Guide to Advanced Practice Family Nursing

Family Nurse Practitioners (FNPs) are integral members of medical care teams, with the skills and knowledge to both deliver and coordinate medical care for patients across the lifespan. FNPs typically provide primary and preventative care services, such as routine check-ups, immunizations, and patient advocacy and education. In addition to directly providing primary care services, FNPs develop comprehensive health plans for patients, monitor patients’ medical outcomes, and supervise registered nurses (RNs) and medical assistants. FNPs collaborate with and may work under the supervision of a physician; however, 21 states and the District of Columbia currently allow FNPs and other types of certified nurse practitioners to work independently and even set up their own private practices.

Family nurse practitioners have the distinct advantage of receiving intensive training to provide care to individuals of all ages. Their broad knowledge of human development and health across the lifespan can provide a useful foundation for addressing both simple and complex health problems. FNPs can work in a wide variety of medical settings, including both primary care and specialized departments of hospitals, private practices, walk-in clinics, and community health centers. Depending on their professional experiences and areas of interest, FNPs can also work in secondary and tertiary care settings with patients encountering severe or complex medical conditions.

To become board certified FNPs, licensed RNs typically must complete a Master’s of Science in Nursing program that is accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN), fulfill a certain number of clinical hours, and pass an examination administered by the American Nurses Credentialing Center (ANCC) or the American Academy of Nurse Practitioners (AANP).

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Where Family Nurse Practitioners Work

where-do-fnps-work-810x300Certified FNPs can work in general primary care family nursing, as well as specific areas of medicine such as cardiology, pulmonology, palliative care, and women’s health, depending on their work experiences and any additional certifications and trainings they obtain during their career. Below is a description of several of the major work settings that employ FNPs.

Primary Care Departments of Hospitals

Two of the most common settings in which FNPs work are hospitals and medical centers. FNPs can find employment in departments that focus on preventative and primary care, such as Family Medicine, Internal Medicine, or Family Community Medicine. FNPs can also work in primary care departments that serve specific populations, such as women, children, or the elderly. In many medical departments, nurse practitioners function as primary care providers alongside physicians, often having their own set of patients whom they see on a regular basis.

Rebecca Lew, FNP-BC, is a Family Nurse Practitioner in the Women’s Health Primary Care Department at University of California, San Francisco (UCSF), where she provides primary care, patient education, and chronic condition management. In an interview with, she explained how she, her fellow nurse practitioners, and the physicians in the Women’s Health Primary Care Department each have their own patients and often collaborate to ensure that each of their patients gets the extent of care that they need.

“In my practice at UCSF, I have my own panel of patients who are assigned to me as their primary care provider. In the Women’s Health Primary Care Practice, we have a mix of internal medicine physicians, family practice physicians, as well as adult and family nurse practitioners providing care to patients,” she explained, “We consult with each other and see each other’s patients as needed if the primary care provider is not available.”

Acute and/or Specialized Care Departments

Though family nurse practitioners’ training generally focuses on primary care services and coordination, FNPs may also be able to work in acute care and specialized departments of hospitals and medical centers, depending on their area of interest, professional history, and any additional certifications and trainings they have obtained. While states may have different regulations around the types of specialized work that family nurse practitioners can do, FNPs have knowledge of human health and development across the lifespan and a broad skill set that, when combined with their previous work experiences, can afford them a degree of flexibility in their work setting.

“FNPs often have considerable flexibility when working in specialty areas,” explained Janice Noort, FNP-BC, who works as a nurse practitioner at the Palliative Care Consult Service at UC Davis Medical Center, in an interview with, “Although advanced certification is not a requirement for practice in the acute setting, it is recommended (if available) in particular specialty areas and may be a requirement by employers. This varies from state to state depending upon state practice acts, and may not always be clearly defined, hence how some hospitals and medical settings require candidates to hold relevant certifications and/or work experience. FNPs do have a very broad scope of practice, and most receive additional training in their employment setting.”

