In a rapidly evolving healthcare system where the needs of a diverse patient populous are broadening, the expansion of the nurse practitioner (NP) workforce is going to be essential. When nurses decide to enter the NP education pipeline to help meet the workforce need, they can opt for many different types of programs.
This guide will help prospective NPs understand what programs are available according to their interests, explore which popular subspecialties are available, and learn how to go about gaining mastery of the subspecialty.
Developed by the National Council of State Boards of Nursing (NCSBN), the Consensus Model for APRN Regulation provides universal guidelines for licensing, accrediting, certifying, and educating APRNs nationwide. To this end, NPs are one of the four APRN “roles,” with the other three roles being nurse anesthetist, certified nurse specialist, and nurse midwife. Regardless of the role chosen, all APRNs are required to choose training within a population focus. Population foci include:
- Family, individual, or across the lifespan (FNP)
- Adult-gerontology–primary or acute (AGNP)
- Neonatal (NNP)
- Pediatrics–primary or acute (PNP)
- Women’s health/gender-related (WHNP)
- Psychiatric-mental health (PMHNP)
Concentrating on a population enables APRNs to acquire the specialized knowledge, clinical judgment, and skills needed to treat and provide care to patients within that focus successfully. Typically, NP degree programs train students to treat a specific segment of the population, so it is essential for prospective NPs to understand which population they want to work with before applying. An NP can switch their population focus after graduation, but only by enrolling in and completing an additional degree program, such as a post-master’s certificate program.
Prospective NPs looking for degree programs will often see population foci titled as “specialties” on university websites. Students wishing to become NPs typically complete core nursing coursework followed by specialty coursework and clinical hours according to their population focus.
Outside of the population focus, many programs offer subspecialties. Some NP students know they want to work with a targeted group or in a specific realm of knowledge within the population focus. These students can add subspecialties to their degree program or pursue subspecialties following graduation.
NP subspecialties are vast and constantly changing to match evolving patient needs. Generally, nurse practitioners looking to subspecialize can do so by adding 6 to 12 credits in a specific topic. While many university websites explicitly mention subspecialties, some refer to them as specializations or concentrations. Listed below are descriptions of popular NP subspecialties, examples of programs offering the subspecialty, and any certification information related to it.
Cardiology
Cardiology is most commonly a subspecialty of AGNP. Cardiology nurses specialize in caring for individuals with cardiovascular disease. Cardiology NPs learn how to assess, diagnose, and help patients to manage issues related to high cholesterol, high blood pressure, congestive heart failure, heart attack, arrhythmias, and other conditions related to the heart.
Duke University and the University of Southern Alabama offer cardiology subspecialties within degree programs. An NP can also become a cardiology nurse through post-graduate fellowships.
- Certification:American Board of Cardiovascular Medicine
Dermatology
Dermatology NPs (DCNP) assess, evaluate, diagnose, and treat superficial to serious issues related to the skin, hair, and nails. It is common for FNPs and AGNPs to choose to move into the DCNP subspecialization. Becoming a DCNP can be done through practical experience, or through fellowship programs offered by the Lahey Clinic or the South Texas Dermatology Residency.
- Certification:Dermatology Nurses Association.
Emergency Medicine
Often an extension of an FNP program, emergency NPs (ENPs) are trained to serve patients of all ages who are experiencing acute or life-threatening health issues. ENPs are trained to provide emergency care in urgent care, emergency departments, and fast-track health centers.
Emory University and the University of Alabama Birmingham (UAB) let students add the subspecialty to their FNP program, while Drexel University offers an ENP post-master’s certificate.
- Certification:American Academy of Nurse Practitioners
Nephrology
The nephrology subspecialization is for NPs wishing to work with patients experiencing health issues related to the kidneys and is often an extension of the FNP, AGNP, and PNP population foci. Within nephrology, NPs can choose to gain expertise in transplantation, conservative management, renal replacement therapy, hemodialysis, or extracorporeal therapies.
NPs looking to subspecialize in nephrology can take kidney-focused electives during their MSN program or can work and take continuing education courses following graduation.
- Certification:Nephrology Nursing Certification Commission.
Oncology
Related to AGNP and PNP foci, the oncology subspecialization prepares NPs to work with individuals with cancer. Oncology NPs can specialize in many different areas of cancer treatment including bone marrow transplantation, chemotherapy, radiation, surgery, and preventative or early detection.
Many university MSN and DNP programs have oncology subspecialties, including the University of Alabama at Birmingham (UAB), Columbia University, and Duke University. Post-graduate fellowships in oncology, like the one at MD Anderson Cancer Center, are available as well.
- Certification:Oncology Nursing Certification Corporation
Orthopedics
An orthopedic NP (ONP) is trained to take care of patients with diseases and disorders of the musculoskeletal system. As a common extension of the AGNP focus, ONPs work with conditions like arthritis, fractures and breaks, and joint replacement surgeries. They may assist doctors with surgery and can also contribute to post-surgery or post-injury recovery. Universities like Duke offer specialized training that can be added to a degree program.
- Certification:Orthopaedic Nurses Certification Board
Palliative Care
Palliative care NPs (PCNPs) work to improve care and reduce the suffering of patients and families experiencing illnesses that are terminal, chronic, or serious. Training to become a PCNP can be an extension of AGNP-AC, AGNP-PC, or PMHNP degree programs.
UAB offers a PCNP subspeciality, the University of Illinois-Chicago offers a post-master’s certificate program, and Massachusetts General Hospital offers a PCNP fellowship program.
- Certification:Hospice & Palliative Credentialing Center
Psychosomatic Medicine and Consultant-Liaison Psychiatry
Psychosomatic medicine is a subspecialization of the FNP and PMHNP foci and exists where physical and mental illnesses come together. Also known as consultant-liaison psychiatry NPs, psychosomatic medicine NPs perform consultations and give recommendations to hospitalists regarding complex medically ill patients that co-present within psychiatric disorders.
Additional training in psychosomatic medicine is not required to work in the field, but psychosomatic medicine NPs can pursue continuing education through organizations like the Academy of Consultation-Liaison Psychiatry. At the time of this writing, there is no official certification body for psychosomatic medicine NPs.
Surgery
Surgical NPs are essential during routine, difficult, elective, and life-saving surgeries. They are trained to prepare patients for surgery and help them with post-operative care following a surgical procedure. Often extensions of the acute AGNP or PNP population foci, surgical NPs can choose to focus their surgical assistant expertise into a specific realm of surgery, such as orthopedic, pediatric, plastic, cardiac. Working in the field following graduation is a common way to become a surgical NP, although NPs can purse surgical fellowships like the one offered by the University of California, San Francisco.
No NP-specific certifications currently exist, but surgical nurse certification is available from the following three organizations:
- Medical-Surgical Nursing Certification Board – Certified medical-surgical registered nurse (CMSRN)
- American Association of Critical Care Nurses – Cardiac surgery certification (adult)
- Plastic Surgical Nursing Certification Board – Certified plastic surgical nurse
