How to become a Family Nurse Practitioner (FNP) in The USA

By ShiftMed Team//Nursing Profession
FNP talking to a mother and her daughter

Do you love working closely with patients, hearing their stories, and helping them find answers to their questions? Is building a relationship with your patients important to your job satisfaction?

If so, you may want to expand your career in nursing by becoming a family nurse practitioner (FNP).

FNPs are advanced registered nurses who can assess, diagnose, and manage their patients’ care, much like physicians.

The biggest difference between an FNP and a doctor is that doctors are licensed to prescribe medication independently, while family nurse practitioners may need to be supervised by a physician.

Becoming a nurse practitioner starts with a foundation as an RN. Once you’ve gained experience working with patients for several years, you can begin to study family medicine in-depth and work toward your FNP licensure. 

Read more: What is a family nurse practitioner?

What are the steps to becoming a family nurse practitioner?

Before you can start tending to your own patients as an FNP, you’ll have to gain enough experience as a nurse and study family medicine through a nurse practitioner degree program. It’s an exciting journey to become an FNP — let’s look at each step in more detail.

1. Become a registered nurse by earning a nursing degree (BSN or ADN)

Associate’s degrees (ADN) and bachelor’s degrees (BSN) in nursing are the two educational paths that open the door to working as a nurse. You’ll take fundamental nursing courses in anatomy, physiology, biology, pharmacology, and psychology in either program. 

Nursing school programs also introduce you to core clinical skills, such as physical assessment, catheterization, intravenous insertion, and care, obtaining and monitoring vital signs, collecting lab specimens, medication distribution and administration, and patient admission and discharge planning. 

Your nursing skills will span various medical domains, such as neurology, psychology, gastrointestinal and cardiopulmonary care. Aspiring nurses also get hands-on experience in acute and non-acute care settings. Therefore, nursing students must learn how to work with a variety of patients and learn how to perform their duties in different types of environments.

If you pursue an ADN, expect to spend at least two years full-time and three years part-time studying. BSN programs take 4 to 5 years of study to complete (full-time vs. part-time). The most significant difference between an ADN and BSN is the courses you take. 

Both associate’s and bachelor’s degrees prepare you to work well as a nurse; BSNs add additional coursework that makes it easier for you to progress to leadership or management roles in your career. 

It’s also worth noting that today, many employers actively seek nursing candidates who have a bachelor’s degree. This is because, in addition to more nursing knowledge, they also have more extensive clinical experience due to the extra two years of study.

2. Pass the NCLEX-RN exam

Your nursing degree is only the first part of your education! Next, you must put all your knowledge to the test by studying for and passing the NCLEX-RN exam. The NCLEX is the only exam that certifies someone as a registered nurse in the United States. No other test is accepted.

Start studying for the NCLEX early, and take a practice exam so you can get an idea of what to expect. The test system is adaptive, meaning it changes its questions based on your responses and competencies. 

Once the system has 95% certainty of your results, it will administer a pass or fail score. Once you pass, your results are sent to your state’s board of nursing. Then, you can complete your registration process and officially obtain your nursing license number!

3. Gain work experience

Before becoming an FNP, you must work for at least two years as a registered nurse. FNPs need solid nursing skills and refined understanding if they tend to their own patients someday. 

Ideally, you’ll have experience working in family medicine since this will be your specialty later. Family medicine can be practiced in both inpatient and outpatient settings. You can even reach out to some schools you’re considering and ask them what types of clinical experience they recommend for future FNP students. 

4. Earn a master’s degree through an FNP program

You can become an FNP by studying an FNP master’s degree program or earning a Doctorate of Nursing Practice (DNP) specializing in family medicine. Your FNP program will introduce you to the field of family medicine and complete at least 675 hours of clinicals with a minimum of 500 patient encounters

To complete your NP clinicals, you’ll have to find clinical preceptors. These medical professionals will mentor and supervise you during your clinical experience. Suitable preceptors include:

  • Board-certified medical doctors (MDs or DOs) in family medicine

  • Board-certified nurse practitioners in family medicine or an appropriate population-focused area

  • Certified nurse midwives with at least a master’s degree

  • A physician’s assistant with at least a master’s degree

FNP students also choose from various clinical sites depending on the population they want to focus on. For example, FNPs generally have to work in primary care, so experience in emergency or specialty settings likely won’t be accepted.

Your school will be with you every step of the way, so don’t stress too much about arranging everything today. Instead, take it step by step, and use this time to learn more about family medicine and what it’s like being a primary care provider.

5. Obtain certification

Before they can practice medicine, all FNPs must hold certification from an accredited organization. You can either become an FNP-c or FNP-BC. FNP-c makes you a certified family nurse practitioner; an FNP-BC marks you as a board-certified family nurse practitioner.

You can earn your FNP-BC through The American Nurses Credentialing Center (ANCC) and the FNP-c through the American Academy of Nurse Practitioners (AANP).

A certification via the AANP – Family Nurse Practitioner - Certified (FNP-C)

The FNP-c focuses primarily on clinical skills and patient care. It’s ideal for FNPs who want to concentrate on building a robust clinical practice. If you envision your career working hands-on with patients, then an FNP-c credential can test you on the skills most relevant to your practice.

Fees associated with the certification

  • $240 for AANP members

  • $315 for non-members

View the fees table on The AANP website

Eligibility Requirements

  • Hold a valid, unrestricted RN license in the U.S. or Canada

  • Be a graduate of an accredited master’s or doctorate nurse practitioner program

  • Complete all required APRN continued education core courses

  • Have at least 500 hours of supervised clinical experience 

A certification via the ANCC – Family Nurse Practitioner - Board Certified (FNP-BC)

The FNP-BC exam focuses more on ethics and healthcare policy than the FNP-c exam. Therefore, it’s a good choice for family nurse practitioners who want to work in research, nursing administration, or education.


