Family Nurse Practitioner Role

Family Nurse Practitioner Role

The purpose of this paper is to describe and focus on the family nurse practitioner role in the American health system, also, the scope of practice, core competencies, and certification requirements. We will summarize two recent articles and one expert opinion about the role of the advanced nurse practice in our society.

There is not a clear definition about the advanced practice nurse. The term “advanced practice nurse,” sometimes also called “advanced practice registered nurse” (APRN) denotes nurses with formal post baccalaureate preparation in one of four roles: nurse midwives, nurse anesthetists, nurse practitioners, and clinical nurse specialists (ANA, 2004a).

The American Academy of Nurse Practitioners (AANP, 2002) defined the NP role in the statement: “Nurse practitioners assess and manage medical and nursing problems. Their practice emphasizes health promotion and maintenance, disease prevention and the diagnosis and management of acute and chronic diseases”

We have concentered in the family nurse practitioner role that is offer at the South University. It is a Master of Science in Nursing with a Specialization in Family Nurse Practitioner. This master degree has some requirements such as a baccalaureate degree in nursing from an accredited collegiate institution and a GPA of 3.0 or better on a 4.0 scale for the last 60 semester hours.  Completion of a three-semester credit hour undergraduate course in statistics with a grade of C or better. Completion of an undergraduate nursing research course or equivalent with a grade of C or better. Official transcripts from every college or university attended. Holds and maintains a valid unencumbered license as a registered nurse in the US state or territory in which the student completes all assignments for the program. along with three references using the Nursing Graduate School Appraisal Form.  At least one of your references must hold a Master’s in Nursing degree.  Submit an essay explaining your career goals, reasons for your choice pursuing an advanced degree in nursing. Also, a resume describing relevant work, professional, and volunteer experiences. The program is design to be completed in approximately 2yrs 2.5 moths with the completion of 62 Quarter Hours and 780 total clinical hours. The clinical core clinical content that focuses on advanced pathophysiology, advanced health physical assessment, and advanced pharmacology. The family nurse practitioner FNP from South University is prepared to care for families and individuals across the life span. After the completion of the program, the nurse will seek national certification. There are multiple certifying agencies. Each state chooses the organizations and certifications that it will accept. An advanced practice nurse must hold certification from a recognized specialty board. There is certification able for the family nurse practitioner through the American Academy of Nurse Practitioners Certification Board. (AANPCB). The FNP certification examination is an entry-level competency-based examination that tests clinical knowledge in family and individual across the life span.  The AANPCB provides a process for validation of an advanced practice registered nurse’s qualifications and knowledge for practice as a primary care nurse practitioner.

The FNP role includes preventative healthcare, the assessment, diagnosis, order of diagnostic help such as X-rays, laboratory work and treatment of illness. The FNP alleviates the problem for primary care, and represents a significant source of primary care providers. The United States experiences a shortage of doctors in primary care, and more patients are suffering from chronic conditions. The number of newly insured patients increased because of the Patient Protection and Affordable Care Act. The United States has a growing need for high-quality and cost-effective primary care services. The primary care physician staff is expected to decrease dramatically, and it is predicted that by 2025, physicians delivering primary care to the general patient population will be limited (Mackinlay, 2008)

Advanced nursing practice in the United States of America has evolved into two main related, but distinct directions: the nurse practitioner (NP) and the clinical nurse specialist (CNS). The two roles require a vast amount of knowledge, skills, and competencies. Clinical nurse specialist has become synonymous with acute care and nurse practitioners with primary. The FNP has also non-clinical roles, such as educator and advisor for patients and communities.

Nurse practitioners play a clinical and non-clinical key role in meeting the national patient safety goals. The 2017 Hospital National Patient Safety Goals are: identify patients correctly, improve staff communication, use medicines safely, use alarms safely, prevent infection, identify patient safety risks, and prevent mistakes in surgery.  Nurse practitioners use at least two of these to identify patients such as the use of patient name and the day of birthday. They prevent infections by using the hand cleaning guidelines from the Centers for Disease Control and Prevention.  Nurse practitioners are constantly assessing and finding risk factors, promoting prevention and health education.  Furthermore, they maintain good communication, which is one of the National Patient Safety Goals (NPSGs) from the Joint Commission on Accreditation of Healthcare Organizations which is a “. . . standardized approach to hand-off communications, including an opportunity to ask and respond to questions” (The Joint Commission, 2008).

