What is a nurse practitioner’s scope of practice?

What does a nurse practitioner do?

As an NP, your scope of practice is defined in each state’s laws, rules and regulations and can vary based on several factors, including your education and training, employer and the state you’re practicing in. Here, we explore some of the roles and responsibilities that are generally inherent to working as an NP.

Assessment

Nurse practitioners gather information about a patient during the assessment process. Depending on the nature of the assessment, nurses often ask questions about medical history and the length of time since a patient first experienced a particular symptom or ailment.

Assessments are instrumental in analyzing a patient’s physical, mental and emotional state. With the right questions and assessment strategies, NPs can quickly gauge a patient’s condition and make recommendations for treatment.

Nurse practitioners tailor a patient’s assessment according to their condition and the reason for the evaluation. For example, assessments might include a physical examination to gauge response to a simple stimulus. In other cases, an NP might ask questions to evaluate mental status. Part of the assessment is reviewing and updating patient records.

Diagnostic and lab tests

Diagnostic tests are a urine analysis, an electrocardiogram (ECG), a pulmonary function test and an ultrasound done in the office. In most cases, nurse practitioners will order diagnostic tests, such as blood work, X-rays, ultrasound, magnetic resonance imaging (MRI) or computed tomography (CT).

By contrast, some patient concerns require more complicated diagnostic tests. For example, pregnant, at-risk patients might need prenatal tests to continually track fetal growth.

If nurse practitioners cannot perform a specific diagnostic examination, they order tests for further examination. A laboratory often handles tests on blood or other fluids, and then delivers the results to the nurse practitioner for analysis. Just as with blood tests, a nurse practitioner may need to send a patient out for an X-ray or MRI to evaluate an internal condition. 

Coordinating care

Nurse practitioners play an important role in coordinating care and referring patients to specialists when needed. Collaborating with other healthcare team members about care provides the best path forward for patients. Referring to specialists helps patients get the specialized care they need for a specific ailment.

To best coordinate patient care, nurse practitioners should maintain strong communication with their team and patients. Clear communication among patients, nurse practitioners and care teams helps eliminate misunderstandings and lost time between a diagnosis and the beginning of treatment.

Working as a healthcare advocate

Nurse practitioners are advocates for patients. This means improving patients’ access to healthcare services, treatment or resources to aid recovery or rehabilitation.

NPs also show patients how simple lifestyle adjustments in diet, activity and other areas can lead to improved outcomes. They may work to integrate lifestyle adjustments as a portion of a treatment plan. For example, they might prescribe medication to improve blood pressure but also advocate for daily exercise to enhance the medication’s efficacy.

Nurse practitioners advocate for patients on a legislative level too. For example, they  might address local, state or federal legislative bodies on their patients’ behalf to advocate for additional resources. This approach is essential when serving a community of patients facing socioeconomic challenges.

Educated NPs serving as healthcare advocates learn to speak productively with decision-makers to improve the healthcare system as a whole. Whether  communicating with local stakeholders, municipal representatives or treatment facility coordinators, nurse practitioners learn how to advocate for solutions that can help address the health challenges facing their community.

Accountability for professional practice

An NP is primarily accountable to the patients they serve. The decisions made, and the treatment plans, implemented, directly affect the health of patients. It’s important for all NPs to maintain transparency and trust with patients through the assessment, diagnosis and care-plan phases of treatment.

Nurse practitioners are encouraged to follow, and may be required to adhere to, the Nursing Code of Ethics, a guide set by the American Nurses Association that dictates appropriate nurse conduct in the workplace. States regulate the practice of nursing, including all nurse practitioners through each state’s laws and regulations, sometimes referred to as a state’s Nurse Practice Act. These state Boards of Nursing develop and maintain robust and statewide nursing standards.  

When an NP violates these accountability standards, they also violate the trust between practitioner and patient. Violations can lead to a loss of licensure and even criminal charges, particularly when patient outcomes suffer as a result.

Nurse practitioner education requirements

It’s important to understand the steps involved in becoming a nurse practitioner before starting your nursing credentials journey. This includes obtaining the specific education and state licensure to become an NP.

First, you’ll need a bachelor’s degree in nursing or in a closely related field. To prepare for licensure as a nurse practitioner, RNs must obtain an appropriate nursing graduate degree, such as a Master of Science in Nursing/Family Nurse Practitioner. This graduate program teaches new and advanced practice theories and skills such as advocacy, nursing practice, problem-solving and research application.

Even after becoming an NP, you will likely need to regularly update your certification (depending on the state) by satisfying peer review and continual learning requirements. Nurse practitioners are expected to stay updated with medical practices as they evolve. Some NPs return to the classroom to pursue a doctorate in nursing practice—a program for working nurses seeking a higher degree for advanced practice.

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