Nurses who choose a career as a family nurse practitioner (FNP) are in good company. Of the more than 325,000 licensed nurse practitioners in the U.S., just over 70% are FNPs. FNPs see patients of all ages with a wide range of conditions. They provide care in private practices, hospitals, and other clinical settings.

Besides their training and education as advanced practice nurses, FNPs also gain certification as either an FNP-BC or an FNP-C. Whether the designation is board-certified (BC) or certified (C), the choice of certification often determines an FNP’s career path.

What are the certification differences that nurses should know when considering whether to become an FNP-BC vs. FNP-C? While these credentials show mastery of similar competencies, they’re different in their approach and goals. Furthermore, they’re available through different professional nursing organizations and have somewhat different eligibility requirements.

Perhaps most importantly, the certification exams have different scopes. The FNP-C is meant for FNPs who plan to go into clinical practice. The FNP-BC is aimed at nurse practitioners who want to make an impact on the profession as a teacher or policymaker (although they are still licensed to practice).

The American Nurses Credentialing Center (ANCC) issues the FNP-BC, which signifies that the FNP is board-certified, whereas the American Academy of Nurse Practitioners (AANP) issues the FNP-C.

The ANCC is a subsidiary of the American Nurses Association. It not only credentials nurses but also accredits health care organizations that support continuing nursing education.

The AANP is a professional association with more than 120,000 members. Its goal is to advance health care quality through education and advocacy of NPs.

The FNP-BC certification exam has a broad focus, testing nurses on clinical care but also covering nursing policy. It’s designed for FNPs who want to go into teaching or who have an interest in guiding policy. Although FNP-BC-credentialed nurse practitioners tend to go into academics, they’re also eligible to practice. Many nurse educators opt to teach and continue in their clinical practice.

The FNP-C, on the other hand, focuses on assessing a candidate’s knowledge of nursing assessment, diagnoses, and treatments. It’s aimed at FNPs who want a clinical career.

The eligibility requirements for the two exams overlap but also reflect the differences between their objectives. Exam questions differ in some areas as well. Once a candidate has passed their respective exam, they’re cleared to practice as an FNP in their state.

Prospective candidates should know the eligibility requirements for FNP-BC vs. FNP-C before they pursue either certification.

FNPs who seek ANCC board certification must meet the following criteria:

• Education. Candidates must have completed a Master of Science in Nursing program with an FNP concentration (MSN-FNP).
• Licensure. They must be registered nurses in the U.S.
• Work experience. Nurses must have at least 500 hours of training.
• Exam fee. This fee ranges between $259 for ANCC members and $395 for nonmembers.

The FNP-C criteria are similar, with a few differences:

• Education. As part of their MSN-FNP program, candidates must have completed certain courses in diagnosis and pathophysiology.
• Licensure. In addition to U.S. RNs, nurses from Canada are also eligible to take the exam.
• Work experience. FNP-C candidates must have at least 500 hours of training.
• Exam fee. This fee ranges from $248 for AANP members to $315 for nonmembers.

The FNP-BC consists of 175 questions, but only 150 are scored. (The remaining 25 are pre-test questions, which are used to gather statistical information.) The pre-test and scored questions are indistinguishable from each other.

The test consists of four categories:

• Assessment. This section measures a candidate’s knowledge of population health, health history, risk assessment, and cognitive and physical assessment.
• Diagnosis. This section covers a candidate’s knowledge of disease, diagnostic tests, and evaluation.
• Clinical Management. This section covers questions on patient guidance, intervention, and evaluation; knowledge of pharmacotherapeutics; and communication with patients and colleagues.
• Professional Role. This section covers ethics, standards of practice, regulatory guidelines, and related professional guidelines.

The AANP FNP-C exam comprises 150 questions, with 15 pre-test questions. The FNP-C also spans four areas:

• Assess. This section covers the candidate’s skill in obtaining patient medical and family history, performing a physical exam, and ordering and interpreting diagnostic tests.
• Diagnose. This section tests the candidate’s knowledge in analyzing data to make a diagnosis.
• Plan. This section covers the candidate’s ability to create a patient plan of care, consult with other professionals, and prescribe medical treatment.
• Evaluate. This section covers the candidate’s ability to evaluate a care plan and modify it as needed.

While estimates vary, industry experts predict that the U.S. will be short some 139,000 health care providers — including 122,000 primary care physicians — by 2030. Additionally, some 83 million Americans currently live in designated health professional shortage areas (HPSA). Many states allow NPs to diagnose patients, prescribe medications, and order tests just as primary care physicians do. These NPs can help fill the need for health care services in HPSAs. As a result, the U.S. Bureau of Labor Statistics (BLS) projects the demand for advanced practice nurses, including family nurse practitioners, will grow 45% between 2020 and 2030.

Salaries for nurse practitioners tend to be considerably higher than for RNs. The BLS reports that the median annual salary for NPs and other advanced practice nurses was $117,670 as of 2020, compared with $75,330 for RNs. PayScale estimates that the median annual salary for FNPs specifically was $97,912 as of March 2022.

Factors such as years of experience and work location also affect salaries.

FNP-BC vs. FNP-C? The choice can mean the difference between treating individuals and families in a private practice, hospital, or clinic and working as a nurse educator or policymaker. Whichever of these important roles appeals to you, Hawai‘i Pacific University’s online Master of Science in Nursing (MSN) program can help prepare you for a career with meaning. Begin your journey to becoming an FNP today.