Nurse Practitioners (NPs) are advanced practice registered nurses who provide comprehensive care to patients. Not only do nurse practitioners provide diagnostic care and treatment, but they also focus on preventive health maintenance. Nurse practitioners are first and foremost nurses, which means patient education and holistic care is a large part of their practice. Depending on the state in which they practice, oversight by physicians may or may not be required.

Why Are Nurse Practitioners So Important?

Nurse practitioners can diagnose and treat patients as well as perform procedures. They differ from physicians in that their patient care approach is more holistic. Being nurses, they gather information about a patient not only to include physical symptoms but psychosocial and environmental information as well. They are skilled in education and therefore can spend time teaching patients and family about disease processes, treatments, and healthcare prevention as well as diagnosing acute health issues.

According to the American Association of Nurse Practitioners, nurse practitioners can also help lower the cost of healthcare, as patients who use NPs as their primary care provider have fewer emergency room visits and shorter hospital stays. Additionally, they help to fill the gap with the primary care physician shortage in the United States. They also tend to have high patient satisfaction.

How to Become a Nurse Practitioner

Nurse practitioners are advanced practice registered nurses who have completed a Master’s of Science in Nursing (MSN) or a Doctor of Nursing Practice program (DNP).

To advance to a master’s degree or doctoral in nursing, a student must complete an accredited nursing program and obtain a Bachelor’s of Science in Nursing (BSN). Upon graduating with a nursing degree, successful completion of the NCLEX-RN is needed for licensure. The length of time it takes to obtain an MSN depends on the nurse’s starting point:

• Nursing students enrolled in a BSN program complete in about four years
• RN to BSN takes about two years
• BSN to MSN takes about two years
• BSN to DNP takes three to four years
• MSN to DNP takes one to two years

Additionally, both online programs and classroom programs are available to accommodate students. Both types have pros and cons depending on students’ needs, therefore researching individual schools is encouraged.

Nurses who enjoy practicing independently and who wish to diagnose and prescribe while still utilizing nursing skills can advance to the field of advanced practice nursing. Nurses who seek to pursue their NP should value autonomy, integrity, and leadership.

Educational Prerequisites

Some graduate programs require nurses to gain a few years of clinical experience before enrollment. Some schools allow nurses to work concurrently during the program. Regardless, obtaining clinical experience is crucial as it prepares the future nurse practitioner to be able to address a multitude of medical concerns and situations.

Nurses are also required to have a baccalaureate nursing degree (BSN). Nurses who hold an Associate’s Degree in Nursing (ADN) will need to obtain a BSN. There are many opportunities to obtain a BSN. Many healthcare organizations also assist employees in advancing degrees and assist in tuition reimbursement, cost of books, and granting time off for nurses.

Nurse Practitioner Program Specialties

There are many clinical areas in which a nurse practitioner can work. From primary care to specialty care, acute care, and long-term care, nurse practitioners are valuable members of the patient care team. Some NP programs include training in certain specialties; otherwise, certification can be obtained through the American Nurses Credentialing Center (ANCC). Some areas include:

• Acute Care
• Gerontology
• Family Medicine
• Neonatal Care
• Pediatrics

Nurse Practitioner Careers and Outlook

Nurse practitioners are valuable members of the healthcare team. As providers, teachers, leaders, and patient advocates, nurse practitioners approach patient care in a holistic manner to ensure patient needs are met at the time of visit.

Nurse Practitioner Responsibilities & Duties

NPs have many responsibilities and duties. These may include:

• Provide acute (i.e. illness) and preventive care (check-ups)
• Take a patient history
• Maintain their own patient panel
• Order diagnostic testing/therapies
• Order prescriptions
• Assist in surgery
• Admit, transfer and discharge hospitalized patients
• Collaborate with specialty departments as needed, refer patients appropriately
• Assess patient/family needs
• Provide education to patients/families
• Promote family-centered patient care

A relatively new specialty, the clinical nurse leader (CNL) is a master’s level educated nurse who is focused on improving the quality of care for a specific set of patients. Working together with a multi-disciplinary team of physicians, pharmacists, social workers, clinical nurse specialists and nurse practitioners, the clinical nurse leader collects and evaluates treatment results and works to improve those outcomes by advocating for evidence-based change. Unlike the clinical nurse specialist, the clinical nurse leader has an advanced knowledge in general medicine as opposed to one primary discipline, and often manages other nursing staff and serves as a resource to the entire care team.

