Question: Can nurse practitioners switch specialties?

Answer: Yes – Nurse practitioners can switch or add an additional specialty to their practice area. To switch specialties, nurse practitioners must complete additional training in their desired new area of specialization, and typically are required to sit for a certification or licensure examination to demonstrate their competency in the new specialty. As the majority of nurse practitioners have already earned their Master of Science in Nursing (MSN), if not their Doctor of Nursing Practice (DNP), post-MSN graduate certificate programs in specific nursing specialties are the most straightforward, and often the most efficient and affordable, means of switching or adding a specialty for nurse practitioners.

Nurse practitioners (NPs) work in a variety of advanced areas of nursing practice, from primary and preventative care to acute care, palliative care, and psychiatric or behavioral health support for patients across the lifespan. As nurse practitioners progress in their careers within a particular specialty, many wish to expand their scope of practice. Specializing in additional areas of advanced nursing practice can provide nurse practitioners with additional career opportunities, allowing them to be more versatile in clinical settings and to also be more competitive for jobs that require interdisciplinary medical skills. Additionally, some nurse practitioners, especially those working in acute care, may want to add a primary care specialization that allows them to achieve a better work life balance later on in their career.

Most nurse practitioners start their careers in one of the following specialties:

• Family Nurse Practitioners (FNPs) engage in primary and preventative care services for patients across the lifespan and within the context of the family unit. They conduct patient health assessments, counsel and educate patients on preventative care measures, order diagnostic tests and conduct differential diagnoses, prescribe medications (depending on their state’s practice authority), and treat minor illnesses and injuries.
• Women’s Health Nurse Practitioners (WHNPs) are primary health care professionals who specialize in caring for women across the lifespan, from early adolescence on through women’s post-menopausal years. They conduct women’s health examinations (such as cervical exams and breast cancer screenings), advise women on fertility and birth control, prescribe medications to address women’s health care needs, and serve as female patient advocates.
• Pediatric Primary Care Nurse Practitioners (PPCNPs) provide primary care to children from infancy on through late adolescence, and also communicate closely with children’s family members/caregivers in order to ensure patients’ ongoing health and well-being. They conduct pediatric physical examinations, order diagnostic tests and interpret results, make treatment recommendations to patient caregivers, and treat minor illnesses and injuries.
• Pediatric Acute Care Nurse Practitioners (PACNPs) specialize in caring for pediatric patients facing more severe and/or complex diseases and injuries that require intensive treatment. They diagnose patient conditions, engage in discussions with patients’ families and the rest of their critical care team to design plans of care, and provide ongoing treatment for chronic severe diseases.
• Adult Gerontology Primary Care Nurse Practitioners (AGPCNPs) provide primary and preventative care services to adult patients from early adulthood through old age. They conduct patient health assessments, diagnose and treat minor conditions, and advise patients on preventative health measures such as regular diagnostic screenings and lifestyle changes.
• Adult Gerontology Acute Care Nurse Practitioners (AGACNPs) serve adult patients across the lifespan who are experiencing complex and/or critical illnesses. They stabilize patients in critical condition, evaluate and prioritize patient needs in critical and intensive care settings, and work with patients’ medical care team and family to develop and implement effective treatment plans.
• Neonatal Nurse Practitioners (NNPs) specialize in caring for high-risk infants who have complications ranging from premature birth to low birth weights, heart abnormalities, or infections. They diagnose and treat neonatal conditions, and also provide follow-up care to infants who have left the neonatal intensive care unit (NICU).
• Psychiatric Mental Health Nurse Practitioners (PMHNPs) evaluate, diagnose, and treat mental, emotional, and behavioral health challenges that patients encounter. They conduct psychosocial assessments, deliver emergency psychiatric care, provide psychotherapy, prescribe psychiatric medications, and follow up with patients on their ongoing mental health care treatment plan.

How Nurse Practitioners Can Switch Specialties

To switch specialties, nurse practitioners typically need to complete additional didactic and clinical training in their new desired area of work. In addition, they are generally expected to earn advanced practice nursing certification(s) in their new area of practice by taking and passing an examination offered through one or more specialized nurse practitioner credentialing bodies. Details on credentialing options for different types of NP specialties are explained below:

• Family Nurse Practitioners generally must earn the FNP-BC credential from the American Nurses Credentialing Center (ANCC), or the FNP Certification from the American Academy of Nurse Practitioners (AANP).
• Pediatric Primary Care Nurse Practitioners and Pediatric Acute Care Nurse Practitioners must earn certifications from the Pediatric Nursing Certification Board (PNCB), which offers examinations for Acute Care Certified Pediatric Nurse Practitioner (CPNP-AC) and Primary Care Certified Pediatric Nurse Practitioner (CPNP-BC).
• Women’s Health Nurse Practitioners and Neonatal Nurse Practitioners generally must earn certification through the National Certification Corporation (NCC), which offers WHNP-BC and NNP-BC certification examinations.
• Adult Gerontology Primary Care Nurse Practitioners can earn certification through the ANCC or the AANP, similarly to Family Nurse Practitioners. While the ANCC offers the AGPCNP-BC certification, the AANP offers the A-GNP certification.
• Adult Gerontology Acute Care Nurse Practitioners generally must earn certification through the ANCC or the American Association of Critical Care Nurses (AACN). While the ANCC’s certification in this area is designated as AGACNP-BC, the AACN’s certification is named the ACNPC-AG (Adult-Gero.) certification.
• Psychiatric Mental Health Nurse Practitioners can earn PMHNP-BC certification through the ANCC. In addition, the PNCB offers a Pediatric Primary Care Mental Health Specialist (PMHS) examination for nurse practitioners who wish to demonstrate competency in providing mental and behavioral health care for children and adolescents.

