Acute vs. Primary Care NP? Can't decide

Advanced Practice Columnist / Guide · Aug 18, 2013

Does anybody know exactly what it takes to get the ACNP cert after accomplishing the FNP? I'm in the process of starting applications and am struggling with the very same FNP (or AGNP) vs ACNP dilemma...

It depends on the school.

Typically, such question is easily answered if you are planning on attending the same school for your post-Master's. You would put the curriculum from both programs side by side (i.e., FNP vs ACNP) and figure out what courses are the same for both and which courses are not present in the second NP specialty you're trying to obtain.

It can be tougher doing the post-Master's in another school where similar courses you've already taken are known under a different name and would need to be assessed for equivalency. The short answer is that since ACNP programs tend to be shorter than FNP (less total credit hours due to less content as courses only cover adult population), 4 semesters worth of courses (or less) would likely cover what the FNP program lacked to enable you to earn ACNP certification.

tubbywumbkins · Jun 29, 2015

So what did you decide? I'm in exactly the same boat (except I have 6 yrs of med/surge experience) and have no idea which program to choose!?! I'm also interested in working in specialty clinic in next 10 yrs.

Rocknurse, MSN, APRN, NP · Jun 29, 2015

I chose ACNP because I've only ever worked in the hospital setting and I have worked mainly in ICU or acute care areas. I absolutely did not want to work with children so I didn't want to do FNP for that reason. A friend of mine did the same program as me and she works for a cardiology practice where she rounds in the hospital some days and others works in their office a few miles down the road. That's the kind of area I think would suit me when I graduate. I would also quite like to work in emergency medicine but I would not want to work with kids so that kinds of puts me off a bit. When I worked in the ED I worked in a department that had a separate children's ED so only adults came into my area. Would be nice to find another place like that. I just like hospitals I guess...I feel comfortable in that environment, although I could so without the weekends and holidays thing. Ideally I'd find some kind of practice or urgent car unit that was closed weekends and holidays or had infrequent call. We'll see.

Neuro Guy NP, DNP, PhD, APRN · Jun 29, 2015

Not sure about that one.... My ACNP program was a solid three years long (fall, spring, and summer semesters). I've not seen the programs be any shorter. That being said I'm so aggravated that people are content with saying FNP can do it all. It is a primary care based education, and IMO on the job training does not replace education. It is a supplement to a foundation received in school. I'm not saying FNPs are incompetent in acute care, but let's face the reality people. The reality is now that if you definitely want to do acute care, you probably should pursue the ACNP path. Let's all realize too that ACNPs are NOT confined to the hospital. We can and do work in outpatient settings.

allnurses Guide · Jun 30, 2015

Not sure about that one.... My ACNP program was a solid three years long (fall, spring, and summer semesters). I've not seen the programs be any shorter. That being said I'm so aggravated that people are content with saying FNP can do it all. It is a primary care based education, and IMO on the job training does not replace education. It is a supplement to a foundation received in school. I'm not saying FNPs are incompetent in acute care, but let's face the reality people. The reality is now that if you definitely want to do acute care, you probably should pursue the ACNP path. Let's all realize too that ACNPs are NOT confined to the hospital. We can and do work in outpatient settings.

I am not sure I understand correctly, are you saying that FNPs shouldn't work inpatient but it's ok in the same vein for ACNPs to work outpatient? Isn't that arguing both sides of the same issue?

For many years physicians have been the gold standard of care; they are generalist educated and, for all intents and purposes, learn on the job to be specialists. This is very similar to NPs, though NPs are afforded the opportunity to specialize in their education prior to practice and have flexibility after they are in practice.

In an ideal world, ACNPs would cover hospitals along with hospitalist/intensvist MD/DOs conterparts. FNP/ANP/PNPs would work outpatient with their IM/FM/Pedi counterparts. I think, in the real world, there is room for both to overlap, especially with experience. Speciality practice further blurs those lines as there is a primary and a tertiary overlap in that practice alone.

Neuro Guy NP, DNP, PhD, APRN · Sep 12, 2015

No I'm not dating FNP should not work inpatient. They should in some circumstances, as in if the PCP they quirk with also sees hospital patients or perhaps as part of hospitalist team but not as an intensivist. The education doesn't back that up.

It is ok for ACNP to do a lot of outpatient, but not primary care. When I say outpatient i mean specialty outpatient practice, such as CV, pulmonary, GI, ENT, endocrinology, etc. because our education DOES include that aspect of outpatient practice. It even says so in the AAACN's position statement. We do inpatient and outpatient as long as outpatient does not include primary care.

Spine_CRNA, BSN, RN · Feb 28, 2017

No I'm not dating FNP should not work inpatient. They should in some circumstances, as in if the PCP they quirk with also sees hospital patients or perhaps as part of hospitalist team but not as an intensivist. The education doesn't back that up.
It is ok for ACNP to do a lot of outpatient, but not primary care. When I say outpatient i mean specialty outpatient practice, such as CV, pulmonary, GI, ENT, endocrinology, etc. because our education DOES include that aspect of outpatient practice. It even says so in the AAACN's position statement. We do inpatient and outpatient as long as outpatient does not include primary care.

Ok I'm lost. How are you guys defining Primary Care? (I see it as working in an office and doing annual checkups and seeing the usual patients.) If that's the case, then I would like to do Outpatient Specialty Practice described above mainly and a bit of inpt., too. If so, AGACNP would be the course to take, yes? Thank you in advance. This specific thread has been so helpful.

Annaiya, NP · Feb 28, 2017

Ok I'm lost. How are you guys defining Primary Care? (I see it as working in an office and doing annual checkups and seeing the usual patients.) If that's the case, then I would like to do Outpatient Specialty Practice described above mainly and a bit of inpt., too. If so, AGACNP would be the course to take, yes? Thank you in advance. This specific thread has been so helpful.

The restriction on practice based on specialty varies between states, which is why you don't always hear the same answer. However, the trend seems to be moving towards primary care specialties (FNP, ANP and PNP) can only do basic primary care, not a specialty clinic. Where as acute care degrees (ACNP, ACPNP and NNP) can do inpatient and outpatient specialty. However, the lines are not clear. It just depends who will hire you. I know PNPs who are were recently hired to an inpatient setting, but their nursing experience gives them the background they need more than a degree would.