Clinical nurse leaders make it their mission to identify ways to improve the quality of patient care by consistently evaluating patient outcomes, assessing cohort risk, changing care plans, advocating for change and mentoring fellow nurses. While other nurse leadership positions may focus on managerial or administrative tasks, the clinical nurse leader focuses on patient care.

According to HealthLeaders Media, units with clinical nurse leaders have experienced the following benefits:

• Shorter patient lengths of stay
• Lower readmission rates
• Improvements in quality and patient safety, such as decreased infection and fall rates
• Lower RN turnover

In addition, a core principle of the clinical nurse leader role is identifying and implementing methods for reducing healthcare costs for the institution. In fact, as part of their 2015 survey of certified CNLs, the Commission on Nurse Certification found that the majority of clinical nurse leaders report often suggesting a cost-saving idea or process that improves institutional efficiency.

RNs interested in becoming clinical nurse leaders requires strong problem solving and critical thinking skills, which are needed in evaluating patient results and making strategic changes to improve the quality of care for their patients. Unlike other leadership positions, the clinical nurse leader is a patient-facing role, so nurses should enjoy working with patients as well as mentoring their fellow nurses. A relatively new specialty, clinical nurse leaders have the opportunity to shape a new career in nursing.

What Are the Educational Requirements for Clinical Nurse Leaders?

The clinical nurse leader is an advanced clinician with education at the master’s degree level. Graduate level education is necessary because the CNL must bring a high level of clinical competence and knowledge to the point of care and also to serve as a resource for the entire nursing team. The MSN degree will prepare nurses for this advanced role.

In order to earn an MSN degree, nurses must first complete their Bachelor of Science degree and pass the NCLEX-RN exam. RNs may then advance to a Master’s of Science Clinical Nurse Leader program, in which they will take advanced courses in pathophysiology, clinical assessment and pharmacology. The final step in becoming a clinical nurse leader is obtaining the CNL certification from the Commission on Nurse Certification.

Find a clinical nurse leader program.

Educational Prerequisites

Requirements for clinical nurse leader MSN programs vary from school to school. The American Association of Colleges of Nursing lists the schools currently offering a clinical nurse leader MSN degree program. These schools offer a variety of program options, including online and traditional in-person classroom programs, as well as full-time and part-time courses of study.

In general, the curriculum for a clinical nurse leader program includes the following courses and clinical practice requirements:

• Advanced Pharmacology
• Advanced Pathophysiology
• Quality and Safety in Healthcare
• Research Methods & Biostatistics
• Advanced Health Assessment & Diagnostic Reasoning
• Advanced Ethical Issues and Decision Making
• The Business of Healthcare
• Evaluation of Health Outcomes
• Advanced Epidemiology: Tracking Health & Disease

Are Any Certifications or Credentials Needed?

Most clinical nurse leader positions require a Clinical Nurse Leader Certification, offered by the American College of Colleges of Nursing’s Commission on Nurse Certification. Eligibility requirements for this certification include an active RN license and completion of a master’s or post-master’s degree program in nursing with a focus on the clinical nurse leader role.

What Does a Clinical Nurse Leader Do?

A clinical nurse leader focuses on improving the quality of patient care outcomes. They work together with a patient’s entire care team to collect and analyze treatment results, assess risk, stay up-to-date on the latest technologies and treatment innovations and then incorporate that knowledge into improved systems for patient care. Clinical nurse leaders become team leaders, educators and advocates for patients, continually seeking new ways to improve patient outcomes.

A typical job posting for a clinical nurse leader position would likely include the following qualifications, among others specific to the type of institution and patient population:

• Master’s degree level education, active RN license and Clinical Nurse Leader Certification
• Prior professional nursing experience with demonstrated leadership capabilities
• Strong problem solving and organizational skills needed to analyze treatment results and develop evidence-based systems and solutions
• Strong interpersonal and communication skills for working with patients, caregivers and medical teams on an ongoing basis, as well as experience managing a nursing team

To search and apply for current clinical nurse leader positions, visit our job boards.