To understand the specific steps required to switch specialties, NPs must first research the relevant examinations offered through the organizations listed above, including how to apply to take the exam(s). From there, candidates must assess the gap between their current academic background and clinical experiences, and the eligibility requirements for their desired certification exam.

In general, to be eligible for a NP certification examination in a particular area of advanced practice nursing, candidates must have completed an MSN, DNP, or post-MSN graduate certificate program in that specialty. In addition, they must have completed a certain number of supervised clinical experience hours that are relevant to the specialty (the specific number of required clinical hours varies, but most credentialing organizations require at least 500). For APRNs who have already earned their MSN and/or DNP in their current specialty and wish to branch out to a new one, post-MSN graduate certificate programs are one of the primary options to efficiently meet the eligibility requirements for a particular NP certification examination.

Steps to Changing Specialties for Nurse Practitioners

1. Research the certification options for one’s desired new area of advanced nursing practice. As noted above, there are often a couple certification options for a given NP specialty, offered through different organizations. Candidates should thoroughly research each of their options to determine which one best meets their professional goals.
2. All credentialing bodies listed above, from the ANCC to the NCC and the PNCB, require candidates to be licensed RNs in their state of residence. Additionally, each state board of nursing may have requirements for APRNs in specific specialties, so NPs looking to expand their scope of practice should always check with their state board of nursing to determine any state specific requirements for licensing in their desired new area of specialization.
3. Once NPs have determined the certification they wish to pursue (and checked with their state board of nursing for any additional licensure requirements, if applicable), they must determine which eligibility requirements they already meet for the certification examination, and which ones they need to obtain through additional academic training in order to sit for the desired exam.
4. Assuming they already have an MSN or DNP and do not wish to enroll in another full degree program, candidates must research accredited post-MSN graduate certificate programs in their desired specialty area, and contact these programs to discuss admissions requirements and a potential Gap Analysis (see the section below for more information on post-MSN graduate certificate programs and Gap Analyses).
5. Enroll in a post-MSN graduate certificate program that offers the coursework and clinical internship hours necessary to qualify for one’s desired certification examination.
6. Take and pass the certification examination for one’s desired specialty, and submit relevant documentation of past clinical training and educational experience in the desired area of nursing practice.
7. Renew certification(s) as necessary by researching recertification requirements for the credentialing body one chooses. In many cases recertification may require the completion of continuing education hours, sitting for another examination after a few years, and/or demonstrating substantial professional experience in the area of practice designated in one’s certification.

Post-MSN Nurse Practitioner Graduate Certificate Programs

As mentioned previously, the specific steps that an individual nurse practitioner must take to switch specialties depends on their current area of practice, academic background, and past professional experience, as well as the requirements of the new specialty they are pursuing, including requirements for certification in that specialty. Post-MSN graduate certificate programs are designed specifically for nurse practitioners seeking a flexible route to changing specialties. In general, post-MSN graduate certificate programs are comprised of 20-26 course credits and around 500-700 hours of clinical training, though the specific curriculum details for programs varies by school of nursing. In addition, many post-MSN graduate certificate programs are offered online (with the exception of the required in-person clinical hours, which students generally can fulfill within their region of residence), which allows for maximum flexibility as students do not have to commute to classes or relocate to attend a particular program.

Due to their past academic training at the MSN and/or DNP levels, nurse practitioners enrolled in a graduate certificate program are generally not required to repeat courses or clinical training they have already completed during their previous graduate programs. For example, NPs typically do not have to repeat courses covering the 3 P’s of Nursing: Physical/Health Assessment; Physiology and Pathophysiology; and Pharmacology. Instead, post-MSN graduate certificate programs include mainly specialized coursework that is similar to the specialization coursework that MSN graduates completed in the second year of their MSN program.

For example, a post-MSN graduate certificate program in pediatric acute care nursing would not generally include foundational coursework on health assessments, but would rather have courses that focus on the principles and best practices for working in the pediatric intensive care unit; diagnosis, triage, and treatment; and treatment of severe and complex pediatric diseases. For additional examples of the course content post-MSN graduate certificate programs may feature, as well as further details on their curriculum structure, please refer to our FAQs on FNP to WHNP graduate certificate programs and FNP to PMHNP graduate certificate programs.

Depending on whether students completed courses or clinical hours in their previous MSN or DNP program that are relevant to their desired new area of practice, some graduate certificate programs may waive courses and/or a portion of the required clinical hours for qualifying students in a process that is often required to as a Gap Analysis. In a Gap Analysis, the graduate certificate program evaluates an admitted student’s past graduate program experience to determine if a limited number of credits and/or clinical hours can be transferred from this past work. Gap Analyses are highly individualized, and each school of nursing has different policies around how it decides which courses and clinical hours are transferable; as a result, students who are interested in a particular program and wish to know if they qualify to transfer some credit hours should always contact the admissions office of these programs prior to applying.

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