The development of advanced practice nursing roles in primary care is becoming popular in many countries. There is recently study across 39 nations that confirms this trend (Maier and Aiken 2016). Dr. Susan Williams, RCN senior international adviser, in her article Looking at AdvancedPractice Nursing Roles, mentions that across the planet there is a necessity to deliver safe quality care to the patients. In the US, UK, Canada, New Zealand and Australia, the healthcare systems are being redefine, there is a general task shifting from doctors, including the introduction of nurse prescribing. Other countries, such as Spain, have only recently changed laws to allow this. The changes are due to the shortages of doctors in primary care as well as the need to deal with the increasing numbers of patients with chronic conditions.

Poghosyan’s (2014) article, Nurse Practitioner Role, Independent Practice, and Teamwork in Primary Care, has a study that conducted a survey of nurse practitioners (NP) in New York state to better understand Nurse practitioner’s roles, with emphasis autonomy in their practice, and teamwork in different primary care organizations. A total of 278 NPs completed the online survey. Forty-two percent of NPs had their own patient panel. Interestingly, the mean score of the autonomy and independent practice measure was higher than that of the teamwork. These conclusions of the survey were positively correlated, suggesting that NP independent practice may improve teamwork. Therefore, having a good open NP Practice had four subthemes: self-empowerment relationships, self-reliance, and defending the NP role. The understanding of having good NP practice will allow NPs to articulate their autonomy clearly and better influence healthcare reform.

Roderick’s (2015) article, Characteristics of Nurse Practitioners and Physician Assistants in The United States, studies two groups of healthcare providers: Nurse practitioners (NP) and physician assistants (PA).  They worked as independent or semiautonomous healthcare providers and as fundamental members of healthcare teams. The purpose of the study was to get a clear differentiation of health professionals’ roles for ideal employment utilization. Clinically practicing PAs and NPs were well considered. The methodology used data that included wage and workforce projections to 2022. Variables included are the number practicing, gender, race, age, ethnicity, education, principal employer, practice specialty, and wages. The result shows that health delivery establishments employed 88,110 PAs and 113,370 NP clinicians in 2013. Both were predominantly female, and in reference to the age variable: NPs were older (49 years) on average than PAs (38 years). The conclusion determines that PAs and NPs constitute 20% of the clinician labor force (MD, DO, NP, PA). Labor market analysis suggests they are in-demand.  Their joint projected growth proposes a solution to emerging workforce shortages and the capability to help meet healthcare demands. There are inferences for the practice, such as the adaptability to changing roles, especially in primary care and underserved areas, and makes them good responders to market demands in a nonstop evolving healthcare environment. The median wages were equal. Growth predictions from 2012 to 2022 were 31%–35%.

After researching the role of the nurse practitioner, we realize the importance of this discipline in the healthcare system. Many countries across the globe are realizing that the solution for their shortage of primary care physician is the employment of nurse practitioners. The United States is a pioneer in the family nurse practitioner field. Many experts had done multiple studies to determine the benefits of the use of advance nurse practitioners in the different clinical settings. The conclusions of the studies had been very positive in every single aspect. Nurse practitioners are making the path for the future health system transformation. The nurse practitioner profession is evolving and developing its own characteristics, which are determining by the good flexibility and adaptation of the professionals. The family nurse practitioner is an exciting profession that allow its members to continue growth and develop new and advance skills. There is not a limit to the potential that the profession can reach. Family nurse practitioners are good at their job.  They use a caring holistic approach and develop strong connections with their patients and the communities that they serve. They understand very well their communities and which are their necessities, making them excellent liaisons in the redesign of the health care system. Nurse practitioners are highly qualified professionals that serves as a primary healthcare provider.  Autonomy is the corner stone of their practice and their high critical thinking abilities had won them the respect of the other health professionals. The forecast for the profession is excellent.









The American Academy of Nurse Practitioners. (2002).

Determining Scope of Practice for Advanced Practice Registered Nurses (APRNs). (2004). Retrieved from

Hooker, R. S., Brock, D. M., & Cook, M. L. (2015). Characteristics of nurse practitioners and physician assistants in the United States. Journal of the American Association of Nurse Practitioners, 28(39 – 46).

