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A Comprehensive Guide to NP Subspecialties

Nurse practitioners (NPs) are an increasingly critical part of the American healthcare workforce, expertly trained to provide a wide range of healthcare services to a broad spectrum of patient populations. But this is still a relatively young profession, compared to that of the physician: the first NP programs were only established in 1965. Since then, however, the NP role has matured to incorporate several specialties and even more subspecialties, each with its own tailored training programs and niche certification processes.

Today, NPs generally fall into one of six main focus areas: adult-gerontology, family care, neonatal, pediatrics, psychiatric-mental health, or women’s health and gender-related. But that’s just the beginning. NPs in those areas can go on to subspecialize in even more specific areas of focus. These subspecialties may have been overlooked in the past, overshadowed by the broader fields of study which house them. But with the establishment of more subspecialized degree programs, the growth of fellowship opportunities, and the overall maturation of the NP role, that’s beginning to change.

Today’s NP subspecialties are deeper, more focused, and more important than they’ve ever been. What kind of NP will you be? To learn more about the main focus areas for NPs, and the subspecialties they can lead to, read on.

Main Specialties for NPs

Adult-Gerontology

Adult-gerontology NPs (AGNPs) provide care to patients aged from adolescence to older adulthood. They can work in either primary care or acute care, and across a wide range of settings, including hospitals, clinics, and outpatient facilities. AGNPs may also go on to subspecialize in a specific area of care, such as oncology, cardiology, or palliative care.

AGNPs typically complete their MSN or DNP in adult-gerontology; they may also obtain a postgraduate certificate in adult-gerontology if their degree is in another area of focus. Adult-gerontology programs typically include coursework that covers areas such as advanced physiology and pathophysiology; advanced practice nursing in adolescents, adults, and older adults; and clinical pharmacology in advanced practice nursing.

The main professional organization for AGNPs is the American Association of Nurse Practitioners (AANP), and they have a specialty practice group (SPG) dedicated to gerontology. For AGNPs focused primarily in gerontology, the Gerontological Advanced Practice Nurses Association (GAPNA) is another premier professional organization. Both the AANP and GAPNA offer certification for AGNPs.

Family Care

The majority of NPs focus on family care, as Family NPs (FNPs). FNPs provide a wide range of healthcare services to patients of all ages. They can work in community health centers, private practice, healthcare systems, and universities. FNPs deal with a diverse patient population on a long time horizon, and their scope of practice is broad: in addition to the diagnosis and treatment of patients, FNPs may also act as patient educators.

FNPs will complete an MSN or DNP program focused on family care. Coursework in these programs typically includes classes such as advanced physiology and pathophysiology; sexual and reproductive health; advanced clinical pharmacology; and symptom assessment and management. FNPs may go on to pursue subspecialization in a specific area of care, such as emergency care.

The main professional organization for FNPs is the American Academy of Nurse Practitioners (AANP), which also offers board certification for FNPs.

Neonatal

Neonatal NPs work with newborn infants who suffer from problems such as prematurity, birth defects, infection, cardiac malformations, and surgical problems. While the neonatal period is typically defined as the first month of an infant’s life, many of the problems that neonatal NPs treat can and do persist beyond that; some neonatal NPs may care for infants up to two years in age. While neonatal NPs typically work in a hospital setting, they can also work in a home care capacity.

Neonatal NPs will typically complete an MSN or DNP in neonatal care; they can also obtain a postgraduate certificate in neonatal care if their MSN/DNP is in a different area of study. Neonatal NP programs typically include classes such as advanced pharmacology and therapeutics for nursing practice; advanced developmental physiology and pathophysiology; high-risk neonate theory; and advanced practice concepts for the childbearing family.

The main professional association for neonatal NPs is the National Association of Neonatal Nurse Practitioners (NANNP). Established in 2007, it represents the unified voice of neonatal NPs and neonatal clinical nurse specialists (CNSs); it also sets standards for the neonatal NP role. Neonatal NPs can also look to the AANP’s SPG for NPs working in neonatal care.

Pediatrics

Pediatric NPs (PNPs) provide care to children from birth to the transition to adult care. They can work in acute, primary, hospital, outpatient, and specialty care settings. Pediatrics is one of the largest and oldest areas of focus for NPs—the very first NP program, in 1965, was focused on pediatrics. It’s also one of the most advanced. Today’s PNPs are extending their role to include mental health, research, and advocacy.