What Are the Roles and Duties of a Clinical Nurse Leader?

Day-to-day job duties for a clinical nurse leader include the following:

• Collect and evaluate treatment results and develop and implement evidence-based solutions to improve care and patient outcomes
• Perform risk assessments and analyses to ensure patient safety
• Responsible for ensuring cost effective care and address barriers to efficiency
• Remain up-to-date on relevant research to ensure patients benefit from the latest innovations in care
• Serve as generalized knowledge resource to entire care team, often directly managing nursing staff
• Provide direct patient care and patient education on an ongoing basis

Workplace Settings

There are a number of settings in which clinical nurse leaders work, including hospitals, private clinics and acute care institutions and research facilities. They may also work as nursing educators in medical colleges, where they develop and implement educational programs aimed at improving the quality of patient care.

Clinical Nurse Leader Salary & Employment

An emerging advanced nursing role, there is a significant demand for certified clinical nurse leaders who will improve patient safety and outcomes while providing cost-efficiency measures and nurse leadership for the institution.

Clinical nurse leaders can expect a median salary of around $75,000, with a range of $50,975 – $100,094. Geographical location is the biggest factor impacting a clinical nurse leader’s salary, followed by career length and experience level.

While a fairly new specialty, many healthcare employers seek clinical nurse leaders who can create new policies and procedures to improve patient outcomes. Further, an increasing number of healthcare facilities are looking for nursing professionals with higher degrees, which means the demand for nurses with this type of education, including the clinical nurse leader, will likely rise.

Simply put, an APRN is an Advanced Practice Registered Nurse. This means that this type of RN has earned a graduate-level degree such as a Master’s of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP), and has been specially trained in one of the four recognized APRN roles. Many RNs who hold an ADN or BSN and wish to progress their careers choose to become APRNs so that they can dive into a more focused nursing practice with a higher degree of autonomy.

According to the APRN Consensus Model, there are four roles an APRN can hold: certified nurse-midwife (CNM), certified registered nurse anesthetist (CRNA), clinical nurse specialist (CNS), and nurse practitioner (NP). While many people use the terms ‘APRN’ and ‘NP’ interchangeably, it’s of note to remember that while an NP is an APRN, an APRN isn’t always an NP, as described above.

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What Is the APRN Consensus Model?

The National Council of State Boards of Nursing (NCSBN) developed the APRN Consensus Model to provide guidance for states on regulating and defining the Advanced Practice Registered Nurse (APRN) role. While many states have adopted the model, APRNs must be aware that there can still be fluctuation from state to state regarding which portions of the model have been adopted. Therefore, APRNs moving from one state to the next will need to brief themselves on the version of the model adopted by their new state.

The following may help clear up any questions that students or APRNs may have on the APRN Consensus Model:

How Does the APRN Consensus Model Define an APRN?

The model states that an APRN is a registered nurse who has completed an accredited graduate degree program in one of the four approved roles, has passed a national certification exam, and has obtained a license to practice in one of the four APRN roles, which are:

• Certified Nurse Midwife (CNM)
• Certified Nurse Specialist (CNS)
• Certified Registered Nurse Anesthetist (CRNA)
• Certified Nurse Practitioner (NP)

APRN in Specialized Population Foci

Beyond these four APRN roles, there are several population foci that nurses can specialize in. This means that APRNs will complete education in one of the four roles, and can also gain specialized knowledge in one of the six population foci, which include:

• Family/Individual Across Lifespan
• Adult-Gerontology
• Neonatal
• Pediatrics
• Women’s Health/Gender-Related
• Psychiatric-Mental Health

For example, a popular APRN role is a pediatric nurse practitioner, where the NP practices within the pediatric population.

While licensure as an APRN is granted at the role and population foci levels, students also have the option of entering an APRN specialty, which are areas of healthcare that exist outside the role and population foci. Examples of APRN specialties include oncology, emergency, nephrology, and more. Research various nursing terms and abbreviations.

Are All RNs with Graduate Degrees APRNs?

