FNP vs. ACNP: What are The Differences
| NurseJournal Staff
By definition, all NPs assess, diagnose, treat, and manage acute episodic conditions and chronic illnesses, regardless of the patient population they are certified to care for. This has left some to wonder, then, what is the difference between an FNP (family nurse practitioner) and ACNP (acute care nurse practitioner)?
The short answer is that as primary care providers, FNPs typically work in clinics and other outpatient settings where they may provide treatment to people with acute conditions, as long as the condition is not life-threatening and the patient’s health is not deteriorating. In contrast, ACNPs are found in emergency rooms, inpatient hospitals and ICUs where they deal specifically with treating acute conditions that very often are life-threatening.
Still, there’s a lot more to the story than that.
Simplification Under the Consensus Model - All NPs Need a Patient Population Focus
All NPs are experts in health promotion, disease prevention, and treating the whole person. They all have the training to diagnose and treat medical conditions, order and interpret tests, prescribe medications, teach and counsel patients, and often serve as independent providers. But not all NPs are certified and licensed to care for the same patient populations in the same settings. An NP population focus is where the road splits and NPs become experts with patients in specific age ranges and stages of life.
Some of the most popular APRN certifications have undergone changes as the certifying agencies that offer these credentials move to align their certificate options with the APRN Consensus Model, a model for regulation that seeks to achieve national uniformity in APRN certification and education, among other things.
The APRN Consensus Model undoubtedly put the advanced practice nursing profession on the right track toward uniformity and simplification. Among many other things, the Consensus Model addressed the lack of common definitions for APRN roles and population foci.
Of course, under the Model, NPs are identified as one of the four APRN roles (along with nurse anesthetists, nurse-midwives, and clinical nurse specialists) and are required to hold national certification in one or more of six patient population foci:
- Family/Individual Across the Lifespan
- Women’s Health/Gender-Related
- Psychiatric/Mental Health
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Retiring Certifications Without a Population Focus, and Introducing New Ones
As a result, certification agencies began to retire certifications that didn’t feature one of the defined population foci, and introduced new certifications that did.
One of the biggest changes was felt when the American Nurses Credentialing Center’s (ANCC) Acute Care Nurse Practitioner (ACNP) exam was retired as a primary certification because it did not focus on a specific patient population, but only identified a specialty area (acute care). This means you can pretty much forget about the ACNP cert since it is no longer available and only those grandfathered in with the old credential still identify themselves exclusively as ACNPs. The ANCC also retired its Adult Nurse Practitioner (ANP-BC) exam and its Gerontological Nurse Practitioner (GNP) exam in response to the Consensus Model’s new patient population focus definitions, which combined the adult and gerontology patient population classifications into one: Adult-Gerontology. This was done because changing demographics have forced the nursing community to address the needs of a growing geriatric patient population.
These three popular certifications were, however, replaced with the Adult-Gerontology Acute Care Nurse Practitioner (AGACNP-BC) certification to reflect the newly minted adult-gerontology population focus. The ANCC also introduced the Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP-CP) certification for NPs interested in serving in a primary care role.
Similarly, the American Association of Critical Care Nurses retired its Acute Care Nurse Practitioner Certification (ACNPC) – Adult and introduced the Acute Care Nurse Practitioner Certification – Adult-Gerontology (ACNPC-AG).
To make things even more interesting, dual role (Family NP/Adult-Gerontological Acute Care NP) graduate programs have since become widely available, allowing nurse practitioner students to prepare for both types of certification through the same program at the same time.
Changes in Population Focus Meant Changes to Scope of Practice
Since the FNP’s scope of practice doesn’t include care for patients with acute or chronic illnesses in deteriorating or life-threatening conditions, the AG-ACNP is the go-to credential for NPs looking to serve adult patients in areas like emergency rooms, trauma units, and intensive care units.
Now, only NPs certified to care for a narrower population focus – the adult-gerontology and pediatric patient populations – can select acute care as part of their primary certification.