Jen Wiles, FNP-BC, MSN, MBA worked in high-acuity medical settings immediately upon graduating from her FNP program. “My first positions as a Nurse Practitioner were in the emergency room at Indiana Health University–Ball Memorial Hospital and with trauma services at St. Vincent Hospital– Indianapolis,” she told, “In the emergency room, I mostly cared for ER patients with a triage acuity level between 3 through 5. These are patients who present with anything from a minor cut to abdominal pain. I occasionally cared for patients with stroke or respiratory symptoms and at a level 2. This emergency room served all ages, and as a Family Nurse Practitioner, I was often assigned women and children as my patients as some of the physicians and physician assistants were only qualified to see adults.”

Karina Berge, FNP-BC, who works as a Nurse Practitioner II in the Pediatric Cardiothoracic Surgery department at UCSF Benioff Children’s Hospital, is another example of how family nurse practitioners can work in acute care settings depending on their level of experience in relevant environments. Ms. Berge provides comprehensive health care and case management to infants and children suffering from congenital and acquired heart disease. Prior to this role, she was a Clinical Nurse II within UCLA’s Pediatric Intensive Care Unit (PICU).

“As an NP II, I deliver comprehensive health care under the supervision of an attending Pediatric Cardiothoracic Surgeon in the cardiac intensive care unit (CICU) as well as the cardiac transitional care unit (CTCU),” she explained, “From admission and preparing patients for surgery to discharge planning and education, I function as an associate of the attending Pediatric Cardiothoracic Surgeon in the delivery of care to infants, children, and adults with congenital and acquired heart disease.”

Private Practice

In addition to larger hospital settings, family nurse practitioners can work in physicians’ private practices, and in some states even establish private practices of their own. In some private clinical settings, FNPs are authorized to take full responsibility for patients in the absence of a physician. FNPs who work for private practices or have their own practice typically work on a smaller team than they would in a hospital setting, and may see fewer patients daily. However, their tasks tend to be very similar to the tasks that FNPs complete in hospital environments, and include making routine health assessments, coordinating patient care, prescribing medications and making treatment recommendations to a medical team, advocating for and educating patients regarding self-care for their conditions, and communicating regularly with patients’ family members.

Corporate Health Centers

FNPs can also work at corporate on-site health clinics, providing convenient primary care services to employees. While corporate health clinics do not typically provide comprehensive health care services, they are growing in popularity because of their ability to reduce health care costs overall through the provision of preventative health care such as immunizations, health and wellness education, and guidance on chronic and acute condition management. While some companies will create their own on-site corporate health center for their employees, many corporations hire an outside worksite health or patient wellness company to establish and manage the staffing of an on-site corporate health clinic.

Carmen Saunders, MSN, FNP-BC works as a Corporate Health Nurse Practitioner at Premise Health, a company that manages over 500 worksite-based medical and wellness centers nationwide. “As a Corporate Health Nurse Practitioner, my main responsibility is to evaluate, diagnose, treat, and educate patients at onsite health clinics throughout New York City,” she told, “I work at many different sites with a few being: Morgan Stanley, Barclays Capital, Time Warner, and New York Life.”

Retail Clinics and Community Health Centers

Similar to corporate on-site health clinics, retail walk-in clinics serve a growing need for quick and affordable primary and preventative care. Retail clinics provide a limited set of primary care services, such as immunizations, patient education and care consultations, routine health check-ups, and treatments for minor conditions such as allergies, colds, and minor injuries. These clinics largely serve as supplements to primary care providers (PCPs), for when patients need quick low-level care and their PCPs do not have appointments available.

After leaving her full-time role in intensive inpatient nursing care to earn her MBA with a concentration in healthcare management, Ms. Wiles began working at CVS Minute Clinic. In her interview with, she explained how retail health provides a useful and accessible complement to patients’ primary care. “Retail Health is a growing service in the healthcare industry. I currently work as a Family Nurse Practitioner with Minute Clinic,” she told, “Patients come to retail health clinics for the affordability and convenient access to medical care.”

