How to Become a Nurse Practitioner: MSN/DNP, Certification & State Practice Authority
Nurse practitioner is the fastest-growing licensed profession in America (45% projected growth) with a $121,610 median salary. NPs diagnose conditions, prescribe medications, and in many states practice independently — here’s how to become one.
The Path
1. Become a Registered Nurse
- BSN (Bachelor of Science in Nursing) — 4 years
- Pass NCLEX-RN exam
- Work as an RN (1 to 2 years recommended before NP program, though not always required)
2. Complete an NP Graduate Program (2 – 4 Years)
MSN (Master of Science in Nursing):
- 2 to 3 years
- Minimum for NP certification
- Includes 500 to 700+ clinical hours
DNP (Doctor of Nursing Practice):
- 3 to 4 years (from BSN) or 1 to 2 years (from MSN)
- Increasingly preferred by employers
- More clinical hours (1,000+) and leadership focus
Direct-entry MSN programs: For non-nursing bachelor’s degree holders — combines RN preparation with NP education (3 to 4 years total).
Specialty Tracks (Choose During NP Program)
| Specialty | Focus | Where They Work |
|---|---|---|
| Family NP (FNP) | All ages, primary care | Clinics, urgent care, private practice |
| Adult-Gerontology (AGNP) | Adults and elderly | Primary care, hospitals |
| Pediatric (PNP) | Children and adolescents | Pediatric clinics, hospitals |
| Psychiatric Mental Health (PMHNP) | Mental health | Psychiatric practices, hospitals |
| Women’s Health (WHNP) | Women’s healthcare | OB/GYN practices, women’s clinics |
| Acute Care (ACNP) | Critically ill patients | Hospitals, ICUs, emergency departments |
Tip: FNP is the most versatile — it covers all age groups and is the most in-demand specialty.
3. Pass National Certification Exam
Two certifying bodies:
| Certification | Organization | Specialties Offered |
|---|---|---|
| AANP | American Association of Nurse Practitioners | FNP, AGNP |
| ANCC | American Nurses Credentialing Center | FNP, AGNP, PMHNP, PNP, ACNP |
- 150 to 175 questions, 3 hours
- Fee: $240 to $395
- Pass rate: 80% to 90%
- Must maintain certification through CE and practice hours
4. Apply for State APRN License
- Apply through your state Board of Nursing
- Submit national certification verification
- DEA registration if prescribing controlled substances ($888 for 3 years)
- State controlled substance license (many states)
- Collaborative practice agreement (in restricted states)
- Application fee: $50 to $300
See NP requirements by state →
Full Practice Authority vs. Restricted States
This is the biggest variable in NP practice:
Full Practice Authority (FPA) States (26 states + DC)
NPs can:
- Practice independently (no physician oversight)
- Prescribe all medications including controlled substances
- Open their own practices
- Sign orders, referrals, and death certificates
FPA states include: Alaska, Arizona, Colorado, Connecticut, Hawaii, Idaho, Iowa, Maine, Maryland, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, South Dakota, Vermont, Washington, Wyoming, and others.
Reduced Practice States
- NPs can practice but need a collaborative agreement with a physician
- May have prescribing limitations
- Business ownership may be restricted
Restricted Practice States
- Require direct physician supervision
- Most limited NP scope
- Includes some of the largest states
The trend: States are steadily moving toward full practice authority. The number of FPA states has nearly doubled in the last decade.
Costs
| Expense | Range |
|---|---|
| BSN program | $30,000 – $100,000 |
| MSN/DNP program | $20,000 – $100,000 |
| Certification exam | $240 – $395 |
| State APRN application | $50 – $300 |
| DEA registration | $888 (3 years) |
| Malpractice insurance | $1,000 – $3,000/year |
| Total to practice | $50,000 – $200,000 |
Salary
| Setting | Salary Range |
|---|---|
| Primary care (FNP) | $110,000 – $130,000 |
| Hospital/acute care | $115,000 – $140,000 |
| Psychiatric (PMHNP) | $130,000 – $175,000 |
| Emergency medicine | $120,000 – $150,000 |
| Private practice owner | $120,000 – $200,000+ |
| Urgent care | $115,000 – $135,000 |
Median: $121,610/year PMHNP is currently the highest-paying specialty due to severe mental health provider shortages.
NP vs. PA vs. Physician
| Factor | NP | PA | Physician |
|---|---|---|---|
| Education | MSN/DNP (6 – 8 years total) | Master’s (6 – 7 years total) | MD/DO (11 – 15 years total) |
| Median salary | $121,610 | $126,010 | $229,300 |
| Independent practice? | Yes (26 states) | No (team-based model) | Yes |
| Specialty switching | Requires additional certification | Can switch with on-the-job training | Requires new residency |
| Prescribing | Yes (all 50 states) | Yes (all 50 states) | Yes |
| Job growth | 45% | 27% | 3% |
Frequently Asked Questions
Can I become an NP without being an RN first? Direct-entry MSN programs accept non-nursing bachelor’s degrees and prepare you for both RN and NP certification. However, you must pass NCLEX-RN and obtain an RN license before your NP certification is valid.
Which NP specialty should I choose? FNP offers the most job flexibility. PMHNP offers the highest salary. Choose based on your clinical interests and desired work setting. Changing specialties later requires additional certification.
Is a DNP required? Not yet, but the trend is toward DNP as the standard. The AACN has recommended DNP as the entry-level for NP practice, though MSN-prepared NPs continue to be licensed and hired. Starting a DNP program now is a safe investment.
How competitive are NP programs? Moderately competitive. Most programs require: active RN license, 1+ years of clinical experience (preferred), GPA of 3.0 to 3.5, letters of recommendation, and a personal statement. The number of NP programs has grown significantly to meet demand.
Can NPs own their own practice? In full practice authority states, yes — NPs can open independent practices, bill insurance, prescribe medications, and admit patients. This is one of the biggest career advantages of the NP role.
Salary data from the Bureau of Labor Statistics. State requirements at LicenseCompass.