As expected, these changes brought about quite a bit of confusion, leading many aspiring NPs to question the differences between the seemingly similar FNP (Family Nurse Practitioner), AG-ACNP (Adult-Gerontology Acute Care Nurse Practitioner), and AG-PCNP (Adult-Gerontology Primary Care Nurse Practitioner) titles.
The Real Question is: What is the Difference Between FNP, AG-ACNP, and AG-PCNP?
Here’s an overview of these three NPs:
- The FNP population focus is primary care for family/individuals across the lifespan (infants to older adults), and may include dealing with acute or chronic conditions that are not life threatening.
- The AG-ACNP and AG-PCNP have one population focus: adults ages 13 years and older (young, middle, and older adults, including the frail elderly).
- The AG-ACNP cares for adults with complex disease states those with new acute conditions or acute exacerbations of chronic conditions.
- The AG-PCNP diagnoses and treats episodic illnesses and chronic diseases in adult and geriatric patients.
The APRN Consensus Model outlines clear distinctions between the FNP, the AG-ACNP, and the AG-PCNP:
Today’s FNPs provide patient-focused primary care to individuals across the lifespan. Their focus includes delivering preventive healthcare services for both acute and chronic conditions. Therefore, their scope of practice includes diagnosing and treating illnesses, performing routine checkups, health-risk assessments, immunization and screening tests, and counseling services.
FNPs are certified and licensed to treat patients of all ages. They very often care for their own patients, although it also not uncommon for them to co-manage their care with other specialists. The term family means that FNPs care for individuals throughout their lifespan from the antepartum period to infancy, childhood, and adolescence and the adult lifespan. FNPs often provide prenatal and postnatal care to mother and baby.
It is common for FNPs to collaborate with healthcare and social service professionals in numerous settings, such as schools, workplaces, and community-based organizations. FNPs often provide primary care services in community-based settings to the most underserved and vulnerable populations.
Although FNPs, like other NPs, are nationally certified and licensed according to the populations they serve, these APRNs are employed in many settings, including private practices, local health departments, VA outpatient clinics, urgent care centers, and retail clinics. Job opportunities remain strong for FNPs because of their ability to work in a spectrum of clinical settings.
FNPs manage acute episodic problems and manage long-term stable chronic diseases. They often specialize their careers in areas like cardiology, neurology, dermatology, endocrinology, women’s health and orthopedics.
FNP graduates are eligible to take the family nurse practitioner examinations offered by the American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners Certification Board (AANPCB).
Adult-Gerontology Acute Care Nurse Practitioners (AG-ACNPs) provide care to adults and older adults with complex conditions in acute care and hospital settings. The patient population for AG-ACNPs includes young adults (13+), adults, and older adults, and competencies are based on patient care needs.
Their work involves stabilizing patients, providing complex monitoring, ordering and interpreting diagnostic tests, and developing complex treatment plans designed to maximize the health of their patients and prevent complications. They work with patients who are acutely ill (often times with multiple, complex problems), or are highly vulnerable to complications.
AG-ACNPs usually work in trauma units, sub-acute care units, emergency rooms, and intensive care units (CICU, MICU, SICU). Their job involves close collaborations with physicians and specialists. In addition to diagnosing and treating medical conditions, ACNPs often provide direct patient management from the time of admission to the time of discharge. It is also typical for these nursing professionals to follow patients to the outpatient setting to ensure their transitional needs are met.
Because of the large Baby Boomer population, ACNPs are in high-demand. Their expertise allows them to work in many specialty areas, such as nephrology, cardiology, neurology, and surgery.
AG-ACNP graduates are eligible to take the adult-gerontology acute care nurse practitioner examinations offered by the American Nurses Credentialing Center (ANCC) and the American Association of Critical-Care Nurses (AACN) Certification Corporation.