Due to the supplemental nature of the care they provide, nurse practitioners at retail clinics often communicate with patients’ primary care providers in order to update PCPs on the care that their patient received at the retail clinic. “We recently began using a new electronic medical record […that] gives us access to patients’ medical history and keeps their primary care providers in the know about their current health status,” Ms. Wiles noted regarding her work at Minute Clinic.

What Family Nurse Practitioners Do

what-do-family-nurse-practitioners-do-810x300Family nurse practitioners’ daily responsibilities vary depending on their work setting, but typically center on primary care medical services and the coordination of patient care. Below is an in-depth description of the types of work FNPs complete across multiple medical environments and contexts.

Primary and Preventative Care

Primary care is defined as the ongoing provision of care aimed at promoting patient well-being, preventing chronic and acute disease, and successfully managing existing chronic conditions. Family nurse practitioners’ daily work in primary care settings within hospitals and medical settings varies, but is typically comprised of evaluating patients’ current health status; reviewing their medical history; discussing patient cases with physicians, RNs, and other members of the care team; developing and updating patient care plans; prescribing medications and treatments to help patients manage existing health conditions; and filling out electronic medical records and medical insurance paperwork.

As mentioned previously, while many family nurse practitioners provide primary care in support of physicians in clinical settings, some FNPs are in fact their patients’ primary care provider, and as such they follow their patients over the course of several years. Rebecca Lew, MSN, FNP-BC explained the daily tasks she completes as a primary care provider at the Women’s Health Primary Care Department at UCSF. “As a Family Nurse Practitioner and primary care provider, I assess, evaluate, diagnose, and treat patients with various acute and chronic health conditions. In addition to this, one of the most important aspects of my role is to be an advocate and educator to patients,” she explained, “Some common health conditions that I see in clinic include upper respiratory infections, urinary tract infections, asthma, hypertension, diabetes mellitus, back pain, and depression.”

Jen Wiles, MSN, FNP-BC also told how her work at CVS Minute Clinic centers on preventative care and helping patients manage both chronic and minor acute health conditions “During a typical day, I will see patients for skin conditions, respiratory infections, bladder infections, vaccinations, administrative/camp/sports/DOT physicals, chronic disease screening, weight management and smoking cessation consults,” she said.

Intensive Medical Care for Severe and Acute Conditions

Some family nurse practitioners work closely with patients experiencing severe health problems. During her time as an FNP at St. Vincent’s Hospital in their trauma department, Ms. Wiles completed a wide variety of tasks that required both her training in primary care family nursing and her strong background in emergency care services as an RN. “We ran trauma codes, performed consults for both services inpatient and in the emergency room, admitted patients, ordered labs, tests, and treatment, answered nursing pages, planned and ordered discharges, and follow-up with patients in the Trauma clinic,” she recalled.

Janice Noort, FNP-BC also works with patients grappling with very severe and debilitating health conditions. As a nurse practitioner in a palliative care setting, Ms. Noort provides her patients with treatments, consultations, and other types of care to help them manage their complex health challenges. “As a nurse practitioner on the palliative care consult service, I assess, evaluate, and manage adult patients with various life limiting conditions including cancer, dementia, heart failure, kidney disease, COPD, and polytrauma,” she told, “Important aspects of my role include aggressive symptom management to promote comfort/quality of life in addition to having goals of care discussions with patients and families to ensure their treatment choices reflect their wishes.”

