I am an ACNP and graduated in November. I work in the ICU and love it. As an ACNP I work primarily in the hospital but can work outside the hospital if the patients I would see are a follow up from an acute episode. For me, I would only work external if part of my time would be spent seeing patients in the hosp as well. I can care for patients 16 yrs of age or older (that might be state practice act specific...not sure), anyone younger is out of my scope. I am not prepared to take care of OB patients but can do a gyn exam if need be but if I wanted to subspecialize then I would need to head back to school and pick up an FNP or ANP. If an OB patient has a hypertensive crisis, I may see them in the ICU, but rest assured, the OB would be heavily consulted. ACNP's focus is in the acute phase of disease processes and now a days that lends itself to a hospital environment. I think it comes down to what you want and like to do. Critical care is in my blood, always has been, thought about CRNA and it was not for me (didn't like the grey walls and stationary workbench). With my delineation of privileges, I intubate, place lines, perform therapeutic bronchs, perform LPs if needed, round on patients, and write orders. I do not float swans but place the introducer. This is what I like to do. So I went with the ACNP route. When I graduated, I thought I would end up with a hospitalist team, but there wasn't an opening. However, I did end up with an Intensivist team and thats where I am.
If I can help your further please let me know.