  • American Nurses Association member - $295

  • American Association of Nurse Practitioners student member - $290

  • American Association of Nurse Practitioners member - $340

  • Non-member - $395

Eligibility Requirements

  • Hold a valid, unrestricted RN license in the U.S. or Canada

  • Be a graduate of an accredited master’s or doctorate nurse practitioner program

  • Complete a minimum of 500 supervised clinical hours in an appropriate healthcare setting

6. Get state licensure 

You must pass the National Council Licensure Examination for Family Nurse Practitioners (NCLEX-NP) exam if you want to work as a licensed FNP in your state. Once you pass this exam, you can apply for a nurse practitioner license through your state’s board of nursing. Some states require you to renew your RN licensure every three years, but it varies by location.

Check with your state’s board of nursing to determine whether your NP credentials will “overwrite” your RN credentials. If that’s the case, you’ll only have to renew your NP license every 3 or 4 years, not your RN.

7. Apply for family nurse practitioner jobs

Once you’ve completed all the educational, certification, and licensing requirements, you’re finally ready to apply for jobs as an FNP! Congratulations! Your job as an FNP can include working in a doctor’s office, family healthcare practice, or community clinic.

Depending on your state, you may have to work under a supervising physician. However, in 25 states, nurse practitioners can work independently. 

Here is the full list of states that grant nurse practitioners full practice authority. 

Can you become a family nurse practitioner online?

You can complete some core coursework in your FNP program online, but you must do all of your clinical hours in person at an approved healthcare facility. Therefore, you will have to coordinate with your school to ensure that your clinicals are all done in an appropriate setting with an approved clinical preceptor. 

What is the difference between a family nurse practitioner and a registered nurse?

FNPs are advanced practice registered nurses (APRNs) who specialize in treating patients in primary care. They can see their own patients, make diagnoses, and prescribe medications. Doctors and nurse practitioners supervise RNs; they follow their care plans and treat patients according to a doctor’s or nurse practitioner’s recommendations.

RNs cannot diagnose patients, though they do perform physical assessments. However, they cannot order lab work, prescribe medications, or make clinical diagnoses. 

What is the difference between a family nurse practitioner and a nurse practitioner?

A family nurse practitioner is a specialization of nurse practitioners. Family nurse practitioners choose to work in family medicine, a field of healthcare that tends to a broad patient demographic spanning from infancy through late adulthood.

What is the difference between a family nurse practitioner and a physician?

Although they perform highly similar roles, family nurse practitioners and physicians have one key difference. A physician is a medical doctor who has completed medical school and a residency. FNPs are registered nurses, albeit advanced practice RNs, who have earned a master’s degree or doctorate in family nursing. 

FNPs and physicians are qualified to treat, diagnose, and manage patient care. However, an FNP can never call themselves a doctor and may not refer to themselves as a physician. 

They are still nurses, so they must introduce themselves as such. However, in practice, they usually go by their first name.

To show respect in a professional setting, some may be called Nurse as a prefix, such as Nurse Meredith or Nurse Robert. 

What positions can you progress to from being a family nurse practitioner?

The next step up from a nurse practitioner is to a physician. You could become a primary care physician or family medicine doctor, must complete medical school and a residency in their specialty area. They also have to earn certification. 

An FNP can become an MD by applying to medical school and completing all their requirements. Their extensive medical knowledge will give them an edge in their courses, but they still have to undergo the same education and licensing process as all aspiring doctors. 

Do your family nurse practitioner qualifications expire?

You must renew your FNP certification every three years through your certifying organization. Recertification processes differ depending on your title (FNP-C vs. FNP-BC). Make sure you prepare to recertify ahead of time, as you’ll need to complete professional development courses or retake the certification exam.

How much do family nurse practitioners make?

FNPs are among the top earners in the nursing field due to their advanced education and clinical expertise. The average nurse practitioner's salary in the United States is $116,438 annually.

Click here to read more about how much nurse practitioners make.

How long does it take to become a family nurse practitioner?

Becoming a family nurse practitioner takes 6 to 8 years of education. However, it’s not uncommon for RNs to work several years between their degrees to develop clinical experience. So, you could be an RN for 3, 5, or even ten years before getting your advanced degree and becoming a nurse practitioner. 

The flexibility of this career path makes it a rewarding option for any nurse that wants to gain new opportunities. 

Read more: How long does it take to become a nurse?

FAQs about becoming a family nurse practitioner

Is it hard to become a family nurse practitioner?

Becoming a family nurse practitioner has its fair share of challenges. Nursing certainly isn’t always an easy field, but it is gratifying for those with enough passion and determination to overcome obstacles. 

The hardest part about becoming a nurse practitioner is learning to go from being a registered nurse to assuming the provider role. You’re building upon all the nursing knowledge and skills you already have to provide even more comprehensive care to your patients.

Is becoming an FNP worth it?

Suppose you are passionate about family health and want to treat your own patients, absolutely. Unfortunately, not all nurses want to assume the role of a primary care provider, so they stick to nursing instead. It comes down to whether you are drawn to the added responsibility of clinical assessment and diagnosis.

FNPs take on greater responsibility for their patient's well-being and overall health outcomes, so it’s important to consider how that role will influence your job satisfaction.

What is the most challenging class in nurse practitioner school?

Your competencies in different subjects will impact which classes you have the hardest time with. That being said, most students find pathophysiology, pharmacology, and medical-surgical courses to be some of the most difficult during their studies.