No, only RNs with an MSN or DNP in one of the four APRN roles (CNM, CNS, CRNA, and NP) are considered APRNs. RNs with graduate degrees in non-patient facing roles (such as healthcare administration) are not considered APRNs.

Housing is one of the most significant concerns for a travel nurse. There are a few options available, and it depends on the travel nurse agency/company regarding how accommodations are set up. Some companies provide housing (i.e., apartment, duplex, etc.). Some companies offer a housing stipend, or a fixed amount of money each month to apply towards housing.

First, nurses need to be aware of where their “tax home” is, as stipends are tax-free if working away from the tax home. Having a tax home is necessary to receive tax-free housing. A “tax home” is defined as the general vicinity of an individual’s primary place of work (regardless of where the primary residence is). Generally, the IRS considers someone traveling away from home (i.e., their “tax home”) if it exceeds one workday.

Different travel nurse agencies offer different stipends – it’s important to research what the living expenses are in a specific area to ensure housing is adequately covered. The General Services Administration (GSA) lists the maximum daily amount for lodging, meals, and incidentals with regards to travel expenses. The key word is MAXIMUM. It’s not required that a company pay employees the listed stipend. In fact, some travel nurse agencies offer higher hourly wages instead of housing stipends. Additionally, the GSA rates are based on short-term travel – usually less than a month. Travel nurse contracts can last three months or more.

Travel nurses have a broad range of responsibilities and duties, and specific tasks depend on the specialty in which the nurse is trained. General nursing responsibilities and duties include:

• Using the nursing process of assessing, diagnosing, planning, implementing, and evaluating to care for patients in a variety of healthcare settings
• Administering medications, fluids, assisting with activities of daily living and patient mobility
• Reviewing and interpreting diagnostic tests such as lab work and imaging
• Provide monitoring and oversight in all aspects of patient care
• Collaborating with physicians in developing a plan of care
• Assessing the psychosocial needs of patients and families
• Recognizing and intervening in clinically unstable patients
• Providing resources for patients and refer as necessary
• Educating patients and families in all areas of healthcare maintenance and prevention
• Working in assignments anywhere from eight to thirteen weeks (on average) in the U.S., one to two years if outside the U.S.
• Learning various patient care systems/documentation
• Providing immediate medical care and aid for large populations during times of war or disaster

Domestic and international travel nurses also have different characteristics specific to their roles.

Domestic Travel Nurses

• Work within the U.S.
• Typically work assignments that range from eight to thirteen weeks
• Can respond to areas of the U.S that experience natural disaster or disease outbreak

International Travel Nurses

International travel nurses should have excellent communication skills, should be open to new experiences and challenges, and should have a strong desire to learn. These nurses are responsible for performing a wide array of duties. As stated previously, the tasks an international nurse will have to perform depend entirely upon their medical specialty. Some of the more general or everyday tasks that international travel nurses will perform include administering medication, wound care and providing emergency medical services and care. Since there are often nursing shortages in many of the regions that international nurses travel to, another general role of these nurses is to educate family members and caretakers about the appropriate patient and medical care. In summary, international travel nurses:

• Work outside the U.S.
• Typically work assignments that range from one to two years
• Respond to areas that experience natural disasters or disease outbreaks, such as the Ebola outbreak in West Africa
• Provide medical care and aid to underserved, rural, and remote populations
• Usually, must wait for document processing before traveling

Travel Nurse Working Conditions

As with any career, there are positive and negative aspects to working as a travel nurse. Nurses can suffer from stress as they may carry a heavy patient load and have many critical decisions to make. Additionally, travel nurses may suffer from feelings of isolation since they tend to relocate often. Having a strong sense of independence and a support system available, even remotely, can help.

Additionally, nurses may work in high-risk areas that may expose them to workplace violence, blood-borne pathogens, and chemicals. Travel nurses must always familiarize themselves and adhere to safety standards set by the organization.

International travel nurses can face different challenges. Travel nurses must be familiar with the country’s laws, geographic-specific diseases, and always keep their overall safety as a priority.

Despite these considerations, travel nursing can be immensely rewarding. Many organizations and staff nurses appreciate the help travel nurses offer. Travel nurses help relieve staff nurses from burnout, as can happen when working short-staffed.