Mackinlay, J. (2008). When there is no doctor: Reason for the disappearance of primary care physicians in US during the early 21st century. Social Science and Medicine, 67(1481 -1491).

Maier, C., & Aiken, L. (2016). Task shifting from physicians to nurses in primary care in 39 countries: a cross- country comparative study. European Journal of Public Health.

Poghosyan, L., Boyd, D., & Knutson, A. R. (2014, Jul/Aug). Nurse Practitioner Role, Independent Practice, and Teamwork in Primary Care. The Journal for Nurse Practitioners, 10(472–479).

The Joint Commission. (2008). Retrieved from

The Joint Commission. (2017). Retrieved from

Weiland, S. A. (2015). Understanding Nurse practitioner autonomy. Journal of the American Association of Nurse Practitioners, 27, 95-104.


Leadership and the Graduate Nurse Role

The Results

After taking the quiz for what’s your leadership style (Cherry, 2016), the results showed that my leadership style is democratic. This type of leader is also identified as a participative leader. It is characterized by taking in consideration and accepting input from all the group members, solving problems or making decisions. The decisions are more effective and accurate due to the input from experts who possess specialized knowledge. The group members are motivated and encouraged by the democratic style of leadership. The leader retains the final say when decisions need to be made.

Those results are accurate with my personal believes about the leadership style. Leaders need to take in consideration the input from the members of the group.  Each member is a great source of knowledge and experience. My leadership style leans towards leaders that inspires others, has a long-term vision, looks at effects, empowers others, and takes input from the group members. Good leadership skills can help an organization reach its goals. A positive and supportive leader whose nursing staff is encouraged, challenged, and recognized, will make the challenging work of a nurse more productive.  This can benefit the hospital, patients, and families. Good leaders are needed in any successfully entity, not just hospitals. The democratic leadership style allows the involvement of all group members, creating a pleasant work environment that allows them to reach the best decisions, and stimulate members grow.

The Attributes for the Leadership


Nursing managers are very knowledgeable of medicine and medical procedures and processes, but they are managers of people, and should exhibit the traits of successful leadership styles.  Successful leaders can’t reach goals without motivating and inspiring others, and nurses look for qualities in their leaders, such as, passion about their work, commitment to the excellence, commitment to couching and develop their staff, clear vision, strategic focus, trustworthiness, empathy and caring. The leader is going to require that the staff maintains frequent communication, accept accountability for assignments, be trustworthy, and show support to leadership decisions. (Sherman, 2012).

Passion for what you do it is very important and it is reflected in patient outcomes. The commitment to the excellence is the promise to deliver quality care to all the patients. The commitment to coach and build the staff is characteristic of a great leader. The truth is that many people benefits from qualities of a great leader, such as caring, clear vision, extensive knowledge, advance skills, passion, commitment to the patients and staff with the love to serve others.

Personal Leadership Attributes


As a leader, my personal qualities are love and passion for my work. You must love what you do.  My commitment to excellence is my corner stone, followed by coaching, development of the staff and appreciation of their vision that I am working with.  Good leaders do not agree with negative reinforcement leadership styles, such as management by exception. Having a good relationship with your manager and the staff is essential to work and career growth. Personally, as a leader, we would benefit from develop a great line of communication at all levels. The mastering of the appropriate strategy to accomplish true and real performance evaluations for the staff will be great and at the same time the skill to help them to be satisfied and grow professionally.  This will come with time, practice, and experience.


Leadership Article


Guyton’s (2012) article Nine Principles of Successful Nursing Leadership, talks about the principles that help to improve the effectiveness of a leader. The nine principles are: (a) commit to excellence.  This principle requires a lot of perseverance, passion, and to know what is your professional purpose. (b) Measure the important things, such as service, that is reflected in patient and staff satisfaction, quality, and safety standards.   Identify people that requires a lot of motivation to do their jobs, develop unit or organization projections measure potential growth opportunities, and do not forget about finances in the business plans.  This factor is equally important to improving people, quality, and service. (c) Build a culture around service. Establish a customer service orientated staff where family and patients are seeing as customers. (d) Create and develop leaders. It is very important to identify the informal and formal leaders and invest in them. (e) Concentration on employee satisfaction is extremely important. Make work an exciting, and great place to work. Created a pleasant work environment. (f) Build individual accountability. It is recommended to keep accurate records on each employee’s performance. The SWOT approach, where strengths, weaknesses, opportunities, and threats are considered for the approach to work well. (g) Correlate behaviors with goals and values. Establish behavioral standards for the staff that are associated with the organization’s mission, values, and standards.  (h) Communicate on all levels. To be able to serve the patients better, interdisciplinary communication needs to be in place. (i) Recognize and reward success. Create goals and objectives for the staff and as they meet them, praise them.