The AG-PCNP provides care to adults across the lifespan starting in adolescence, at the age of 13. Similar to FNPs, AG-PCNPs emphasize high-quality, cost-effective care that focuses on disease prevention and health promotion. Counseling, in the form of teaching individuals and their families about maintaining their health and preventing disease, is an important part of the AG-PCNP’s role.
In addition to diagnosing and treating acute and episodic illnesses and diseases in adults, the AG-PCNP often orders diagnostic testing, collaborates with other healthcare providers, prescribes medications, and refers patients to appropriate specialists.
Different from the FNP, who focuses on patients across the lifespan to include infants, women’s care (including pre- and post-partum care), and children, the AG-PCNP has the added value of being focused on adolescent and geriatric health, including palliative and end-of-life care. They often specialize in an area within adult medical care, such as cardiovascular care, oncology, HIV/AIDS, diabetes, and pulmonary care.
AG-PCNP graduates are eligible to take the adult-gerontology primary care nurse practitioner examinations offered by the American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners Certification Board (AANPCB).
Comparing Salary, Job Outlook, Duties, Settings, Qualifications and Training
And the differences between FNPs, and adult-gerontology NPs in either acute or primary care don’t stop with differences in the age and gender of the patients they see and the related scope of practice. The population focus an NP chooses can also affect everything from daily job duties, working hours and work setting, to salary and job outlook.
Differences in the kinds of hours FNPs, AG-ACNPs, and AG-PCNPs work depends largely on the setting in which they work.
NPs in acute care, because they tend to work in settings like emergency rooms and trauma units, usually have non-traditional work hours that require them to be available to meet the demands of the hospital based on peak emergency hours and unforeseen emergencies.
Ordinarily, FNPs, who generally work in primary care outpatient settings, enjoy traditional work hours that mirror doctor office hours.
Adult-gerontology NPs in primary care also most often enjoy standard doctor’s office hours; however, those that work in nursing homes and other long-term care settings may work irregular hours.
Still, both FNPs and adult-gerontology NPs in primary care can also be certified to work in emergency medicine where they’ll more often work in urgent care settings, though this is less common.
Duties and Responsibilities
Family nurse practitioners deliver primary healthcare to individuals across the lifespan (pediatrics to older adults), with an emphasis on family-centered preventive care. Their expertise lies in working with a variety of patients to manage any number of health conditions at various stages of life.
In these settings their job duties and responsibilities include:
- Diagnosing and managing acute and chronic conditions that are not immediately life-threatening
- Promoting healthy lifestyles through education and counseling
- Managing patients with chronic health issues
Clinical practice for FNPs includes making referrals to specialists, collaborating with other healthcare professionals, and consultation.
They are trusted advocates in a constantly changing healthcare environment, and their broad knowledge base makes them widely adaptable, capable of applying theory and research in practice, and developing and implementing nursing strategies that assure quality of care.
Adult-Gerontology Acute Care Nurse Practitioners (AG-ACNP) care for acutely ill patients in acute care settings emergency rooms and trauma units.
Their focus is solely on caring for the adult population (young, middle, and older adults, ages 13 and older) with complex diseases.
Their expertise lies in providing advanced acute and chronic care services to adults and the elderly, often in high-acuity settings where patient care requirements are complex. In addition to managing patient care, AG-ACNPs are often required to implement invasive procedures to stabilize patients, which could include intubation.
These APRNs diagnose and treat medical conditions and provide direct patient management from the time of admission to the time of discharge. In many states, they are allowed to both admit and discharge patients.
They are called upon to collaborate with physicians and other members of the healthcare team to ensure comprehensive care to acutely ill patients, many of whom have multiple/complex conditions that are life threatening.
Adult-gerontology primary care nurse practitioners (AG-PCNP) care for adult patients with acute and chronic illnesses in a primary care setting. Their emphasis is on health promotion, disease prevention, and the management of common acute illnesses and chronic health problems that are not immediately life threatening. They differ from the acute-care NP because their expertise lies in treating adult patients with stabilized chronic conditions.
