How to Become a Primary Care Nurse Practitioner? (Answered by an NP)

Written By: Kasee Wiesen DNP, APRN, FNP-C

Primary care nurse practitioners are in demand. The population is growing, there is a predicted shortage of physicians in primary care, and the overall population is living longer, demonstrating the need for more primary care NPs.

But, you may be wondering, what exactly do primary care NPs do? How do I become a primary care nurse practitioner? Below you will find the steps needed to become a primary care nurse practitioner, the pros and cons of being a primary care NP and the average salary.

What Does A Primary Care Nurse Practitioner Do?

What does a primary care nurse practitioner do? The primary care NP does various tasks throughout their day—as it is entirely dependent upon their daily schedule. This may include caring for patients with acute or chronic concerns or completing annual physicals. Below, there is a list of seven duties of the primary care NP.

1. Knowledge of preventative care:

In primary care, you must know preventive care and cancer screenings. This includes ensuring your patients have a yearly physical with lab work to monitor their cholesterol and kidney function and assess if they are at risk for diabetes. You need to know when specific cancer screenings start and how often they need to be done, including mammograms and colonoscopies. You must ensure women are current with DEXA scans, and if patients smoke, educate them on smoking cessation and provide resources.

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2. Knowledge of immunization schedule:

Working in primary care requires knowledge of the immunization schedule. You do not need to have it memorized. Still, you must have resources to ensure patients receive their immunizations at appropriate times—which is incredibly important for pediatrics as they receive numerous vaccines during their first two years of life. You must also know which vaccines are needed for children to enter kindergarten, 7th grade, and college. Then, once adults, you need to know when they can receive pneumonia, tetanus, and shingles vaccine. Lastly, you must know when it is most valuable to receive the influenza vaccine and, more recently, the schedule for the Covid-19 vaccine.

3. Interpretation of lab work and other diagnostic tests:

You will order numerous diagnostic tests, including lab work and imaging—and it is vital you know how to interpret and develop a plan based on these results. This may include titration of a medication based on the lab value, medication order, or determining the frequency the lab or image needs to be done.

4. Complete thorough head-to-toe assessments:

Throughout your day as a primary care NP, you will need to complete comprehensive evaluations. You will also need to know how to complete symptom-specific assessments when required.

5. Management of chronic medical problems:

You will manage numerous chronic conditions in primary care. This includes hypertension, type 2 diabetes, hyperlipidemia, obesity, GERD, etc. You must have a solid foundation of these various illnesses, including how to assess accurately, titrate medications as needed and monitor lab values as appropriate.

6. Management of acute illness:

Besides managing chronic disease, you will also manage acute conditions such as urinary tract infections, upper respiratory infections, orthopedic complaints, and rashes. It is vital to know how to assess these concerns, interpret the diagnostic tests (labs or imaging) and develop an appropriate treatment plan with follow-up as needed.

7. Collaboration with specialties:

As a primary care NP, you must collaborate with specialty services at times to ensure your patient receives appropriate care. For example, this may mean consulting pulmonology or cardiology due to acute concerns, general surgery due to an abnormal mammogram, or orthopedics for a fracture. You may also consult physical and occupational therapy with concerns of weakness or unsteady gait and the inability to complete activities of daily living.

What Skills And Abilities Are Needed To Work As A Primary Care NP?

To become a primary care NP, many skills are needed to succeed. The duties of a primary care nurse practitioner cover a broad spectrum ranging from interpersonal, interprofessional, and technical. Below you will find a list of skills and abilities needed to work as a primary care NP.

1. Communication Skills:

Communication is vital in primary care. This includes effective communication with the front staff scheduling appointments, the nurse assisting you in care with the patient, and the triage nurses who will take phone calls from patients and communicate your answer back to them. If there is a gap in one of these areas, it may impact the patient's care. Communication with the patient regarding their results from diagnostic tests, formal diagnoses, treatment plans, and reasons for diagnoses is also essential. Communication must also be strong regarding medications and their potential side effects.

2. Teamwork:

Teamwork is essential in primary care. Often, the RN calls the patient and provides education, results, treatment plans, etc., to the patient. Therefore, you must work well with the team to ensure your patients receive the best care possible.