The success as a nurse leader will follow you, if you show commitment and determination to develop a team that will support and assist you in achieving the objectives and goals.

Don’t follow the path that lies ahead; instead, blaze a new trail! (Guyton, 2012)




Cherry, K. (2016). What’s Your Leadership Style? [Measurement instrument]. Retrieved from

Guyton, N. (2012, August). Nine principles of successful nursing leadership. American Nurse today, 7. Retrieved from

Sherman, R. O. (2012). What Followers Want in Their Nurse Leaders. American Nurse today, 7(9). Retrieved from



Working as a Family Nurse Practitioner

A Family Nurse Practitioner (FNP) works with people and how they live their life, encouraging disease prevention, diagnosing diseases, performing exams, educating, and prescribing medication. FNP can work as a specialty primary health care provider under a physician or run their own private practice. FNPs may work in a multitude of different locations, such as medical offices, patient homes, clinics, healthcare centers, schools, and hospitals.

Health Care Organization

The Family Nurse Practitioner (FNP) is prepared to bring primary health care to individuals and families in a diversity of locations. FNP takes care of people through the life span, applying obstetric, pediatric, gynecologic, adult and geriatric care, diagnostic and treatment. For this writer, an ideal place to work will be a family doctor’s office or at the Orange County Health Department, which part of my local community.  The County Health Department (CHD) serves a wide and variable amount of the population, mainly people who are uninsured, but there are people with insurance that sometimes has problems for their insurance to be accepted by the providers, or the deductible amount is so high that it is better for them to find a place like CHD where they can have a good service with a fee that is affordable.  The CHD offers basic family health services such as breast and cervical cancer early detection, dental care, family planning, healthy start, pregnancy care, refugee health, school health, travel vaccinations, and WIC.  They also have infectious disease prevention and controls which includes HIV/AIDS testing, surveillance and treatment, STD testing, surveillance and treatment, hepatitis testing, surveillance and treatment, immunizations, and tuberculosis (TB).  Prevention is the key when we are talking about living healthy lives and the CHD has a lot of information to educate the patients. All children have access to vaccination free of cost. We believe that education and disease prevention helps people to have longer lives free of preventable diseases.  Investigators in Syracuse, New York, cooperated with the district health department, provides vaccination education. This resulted in vaccinated children increased by 45%. (Potera, 2013)


Table 1

Population sever by Age and Gender at Orange County, Fl. 2015



Age Group          Male      Female Total

< 5          41,787   40,080   81,867

5-14       85,308   81,682   166,990

15-24     98,697   95,984   194,681

25-44     188,731 189,836 378,567

45-64     147,886 154,830 302,716

65-74     37,821   43,807   81,628

> 74        23,686   34,902   58,588


Table 1 illustrate the population that the Orange County Health Department serve.

Data Source: The Florida Legislature, Office of Economic and Demographic Research. (“Statistics Economic and Demographic research,” 2015)

The FNP work hours depend of the place of work. Working at the County Health Department or doctor’s office may only work during business hours that are usually between 8 am to 5 pm week days. These hours could be different depending on the office. If a nurse practitioner works in a hospital, then he/she usually works three or four shift per week with 10 to 14 hour shifts.

Generally, primary care offices and clinics plan patients visits every 15 minutes for follow-ups. For complete adult, pediatric or new patient physical exams, the visits are allotted more time, around 30 minutes per visit.



Qualification of the Family Nurse Practitioner

Becoming a FNP involves a bachelor in science of nursing, then obtaining a licensed register nurse (RN). After that, most FNP candidates obtain a Master’s Degree in Nursing (MSN), or a Doctor of Nursing Practice (DNP).  They are eligible for national certification. The great majority of states require a national certification for FNP licensure. (Graduate Nursing, n.d.)