Pediatric NP programs typically include didactic coursework in areas such as pediatric pathophysiology; advanced pediatric health assessment; pharmacologic management in pediatrics; clinical management of the pediatric patient in either acute, primary, or chronic care; pediatric sociocultural and ethical issues. PNPs may go on to subspecialize in a specific area of care, such as dermatology.

The professional organization for PNPs and all pediatric-focused APRNs is the National Association of Pediatric Nurse Practitioners (NAPNAP). Established in 1973, it is the oldest professional society for NPs and currently has over 8,000 members. NAPNAP is dedicated to advancing the APRN role and to improving the quality of healthcare for infants, children, and adolescents.

Psychiatric-Mental Health

Psychiatric-mental health NPs (PMHNPs) assess, diagnose, and treat the mental health needs of patients. They may provide therapy or prescribe medications to patients with mental health or substance abuse problems, or they may focus on emergency psychiatric care. Most PMHNPs work in inpatient settings and they can work with either adults, children, or older adults.

PMHNPs often complete their MSN or DNP in psychiatric-mental health; they can also obtain a postgraduate certificate in psychiatric-mental health if their degree is in a different area of study. PMHNP programs typically include coursework in areas such as medication and psychotherapeutic management; crisis intervention; and neuroscience. PMHNPs may also go on to subspecialize in an area such as pediatric mental health or emergency psychiatric care.

The main professional association for PMHNPs is the AANP, which has an SPG specifically dedicated to PMHNPs. PMHNPs may also look to the American Psychiatric Nurses Association (APNA), which represents both psychiatric nurses and PMHNPs. Certification for PMHNPs is offered through the American Nurses Credentialing Center (ANCC).

Women’s Health and Gender-Related

Women’s health NPs (WHNPs) typically provide care to women from adolescence through adulthood. They can work in a wide variety of settings, including private clinics, community health centers, hospitals, and health departments. It’s not only cis women that they care for, either: WHNPs provide care that is inclusive of all gender identities. WHNPs may go on to subspecialize in areas such as palliative care or forensics.

WHNPs typically complete their MSN or DNP in women’s health; they may also obtain a postgraduate certificate in women’s health if their degree is in another area of study. WHNP training typically covers complex and common gynecologic, sexual, reproductive, menopause transition, and post-menopause healthcare. It may also include sexual and reproductive healthcare for men, uncomplicated and high-risk antepartum and postpartum care, and care for uncomplicated non-gynecologic health problems.

The main professional association for WHNPs is Nurse Practitioners in Women’s Health (NPWH), which promotes women’s health and other gender-related healthcare through research, advocacy, and continuing education. WHNPs may also look to the AANP’s SPG in women’s health. Board certification for WHNPs is offered through the National Certification Corporation (NCC).

Subspecialties for Nurse Practitioners

Acute Care

Acute care NPs (ACNPs) provide care to patients in acute and/or hospital settings. Unlike the comprehensive and continuous care provided by primary care NPs, ACNPs focus on the diagnosis, treatment, and management of episodic, short-term, and dynamic conditions.

ACNPs often complete MSN and DNP programs in adult-gerontology with an acute care focus, or obtain a postgraduate certificate in acute care. MSN and DNP programs in acute care may also offer students the opportunity to further specialize in areas such as cardiology, nephrology, or transplantation.

The main professional association for ACNPs is the American Association of Critical-Care Nursing (AACN). As the world’s largest specialty nursing organization, AACN supports both nurses and NPs working in acute care settings. AACN also publishes an evolving Scope and Standards packet for ACNP practice and administers board certification for ACNPs. ACNPs may also look to the AANP’s SPG in acute care.

Cardiology

Cardiac NPs and cardiovascular NPs provide care to patients with heart and blood conditions. They can work in either inpatient or outpatient settings, and sometimes in a combination of both. Cardiac NPs and cardiovascular NPs may also choose to specialize in a particular cardiac intervention, such as cardiac catheterization, myocardial infarctions, or cardiac surgery.

Cardiac NPs and cardiovascular NPs typically earn their MSN or DNP as an adult-gerontology NP, then pursue postgraduate certification in cardiology. Some MSN and DNP programs also allow for immediate specialization in cardiology, which will include a focused study of the cardiovascular system and cardiovascular synthesis.

Cardiac NPs and cardiovascular NPs do not have their own independent professional organization. However, both the American Association of Heart Failure Nurses (AAHFN) and the Preventive Cardiovascular Nurses Association (PCNA) count cardiac NPs and cardiovascular NPs amongst their membership. The American Association of Nurse Practitioners (AANP) also has a specialty practice group (SPG) dedicated to NPs working in cardiology. Board certification is offered through the American Board of Cardiovascular Medicine (ABCM).