3. Knowledge of preventative care:

In primary care, you must know preventive care and immunization schedules. You need to know when specific cancer screenings start and how often they need to be done. You need to ensure patients (especially pediatrics) are current on their immunizations and the older adult has received any vaccinations pertinent to them based on their health and age.

4. A desire for professional development:

In primary care, you must demonstrate a passion for professional development. This may include goals you have set for yourself and participation in continuing education through conferences and other CEUs. This may also include reading journals and being an active member in your professional organization(s).

5. Knowledge of multiple chronic illnesses, including managing the disease processes:

In primary care, you will manage numerous chronic conditions. You must have a solid foundation of these various illnesses and have resources available to you to ensure the treatment you provide is the most up-to-date and driven-by evidence-based practice.

6. Critical Thinking:

You must be able to think critically as a primary care NP. It is not uncommon that a patient will have multiple co-morbidities or present with very vague or unique symptoms. Therefore, you must be able to think critically to determine which diagnostic tests are appropriate and the best treatment plan based on the results or symptoms presented to you.

Where Do Primary Care Nurse Practitioners Work?

A primary care nurse practitioner typically works in a clinic or office setting—which may be a private practice, physician-owned, and NP-owned practice. A lot of primary care NPs work in a family practice setting. Still, there are adult-gerontology primary care nurse practitioners who may work in internal med, and pediatric primary care NPs work in pediatrics. A primary care NP may also work for a business or corporate office, nursing home, or school/university.

What Is The Typical Work Schedule For A Primary Care NP?

Becoming a primary care nurse practitioner may lead to a more consistent work schedule. The typical work schedule for a primary care NP is 8 am to 5 pm. This may vary slightly depending on the hours of operation of where the primary care NP works. Some practices will require an occasional Saturday morning from 8 am, or 9 am to noon. You may also be a part of the on-call rotation for weekday and weekend call coverage.

What Is The Difference Between Primary Care NP And Primary Care Nurse?

The difference between a primary care NP and primary care nurse is their scope of practice.

To start, their educational requirements are different. The primary care RN requires an undergraduate degree such as an ADN or BSN, and the primary care NP requires a graduate degree such as an MSN or DNP.

Then once you graduate with your degree, the certification and licensure process is different. The RN must pass the NCLEX before practicing as a nurse—and they must renew their license every two years. The primary care NP must pass their board certification exam (most commonly family practice) and maintain good status with their RN and APRN license—APRN license must be renewed every five years and RN every two years.

Lastly, their scope of practice is different. The RN will check patients in, schedule consults/appointments, and deliver education both in-office and over the phone. The RN may also perform simple wound care and dressing changes and administer vaccines and other IM injections. The RN works continuously with the primary care NP to ensure the patient receives the appropriate results, treatment, and education.

On the other hand, the primary care NP’s scope of practice is much broader, giving the primary care NP more responsibility in the patient’s care. The primary care NP will ensure the patient is up to date with their preventative screenings, including cancer screenings, cardiovascular disease, screenings for osteoporosis, and vaccines. They do manage chronic illnesses such as hypertension and diabetes and ensure their treatment plans are working for the patient and will alter treatment plans as needed. They also perform their annual physicals, school physicals, and sports physicals.

The primary care NP cares for acute problems as well. They will assess, order diagnostic tests, evaluate the results, and diagnose the patients based on those results. They will also order appropriate treatment, which may include therapy or medications. The NP will also consult when necessary to ensure the patient receives the care they need. The primary care NP will also re-evaluate their patients as needed.

Top 5 Pros Of Becoming A Primary Care Nurse Practitioner

There are many pros of being a primary care nurse practitioner. Below you will find five of these reasons.

1. Favorable Hours:

The typical hours of a primary care NP is 8 am or 9 am to 5 pm—allowing the NP to be home most evenings and weekends. However, depending on where you work, you may have to work a Saturday morning every few weeks.

2. Flexibility:

Working in primary care allows you to work in family practice and primary care pediatrics, and internal medicine.

3. Higher Salary:

The average annual salary for a primary care NP is $112,408. This salary is significantly higher than an RN, and in regards to NP salaries, it is on the higher end.

4. Opportunity to care for patient’s throughout their lifespan:

A pro of working in primary care is the opportunity to care for patients throughout their lifespan. This is especially true if you work in family practice as you can care for patients from birth to death. This allows you to develop strong and trusting relationships with your patients.

