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ADVANCE Voice: NP

Are NPs Becoming Too Specialized?

Published December 10, 2007 11:32 AM by Jill Rollet
One important finding of the 2007 National Salary and Workplace Survey of Nurse Practitioners is that NP subspecialties have mushroomed, even since the 2005 survey.

We asked NPs to choose their primary employment setting from a list of 22 choices, including "other." Over the years, the setting choices have expanded in response to what survey takers said in previous years. This year's survey included such new choices as "cardiology clinic," "diabetes/endocrinology clinic," "HIV clinic" and "oncology clinic," among others.

Even so, 24% of respondents listed "other" as their practice setting. These NPs almost always wrote in an even more specialized setting than the choices listed. For example, instead of choosing "pediatrics," one respondent wrote in "pediatric allergy and asthma clinic," another wrote "pediatric dermatology practice," another "pediatric neurology," and so on.

This specialization can lead NP education programs, certification agencies and credentialing bodies (state boards of nursing) to butt heads: universities offer NP programs that don't have corresponding certification exams; states have licensing regulations that require national certification; nurse practitioners, employers and specialty groups want the freedom to deploy the best providers in new and challenging roles.

It's not always clear where this leaves a family nurse practitioner who has been practicing in a pediatric neurology office.

What do you think? Have you experienced an education-practice-certification disconnect? Should NPs be generalists or specialists?

(Be sure to check out the January 2008 print edition of ADVANCE for Nurse Practitioners for complete results and analysis of the survey.)

posted by Jill Rollet
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7 comments
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marie, anti aging - owner, medi spa May 9, 2008 11:15 PM
Madison Ave, NYC NY

The NP program I was in was a general program under the heading acute/critical care. As far as a specialty, it was up to me and my past experience as an RN to gravitate my studies towards a specific area. I feel my program hit the major areas of the medical part of advanced practice but I was limited by my previous experience in the type of practicums I would get and I only got 3 different practicums. In looking for a job, I feel that I am limited by the limited experience. Any comments?
jan, NP January 9, 2008 6:59 AM

I worked in a speciality area for 3 years. I made less money after 3 years than I did as an RN. I decided to leave but no one wanted to hire me into a family practice or internal medicine area because they wanted people with that type of experience. I am now working in a retail clinic and am extremlyhappy. I am glad I made the switch.
Jane Lilley January 8, 2008 3:03 PM

I think it is important for N.P.s to specialized to better serve the community. It provides them  with the opportunity to stay competitve and experienced in an area of choice. N.P.s have to compete with P.A.s especially in the NYC area so for them to have an area of speciality is an advantage. However from what I have seen most N.P. are trained as generalist and as they get more experienced they will choose an area of speciality.
sophia, Neuro - N.P., Mt.Sinai January 1, 2008 10:12 AM
New York NY

The medical field is far to broad to be a generalist in of any significant standing.  Most nurses become NP's so that they can advance their skills and knowledge in an area (specialty) that they have gravitated to during their tenure as an R.N.  While by an large APRN programs are quite broad, this is not a bad thing.  The programs need to provide a basis for focus (similar to medical school)  and allow the NP to acquire expertise with experience. in their area of interest.  This could then allow for certification in those particular subspecialties.   The problem that I have with NP programs is that they do not provide enough in the way of the medical model (assess, diagnose

Marty Ruiter, EMERGENCY MEDICINE - N.P. (MSN, APRN, B.C.), North Ottawa Community Hospital December 22, 2007 1:25 PM
Grand Haven MI

I am one of those NP's that works in a speciality practice-Dematology.  I have found my forte.  I am look forward to each work day and happy with my career choice.  And my patients seem to agree.  %0d%0aIf you are able to practice in a speciality medical practice you become an expert in that speciality.  You don't have to be a practitioner with general knowledge in most medical modalities and a master of none.  This practice really works for me, I hope you all are this happy.  Joan Csaposs
Joan Csaposs, Dematology - NP December 21, 2007 11:12 PM
Castleton NY

I for one don't believe NP's are becoming too specilizied. I believe NP's should pursue their personal choice of practice specialty regardless of the area. However, I do believe NP education is becoming too specilized! It is impossible to have a specility education track for ever practice area a NP maybe interested in practicing.

I would like to see all NP's go through a common general practice/primary care type education program. Then offer specilty practice electives and post graduate specility training when needed. This is how Physician Assistant education programs work and they practice in almost all subspecilities plus primary care areas. At the present time NP education programs are too fragmented and certification is too fragmented. I think more standardization in education would help us get rid of the alphabet soup behind are names aswell. Physician assistants put PA-C behind their names period! To gain public understanding of who we are and what we do we have to simplify what we call our selves. I would love to see all NP's simply put "N.P." behind their name regardless of where they may work, Jan Doe, RN, MSN, APRN,C, FNP-C, CCRN is NOT necessary!!!

Just my 2 cents,
William December 10, 2007 3:09 PM

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