Dermatology

Dermatology NPs specialize in treating diseases and conditions related to the skin, hair, and nails. They may treat common conditions like acne and eczema, or more complex issues such as cutaneous lymphoma. Dermatology NPs can further specialize in areas such as cosmetic dermatology, surgical dermatology, and pediatric dermatology.

Currently, there are very few degree programs and fellowships dedicated specifically to dermatology. Dermatology NPs typically earn an MSN or DNP as a family NP, pediatric NP, or adult-gerontology NP, then gain work experience in a dermatology clinic as part of a collaborative care team.

The main professional organization for dermatology NPs is the Dermatology Nurses Association (DNA). Founded in 1978, it counts both dermatology nurses and dermatology NPs in its membership of over 2,000 and has a dedicated Dermatology NP Society (NPS) dedicated to dermatology NPs. Optional certification for dermatology NPs is offered through the Dermatology Nurse Practitioner Certification Board (DNPCB). Dermatology NPs may also look to the AANP’s SPG in dermatology.

Emergency Care

Emergency NPs (ENPs) are part of the interdisciplinary care team that assesses, diagnoses, and treats patients of all ages in emergency settings. They typically work in emergency departments (EDs), trauma centers, and urgent care facilities. But ENPs can also work as flight NPs as part of first-response teams in emergency situations.

Aspiring ENPs may join a family nurse practitioner (FNP) program with an emergency NP specialization, or a post-FNP graduate certificate program. ENP-related courses in these programs can include principles of advanced emergency nursing and advanced physiology.

Fellowship programs for ENPs, which are around 12 months in length, include both didactic and clinical experiences in further specialty areas such as critical care or cardiology. Specialized training can include topics such as advanced airway management, emergency ultrasound, and advanced life support courses.

The preeminent specialty organization for Emergency NPs is the American Academy of Emergency Nurse Practitioners (AAENP). Established in 2014, AAENP promotes high-quality, evidence-based practice for NPs providing emergency care to patients of all ages and acuities in collaboration with an interdisciplinary team. AAENP is also a key force in establishing ENP guidelines, encouraging ENP continuing education, and facilitating further research in emergency care. ENPs may also look to the AANP’s SPG in emergency care. AANP also offers certification for ENPs.

Forensics

Forensic NPs combine the nursing, forensic, and legal sciences to provide care, safety, and justice to their patients. Within a specialized practice setting such as primary care, acute care, or pediatrics, they are expertly equipped to handle cases of trauma. In addition to providing care, forensic NPs may also interface with the legal system: documenting evidence, taking statements, and providing testimony.

Specialty education in the trauma-based approach of forensic NPs typically builds upon specializations in other areas of care. Forensic NPs may complete either MSN programs in forensic nursing or post-MSN forensic nursing programs. Both typically include coursework in areas such as forensic science and the legal system; advanced forensic nursing; and criminal law and the courts.

Forensic NPs may look to the Academy of Forensic Nursing (AFN), the American Association of Forensic Science (AAFS), and the International Association of Forensic Nursing (IAFN) as professional organizations. Board certification is available through the Forensic Nursing Certification Board (FNCB).

Gastroenterology

Gastroenterology NPs, also sometimes referred to as GI NPs, work with conditions related to the digestive system or gastrointestinal (GI) tract. They may specialize further in areas such as inflammatory bowel disease (IBD), pancreatic diseases, or neurogastroenterology.

GI NPs typically complete their MSN or DNP as a family NP or an adult-gerontology NP. Specific programs dedicated to GI NPs are rare at the degree and certificate level, but a small number of fellowships are available in gastroenterology and hepatology. These 12-month programs typically include didactic and clinical training in both inpatient and outpatient gastroenterology and hepatology.

The main professional organization for GI NPs is the Society of Gastroenterology Nurses and Associates (SGNA). Supporting both GI nurses and GI NPs, SGNA promotes advocacy, collaboration, and research amongst its members and the community at large. The AANP also has an SPG specifically dedicated to NPs working in gastroenterology.

Hospice & Palliative Care

Hospice NPs focus on the care of terminally ill patients towards the end of their life, while palliative care NPs focus on improving the lives of patients facing serious illnesses or the side effects of treatment. Both can work in both inpatient as well as outpatient settings.