Family nurse practitioners who work in acute and/or specialized care often have responsibilities that are similar to those of their peers who work in primary care settings–that is, collaborating with physicians and other medical staff to develop ongoing medical care plans for patients, working closely with patients and their families to ensure positive health outcomes, monitoring patients’ health during their time in the hospital, and helping coordinate patients’ discharge from the hospital when their conditions are under control. FNPs in acute care settings conduct regular health assessments, continually monitor the health status of the patients under their care, prescribe and administer medications and treatments as needed, and direct other medical staff in inpatient settings to ensure positive health outcomes for their patients.

Care Coordination and Staff Leadership

In addition to directly providing care to patients, either in collaboration with physicians or as primary care providers themselves, FNPs also serve as crucial care coordinators, guiding medical staff members in their care of patients and working on a more organizational level to optimize patients’ health outcomes. Care coordination complements direct medical services, and involves communicating with and organizing various parties such as medical staff, specialists, and community health resources around a given patient’s medical background and needs.

Ms. Lew explained how care coordination is part of her regular work with patients, especially when they are experiencing complicated or severe medical challenges. “Depending on the complexity of the patient’s health status, I also work and consult with various specialists in addressing the patient’s concerns and diagnoses that are beyond the scope of primary care,” she said.

Jen Wiles, MSN, FNP-BC also explained to how she participates in care coordination on a daily basis, and how electronic medical records are becoming increasingly important in the efficient coordination of care for patients at CVS Minute Clinic. “We recently began using a new electronic medical record and are now able to connect with other healthcare providers across the nation,” she explained, “This gives us access to patients’ medical history and keeps their primary care providers in the know about their current health status. We are able to refer patients to higher levels of care or back to their primary care providers when needed and encourage them to obtain regular medical care when they lack it.”

Ms. Wiles also engaged in care coordination when working as a nurse practitioner at University of North Carolina (UNC) Health Care in their Intermediate Surgical Care Unit and Neurosciences floor. In her interview with, she explained the organizational tasks and staff guidance responsibilities she had. “During my time [at UNC Health Care], I did not only provide direct patient care,” she said, “I facilitated intern orientation and supervision on the service, provided educational inservices for the nursing staff who were new to neurosurgical care, created a protocol for the inpatient stay and follow-up of patients admitted for Minimally Invasive Pituitary Surgery, and standardized wound, follow-up, and discharge education for our patients.”

The transition from solely providing medical services to evaluating patients’ health, developing patients’ entire plan of care, and making autonomous decisions as a care coordinator is one of the key transitions that RNs must prepare for when moving into a nurse practitioner role. “Keep in mind that your role as a Nurse Practitioner is very different from that as a nurse,” Ms. Wiles advised, “As a nurse, you are taking care of patients, utilizing the orders of someone else. While great nurses will advocate for their patients and be a part of the planning process, they are ultimately the ‘doers’ of the orders. However, in my role as a Nurse Practitioner, I am now making decisions that greatly impact another person. I am performing complete examinations, looking over the diagnostic tests, and putting the pieces together to make a diagnosis. I then have to come up with a treatment plan that will lead to the best outcome. You begin to worry about the financial situation of your patient or their compliance. Sometimes the easiest or best treatment plan can be different from patient to patient.”

Program Development

FNPs can also participate in the development of patient care and education programs to help underserved populations struggling with chronic conditions. These programs often focus on making preventative care (such as immunizations, health screenings, etc.) more accessible to vulnerable populations, and/or informing patients about the best ways to manage their health conditions. Such initiatives can be immensely valuable in preventing severe health conditions among certain patient populations, and in reducing health costs for individuals and the health care system overall. In her interview with, Rebecca Lew, FNP-BC described her work to develop both the Teen Sensitive Services and COPD Support Services programs while at the Chinese Hospital Association.

“I started the Teen Sensitive Services with one of my colleagues, a Pediatrician specializing in Adolescent Medicine,” she explained, “My Pediatrician colleague and I worked at separate locations and we both saw the need for access to sensitive services (reproductive health services) for teens in the San Francisco/peninsula region. […] My colleague and I met with various school district nurses in the San Francisco Unified School District and discussed the needs of the teen students, as well as the services we would be able to offer to the teens. We developed a protocol and provided training for the staff of our clinics. Both my colleague and I communicated regularly with each other and the various individuals at the school sites to continually improve the program.”