Many adult-gerontology NP programs emphasize providing care to, and advocating for, culturally diverse and high-risk populations.
FNPs generally work in primary care practices including women’s health, family practice, pediatric, and internal medicine clinics. As such, they are often found in outpatient/ambulatory settings like independent and partner practice clinics and community health clinics. Their expertise also makes them valuable contributors to managed care organizations, businesses, and governmental agencies.
AG-ACNPs assess and manage acutely ill patients in a variety of specialized units within the hospital, and beyond:
- Emergency rooms
- Trauma units
- Intensive care units (ICU)
- Acute/sub-acute wards
- Specialty clinics (e.g., nephrology, neurology)
Many NPs in acute care focus their careers on specific areas of medicine, such as critical care, emergency department/trauma, and cardio-pulmonary, neurosurgery, and oncology. Their expertise is also valued in post-acute settings, including rehabilitation units and cardiac step-down units.
Although AG-ACNPs usually work in emergency/urgent care settings, they are also qualified to work in primary care. The role was developed not to limit them from working in certain settings, but to prepare them to care for patients with new, existing, or acute exacerbations of chronic conditions.
In a primary care setting, AG-PCNPs provide broad, comprehensive clinical healthcare services to adults and their families. However, their job duties and responsibilities extend to consultation, collaboration, coordination, and specialist referral in a variety of settings, including:
- Family practices
- Internal medicine
- Long-term care/skilled nursing facilities
- Community clinics
- Occupational health
- Home care
Qualifications and Training
As state-licensed and nationally-certified advanced practice registered nurses, FNPs, AG-ACNPs, and AG-PCNPs are registered nurses (RNs) who earned a Master of Science in Nursing (MSN), Doctor of Nursing Practice (DNP), or post-master’s certificate with an NP population focus.
The national certification they hold in their respective patient population focus would be granted through one of four certifying bodies:
- American Nurses Credentialing Center (ANCC)
- American Association of Critical-Care Nurses (AACN) Certification Corporation.
Salary and Job Outlook
According to the Association of American Medical Colleges, the U.S. healthcare system will experience a shortfall of between 15,000 and 35,000 primary care physicians and a shortfall of between 37,000 and 60,000 physician specialists by 2025. As nurse practitioners are given greater autonomy under state laws that are coming into alignment with the APRN Consensus Model, this projected physician shortage and the continual push to bring down the cost of healthcare will contribute to a strong and growing demand for FNPs, AG-ACNPs, and AG-PCNPs for the foreseeable future.
According to the Health Resources and Services Administration (HRSA), this shortfall could be reduced by as much as two-thirds by 2020 with a 30 percent increase in the supply of NPs coming into the healthcare system.
The HRSA also reports that if NPs and physician assistants were fully integrated into the U.S. healthcare system and allowed to practice to the full extent of their knowledge and training, by 2020 they would be able to handle as much as 28 percent of all primary care services provided in the U.S.
According to May 2016 statistics from the U.S. Department of Labor, Bureau of Labor Statistics (BLS), the annual, average salary for nurse practitioners was $104,610, with the top 10 percent earning $140,930. Although the BLS does not differentiate between NPs in different patient population focus areas, it does break down annual salaries based on work setting.
For example, NPs in specialty hospitals earned some of the highest annual salaries, averaging $117,120, as did NPs in general medical and surgical hospitals, who earned an average salary of $109,030. These top salaries are likely associated with AG-ACNPs, who usually work in these acute care settings.
Primary Care Providers
This isn’t to say that AG-PCNPs and FNPs don’t enjoy great pay too, as the BLS reported that NPs working in outpatient care settings earned an annual salary of $107,160. NPs working in physicians’ offices earned an average of $103,030 in 2016, close to the annual average for NPs.
NPs working outside of the clinical setting earned considerably more than their clinician-based counterparts. For example, NPs in consulting roles in the scientific and technical industries earned a salary of $132,010.
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