The Process to Become a Nurse Practitioner – What to Know

Expert Advice on Becoming a Nurse Practitioner: Benita Walton-Moss, PhD

Dr. Benita Walton-Moss has been a nurse practitioner for over 30 years. Currently, she is a clinical associate professor at the University of Southern California Suzanne Dworak-Peck School of Social Work. 

Before this role, she served as the director of the master’s program at Johns Hopkins University School of Nursing. Her clinical and research interests focus on healthcare for vulnerable populations, including women’s health and substance abuse, and she is enthusiastic about community-based research. 

Throughout her long career as a nurse practitioner and educator, Dr. Walton-Moss has developed a keen understanding of this role: “Nurse practitioners are very different from physicians. We emphasize different things that physicians and other healthcare providers don’t. All these roles are complementary, and we work as a team to care for the patient, but the key is the patient should be at the center of everything, always,” she says.

According to Dr. Walton-Moss, deciding to become a nurse practitioner should include careful introspection and research. “First, ask yourself, why do you want to be a nurse practitioner? The most typical answer I hear is, I want to develop my career, or this is the next step. But it needs to be more than that. Find out what makes you passionate about becoming a nurse practitioner,” she says. “We need people who are passionate about helping the underserved because that’s where most of the need is. We also need people who are passionate about providing primary care, promoting wellness, and preventing illness.”

She continues, “The most important thing is to be very comfortable in your role as a nurse because becoming a nurse practitioner is advanced training as a nurse. So you are a nurse first. You’re building on all of the skills you’ve and wealth of experience gained as a nurse to then learn how to diagnose and treat patients on your own.” 

To help nurses determine if this role is for them, she recommends shadowing a nurse practitioner to learn what day-to-day work looks like.

Post-Master’s Certificates for Nurse Practitioners

Each nurse practitioner specialization has its own education and certification requirements. If a student completes a general nurse practitioner program such as family practice, they can later choose to earn an additional post-master’s certification in a chosen specialty. 

When completing a post-master’s certificate, many programs require a gap analysis to determine which classes a student must complete. This is a thorough, formal process that compares courses taken in the original master’s program to classes in the new program. In addition to looking at content, a gap analysis considers clinical experience hours completed as part of the course. This ensures a comprehensive understanding of an applicant’s education and experience. Once the analysis is complete, students are informed of which classes they are required to take as well as how many clinical hours they must complete. 

In addition to a gap analysis, many programs will accept transfer credits. Students will often have to submit a syllabus for the course they wish to transfer. The new school will evaluate the class content and determine if there is a suitable equivalent. If there is, the school will award the student credit for already completing the class. There is often a limit on the number of transfer credits allowed per course. Students can earn their degree or certificate much quicker and save money because they receive credit for classes they have already finished.

Become a Family Nurse Practitioner (FNP)

Education: MSN, Post-master’s Certificate, or DNP Programs

Family nurse practitioners are primary care providers to patients of all ages. They have the training to care for infants up to the most elderly clients. They are often a patient’s first point of contact whenever they have a medical issue. 

• Sample program: Baylor University’s BSN-to-DNP FNP program at the Louise Herrington School of Nursing can be completed through online coursework and in-person clinicals. Most students complete this degree in three years and four months. The motto of the school is Learn. Lead. Serve.® Graduates of this program have strong servant leadership qualities and a commitment to care for their communities. 

Family NP Certifications and Eligibility

Certification for FNPs is offered through the American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners (AANP). 

To be eligible for the ANCC FNP-BC certification candidate must have:

• A current, active RN license
• A master’s, post-graduate certificate or doctor of nursing practice (DNP) from a family nurse practitioner program accredited by the Commission on Collegiate Nursing Education (CCNE), the Accreditation Commission for Education in Nursing (ACEN), or the National League for Nursing (NLN) Commission for Nursing Education Accreditation (CNEA), with a minimum of 500 FNP faculty-supervised clinical hours 
• Graduate courses in advanced physiology/pathophysiology, advanced health, and advanced pharmacology

The AANP FNP certification eligibility requirements are:

• A current and active RN license
• A master’s, post-graduate certificate or doctor of nursing practice (DNP) from a family nurse practitioner program accredited by the Commission on Collegiate Nursing Education (CCNE), the Accreditation Commission for Education in Nursing (ACEN), or the National League for Nursing (NLN) Commission for Nursing Education Accreditation (CNEA), with a minimum of 500 FNP faculty-supervised clinical hours 
• Complete the nationally recognized competency of Family/Across the Life Span
• Official transcripts

FNP Certification Renewals

To recertify the FNP AANP certification, candidates must provide proof of 1,000 hours of clinical practice as a family nurse practitioner within a five-year period, 100 hours of continuing education, of which 25 must be in pharmacology, and a current RN or APRN license. Alternatively, candidates may recertify by retaking the FNP exam.