Ms. Lew also saw a need for respiratory health services in her community, and consequently worked in collaboration with other healthcare providers to develop a program and protocol serving patients struggling with Chronic Obstructive Pulmonary Disease. “COPD was identified as one of the most common diagnoses for admission and readmission to the Chinese Hospital. One of the greatest needs that I was able to identify as a clinician serving this population was the lack of understanding on how to use inhalers properly and effectively,” she recalled, “Gathering information from the most up-to-date guidelines, I created a protocol for COPD self-management, which included information on proper inhaler use, smoking cessation, nutrition, immunizations, exercise, as well as an action plan for patients who are decompensating from their disease process.”

Once she and her colleagues developed the COPD Support Services program, Ms. Lew worked to coordinate its implementation. “After creating this protocol, I presented the program curriculum to an interdisciplinary committee, which included primary care providers, pulmonologists, and case managers. Once the protocol was finalized, we implemented the program within the support services clinic.”

Karina Berge, FNP-BC was also deeply involved in program development during her time as a Nurse Practitioner II at UC Davis Medical Center. At UCDMC, she helped to build and manage the Pulmonary Rehabilitation Program (PRP). “It became clear that acute symptom management was needed for patients who presented with breathing problems when attempting to exercise; wanting to engage with this need and help patients address their barriers to exercise motivated me to become an NP in the pulmonary rehabilitation program,” she explained to, “During my time in this program, we worked to achieve national certification and grew from a part-time to a full-time program.”

As the PRP Coordinator, Ms. Berge worked on a multidisciplinary team that included a medical director, a nurse practitioner, and respiratory therapists who collaborated to educate, guide, support and advocate for patients struggling with chronic lung diseases. “Our program was a primary palliative care pulmonary rehabilitation program, meaning we focused on increasing patients’ quality of life and their ability to perform activities of daily living through the relief of symptoms and through patient education and maintaining healthy practices such as exercise, appropriate oxygen use, adherence to medications, proper nutrition, and many other helpful practices for patients with chronic lung disease,” she said.

Why People Become Family Nurse Practitioners

why-family-practice-nursing-810x300Registered nurses who become board certified family nurse practitioners expand and deepen their knowledge of how to care for patients of all ages within the context of the family unit; such knowledge is valuable as it is applicable to a wide range of medical environments. “I knew that I wanted to work in the community as a clinician, and the training to become an FNP gave me the capability to treat patients across the lifespan,” Ms. Lew told, “From a practicality standpoint, the Family Nurse Practitioner specialty is also the broadest specialty, theoretically, increasing one’s employability.”

Karina Berge, MSN, FNP-BC described how concentrating in primary care family nursing with an emphasis in underserved populations during her MSN program gave her the breadth in training that she needed to expand her career opportunities beyond specialized acute care settings. “When I chose to become a family nurse practitioner (FNP), and then to obtain a subspecialty in underserved populations, I was working as a PICU bedside nurse, which is very specialized. I wanted to broaden my scope to be able to work in primary care and within any age group as well,” she told, “I’ve always had an interest in public health, especially the underserved. While being an FNP served me well in the pulmonary rehabilitation program, the combination of my PICU nursing experience and being an FNP truly helped prepare me to work in pediatric cardiothoracic surgery.”

By completing training to become FNPs, registered nurses can also develop the expertise and credentials to take on leadership roles in healthcare environments and have a stronger impact on patient health outcomes. As the Coordinator of the Pulmonary Rehabilitation Program at UC Davis Medical Center, Ms. Berge found the impact of her work to be very rewarding on a daily basis. “Helping a person breathe better is life-changing, both for the patient and for me. Empowering patients to take back their lives from a disease that has seized it is rewarding,” she told, “My time working on the Pulmonary Rehabilitation Program at UC Davis was incredibly rewarding because this program has the potential to become a center of wellness for people with chronic lung disease with a focus on primary palliative care.”