International travel nurses are also highly appreciated. They provide medical care and assistance to many patients in remote settings who otherwise would have no access to healthcare. They help with relief efforts in war zones or after disaster events, which can be both rewarding and enriching.

Travel Nurse Salary and Employment

According to the American Nurses Association, as of 2015 fourteen states had mandatory nurse-patient ratios. Nurses are pushing for federal legislation supporting safe staffing and because of this, and if more states pass safe-staffing laws, nurses will be in even more demand. Travel nurses will help mend the current and projected nursing shortage. The Bureau of Labor Statistics projects a 16% overall growth for nurses until 2024, which is much faster-than-average growth for all occupations.

Travel nursing has many incentives for nurses regarding pay and benefits including:

• Travel reimbursement
• Free housing
• Bonuses
• Medical, dental, and vision coverage
• Retirement plans
• Assistance in obtaining passports/work visas
• Choice of location
• Selection of hours/shifts worked
• Competitive pay
• Higher-than-average pay for RNs

According to Indeed, the average yearly salary for a travel nurse is $75,109. However, since pay is competitive in travel nursing, some companies are offering salaries of around $100,00 annually for domestic travel nurses.

International travel nurses tend to have lower salaries than domestic, except for assignments in some middle eastern countries. This is because, for the most part, nurses tend to make less outside of the U.S.

Salary is dependent on the agency, and nurses should research each company to find the right salary and benefits that best fit their needs.

A trauma nurse is a nurse who specializes in the care of patients who suffer an acute injury or illness, whether it is accidental or intentional. Trauma nurses are skilled in caring for patients of all ages—from newborn to the elderly. Examples of cases that trauma nurses may be involved in are:

• Motor vehicle accidents
• Assault
• Gunshot wounds
• Stab wounds
• Environmental injuries such as a crush or penetrating injury
• Head injuries
• Physical or emotional abuse/neglect

Trauma nurses need to be able to function in a high-stress, chaotic environment while maintaining an outwardly calm demeanor. They must also be able to think and intervene quickly as trauma patients often arrive without easily identifiable diagnoses. Trauma patients can be critically unstable, so nurses in this specialty need to be able to intervene as rapidly as possible.

Effective communication is also essential in trauma nursing. Nurses must be able to multitask, often performing life-saving care while reporting to physicians and other members of the medical team. Communication is crucial in preventing errors during emergencies.

Trauma nurses also need to be able to handle the emotional strain that is involved with caring for trauma patients, as sometimes there are poor outcomes. Having a healthy support system and an outlet for stress is crucial to combat caregiver burnout.

Those interested in trauma nursing should first pursue a nursing degree through a two or four-year university. The trauma specialty houses nurses of all levels – from vocational nursing to nurse practitioners. For those pursuing registered nursing, obtaining an associate’s degree (ADN) or bachelor’s degree (BSN) in nursing is required. After completion of an accredited nursing program, successful completion of the NCLEX-RN is required for licensure.

Are Any Certifications or Credentials Needed?

Since trauma nursing involves caring for patients who can be critically ill, trauma nurses must not only be certified in basic life support (BLS) but advanced cardiac life support (ACLS) as well. Pediatric advanced life support (PALS) may also be required. These courses are available through the American Heart Association, but most workplaces arrange and cover the cost of required courses.

Additional certifications may also be required based on the place of employment. There is a great deal of overlap between emergency and trauma nursing, and some emergency medicine training is required for trauma nurses. The Trauma Nursing Core Course (TNCC) is a two-day certification course that prepares nurses for caring for trauma patients. It provides hands-on learning as well as classroom and online learning. Certification is valid for four years.

The Emergency Nursing Pediatric Course (ENPC) may also be required depending on the workplace. Students learn medical and pharmacological interventions as well as how to recognize medical emergencies in children. Certification is valid for four years.

Trauma nurses can also become certified in flight nursing—responding to medical emergencies from the air and participating in evacuation/disaster relief. The Board of Certification for Emergency Nursing (BCEN) offers a Certified Flight Registered Nurse (CFRN) credential for nursing. Eligibility for certification include:

• Must possess an active, unrestricted RN license
• Two years of experience as a flight nurse recommended, but not required

The CFRN credential is valid for four years. A BSN is not required.