5. Employment Opportunities:

Overall, the employment opportunities for primary care NPs are high. This is due to the aging population, physician shortage, and more people seeking primary care services.

Top 4 Cons Of Becoming A Primary Care Nurse Practitioner

There are a few cons to consider when becoming a primary care NP. Below you will find a list of four cons of being a primary care nurse practitioner.

1. Possibility of being on-call:

One con of becoming a primary care NP is the possibility of being on-call. You may have to be on-call for a specified number of weekdays and weekends throughout the year, based on where you work.

2. Potential for increased stress:

Working in primary care may lead to increased stress. This stress may be due to the number of patients you see daily, remembering all the appropriate screenings, and knowledge of the multiple chronic illnesses you will manage. While this can be stressful, technology has helped lessen this stress, whether it is prompted within the electronic medical record for preventative screenings the patient is due for or online resources such as Up-To-Date, which contains the most up-to-date/evidence-based practice information.

3. Possibility of having to work a Saturday morning:

There is a possibility for an occasional Saturday morning every couple of months—typically 8 am to 12 pm.

4. Emotional Stress:

Working in primary care, there is the possibility of emotional stress—from telling a patient bad news or losing a patient to cancer. This can happen in many NP specialties, but you may have developed a strong patient-provider relationship in primary care, impacting the emotional stress from the diagnosis or death.

How Long Does It Take To Become A Primary Care Nurse Practitioner?

It takes 6-8 years to become a primary care nurse practitioner on average. This number is just an average and can be impacted by multiple factors, which I will discuss below.

To apply to graduate school, you must have your bachelor of science in nursing (BSN) degree. To obtain your BSN, you can take a few different paths. You can complete a traditional BSN program which takes four years but may take longer if you attend part-time. You may also choose to complete an associate's degree in nursing (ADN) first and then apply to an RN-BSN program. Regardless, it doesn't matter the path you choose as long as you graduate with a BSN degree.

Once you have your BSN, you must complete a master of science in nursing (MSN) or doctorate of nursing practice (DNP). On average, an MSN degree takes 2-3 years to complete, and a DNP takes 3-4 years. A DNP is not required to practice as an NP, but if you wish to teach or complete a terminal degree, you should pursue a DNP. You can also complete your MSN first, and once you practice for a few years, return and complete your DNP, which will then take 1-2 years to complete.

One other point to consider is years of experience. It is not required at this time to have any years of experience as a nurse before applying to NP school, but I highly encourage a minimum of 1-2 years. The knowledge, skills, and experience you get as a nurse are invaluable in your pursuit of being an NP.

How Much Does It Cost To Become A Primary Care Nurse Practitioner?

Exactly how much does it cost to become a primary care nurse practitioner?

To apply to graduate school, you must complete your BSN. The average cost for completing your BSN ranges from $40,000 to more than $200,000. This is a significant range and is determined by multiple factors, including the school you attend. Attending a private school may be more expensive than attending a public school—in-state public tuition will most likely be cheaper than out-of-state public or private school tuition.

Attending school part-time vs. full-time may also impact the cost. Lastly, completing your ADN and an RN-BSN program may also affect cost.

Once you graduate with your BSN, you must complete graduate school before becoming a primary care nurse practitioner. You can take two paths to do this—either completing your master’s in science of nursing (MSN) or doctor of nursing practice (DNP). The average cost of an MSN program is $81,810 to $185,280, and the average cost of a DNP program is $26,490 to $254,260. The factors that impact the cost of your graduate degree are the same ones that impact your BSN degree. You can also always complete your MSN degree first and pursue your DNP at a later time.

When considering the cost of becoming a primary care nurse practitioner, you must also consider other expenses such as the cost of board, board prep courses and licensing fees, and DEA license. If you are pursuing a fellowship or residency program, that will be an added cost.

What Is The Step-By-Step Process Of Becoming A Primary Care Nurse Practitioner?

1. Complete your BSN: First, you must complete your BSN degree. It does not matter your path—as long as you have your BSN.

2. Pass NCLEX and obtain RN license: Next, pass the NCLEX exam and get your RN license. You cannot practice as a nurse until you do this.

3. Get experience: This is optional, but I highly encourage a minimum of one or two years of experience in any nursing field. The knowledge you gain will be invaluable to your primary care NP career.

