What Is a Family Nurse Practitioner’s Scope of Practice?

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FNP talking to a family in a hospital.

Family nurse practitioner (FNP) is a popular career path in the nursing field. In fact, about two-thirds (65.4 percent) of all nurse practitioners (NPs) are certified to provide family care, according to the American Association of Nurse Practitioners (AANP) in 2019.

Many nurses aspire to become FNPs because of the rewarding nature of the job. During a single day, an FNP may provide primary care to children, teenagers, young adults, parents and seniors, some of whom may all be from the same family the FNP has seen for years.

As advanced practice registered nurses (APRNs), FNPs are educated and licensed to perform a wide range of clinical duties. But what exactly does a family nurse practitioner do?

What Is an FNP?

First, let’s define what a family nurse practitioner is and how to become one. FNPs are APRNs who specialize in providing family-focused health care to patients of all age demographics. They can work in many different employment settings, including private independent practice, physician’s offices, hospitals, health care systems, outpatient clinics, universities, community clinics and more. In fact, in some rural or underserved areas, FNPs may be the only care providers accessible.

There are a few core steps to becoming an FNP:

Earn a bachelor of science in nursing (BSN)
Become a licensed registered nurse (RN)
Earn a graduate degree, such as a master of science in nursing (MSN) or doctor of nursing practice (DNP)
Pass and secure FNP national certification examination
Become licensed by a state board of nursing as an advanced practice provider

What Does a Family Nurse Practitioner Do?

Family nurse practitioners are NPs. According to the AANP, NPs are educated and licensed to:

Perform health assessments and manage patient data in electronic health records
Order and interpret diagnostic and laboratory tests
Make diagnoses and create, implement and manage treatment plans
Coordinate care with other stakeholders and medical professionals
Treat and help patients manage acute and chronic conditions
Provide counseling and health education to patients and their families

Like all NPs, FNPs approach health care through a patient-centric model. That is, the care decisions made by an FNP are reached in close consultation with the patient and family, based on needs, wants and preferences. The education and experience of FNPs makes them uniquely qualified to carry out this vision, according to AANP (date). In reality, it may mean focusing on building a relationship with patients and their families through engagement, bedside manner and education about topics like disease prevention and health promotion.

What differentiates the family nurse practitioner scope of practice is the everyday clinical experience, shaped by an individual FNP’s work setting, patients, additional certifications and focus area. The AANP in 2019 lists the top three clinical foci for FNPs as primary care, urgent care and internal medicine.

On a given day, an FNP may provide prenatal care to expectant parents, administer immunizations to school-aged children, treat a teenager’s broken arm, conduct an annual physical for a young adult, craft a treatment plan for a middle-aged patient with hypertension or talk to a senior about solutions to mobility challenges as they age.

Increasingly, the FNP scope of practice has widened to include providing mental health care. According to a 2019 article published in the Journal for Nurse Practitioners (JNP), patients with common mental illnesses such as depression and anxiety are most likely to be treated initially by an FNP. However, an important distinction is while some duties fall within the family nurse practitioner scope of practice (like initial mental health screenings), there are others that fall outside this scope, such as treating patients with complex mental health issues which would be more appropriate for a psychiatric nurse practitioner.

Can FNPs Prescribe Medications?

FNPs, like all NPs, have prescriptive authority. This is a crucial aspect to the family nurse practitioner scope of practice, as these professionals are educated and licensed to prescribe pharmacologic agents and non-pharmacologic therapies, such as medical devices or durable medical equipment like a back brace.

While FNPs can prescribe and manage medications, prescriptive authority is tightly regulated on a state level. This is important to note for any nurse who wants to become an FNP. Each state’s nursing board determines whether:

A physician’s involvement is required to prescribe medications
An FNP has authority to prescribe Schedule III-V controlled substances
An FNP can prescribe Schedule II controlled substances
What additional educational requirements may be needed for prescriptive authority

This resource from the American Medical Association (AMA) has state-by-state regulations. Some states require physicians to be present, while others do not — just as states vary widely in their requirements for additional hours of education or experience.

What Can a Family Nurse Practitioner Do to Practice Independently?

Similar to prescriptive authority, the level of practice autonomy afforded to FNPs is decided by all 50 states, plus Washington, D.C., and other U.S. territories. The levels of practice autonomy, according to the AANP, are:

Full practice: State practice and licensure laws allow all NPs (including FNPs) to perform duties within their scope of practice (e.g., ordering and interpreting diagnostic tests and prescribing medications).
Reduced practice: State laws reduce the ability of NPs to engage in at least one element or setting of practice and require a career-long collaborative agreement with another provider for the NP to provide patient care.
Restricted practice: State laws restrict the ability of NPs to engage in at least one element of NP practice and require career-long supervision, delegation or team management by another health provider.

As of December 2019, FNPs can practice independently in Alaska, Arizona, Colorado, Connecticut, District of Columbia, Guam, Hawaii, Idaho, Iowa, Maine, Maryland, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Northern Mariana Islands, Oregon, Rhode Island, Vermont, Washington and Wyoming.

States and territories with reduced or restricted practice environments include:

Reduced practice: Alabama, Arkansas, American Samoa, Delaware, Illinois, Indiana, Kansas, Kentucky, Louisiana, Mississippi, New Jersey, New York, Ohio, Pennsylvania, Puerto Rico, Utah, Virgin Islands, Wisconsin and West Virginia.
Restricted practice: California, Florida, Georgia, Massachusetts, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee and Virginia.

It’s important for current and prospective FNPs to keep an eye on current affairs and developments at a state level. There has been a push in recent years to expand practice autonomy for NPs to help meet health care demands and better serve rural populations. State laws are always changing, and new legislation may be introduced in states without full practice authority.

Study at Bradley to Become an FNP

FNP is a popular career path not only because of its rewarding nature, but also because of its high-level responsibilities. However, there are significant educational and experiential requirements needed to become an FNP.

If you’re interested in a career as an FNP, earning an MSN or DNP from Bradley can prepare you with a focused education. Our online program is designed to help students work toward FNP certification, with courses focused on FNP principles of practice, including: