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FNP vs. ACNP + Core Differences

Courtney Smith-Kimble, MA
Updated December 7, 2022
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Learn about the core differences between FNP and ACNP, common responsibilities, educational requirements, earning potential, and how to choose the best specialty.
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By definition, all nurse practitioners assess, diagnose, treat, and manage acute episodic conditions and chronic illnesses, regardless of their certification. This has left some to wonder, what is the difference between a family nurse practitioner (FNP) and an acute care nurse practitioner (ACNP)?

As primary care providers, FNPs typically work in clinics and other outpatient settings where they may treat people with acute conditions, as long as the condition is not life threatening and the patient’s health is not deteriorating. In contrast, ACNPs work in emergency rooms, inpatient hospitals, and intensive care units (ICUs), where they specifically treat acute, often life-threatening conditions.

The Difference Between FNPs and ACNPs

The nursing field constantly evolves, addressing issues that lead to better care for patients. For instance, certificate options change as certifying agencies align their credentials with the Advanced Practice Registered Nurse (APRN) Consensus Model. This model provides guidance that allows states to regulate APRN education, licensure, job description, and accreditation.

Today, the ACNP exam is no longer required as a primary speciality of certification, as it served a specialty area instead of a specific target population. The American Nurses Credentialing Center (ANCC) also retired the adult nurse practitioner and gerontological nurse practitioner exam in favor of combining these classifications into adult-gerontology.

Practitioners can now choose between becoming an adult-gerontology acute care nurse practitioner (AG-ACNP) or a pediatric nurse practitioner acute care (PNP-AC). Prospective students should examine the differences between these specialities to determine the best path.

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FNP and ACNP Core Differences

The APRN regulatory model uses a multitiered system to classify nurse practitioners, which begins with four APRN roles, followed by population focus. The next tier considers healthcare needs, such as acute care. For instance, an FNP’s role is a nurse practitioner and their population covers the entire family across their lifespan.

Contrastingly, AG-ACNPs and PNP-ACs only work with patients from a specific age range who suffer from complex conditions. The table below provides additional distinguishing factors for each role.

Core Differences Between FNPs and ACNPs
NP SpecializationPopulation FociScope of Practice
Family Nurse Practitioner (FNP)Family/Individual across lifespanBroad focus including patient education, disease prevention, and treating of serious illnesses
Adult Gerontology Acute Care Nurse Practitioner (AG-ACNP)Adults beginning at late adolescenceAcute, critical, and complexchronic physical and mental illnesses
Pediatric Nurse Practitioner – Acute Care (PNP-AC)Infants, children, adolescents, and young adults up to age 21Acute, critical, and complexchronic physical and mental illnesses

Duties and Responsibilities

All nurse practitioners can diagnose, treat, and manage both acute and chronic health conditions. In some states, they work autonomously, while in others, they must be supervised by a health provider. The following sections explore specialty-specific roles and responsibilities.

What Does an FNP Do?

Family nurse practitioners deliver primary healthcare to individuals across the lifespan, with an emphasis on family-centered preventive care. Their expertise lies in working with a variety of patients to manage health conditions at various stages of life.

Responsibilities include diagnosing and managing acute and chronic conditions that are not immediately life threatening, promoting healthy lifestyles through education and counseling, and managing patients with chronic health issues.

What Does an AG-ACNP Do?

AG-ACNPs care for patients in acute care settings, emergency rooms, and trauma units. They focus on caring for the adult population (young, middle, and older adults, ages 18 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 with complex patient care requirements. Besides managing patient care, AG-ACNPs may need to implement invasive procedures to stabilize patients, which could include intubation.

What Does a PNP-AC Do?

PNP-ACs care for babies, children, adolescents, and young adults up to age 21 dealing with complex or critical health conditions. These practitioners can find work in many different settings, including hospitals, emergency departments, ICUs, and subspecialty clinics. Practitioners must have an advanced knowledge of child healthcare.

Responsibilities include diagnosing and treating acute health issues, coordinating with patients’ healthcare teams, and empowering a patient’s family through education and an effective care plan. While PNP-ACs focus on a younger population, they perform many of the same duties as AG-ACNPs and FNPs, as these specialties share target populations or healthcare needs.

Education and Certification

While all NPs must earn an advanced degree to practice, the nursing field offers multiple educational routes for these professionals. For instance, the simplest route to qualify for a master’s in nursing requires students to earn a bachelor of science in nursing (BSN) and get experience with their target population. Students interested in launching their career quickly may earn an associate degree in nursing (ADN), then a BSN or apply for an RN-to-BSN bridge program.

How to Become an FNP

Aspiring family nurse practitioners can begin their career by completing an ADN or BSN program and passing the National Council Licensure Examination for RNs (NCLEX-RN). Practitioners go on to earn a master’s or complete a bridge program from an accredited school to qualify for licensure. Students should note that advanced nursing programs often require several years of experience working with their target population before admission.

The ANCC and the American Association of Nurse Practitioners (AANP) offer the FNP exam required for licensure. Recertification includes 1,000 hours of clinical practice within the past five years, 100 hours of continuing education, and 50 hours of pharmacology. Students should view their state’s nursing requirements to determine how to apply. FNPs must renew their certification every five years through the board. State renewal may include additional requirements.

How to Become an AG-ACNP

Acute care nurse practitioners must hold an unencumbered RN license and earn an advanced degree from a nationally or regionally accredited school to practice. AG-ACNP nursing programs want to see applicants who possess experience working with adult-gerontology patients in acute care settings. Programs may require a minimum of two years and/or ICU or postanesthesia care unit experience to be admitted.

AG-ACNPs must specialize in adult-gerontology and focus on acute care. Graduates must pass the exam offered by the ANCC or AANP. AG-ACNPs must renew their license every five years, which requires continuing education requirements. Students should also research state-specific requirements for licensure and renewal.

How to Become a PNP-AC

Becoming a PNP-AC requires an advanced nursing degree. Both a master’s and doctor of nursing practice (DNP) typically require at least two years of full-time attendance. Students may want to consider bridge programs that offer accelerated coursework, such as a BSN-to-DNP program.

Graduates must pass a licensing exam. Unlike FNPs and AG-ACNPs, aspiring PNP-ACs can only complete the Acute Care Certified Pediatric Nurse Practitioner Exam offered through the Pediatric Nursing Certification Board. PNP-ACs need to renew their license every three years. Renewal also requires nearly 440 hours of direct care and at least 100 continuing education points.

Salary and Career Outlook

NPs enjoy many career options with ample job security. In fact, the U.S. Bureau of Labor Statistics projects a 52% increase in demand for NPs from 2020-2030, with median annual salaries of $111,680. Nurse practitioners should note that multiple factors influence earning potential, including location, work setting, experience, and specialty.

Earnings may also vary by chosen speciality. FNPs can expect a salary of about $97,580, according to Payscale as of February 2022. Earnings for AG-ACNPs and PNP-ACs are higher at $104,800 and $102,000, respectively. Over 65% of NPs nationwide specialize as FNPs, while less than 1% specialize as PNP-ACs, and only 7.8% specialize as AG-ACNPs.

Annual Salaries




FNP vs. ACNP: Which Is Best?

RNs considering the next step in their career can advance to multiple speciality roles, including a career as an acute care nurse practitioner and family nurse practitioner. However, prospective students must examine their own interests to determine which role is best.

For instance, ACNPs’ target population includes patients dealing with complex or critical conditions. The primary workplace for acute care NPs will be within hospital ICUs or working with surgeons or physicians conducting rounds in a hospital setting. FNPs primarily work in outpatient settings. They interact with patients and families over the lifespan, allowing greater opportunity to develop relationships.

Becoming an ACNP requires a firm emotional disposition that allows the practitioner to display empathy and compassion while maintaining quality care. Contrastingly, FNPs focus on preventative care, which means most of their patients maintain good health. Practitioners may also want to consider the target population to determine which speciality meets their career goals.

While comparing the two positions can help RNs get an idea about which specialty meets their professional goals, students may also want to shadow practitioners in both roles to gain first-hand experience.

Related Nurse Practitioner Programs

Reviewed by

Portrait of Elizabeth M. Clarke, FNP, MSN, RN, MSSW

Elizabeth M. Clarke, FNP, MSN, RN, MSSW

Elizabeth Clarke (Poon) is a board-certified family nurse practitioner who provides primary and urgent care to pediatric populations. She earned a BSN and MSN from the University of Miami.

Page last reviewed August 25, 2021

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