4. Apply to graduate school: Once you decide to pursue primary care—apply to a graduate program that is family practice (you could also do an acute care pediatric or adult-gerontology). Be mindful of pre-requisites that must be completed before you start the program.

5. Attend and Graduate from an accredited graduate program (MSN or DNP): Once accepted, attend and graduate from your accredited FNP program—with either an MSN or DNP degree.

6. Pass board licensure exam: Before practicing in primary care, you must pass the FNP board certification exam.

7. Obtain APRN license: Once you have passed the FNP board certification exam, you can obtain your APRN license.

8. Apply for primary care NP fellowship: If you choose to continue and complete a primary care NP fellowship, this is the time to apply and attend.

9. Apply for primary care nurse practitioner jobs: If you choose not to attend a primary care fellowship program, you can now apply for direct care jobs—this step can be started before graduation and passing your board certification exam.

10. Enjoy your career in primary care!—Once you accept your job in primary care, enjoy it!

11. Pursue DNP if you desire—If you have not already, at any time during your primary care NP career, you can return to school to complete your DNP. Please note that if you desire to teach—you will need a terminal degree such as a DNP.

Primary Care Nurse Practitioner Programs

When selecting a primary care NP program, there are a couple of points to consider. First, many primary care NPs pursue a degree in family practice. A family practice NP can provide care from birth to death, making it appealing for people who are not sure of the specific population they wish to care for. There are many programs for family practice NPs to complete throughout the United States.

However, there are specific pediatric primary care and adult-gerontology primary care NP programs for those interested in adult-gerontology or pediatrics.

Recommended Certifications To Enhance Your Job Role As A Primary Care NP

There are no specific certifications explicitly directed toward a primary care NP.

You must be certified in the specialty you pursued in school, whether family medicine, adult-gerontology primary care, or pediatric primary care. The program you complete should direct you to the correct organizations to get you scheduled for the appropriate board certification exam—which you will take after you graduate but before you can practice as an NP.

Based on the environment or specialty you work in, there may be additional certifications you could get to enhance your role as an NP.

List Of Fellowships And Residency Programs For Primary Care Nurse Practitioners

It is not required to complete a fellowship or residency program to become a primary care nurse practitioner. Still, there are a few primary care fellowship programs but they are primarily directed towards family medicine NPs. These programs are designed to better prepare you for working as a primary care NP. Below I will provide information on two of these programs.

Mayo Clinic School of Health Science:

The Mayo Clinic School of Health Science offers a 12-month family medicine fellowship for nurse practitioners at their Phoenix/Scottsdale, Arizona campus. The program combines didactic and clinic opportunities to better prepare the NP to deliver care in the family practice/primary care setting.

Ohio State University Wexner Medical Center:

The Ohio State University Wexner Medical Center offers a 12-month post-graduate primary care fellowship program. This program is directed toward NPs and PAs and focuses on family and community medicine.

Continuing Education Requirements For Primary Care Nurse Practitioners

To continue to practice as a primary care NP, you must complete continuing education requirements (CEUs) to maintain licensure, including CEUs for your RN license, NP license, and certifications.

The state determines the CEUs requirements you are licensed—and in most states, you must renew your RN license every two years and NP license every five years. Each state has specific guidelines regarding the number and type of CEUs needed to renew your licenses. It is not uncommon to have specific requirements for prescribing opioids and other medications. For detailed information regarding RN and NP license renewal, visit your state board of nursing.

Be mindful that if you hold any certifications, there may be CEU requirements to fulfill before renewing your certificatation.

What Is The Starting Salary Of A Primary Care Nurse Practitioner?

The starting primary care nurse practitioner salary is $75,680 per year. This number is influenced by multiple factors such as if you work in an urban or rural community or private practice vs. large organization. Salary is also influenced by the status you work—part-time vs. full-time.

Per Hour	$36.38
Per Month	$6,310
Per Year	$75,680

What Is The Average Salary Of A Primary Care Nurse Practitioner?

So, what is the average salary of a primary care nurse practitioner? The average primary care nurse practitioner salary is $112,408 per year. This number is influenced by the same factors I listed above—rural vs. urban community, private practice vs. large organization and part-time vs. full-time.

Per Hour	$54.04
Per Month	$9,370
Per Year	$112,408
(Source: Ziprecruiter.Com)

What Is The Average Salary Of A Primary Care Nurse Practitioner In Your State?