There are several organizations that offer a national certification for the family nurse practitioner, we will mention the most recognized organizations. The American Academy of Nurse Practitioners (AANP), and The American Nurses Credentialing Center (ANCC) offer a nationwide certification in family practice. The American Nurses Credentialing Center (ANCC), offers the FNP-BC certification on primary care. This certification examination has a fee of $250 dollars and is valid for five years. (American Nurses Credentialing Center, n.d).

To continue with the process of certification, the ARNP needs to complete an application for the State Board’s prescriptive authority. This application requires proof of pharmacology instruction, complete an application form, and enclose the fee. (American Association of Nurse Practitioners, n.d.)

Work Description

The Family Nurse Practitioner (FNP) is a licensed autonomous practitioner who cares for individuals and families in agreement with nursing standards of care and the State and Federal rules and regulations. The FNP should follow national standards of care that include assessment, diagnosis, treatment, execution of the care plan, and evaluation of patient. (American Association of Nurse Practitioners, n.d.)

The main clinical focus for FNP is primary care. FNPs work with a diverse patient population, and they provide a wide range of healthcare services for every member of the family.

A typical day for a FNP at the doctor’s office or at the health care department is from 8 A.M to 5 PM, but usually the FNP arrives about 30 to 40 minutes early. The FNP goes first through the phone and internet messages, then check for any lab results with any abnormalities that will require the patient to be informed immediately, or follow up. The appointments are planned every 15 minutes for follow-up visits and illnesses and every 30 minutes for annual physicals and gynecologic exams. The FNP has thirty minutes for lunch, but usually only take fifteen because she tries to catch up with all the documentation or answering the phones call from patients. After the lunch break the second round starts. At the end of the day, the FNP has a meeting with the physician to discuss difficult cases that she had managed during the day.



Florida Board of Nursing

The writer is planning to practice as a Family nurse practitioner at the state of Florida. Each state has its own Board of Nursing, which stablished the Nurse Practice Act of that state. The Florida Nurse Practice Act, Chapter 464, Florida Statutes, was created to guarantee that every license nurse practicing in Florida meets the requirements for safe practice. Any nurse that present a threat to the public shall be forbidden to work as a nurse in the state of Florida.  The Nurse Practice Act covers explanations that include the performing tasks and responsibilities for all licensed nurses and nurse practitioners. Each licensed register nurse who works in Florida must be familiar with these explanations, as they describe the parameters on what the nurse can legally do. (Indest, 2008)


The Advanced Registered Nurse Practitioner (ARNP) or in this case, a FNP, is a nurse who is certified by the Florida Board of Nursing to perform advanced-level nursing acts, and acts of nursing diagnosis and treatment of health status. Also, The ARNP may perform acts of medical diagnosis, treatment, and give prescriptions. (Indest,2008)

Here is a quick view of the Florida Nurse Practice Act, Chapter 464, Florida Statutes.

64B9-4.004 Requirements for Documentation. (1) A Registered Nurse applying for initial certification as an ARNP shall file,” Form DOH-NUR 105 (9/97)

64B9-4.005 Filing of the Application. Application shall be made on a form prescribed by the Department and submitted together with the appropriate fee. Valid for one year.

64B9-4.006 Certification in More Than One ARNP Category. (1) required to submit separate application in accordance with Section 464.012(1), F.S.,

64B9-4.008 Purpose. An ARNP may perform additional acts of medical diagnosis, treatment, and operation in accordance with this rule chapter. Rule 64B9-4.010, F.A.C

64B9-4.009 Functions and Scope of practice of the Advanced Registered Nurse (ARNP). All categories of ARNP may perform functions listed in Section 464.012(3), F.S.

64B9-4.010 Standards for Protocols. (1) An ARNP shall only perform medical acts of diagnosis, treatment, and operation pursuant to a protocol.