The renewal requirements for the ANCC FNP-BC certification must be completed every five years and include a current RN license, current ANCC certification, 75 hours of continuing education, of which 25 must be in pharmacology, and complete one of the eight ANCC certification professional development categories in its entirety.

Become a Neonatal Nurse Practitioner (NNP)

Education: MSN, Post-master’s Certificate, or DNP Programs

Neonatal nurse practitioners focus on caring for babies who are born sick or premature. 

• Sample program: Old Dominion University offers an MSN in NNP. This distance learning program covers both acute and chronic care of the tiniest patients. This is primarily an online program with some campus visits for intensives and labs. All clinicals take place at approved sites near the students’ homes. 

NNP Certifications and Eligibility

The National Certification Corporation (NCC) offers the only NNP certification. The eligibility requirements include:

• Current, active, and unencumbered US nursing or advanced practice nursing licensure
• Complete an accredited graduate nurse practitioner program that meets NCC program requirements and prepares neonatal nurse practitioners; the program can be a master’s DNP or post-master’s
• Be within eight years of graduating from your program

NNP Certification Renewals

To renew an NCC NNP certification, the holder must have a current, active, and unencumbered US nursing or advanced practice nursing license, complete the Continuing Competency Assessment, earn continuing education credits based on the outcome of the assessment, and submit a completed maintenance plan. Renewals must be completed every three years.

Become a Pediatric Nurse Practitioner (PNP)

Education: MSN, Post-master’s Certificate, or DNP Programs

Babies, children, and adolescents aren’t just small adults. They have unique healthcare needs that pediatric nurse practitioners (PNPs) can meet. PNPs can either provide primary care, acute care for urgent needs, or mental health care. 

• Sample program: Johns Hopkins University School of Nursing provides one of the top PNP-DNP programs in the country. There are two program options: pediatric primary care and a dual in pediatric primary care and acute care. Applicants can have a BSN or MSN to be eligible for this program. 

PNP Certifications and Eligibility

PNPs can earn a primary care, acute care, or mental health specialist certification through the Pediatric Nursing Certification Board (PNCB). 

To be eligible for the PNCB Acute Care Certified Pediatric Nurse Practitioner (CPNP-AC) or Primary Care Certified Pediatric Nurse Practitioner (CPNP-PC) candidates must:

• A current, active RN license
• A master’s, post-graduate certificate or doctor of nursing practice (DNP) from a nurse practitioner program accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN), with a minimum of 500 acute or primary care pediatric faculty-supervised clinical hours 

The Pediatric Primary Care Mental Health Specialist (PMHS) certification eligibility requirements are:

• A current, active RN license
• Have a current APRN certification such as primary care PNP, FNP, or ​​PMHNP-BC
• A master’s, post-graduate certificate or doctor of nursing practice (DNP) from a primary care PNP, FNP, psychiatric NP, child/adolescent psychiatric CNS, or child/adolescent mental health CNS program accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN)
• 2,000 hours of pediatric developmental, behavioral, and mental health (DBMH) clinical practice experience
• 30 hours of pediatric DBMH continuing education or one graduate level pediatric DBMH course of at least two credits in the past five years

PNP Certification Renewals

PNCB CPNP-AC and CPNP-PC holders must recertify annually. To recertify, candidates must complete 15 contact hours of continuing education. Every seven years, certification holders must submit 15 hours of pediatric pharmacology and complete four required PNCB modules. 

PMHS certification holders must recertify every three years by maintaining an APRN certification, an unencumbered and active RN license, and completing 45 contact hours of pediatric developmental/behavioral/mental health (DBMH), of which 15 contact hours must be pediatric psychopharmacology.

NP Subspecializations with Certification

Within each specialization, nurse practitioners can further narrow their care field by working in a subspeciality. The primary subspecialties and certifying organizations are:

Acute Care NPs

Short-term, episodic illnesses can be managed by acute care NPs. Scope of practice can include assessment, diagnosis, treatment, and management. Certification is through the American Association of Critical-Care Nursing (AACN). Certifications are available in adult, pediatric, and neonatal specializations. 

• Eligibility: To be eligible for any of the AACN acute/critical care certifications, candidates must have a current, unencumbered,  and active RN license and have completed a master’s, post-graduate certificate or doctor of nursing practice (DNP)  program accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN), with a minimum of 500 faculty-supervised clinical hours 
• Renewal: Renewals must be completed every three years. To renew, candidates must have either 1,000 practice hours and 150 continuing education points, 1,000 practice hours along with 25 pharmacology continuing education hours and retake the exam, or 150 continuing education hours and retake the exam. 

Cardiology NPs

Cardiology NPs work with patients who have heart or vascular conditions. These can include patients of all ages, from babies to elderly adults. Certification can be obtained through the American Board of Cardiovascular Medicine (ABCM).

• Eligibility: To be eligible to take the exam for Cardiovascular Nurse Practitioner Level IV (CVNP-BC) certification, candidates must be licensed nurse practitioners working in cardiology settings. 
• Renewal: Recertification for CVNP-BCs is required every three years. To be eligible to recertify, certification holders must submit an application, pay a fee, and submit proof of 30 hours of continuing education. 

Dermatology NPs

Diseases that relate to skin, hair, or nails can be treated by dermatology NPs. The Dermatology Nurse Practitioner Certification Board (DNPCB) certifies Dermatology Certified Nurse Practitioner (DCNP) in this field. 

• Eligibility: The eligibility requirements to sit for the DCNP exam include a master’s or doctoral degree in nursing, current NP state licensure, national certification as an NP, and a minimum of 3,000 hours of recent dermatology NP practice within the last three years, with current practice in dermatology
• Renewal: DCNP certification must be renewed every three years. To renew, certification holders must have a valid RN license, have three years of nurse practitioner dermatology practice, have national NP certification, and either retake the exam or have 60 continuing education credits in dermatology. 

Emergency Care NPs

Emergency care NPs work as part of a team to evaluate and provide care to patients in emergencies. Many NPs in this field work in emergency rooms. Certification is through the American Academy of Nurse Practitioners (AANP).

• Eligibility: There are three options for certification as an emergency nurse practitioner through the AANP. The first is 2,000 hours of direct, emergency care clinical practice hours as a family NP in the past five years, evidence of 100 hours of continuing emergency care education, and a minimum of 30 continuing emergency care education hours in emergency care procedural skills within those five years. The second option is either complete an academic emergency care graduate/post-graduate NP program from an accredited nursing program or complete a dual FNP/ENP graduate/post-graduate certificate program from an accredited nursing program. The final option is to complete an approved emergency fellowship program. 
• Renewal: Every five years, emergency nurse practitioners must renew their credentials. To renew, they must have 1,000 hours of clinical practice as an emergency nurse practitioner within a five-year period, 100 hours of continuing education of which 25 must be in pharmacology, and a current RN or APRN license. Alternatively, candidates may recertify by retaking the emergency nurse practitioner exam.

Forensic NPs

Trauma cases or any patients that require obtaining evidence may be cared for by forensic NPs. Often, forensic nurse practitioners can be called on to testify in court. Certification as an Advanced Forensic Nurse Certified (AFN-C) is available from the Forensic Nursing Certification Board (FNCB).

• Eligibility: To be eligible for the AFN-C certification, candidates must hold a master’s degree or doctoral degree from a program accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN) and have a current RN license. They must also have either 12 credit hours of forensic nursing coursework and 300 clinical hours of forensic nursing or 90 continuing education credits and two years and 2,00 hours of forensic nursing practice. 
• Renewal: Every three years AFN-Cs must recertify. The requirements are to have a current and unencumbered RN license, be currently certified with the FNCB, have 1,000 hours of forensic nursing practice, and have either 45 continuing education credits or retake the exam. 

Gastroenterology NPs

Gastroenterology NPs are experts on all things related to the gut, the digestive system, or the gastrointestinal (GI) tract. They can be certified by the American Board of Certification for Gastroenterology Nurses (ABCGN) as a Certified Gastroenterology Registered Nurse (CGRN). While this isn’t an NP-specific certification, NPs can earn it to demonstrate competency in this field. 

• Eligibility: The CGRN exam is open to registered nurses currently engaged in gastroenterology or endoscopy. To sit for the exam, candidates must have at least two years of full-time work or 4,000 hours of work in this field. They must also submit the names and contact information of two practitioners who can verify their work experience. 
• Renewal: To be eligible for recertification, CGRNs must currently be employed in the field and have at least two years of full-time work or 4,000 hours. They must also have 75 hours of continuing education, of which 60 must be GI-specific. Recertification must be done every five years. 

Hospice and Palliative Care NPs

End-of-life care can be provided by hospice and palliative care NPs. Not only do NPs in this field know how to expertly care for patients who are nearing the end of their lives, but they are also outstanding at helping family members through the process. Advanced Certified Hospice and Palliative Nurse (ACHPN) Certification is available through the Hospice and Palliative Credentialing Center (HPCC).

