Nurse Practitioner Subspecialty Certification Guide

A subspecialty certification proves you can manage a specific patient population at an expert level. It also sets you apart as the NP field grows and competition for the best jobs tightens. Here are seven common NP subspecialty credentials, with the organization behind each one, what it costs, and what you need to qualify.

The Four Major NP Specialties

The American Nurses Credentialing Center (ANCC) is the most widely recognized certifying body in nursing. It certifies NPs in four core specialties:

• Family Nurse Practitioner (FNP-BC)
• Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP-BC)
• Adult-Gerontology Acute Care Nurse Practitioner (AGACNP-BC)
• Psychiatric-Mental Health Nurse Practitioner, Across the Lifespan (PMHNP-BC)

The subspecialty certifications below sit on top of one of these primary credentials. You hold an NP license first, then add the subspecialty.

Seven NP Subspecialty Certifications

1. Orthopedic Nurse Practitioner

Orthopedic NPs assess, diagnose, and manage musculoskeletal conditions: arthritis, fractures, dislocations, carpal tunnel. Most come from a family, pediatric, or geriatric background and work in rehabilitation facilities, sports medicine practices, and outpatient surgery centers. Payscale put the average orthopedic NP salary at $100,035 as of March 2024.

• Certifying body: Orthopaedic Nurses Certification Board
• Renewal: Every five years
• Cost: $300 for members of NAON, AANP, NOVA, or CONA; $425 for nonmembers

Requirements: at least three years as an RN or APRN, 2,000 hours of advanced practice experience in the past three years, current practice treating musculoskeletal conditions, an unencumbered license and NP certification, and a passing exam score. The exam covers degenerative disorders, orthopedic trauma, sports injuries, inflammatory and metabolic bone disorders, congenital and pediatric conditions, musculoskeletal tumors, and neuromuscular disorders.

2. Emergency Care Nurse Practitioner

Emergency NPs triage and treat whatever comes through the door. They work in hospital emergency departments, freestanding emergency centers, emergency transport, the military, and disaster settings. Payscale listed the average at $99,044 as of March 2024.

• Certifying body: American Academy of Nurse Practitioners National Certification Board
• Renewal: Every five years
• Cost: $240 for AANP members; $315 for nonmembers

Requirements: 2,000 direct emergency care hours as an FNP in the past five years, 100 continuing education hours in emergency care plus 30 in procedural skills, completion of an accredited emergency care NP or dual FNP/ENP program (or a 12-month emergency fellowship), an unencumbered license and NP certification, and a passing exam. The exam spans five domains: medical screening, decision-making and differential diagnosis, patient management, transitions of care, and professional practice. Clinical topics include thoracic, cardiovascular, dermatologic, abdominal, musculoskeletal, renal, neurologic, and traumatic disorders.

3. Hospice and Palliative Care Nurse Practitioner (ACHPN)

These NPs provide end-of-life care in patients' homes, hospice centers, and residential care facilities. Payscale put the average at $97,069 as of March 2024.

• Certifying body: Hospice and Palliative Credentialing Center
• Renewal: Every four years
• Cost: $320 for HPNA members; $465 for nonmembers

Requirements: 500 hospice or palliative care hours in the past year or 1,000 in the past two years, a transcript showing advanced physical assessment, pathophysiology, and pharmacology with at least 500 clinical practicum hours, an unencumbered license and NP certification, and a passing exam. The exam covers assessment, diagnosis and planning, intervention and evaluation, disease process, prognosis, grief and bereavement, ethics, quality improvement, and care coordination.

4. Oncology Nurse Practitioner (AOCNP)

Oncology NPs treat cancer patients across inpatient and outpatient settings. Payscale listed the average at $101,280 as of March 2024.

• Certifying body: Oncology Nursing Certification Corporation
• Renewal: Every four years
• Cost: $300 for ONS or APHON members; $420 for nonmembers

You qualify through one of two pathways. Pathway 1: 500 supervised hours as an adult oncology NP in the past five years, plus a graduate oncology course (two-plus credits) or 30 continuing education hours, plus a graduate NP degree with an oncology concentration. Pathway 2: 1,000 adult oncology NP hours during or after a graduate program, the same coursework requirement, and a graduate NP degree in adult, family, gerontology, or women's health. Both require an unencumbered license, NP certification, and a passing exam covering screening and genetics, diagnosis and staging, treatment, symptom management, oncologic emergencies, survivorship, end-of-life care, and the advanced practice role.

5. Dermatology Nurse Practitioner (DCNP)

Dermatology NPs diagnose and manage skin disorders, from acne to skin cancer, usually in hospitals and clinics. Some specialize in aesthetics: botox, fillers, sclerotherapy, chemical peels, microdermabrasion, and laser hair removal, often in dermatology offices or medical spas. Payscale put dermatology NPs at $94,742 and aesthetic NPs at $85,360 as of March 2024.

• Certifying body: Dermatology Nurses Association
• Renewal: Every three years
• Cost: $400

Requirements: at least 3,000 recent NP practice hours with current dermatology practice (formal program, fellowship, or residency hours count), an unencumbered license and NP certification, and a passing exam. The exam tests assessment and diagnosis across the lifespan, evidence-based interventions, patient and community education, and professional practice.

6. Nephrology Nurse Practitioner (CNN-NP)

Nephrology NPs treat kidney conditions: chronic kidney disease, kidney stones, renal cysts. Most work in hospitals or private practices. ZipRecruiter listed the average at $130,295.

• Certifying body: Nephrology Nursing Certification Commission
• Renewal: Every five years
• Cost: $350 for NNCC and partner members; $375 for nonmembers

Requirements: 2,000 hours and two years of nephrology NP practice within the past two years, 20 contact hours of approved nephrology continuing education in the two years before applying, an unencumbered license and NP certification, and a passing exam. Approved continuing education must come from an ANCC-accredited organization, AACN, the Council of Continuing Education, AANP, a state board of nursing, or an ACCME-accredited body. The exam covers acute kidney injury, all stages of chronic kidney disease, kidney replacement therapies, pharmacology, and interdisciplinary care planning.

7. Cardiology Nurse Practitioner (CVNP-BC)

Cardiac NPs manage heart failure, stroke complications, peripheral arterial disease, and related conditions across inpatient units and outpatient clinics. Payscale put the average at $96,461 as of March 2024.

• Certifying body: American Board of Cardiovascular Medicine
• Renewal: Every three years
• Cost: $429.95

Requirements: at least two years as a cardiac NP, an unencumbered license and NP certification, and a passing exam. The exam covers cardiovascular diseases (heart failure, hypertension, acute coronary syndrome, cardiomyopathy), heart sounds and bedside assessment, 12-lead ECG and arrhythmias, cardiovascular pharmacology, pacemakers and ICDs, and interventional and noninvasive cardiology procedures.