64B9-4.011 Dispensing Practitioners. (1) Those ARNP’s whose protocols permit them to dispense medications for a fee as contemplated by Section 465.0276, F.S. (2) The ARNP must comply with all state and federal laws and regulations applicable to all dispensing practitioners under Section 465.0276, F.S. (Nurse Practice Act Chapter 464 Florida Statutes, 2007)



FNP takes care of patients through the life span, applying obstetric, pediatric, gynecologic, geriatric primary care diagnostic as well as management skills. The FNP is prepared to work in different locations including doctor’s offices, healthcare centers, clinics, hospitals and schools. Many states require a nationwide certification for the FNP candidates. There are different organizations that provide the national certification. The American Nurses Credentialing Center (ANCC) and The American Academy of Nurse Practitioners (AANP) offer a nationwide certification in family practice. Each state has its own Board of Nursing. For the state of Florida, The Nurse Practice Act, Chapter 464, covers definitions, the performing tasks and responsibilities for nurse practitioners, and licensed registered nurses. Every licensed nurse who works in Florida must have knowledge of these explanation and definitions, as they in detail describe the parameters on what nurse can legally do. The writer learned the steps to follow once she obtains her master degree. The family nurse practitioner master will allow her to practice and growth in the advance register nurse practice. The health care system is in continue evolution, trying to solve the problem of primary quality care for everybody. The family nurse practitioner contributes enormously to reach the health care goals for the country.  With the help of the Nurse Practice Act, in this case the one for the state of Florida, guidance will be provider for the new nurse practitioner, when she works with the families of the undeserved communities.








American Association of Nurse Practitioners. (n.d.).

American Nurses Credentialing Center. (n.d.).

Florida Board of Nursing. (2007).

Graduate Nursing (n.d.).

Indest, G. F. (2008).  CH 6 Nurse Practice Act & Scope of Nursing. In Nursing Law Manual. Retrieved from

Orange County Health Department. (2015). Retrieved from

Potera, C. (2013, November). Collaboration with Community base organizations improving immunization rate in children from low income families. American Journal of Nursing, 113(11), 14. Retrieved from


Advance Practice Competences

The nursing field is very complex, and offer many opportunities to specialization such as nurse informatics and family nurse practitioner, each one has their own competences, instruction requirements and responsibilities. These specializations even if they have different work tasks, they are very interrelated.

Nursing informatics was accepted as specialty on 1992 by ANA. This specialty incorporates the computer and information science with nurse science. The nursing informatic main function is to serve as support for patients, consumer and providers, helping them to reach the best decisions in all kind of settings. Every nurse share some competencies with the nurse informatic specialization, since each professional need to be information and computer literate.

Competences are mark for an ongoing evolvement, and divide in groups. The Quality and Safety Education for Nurses (QSEN) informatics competence, which mission is to make sure that nurses have the knowledge, skills, and attitudes (KSA) necessary to continuously advance the quality and safety of the healthcare systems in which they work; The American Nurses Association(ANA) competences that include computer and information literacy, in addition professional leadership development, and the Technology Informatics Guiding Education Reform (TIGER) initiative that includes basic computer, information literacy and management. The basic computer competence is based on The European Computer Driving License (ECDL) that includes the concept of information technology(IT) and communication. Information management is the underlying principle upon which Clinical Information Management Competencies are built. It is a multistep process consisting of (a) collecting data, (b) processing the data, and (c) presenting and communicating the processed data as information.

Other competencies that are share with other health professionals are provide patient care, employed evidence base practice, apply quality improvement and use informatics. The most important and fundamental information management competencies for nurses are those that relate to the clinically related information system of our time: the electronic health record system (EHRS), that allow immediate electronic access, providing knowledge and decision support.

Nurse practitioners are highly qualified professionals. The family nurse practitioner specialization allows its members to continue growth and develop new and advance skills. They approach is holistic and their connection with the individuals and communities that they serve is strong. To become a nurse practitioner there are some competences that need to be master. The competences are divide in areas such as Scientific Foundation, Leadership, Quality, Practice Inquiry, Technology and Information Literacy, Policy, Health Delivery System, Ethics, and Independent Practice.

Nurse Informatics and Nurse Practitioner are considered advance nurse practitioner specializations that require advance skills and knowledge. Both are masters that can be taken by license register nurses. The nurse informatics collect data, processes the data and presenting the results, for the family nurse practitioner there is also some similar processes, collection data, the processing of the data that include the integration of assessment, laboratory work and analysis of the information obtained, at the end the communication of result that is represented by a diagnosis and plan of care. Both specializations allow its members to growth and develop new and advance skills. They also shared basic information competences and the use of the electronic health record system (EHRS). There also differences



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URLs to assist you in answering this question: