practitioners, work with patients, their roles and educational preparation differ.  

Registered nurses must have earned an associate’s degree, diploma or bachelor’s degree and passed the NCLEX-RN exam. They provide direct care to patients, following through on orders and treatment plans written by a physician, nurse practitioner or physician assistant. They monitor patients for changes in their condition and alert the provider of concerns, assist providers with patient exams and treatments, maintain records, consult with other members of the healthcare team, and educate patients and their families about care plans and matters related to health. 

Nurse practitioners are advanced practice registered nurses (APRNs). They have received additional education, either a master’s or doctoral degree, and hold an additional license in the location where they treat patients. 

“RNs who work in hospitals often see patients for episodic care during a short hospital stay” said Louise Kaplan, PhD, ARNP, FNP-BC, FAANP, FAAN, associate professor and associate academic director at Washington State University Vancouver College of Nursing. “NPs, whether in primary or specialty care, have the opportunity to build long-term relationships with patients. That continuity of care and the resulting relationship and partnership allows NPs to make sustained contributions to the health of individuals, families and communities.”

An RN with a bachelor’s degree can complete a two-year nurse practitioner program and start earning more and doing more. The American Association of Colleges of Nursing reports that enrollments in nurse practitioner programs were up 51.6 percent in 2019, as compared to 2014, 110,217 students vs. 72,682 respectively. 

Nurse practitioners diagnose and treat patients. They prescribe medicines, including controlled substances, and order diagnostic tests. 

“Many nurses whose careers have been hospital based are interested in preventing the problems that cause health conditions leading to hospitalization,” Kaplan said. “They want to be part of the upstream solution. NPs have always been advocates for health promotion and disease prevention making this the logical career choice for many RNs.”

In many states, nurse practitioners can work autonomously, without a written collaborative agreement with a supervising physician. The Auerbach study indicated greater growth of nurse practitioners in states with full practice authority, 133 percent, compared to 100 percent in restrictive states. 

“NP practice, even in states that require physician collaboration or supervision, provides an opportunity [for nurses] to use their knowledge, skills and abilities,” Kaplan said. “NPs engage in shared decision-making, counseling and use education as an important tool for patient empowerment. It’s a role that allows nurses to contribute to patient care differently than most RN jobs.”

Both RNs and NPs can specialize, and both remain in high demand.

By the numbers

More than 3.95 million registered nurses held active licenses in the United States in 2017, according to the 2017 National Nursing Workforce Survey. Eighty-one percent were employed in nursing. More than 10 percent identified as advanced practice registered nurses, which includes nurse practitioners, nurse midwives, certified registered nurse anesthetists and clinical nurse specialists.

The national survey reported that 55.7 percent of RNs work in hospitals, followed by ambulatory care at 9.4 percent. On the other hand, most NPs work in clinics or private practices. 

The incomes for RNs vs. nurse practitioners differ as well. The U.S. Bureau of Labor Statistics (BLS) reported in 2019 that median pay for RNs was $73,300 annually, while nurse practitioners and other APRNs earned a median of $115,800 in 2019. AANP’s 2019 survey found that NPs earned a median base salary rate of $110,000.

BLS estimates RN job growth at 7 percent from 2019-2029 and nurse practitioners and APRNs’ growth at 45 percent during the same time period. 

The AANP reports more than 290,000 nurse practitioners are licensed in the United States. More than 30,000 graduated in 2019. Nearly 90 percent of nurse practitioners are certified in primary care and 69 percent provide primary care. 

Not only do nurse practitioners provide a critical service in the delivery of primary care, but they often practice in underserved rural areas. Research has shown that they are more likely to work in rural areas than physicians. About 80 million people live in Health Care Professional Shortage Areas, and NPs often step up to fill the void. 

So how does one decide in the RN vs. NP debate? It depends on each nurse and his or her goals. Either way, opportunities abound. An advanced practice role offers a chance to practice in a different and also rewarding way. 

“From my vantage point as a family nurse practitioner since 1981, I think the question is not why are so many RNs becoming NPs, but rather why aren’t more, given how satisfying my career has been!”

 

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