Now that I have told you the average starting salary and overall average salary of a primary care NP, you may wonder what that means. Below, I have provided a list of the average salary for each state, including the hourly and monthly salaries.

State	Average Salary
	Hourly	Monthly	Annual
Alabama	$46.88	$8,130	$97,520
Alaska	$52.11	$9,030	$108,390
Arizona	$54.90	$9,520	$114,190
Arkansas	$49.02	$8,500	$101,970
California	$69.51	$12,050	$144,590
Colorado	$51.54	$8,930	$107,210
Connecticut	$55.14	$9,560	$114,700
Delaware	$53.21	$9,220	$110,680
Florida	$48.00	$8,320	$99,830
Georgia	$50.16	$8,690	$104,330
Hawaii	$58.37	$10,120	$121,410
Idaho	$48.21	$8,360	$100,270
Illinois	$55.15	$9,560	$114,720
Indiana	$51.96	$9,010	$108,080
Iowa	$55.57	$9,630	$115,580
Kansas	$49.77	$8,630	$103,520
Kentucky	$48.57	$8,420	$101,020
Louisiana	$51.58	$8,940	$107,280
Maine	$53.28	$9,240	$110,820
Maryland	$52.97	$9,180	$110,180
Massachusetts	$59.31	$10,280	$123,360
Michigan	$49.80	$8,630	$103,580
Minnesota	$58.15	$10,080	$120,950
Mississippi	$51.16	$8,870	$106,420
Missouri	$47.38	$8,210	$98,550
Montana	$52.98	$9,180	$110,190
Nebraska	$51.58	$8,940	$107,290
Nevada	$56.63	$9,820	$117,780
New Hampshire	$55.27	$9,580	$114,970
New Jersey	$62.73	$10,870	$130,470
New Mexico	$54.25	$9,400	$112,830
New York	$61.32	$10,630	$127,550
North Carolina	$51.61	$8,950	$107,350
North Dakota	$51.61	$8,950	$107,340
Ohio	$51.50	$8,930	$107,120
Oklahoma	$53.40	$9,260	$111,080
Oregon	$58.69	$10,170	$122,070
Pennsylvania	$53.69	$9,310	$111,670
Rhode Island	$58.03	$10,060	$120,710
South Carolina	$47.09	$8,160	$97,940
South Dakota	$51.42	$8,910	$106,960
Tennessee	$43.55	$7,550	$90,580
Texas	$53.98	$9,360	$112,270
Utah	$51.70	$8,960	$107,530
Vermont	$51.52	$8,930	$107,170
Virginia	$51.42	$8,910	$106,960
Washington	$59.90	$10,380	$124,600
West Virginia	$47.96	$8,310	$99,750
Wisconsin	$53.56	$9,280	$111,410
Wyoming	$52.44	$9,090	$109,070

Job Outlook For Primary Care Nurse Practitioners

The demand for primary care nurse practitioners is growing. The population is continuing live longer, leading to an increased need for primary care providers. The U.S. Bureau of Labor Statistics predicts the job growth for NPs to be 45% between 2020-2030—and while this is not specific to primary care, the job outlook for nurse practitioners is excellent!

Plus, the Association of American Medical Colleges (AAMC) predicts that by 2034 there will be a shortage of between 17,800 and 48,000 primary care physicians. This predicted primary care physician shortage further supports the need for primary care NPs.

Useful Organizations And Associations

There are not many organizations and associations specific to primary care. However, there is one organization that applies to all NPs which is the AANP.

American Association of Nurse Practitioners (AANP):

The AANP is a national organization for nurse practitioners. It offers a wide variety of information to nursing practitioners, including practice updates and CEU opportunities, including conferences and conferences. There are also opportunities to be an advocate for NPs and will provide information regarding current policies and legislature regarding NPs and their practice. The AANP is an excellent organization for all nurse practitioners to join, including primary care NPs and even students!

Finally, Is Primary Care Nursing The Right NP Specialty For You?

After reading the above, do you better understand how to become a primary care nurse practitioner? I have provided information regarding the steps to becoming a primary care nurse practitioner, the pros and cons of the specialty, and the average salary of a primary care NP. Becoming a primary care NP is a gratifying and satisfying career.