Trauma nurses can also obtain Trauma Certified Registered Nurse (TCRN) Certification. The TCRN is the first nationally recognized certification available to trauma nurses. According to the BCEN, requirements for testing include:

• Possess an active, unrestricted RN license
• Two years or 1,000 practice hours in trauma nursing, to include direct and indirect patient care
• Twenty to thirty hours of trauma-specific coursework across the trauma continuum

The TCRN certification is valid for four years. Read more for further clarify on trauma nurse certifications.

Trauma nurses must observe certain precautions to preserve their safety and well-being. They often don’t know anything about the patient when they are first brought in to the Emergency Department – only a basic assessment of their injury. They must treat all patients as though they carry bloodborne pathogens. Trauma patients commonly arrive bleeding, so personal Protective Equipment should be readily available to include gloves, gowns, masks, goggles, etc.

Trauma patients can also experience behavioral disturbances. The shock from the trauma or substance abuse can make patients confused and agitated – nurses should be aware of their surroundings at all times, and avoid wearing long or dangling accessories such as earrings or lanyards. Chemical or mechanical restraints may be necessary until the patient is stabilized.

Some trauma patients arrive due to gunshot wounds, assault, or battery. Many facilities employ “lockdowns” on suspected or confirmed gang-related injuries, so trauma nurses should know and follow the organization’s workflows surrounding this. For example, visitors are restricted, and nurses should know how to deter attempts to reach patients and maintain patient privacy.

Nurses working in trauma units may also care for patients requiring total care with extremely limited mobility. Nurses should be cognizant of ergonomics when moving or mobilizing patients. Using a team approach helps reduce the physical strain of moving patients.

Trauma nurses can work in care areas such as:

• Emergency rooms
• Intensive care units
• Trauma step-down units
• Trauma Med/Surg units
• Ambulance transport/flight nursing

What Does a Trauma Nurse Do?

Trauma nurses have a tremendous responsibility – they are often the front-line staff when patients present to emergency rooms, or when responding to emergency calls. They must be able to quickly triage patients based on acuity and must be able to work in high-pressure environments.

What Are the Roles & Duties of a Trauma Nurse?

The primary role of trauma nurses is to stabilize patients. Specifically, trauma nurses:

• Triage patients based on acuity
• Recognize signs and symptoms of deterioration in clinically unstable patients
• Administer first aid or CPR if needed
• Administer emergency medications, such as those given during a Code Blue
• Administer IV fluids or blood products
• Perform wound care
• Communicate and collaborate with physicians throughout the hospital stay
• Provide reassurance to patients and families during traumatic events
• Provide resources to patients who have suffered a traumatic injury or event, including abuse and assault
• Report cases of abuse and neglect to adult/child protective services
• Work with law enforcement in trauma cases resulting from criminal activity
• Maintain thorough documentation of the care of trauma patients

What Does a Trauma Nurse Practitioner Do?

As with any nurse practitioner, trauma NPs can perform extensive physical exams, diagnose patients, order medications, treatments, and procedures, monitor progress and healing, and more. For example, if a patient comes in to the emergency department following a car accident, a trauma NP can perform a rapid assessment, order pain medications and imaging tests, and determine the recommended disposition.

In order to work in the field of trauma, nurse practitioners should have several personality traits. They must be able to work well under pressure, as some trauma cases come in quickly and require fast thinking. Similarly, they need to be able to rapidly assess a situation and order pertinent treatments. They must also keep calm in the face of severe trauma cases, which is imperative when deciding which courses of action are needed.

Trauma Nurse Salary & Employment

According to Payscale, trauma nurses with a TNCC credential can earn a median salary of $66,544-$96,109, depending on the job. Nurses with this certification can work as a staff nurse, in emergency rooms, as nurse managers, emergency room directors, or nurse supervisors and therefore salaries can differ. Salary is also dependent on city/state, additional certifications/degrees held, and the organization of employment.

While the Bureau of Labor Statistics does not have published information on trauma nurses specifically, it does outline the projected growth of RNs in general—16% by the year 2024. This rate is considered much faster than average for all occupations.