Ms. Wiles also noted that the level of responsibility and effect she had on patient health outcomes when working with neurosurgery patients at UNC Health and with trauma patients at St. Vincent’s Hospital was a deeply rewarding challenge. “Working as a Nurse Practitioner, you get to directly affect lives on a daily basis. You meet needs when someone is at their lowest point,” she said, “It is a rewarding but challenging role. My time at St. Vincent and UNC Health were my two most rewarding positions as a Nurse Practitioner. I never imagined after graduating from a Family Nurse Practitioner program that I would be caring for patients with such complex medical conditions. Taking care of these patients from their first day in the hospital to their last revealed the impact you can truly have on a person’s health when you are running a tight ship and giving excellent care.”

The Challenges of Advanced Practice Family Nursing

challenges-of-advanced-practice-family-nursing-810x300While it is a rewarding and impactful field, advanced practice family nursing can also be incredibly challenging due to the level of responsibility that FNPs have over their patients’ well-being, as well as the complexities of the medical conditions that they may encounter. Additionally, the changing landscape of health care in the United States can also pose a challenge as new regulations and standards emerge for nurses, nurse practitioners, and physicians.

“Even if you do the best that you can as a provider, ultimately, there will be cases when untoward things happen to patients, or a patient’s disease process continues to decline,” Ms. Lew told, “It can be a challenge professionally and personally to deal with these situations and to not think to yourself, ‘Was there something else I could have done?’”

Ms. Noort also explained the challenges of her role as a palliative care nurse practitioner. “Although the rewards can be great, the role can be very challenging at times, as I am involved with end of life care and dying patients on a frequent basis. Palliative care is essential throughout the entire trajectory of serious illnesses; however, in a hospital-based setting the palliative care service provides a lot of care for dying patients definitely putting one at risk for compassion-fatigue and burn-out.”

To manage the stress and emotional strain of their work, nurse practitioners should invest time in self-care and develop a strong support network of mentors and peers. “It is essential to have a healthy work-life balance and utilize activities such as self-reflection, exercise, peer-support, journaling, etc. to cope with associated stressors,” she said.

Ms. Lew also emphasized the importance of encouragement, commiseration, and guidance from peers and mentors. “It is important to seek out a strong support system to debrief about some of these challenges,” she said, “One of my clinical instructors has become a close friend and mentor whom I often reach out to for advice and guidance. I also became close friends with four other nurse practitioners that I used to work with. We have dinner outings once every several months and debrief, laugh, and cry about our various professional and personal life experiences.”

Ms. Wiles explained how the evolving role of the nurse practitioner in health care settings also presents a challenge for graduate nursing students. Nurse practitioners’ increased responsibilities and autonomy in medical settings necessitate a high standard of training and certification. Ms. Wiles recommended that students research and mentally prepare for the rigorous academic and clinical training, tests, and certification processes that their field of practice may require. “As laws and regulations for our field change, it is important for students to ensure that they are being trained appropriately for their desired scope of practice,” she said, “I was fortunate to have a lot of on-the job credentialing and training and supportive physicians since I worked mostly in facilities with residency programs.”

Relationship management as a member of a larger medical care team is another responsibility and challenge that nurse practitioners may encounter on the job. “You will often find yourself mediating between physicians and nurses, and it is important to be diplomatic while also staying true to your training as a patient advocate,” Ms. Wiles noted. Navigating conflict and high pressure situations in medical settings requires strong interpersonal skills and the ability to interact well with many different types of people; thus, in addition to building their knowledge of medical conditions, treatments, and care coordination practices, nurse practitioner students and professionals should work on building emotional and social intelligence so that they can handle politics and disagreements among colleagues in medical settings both tactfully and constructively.

