The future of the family nurse practitioner

Becoming a family nurse practitioner (FNP) is a popular choice among graduates, with many choosing to undertake further qualifications after...

The future of the family nurse practitioner

Becoming a family nurse practitioner (FNP) is a popular choice among graduates, with many choosing to undertake further qualifications after working for a few years as a registered nurse (RN). FNPs work with patients as a whole, rather than simply on a particular condition, and may work with whole families, seeing patients at all stages of their lives from prenatal to geriatrics. 


As with all areas of nursing, the role of the FNP has developed and changed over time to how it is today. And as the medical world never stands still, it is likely that this role will continue to develop to adapt to new technologies, policies and changing demographics. As well as making this an exciting area of nursing to enter, it will also have implications for patients, and the question of how to maintain and improve the standard of their care.

The history of the FNP

While officially the role of nurse practitioner came into the being in the 1960s, actually the roots stretch back further than this to the late 19th century when nurses started working in remote communities, giving them access to family medical care that had previously been impossible. However, it was not until 1965 when Doctor Henry Silver and Nurse Loretta Ford collaborated on the first official training program that the role became more formally recognized.


Initially, the nurse practitioners worked in collaboration with doctors and were limited in their autonomy and ability to prescribe medicine. In 1985 the American Academy of Nurse Practitioners (AANP) was set up, bringing added credibility to the profession, and when in 1993 the AANP founded their certification program, this allowed the skills to be certified and high standards of knowledge and skill to be set evenly across the country.


While the role of nurse practitioner often means specializing in an area such as women’s health or geriatrics, the family nurse practitioner specializes in family medicine, caring for patients throughout their lives, giving lifestyle advice and treating a range of conditions.

FNPs today

Today, FNPs hold an accredited master’s or doctorate degree and have extensive clinical experience that makes them highly experienced medical professionals. While RNs can work with families, they do so under the supervision of a physician or a nurse practitioner. An FNP has far greater autonomy and more responsibilities than an RN. They will have their own patients and are responsible for the patient’s primary care plan and treatment, including being able to prescribe medication and make diagnoses. 


Generally, an FNP will work in an outpatient’s clinic or a physician’s office, but they can also run their own practices. They do not specialize in a particular branch of medicine, but instead will cover the many different short and long-term conditions that patients experience throughout their lives, while also making recommendations to improve a patient’s general health. An FNP is a demanding, challenging career, but is also an incredibly rewarding one with good long-term job prospects.


The role is continuing to develop, however, with FNPs needing to be abreast of the latest changes and using them to further benefit their patients. Becoming an FNP involves a journey of lifelong learning as you hone your skills and discover the new treatment options that are continually in development.

A growing demand

One way in which the role of the FNP is developing is increasing demand. There are several reasons that people are increasingly turning to FNPs, including changing healthcare regulations and expanded insurance options, combined with a shortage of physicians that will see people. An aging population also means that there will be an increased demand for the continuous, family-based treatment an FNP can offer, and in rural communities, an FNP is an excellent choice for delivering primary care. For the FNP this means excellent prospects for finding work, job security and a generous salary.


While treatment and cure remain integral to medicine, since the arrival of the global Covid-19 pandemic, there is also a move to focus more on preventative measures such as encouraging a healthy lifestyle with a good diet, exercise, moderate alcohol intake and no smoking. This health advice very much falls in the remit of the FNP, who are accustomed to acting as health educators as well as practitioners. Their familiarity with their patients and knowledge of healthcare needs throughout a patient’s life makes them well placed to give the advice to encourage their patients towards a healthier lifestyle. And with prevention being better than a cure, we can expect to see the demand for this advice increase.


As the demand for FNPs increases, nurses are reaching retirement age, with the physical nature of the work meaning that many are choosing early retirement. This means there is a greater demand for training more RNs to replace them and a need to make it easy for them to undertake further training to become nurse practitioners, including FNPs.

Training options

Traditionally, gaining the master’s or doctoral degree needed to become an FNP would take place at a university with a mixture of classes, coursework and clinical placements where students can gain the knowledge, skills and experience needed to deliver this holistic care and become an autonomous practitioner. However technological advances have changed the way nurses study in recent years, with the option of high-quality online courses, and this is a trend that looks set to continue.


Online courses work through 100% online study and coursework, with the materials provided for the students to access and classes available online. Universities will generally work hard to support their online students as well as their in-person students, with support available via email or video conferencing. Clinical placements cannot be accessed online, with students needing to experience the reality of a healthcare setting, but universities have services to find clinical placements that can be conveniently accessed by the students, no matter where they live.


The greater accessibility of courses is beneficial to both nurses and patients alike. For nurses, this means study can be achieved in a way most convenient to them with online courses particularly offering a flexibility that was impossible for previous generations. As can be seen on the Carson Newman MSN-FNP program, registered nurses wanting greater nursing autonomy can gain the qualification they need, including high-quality clinical placements and residencies, on a schedule that supports their work-life balance. While for patients, the greater accessibility of courses means that nurses do not need to put off their training and can qualify, helping to meet the growing demand.


As technology continues to advance, it is likely that these developments will continue to play a part in training the next generations of FNPs.

Legislative changes

The increasing autonomy of FNPs has been backed by legislative changes across much of the USA. It was more than a decade ago that the National Academy of Medicine recommended that nurse practitioners should be allowed to practice more fully to use the whole range of their training and expertise. In 2022, Kansas adopted full practice authority, allowing nurse practitioners to be able to conduct medical studies, order and interpret medical tests and prescribe medication. In doing this they joined the 25 other states and the District of Columbia that have already implemented this.