• Eligibility: The ACHPN requires that HPCC applicants hold a current, unrestricted active APRN license or APRN certification in the United States and have completed an accredited graduate, post-graduate, DNP or clinical nurse specialist (CNS) program. The degree must have the key elements of APRN preparation, including completing three separate comprehensive graduate-level courses in advanced pathophysiology, advanced health assessment, and advanced pharmacology. Applicants must also have 500 hours as an NP or CNS with hospice and palliative advanced nursing practice in the past 12 months or 1000 hours out of the last 24 months before applying for the exam.
• Renewal: Recertification for HPCCs is every four years. To recertify, applicants must have a current HPCC certification, have an unrestricted RN license, earn 1000 professional development points, and have 500 hours as an NP or CNS with hospice and palliative advanced nursing practice in the past 12 months (or 1,000 hours out of the last 24 months) before applying for the exam.

Nephrology NPs

Kidneys require specialized care from practitioners such as nephrology NPs. NPs in this field often work with patients on dialysis or awaiting a transplant. Certified Nephrology Nurse – Nurse Practitioner (CNN-NP)  can be obtained from the Nephrology Nursing Certification Commission (NNCC).

• Eligibility: To be eligible for the CNN-NP certification, candidates must hold a full and unrestricted license as a registered nurse in the United States and have 2,000 hours and two years as a nurse practitioner practicing in nephrology within two years before submitting an application. Applicants must also possess a minimum of a master’s degree in nursing and complete 60 contact hours of approved continuing education in nephrology within the last two years. 
• Renewal: To recertify, every five years, CNN-NPs must submit an application, pay the renewal fee, and either submit 150 hours of continuing education from approved providers or retake the exam. 

Oncology NPs

Oncology nurse practitioners care for cancer patients. They can diagnose, treat, and provide ongoing care. Advanced Oncology Certified Nurse Practitioners (AOCNP) are certified through the Oncology Nursing Certification Corporation (ONCC).

• Eligibility:  The AANP eligibility requirements to sit for the AOCNP exam include a current unencumbered nursing license and a graduate-level oncology course of at least two credits or 30 hours of oncology continuing education within the past five years. Applicants must have either earned a degree from an accredited NP program with a concentration in oncology and have 500 hours of practice as an adult oncology NP in the last five years or a degree from an accredited nurse practitioner program with a concentration in adult (primary or acute), family (across the lifespan), gerontology, or women’s health and 1,000 hours of practice as an adult oncology NP in the last five years.
• Renewal: Every four years, AOCNPs must renew their certification. They must have at least 1,000 hours of practice as an adult oncology NP in the previous four years. They must also have either taken the Renewal Assessment and earned the required renewal points or take the exam again.  

Pain Management NPs

Chronic pain patients can receive care from pain management NPs. Professionals in this field work closely with patients to help them keep their long-term pain under control. Advanced Practice Nurses specializing in pain management  (AP-PNM) can earn recognition through the American Society for Pain Management Nursing (ASPMN). 

• Eligibility: The ASPMN awards the AP-PNM by fulfilling the activity requirements of the Advanced Practice Portfolio and having met the eligibility requirements. To be eligible, applicants must hold a current APRN license or advanced practice nursing position, possess current entry-level ANCC pain management certification, hold a master’s, post-master’s, or doctorate degree as a nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, or certified nurse midwife, and demonstrate professional contributions to the advancement of AP-PMN. Applicants must have at least 100 advanced practice points. Points are accrued through activities such as continuing education, program or project, research, education/publication, teaching, professional organizations, or professional certifications/academic education
• Renewal: The AP-PNM designation must be renewed every five years. To renew, candidates must hold a current APRN license or advanced practice nursing position, maintain current entry-level ANCC pain management certification and demonstrate professional contributions to the advancement of AP-PMN. 

Transplant NPs

NPs who work in transplant medicine work with patients before or after transplants. Their care scope includes diagnosis, treatment, and follow-up with patients. They are certified as Clinical Transplant Nurses (CCTN) by the American Board for Transplant Certification (ABTC). While the CCTN certification is open to all eligible registered nurses, it can benefit NPs who wish to demonstrate their proficiency in this field. 

• Eligibility: The eligibility requirements for  CCTN certification include 12 months of general experience as an RN and an additional 12 months of experience while working as a transplant nurse.
• Renewal: Certification as a CCTN is valid for three years. To renew, certification holders must have 60 Continuing Education Points for Transplant Certification (CEPTC), fill out an application, and pay the renewal fee.