Hospice and palliative care NPs typically complete degree programs in adult-gerontology before obtaining postgraduate certification in hospice or palliative care; certificate programs are available in pediatric palliative care as well. In these programs, NPs will learn about serious and chronic illness care, including its physical, psychosocial, and spiritual components.

The main professional association for hospice and palliative care NPs is the Hospice & Palliative Nurses Association (HPNA). Established in 1986, HPNA represents both nurses and NPs working in hospice and palliative care, supporting the profession through advocacy, education programs, and research initiatives.

Nephrology

Nephrology NPs care for patients with disorders related to the kidneys. They typically work in inpatient settings, and often with patients who are either undergoing dialysis or are candidates for transplant.

Nephrology NPs typically complete their MSN or DNP in an area such as adult-gerontology. Few specialized degree or certificate programs exist specifically for nephrology NPs, and fellowship programs are also rare. Many nephrology NPs will either seek on-the-job experience or fellowship programs in transplant nursing to bolster their understanding of chronic kidney disease (CKD) and advanced nephrology.

The main professional association for nephrology NPs is the American Nephrology Nurses Association (ANNA), which represents both nephrology nurses and nephrology NPs. Nephrology NPs may also look to the AANP’s SPG in urology and nephrology. Professional certification for nephrology NPs is available through the Nephrology Nursing Certification Commission (NNCC).

Oncology

Oncology NPs specialize in diagnosing, treating, and managing cancer patients. They can work in a wide variety of settings, including hospitals, cancer centers, ambulatory clinics, private practice, palliative care, and hospice.

Oncology NPs will typically complete their MSN or DNP in adult-gerontology or pediatrics, and some programs offer specializations in oncology. Specialization coursework in those programs covers topics such as cancer symptom management and the principles and practice of oncology.

The main professional association for oncology NPs is the Advanced Practitioner Society for Hematology and Oncology (APSHO), which brings together all advanced practice providers, including NPs, to improve the quality of care for patients with cancer. Certification for oncology NPs is offered by the Oncology Nursing Certification Corporation (ONCC).

Pain Management

Pain management NPs focus on the treatment of pain, and the side effects of that treatment. Working within a collaborative team, they diagnose, assess, and monitor a patient’s pain and their responses to treatment. They can work in both inpatient and outpatient settings, with either adult, geriatric, or pediatric populations.

Pain management NPs typically earn their MSN or DNP as a family NP or adult-gerontology NP. Dedicated degree programs for pain management NPs remain rare, but a small number of postgraduate certificate and fellowship opportunities are available. These programs include didactic and clinical experiences related to opioids, tissue damage, and subjects related to anesthesia.

The main professional association for pain management NPs is the American Society of Pain Management Nursing (ASPMN). Representing both pain management nurses and pain management NPs, ASPMN is dedicated to promoting best practices in pain management, and they offer certification specifically for pain management NPs. Pain management NPs may also look to the AANP’s SPG in pain management.

Transplant

Transplant NPs work with transplant patients during the pre-transplant and post-transplant stages of their care. Differentiated from transplant nurses, transplant NPs enjoy a wider scope of practice that allows them to effectively assess, diagnose, treat, and follow-up with patients. Transplant NPs can work in clinics, hospitals, and outreach centers.

Most transplant NPs will complete their MSN or DNP in an area such as acute care or adult-gerontology, then focus on gaining work experience in transplant services. Currently, there are not many dedicated degree or certificate programs for transplant NPs. But there are some fellowship programs designed specifically for transplant NPs, and they cover areas such as pathophysiology, immunosuppressants, infectious diseases, and assessment and intervention components for each organ system.

The main professional association for transplant NPs is the International Transplant Nurses Society (ITNS). Founded in 1992, it counts both transplant nurses and transplant NPs among its membership. Other professional societies of note for transplant NPs include the American Society of Transplantation (AST) and the American Society of Transplant Surgeons (ASTS).

Matt Zbrog

Writer

Matt Zbrog is a writer and researcher from Southern California, and he believes nurse practitioners (NP) are an indispensable component of America’s current and future healthcare workforce. Since 2018, he’s written extensively about the work and advocacy of NPs, with a particular focus on the rapid growth of specialization programs, residencies, fellowships, and professional organizations. As part of an ongoing series on state practice authority, he’s worked with NP leaders, educators, and advocates from across the country to elevate policy discussions that empower NPs. His articles have featured interviews with the leadership of the American Association of Nurse Practitioners (AANP), the National Association of Pediatric Nurse Practitioners (NAPNAP), and many other professional nursing associations.