Updated October 2026
Nurse practitioners diagnose illness, order tests, prescribe medication and, in many states, run their own practices. NP is one of the fastest-growing careers in America: jobs are projected to grow 41% from 2025 to 2035, and the median salary is $132,300. Here is how to get there.
The 6 steps to becoming an NP
- Become a registered nurse: earn an ADN or BSN and pass the NCLEX-RN. See how to become an RN. Most NP programs require a BSN, or offer an RN-to-MSN bridge for ADN nurses.
- Gain clinical experience: most programs want 1–2 years. Acute care and neonatal programs often require ICU experience.
- Choose a population focus (see the table below).
- Complete an accredited MSN or DNP program: about 2–3 years for an MSN and 3–4 years for a BSN-to-DNP, including at least 500 supervised clinical hours (DNP programs require more). Accreditation by CCNE or ACEN is essential.
- Pass national board certification through the AANPCB or ANCC (for example FNP-C or FNP-BC, PMHNP-BC, AGACNP-BC).
- Get your state APRN licence, prescriptive authority and, if you will prescribe controlled substances, DEA registration.
NP specialties (population foci)
| Specialty | Patients | Where they work |
|---|---|---|
| Family NP (FNP) | All ages | Primary care, urgent care, retail clinics, telehealth. The most common specialty. |
| Psychiatric-Mental Health NP (PMHNP) | All ages | Mental health clinics, telepsychiatry, inpatient psych. Very high demand. |
| Adult-Gerontology Acute Care NP (AGACNP) | Adults, acutely ill | ICU, hospitalist teams, emergency and specialty services |
| Adult-Gerontology Primary Care NP (AGPCNP) | Adults and older adults | Primary care, long-term care |
| Pediatric NP (primary or acute care) | Children | Pediatric clinics and hospitals |
| Neonatal NP (NNP) | Newborns | NICU |
| Women’s Health NP (WHNP) | Women | OB-GYN and reproductive health |
Where you practise determines how independently you can work.
- Full practice (27 states plus DC): Alaska, Arizona, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Idaho, Iowa, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Dakota, Oregon, Rhode Island, South Dakota, Utah, Vermont, Washington and Wyoming.
- Reduced practice (12 states): NPs need a collaborative agreement for at least one element of practice. Alabama, Arkansas, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Jersey, Ohio, Pennsylvania, West Virginia and Wisconsin.
- Restricted practice (11 states): NPs need physician supervision or delegation. California, Florida, Georgia, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas and Virginia. (Some of these states, such as California and Florida, offer paths to more independence after transition-to-practice hours.)
Classification per AANP, as reported by Becker’s ASC (July 2026). State laws change frequently, so check your board of nursing.
How much does NP school cost, and how will you pay?
Tuition ranges widely, from affordable public online MSN programs to expensive private DNPs. Since July 1, 2026, Grad PLUS loans are gone for new borrowers. MSN and DNP students are currently treated as “professional” students (up to $50,000 a year and $200,000 in total) under interim guidance after a court stay. Read the full details in our graduate nursing loans guide. Also look at employer tuition assistance, HRSA Nurse Corps and military programs.
Choosing a program: red flags
- “Find your own preceptor” programs: many online programs leave students to find their own clinical placements, which can delay graduation by months. Ask what placement support is provided.
- No published certification pass rates: ask for first-time board pass rates.
- Accreditation: without CCNE or ACEN accreditation, you may not be able to sit for certification.
FAQ
How long does it take to become a nurse practitioner? About 6–8 years from starting nursing school, or 2–4 years if you are already a BSN-prepared RN.
Can I work while in NP school? Many students work part-time, especially in online MSN programs, but clinical rotations make full-time work difficult in the final year.
Which NP specialty pays the most? Psychiatric-mental health and acute care NPs often earn above the $132,300 median. Location matters too: see NP salary by state.
Sources: BLS Occupational Outlook Handbook (May 2025); Becker’s ASC, “Nurse practitioner scope of practice by state: 2026 breakdown” (July 15, 2026), citing AANP; Nurse.org on graduate nursing loans (October 2026).