Advice for Registered Nurses Interested in Becoming FNPs

advice-for-students-interested-in-family-practice-nursing-810x300Becoming an FNP requires a great deal of academic and clinical preparation, the passing of rigorous exams, maintenance of one’s state certification, and constant vigilance and problem solving while on the job. Graduate nursing students who wish to succeed as family nurse practitioners should aim to be proactive and engaged in their classes and clinical practicums, and also participate in volunteer work as often as possible in medical settings to expand their skills and gain exposure to different work environments and teams. Prospective FNPs should also remain apprised of any changes in requirements for the maintenance of certification in their state of residence.

Ms. Noort told about the importance of constantly engaging in new learning and mentorship opportunities and continually evaluating what types of fields within advanced practice nursing would interest them. “For current MSN students in an FNP program, my advice would be to absorb as much information as possible, including exposure to as many varied clinical experiences as possible,” Ms. Noort said, “There is a significant amount of clinical content in graduate school which will help provide a strong solid foundation and refine critical thinking skills. […] For the MSN student considering either the FNP or palliative care specialty, I whole-heartedly recommend seeking out potential mentors and experts in your desired field. Speak to these mentors and experts in depth about their roles and responsibilities to see if it aligns with your professional vision. Seek out as many educational opportunities as possible in your areas of interest.”

The FNPs whom we interviewed also recommended that registered nurses who wish to become APRNs work to understand how the nurse practitioner role will expand and change over the years. Ms. Wiles advised students to stay updated on the state of the nurse practitioner profession, and urged prospective APRNs to regularly research how the role and responsibilities of APRNs will evolve in coming years so that they can stay on top of any important trainings, certifications, and state regulations to meet employer expectations. “As the nursing profession grows, it is extremely important to keep up with new requirements and regulations. As our profession becomes more adopted and utilized, our scopes may go through periods of growth and shrinkage,” she said, “We may add even more specialties to reflect that of medical programs or become more generalized in order to fulfill a gap in care.”

Ms. Wiles also advised students to think carefully about whether they want to specialize or obtain broad training in advanced practice nursing. “I believe that advance practice provider specializations allow a student to gain important knowledge and experience for their future careers. If you know that you only want to work with women or pediatrics or in psychology or acute care, your program of choice should reflect this intent. It will make you more qualified and competent for these positions,” she said, “That said, nursing allows many people the opportunity to dabble in many areas of healthcare. A generalized or family specialty allows you to take care of almost any patient that walks in the door. However, if regulation on acuity is enacted and on-the-job training is no longer sufficient to expand your scope, you may be limited in your ability to work in hospitals or for acute care services.”

In her interview with, Ms. Lew explained how students can and should take the initiative to explore different subspecialties within nursing, and be active learners throughout their career through continuing education, clinical work, research, and seeking support and advice from peers and supervisors. “The field of nursing is an incredibly exciting one! As RNs you have the ability to jump from one specialty to another (i.e. med/surg, public health, oncology, etc). It is similar as an FNP. I have friends who are Family Nurse Practitioners in post-kidney transplant care, gastroenterology, obstetrics and gynecology, as well as primary care,” she said.

Ms. Lew also noted that, while MSN students learn essential new skills during their nursing program, they will learn some of the most essential knowledge and skills for their career while on the job. “It is important to have a solid clinical foundation and solid critical thinking skills, but ultimately, much of your role and responsibilities will be taught on the job. If you decide to specialize, or go into primary care, one of the most important considerations for yourself is, ‘What are you passionate about?’ Find your passion! It makes going to work so much more enjoyable, and we as nurses are incredibly fortunate to have the flexibility to choose!”

About the Author: Kaitlin Louie is the Managing Editor of, and creates informational content that aims to assist students in making informed decisions about graduate programs. She earned her BA & MA in English from Stanford University.