As a professor in a BSN-DNP program that prepares primary care nurse practitioners (NP), I worry when I see graduates that are employed by health care organizations to practice outside the primary care scope of practice without the proper credentials. NPs who do this not only put themselves at risk of legal ramifications, but also place the reputation of their entire profession at risk.

The NP role began in 1964 with an advanced role for nurses in primary care pediatrics. Now the majority of U.S. NP educational programs prepare primary care NPs in one or more specialties categorized around six broad population foci. These include: adult/gerontology; family/lifespan; pediatrics; neonatalology; psychiatric/mental health; and women’s health/gender. 

Recently, acute care NP certification programs have been developed to prepare NPs for the increasing health-care demands of critically ill patients, and those with unstable and/or complex chronic conditions. Graduates are eligible for certification in two areas: adult/gerontology and pediatrics.

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Although there are certainly areas in which primary care NPs and acute care NPs scopes of practice overlap, a new statement from the National Organization of Nurse Practitioner Faculties (NONPF) helps provide some clarity regarding how both practitioners can work together to achieve optimal patient outcomes.

The report also cautions that the difference between these two roles is not similar to roles differentiated by setting (in-patient vs. out-patient), but is bound by educational preparation. This is why it is so important for each and every NP to be responsible for adhering to his or her scope of practice, as well as individual state regulations. 

Nurse practitioners have built an excellent reputation based on providing safe, high-quality care to their patients, and this reputation must be upheld.

Julee B. Waldrop, DNP, FNP, PNP, is the Director of the MSN-DNP Program and an associate professor at the University of Central Florida. She provides health care to children at a local community health center.


Murphy, M. A. (1990).  A brief history of pediatric nurse practitioners and NAPNAP 1964-1990. Journal of Pediatric Health Care, 4(6):332-337.