These changes means that as well as offering ongoing care and advice throughout their lives, patients can also rely on them to access the diagnostics and treatments that they need. It seems likely that in the future, further states will also put through this legislation, perhaps one day meaning the entire country can use FNPs as their primary care provider, confident they will get the high standard of patient care they require though a holistic approach to medicine. 

Telemedicine

One of the technological changes FNPs will need to understand is telemedicine. Telemedicine is not a new phenomenon. Telephone consultations have long been an established part of medicine as part of an initial consultation or to see if a consultation is necessary. But technological advances means that telemedicine has become increasingly sophisticated and is playing an ever-increasing role in both initial consultations and the management of chronic conditions.


Generally, telemedicine requires nothing more than a desktop computer with a good connection and video conferencing software to facilitate communication between the practitioner and the patient. For the patient there are many benefits. It can be cheaper than seeing a medical professional in person and reduces the wait, allowing them to speak to a professional from the comfort of their home, something that is particularly beneficial to the elderly and infirm. It is also something that can always be available, allowing patients to contact a medical professional at night or any other time when the clinics are closed.


Many of the common uses of telemedicine are firmly in the remit of the FNP. They might be used to making an initial consultation in a non-emergency scenario or to helping a patient in the management of a chronic condition such as diabetes where it is not, at that time, necessary to see them in person. With patient records stored online, it makes it possible for someone seeking advice to be able to speak to an FNP who is not necessarily their regular primary care practitioner and be able to receive relevant information and options.


It is already possible for telemedicine to use devices such as heartrate monitors or blood glucose monitors to check on patients, although at present such devices are often unwieldy and uncomfortable. But apps are already developed to make such monitoring more convenient and portable with this likely to increase in the future. And these technological advances are something that the FNPs will need to learn to use in monitoring their patients.

3D printing

3D printing is one of the most exciting developments in medicine with what can be achieved already impressive with the promise of this to only become more sophisticated in the future. From prosthetic limbs to cranial implants to custom-made surgical tools, 3D printing can tailor medicine to the individual. The future might include the 3D printing of replacement organs or skin grafts, improving the outcomes for patients as they no longer have to wait on an organ transplant register.


As well as being aware of these major surgical developments so they can refer their patients to a specialist, an FNP may be able to use 3D printing in their own practices. One day it may be possible to print medicines to the exact dosage and combination that an FNP has prescribed. While this may sound impossibly futuristic, already the FDA have approved a 3D printed epilepsy treatment with a large dose of the active ingredient that can dissolve in water.


While 3D printing in medicine is an exciting development with many benefits to patients, it does also come with significant safety and ethical concerns that the FNP will need to thoroughly understand in order to be able to use this technology to their patient’s best advantage.

Genomics

With FNPs taking a holistic approach to patient care, focusing on the whole patient, genomics is going to be a field that can have implications for several areas of holistic care. Genomics is the study of a person’s genes and how they interact with each other. Until recently genomics was mostly used in diagnosing birth defects and a limited set of diseases and research is still ongoing into how genetics affects conditions or increases susceptibility to different diseases such as cancer. But in the future, it is likely to become part of a patient’s medical care across a much wider spectrum of conditions. 


For the FNP, understanding the patient’s genetics may have implications for the lifestyle advice they give. If a patient’s genome suggests they have a susceptibility to a particular disease such as cancer, cardiovascular disease or diabetes, this may influence what diagnostic tests an FMP orders if a patient is unwell. It may one day be possible to tailor treatments to a person’s genetic makeup, again allowing the FNP to tailor their treatments and advice to the individual. As the FNP continues to take a holistic approach they will also need to consider the genetic implications as part of a wider picture of physical, mental, social, emotional and spiritual health. 


As with 3D printing there will also be ethical issues around the sequencing of a patient’s genome and how it impacts patient care, raising issues such as how ethical is it to burden a patient with the knowledge that they might develop a certain serious condition in their 70s when they are in their 20s? But equally, is it ethical not to tell them? Regardless, it will be important for an FNP to fully understand the implications.

Geriatric expertise

People are living longer, and the average age of the population is increasing. This means that although FNPs work with all ages, it may be that an ever-greater proportion of their patients are older adults. There are certain conditions such as dementia and Parkinson’s disease that are common among the elderly and rare in younger people. Other conditions including cancer and heart disease also become more common the older a patient becomes. This means that FNPs are likely to become increasingly expert in spotting these conditions and more knowledgeable about how they are treated. 


An FNP may also find they are spending more time advising older people on lifestyle choices such as the ability to drive, fall prevention and avoiding loneliness. Eventually, they will become involved in the decisions around end-of-life care. While none of this is new to FNPs, in the future it is likely to become a greater part of their work. Choice is always beneficial in medicine and for elderly patients, they can choose whether to benefit from the expertise of the increasingly experienced FNP they may already know, or consult a nurse practitioner who specializes in gerontology.

Becoming an FNP

If you are considering a career in nursing or are already a registered nurse and are considering your next career goal, becoming part of the next generation of FNPs is an option well worth considering. Many nurses enjoy the autonomy FNPs’ experience, something that is likely to increase in the future, and many also are excited at the thought of being part of the cutting edge of medicine as new developments play an increasing role in primary care. 


If this sounds like the career path for you, there is no better time to start considering your training options. With the choice between in-person and online study, and full-time and part-time courses, training has never been so accessible. Nurses at all levels are in high demand, so any investment in training will be worth it, with excellent long-term job prospects. Working as an FNP, getting to know your patients at different stages in their lives is always a rewarding option where you will truly make a difference. And that is one element of being an FNP that is unlikely to ever change.

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