Acute vs. Family NP

Advanced Practice Columnist / Guide · Dec 22, 2006

I can give you my perspective as an ACNP. Acute Care NP's are trained to manage acute and critically-ill adults. Our didactic sessions focus on the assessment, diagnosis, and management of acute and chronic illnesses of adults. There are some critical care components of the course and a few emergency management in adults. The lessons are presented in a body systems approach which means we go through Neurologic all the way down to Musculoskeletal disorders. Programs vary, but in mine we had three semesters of didactics covering all the body systems. Our pre-clinical courses were shared with the ANP students: Advanced Pathophysiology, Pharmacotherapeutics, and Advanced Health Assessment of Adults. We have 4 semesters of clinical rotations that are mostly in the hospital setting.

Our certification exam is solely administered by ANCC (an arm of ANA). There is talk about the American Assoc of Critical Care Nurses starting an ACNP certification exam in the future. ANCC and AACN used to administer the exam jointly but the relationship split a few years back.

All of my batchmates ended up in hospital-based practices but that doesn't mean that some do not have clinic duties in addition to hospital rounds. About half of my batchmates are now working in cardiology, 2 in adult ER, 1 in transplant surgery, and 3 of us in critical care.

There is a yahoo group for ACNP's. I can give you the address if you wish. A lot of faculty from ACNP programs post there but the topics are heavily ICU related so I don't know if that will interest you.

Also want to say that it is not uncommon for you to see NP's crossing over to other roles even though this is not what the NP trained under (i.e., FNP working in a hospital setting or ACNP in a purely out-pt role).

BrandyNP · Jan 1, 2007

Also want to say that it is not uncommon for you to see NP's crossing over to other roles even though this is not what the NP trained under (i.e., FNP working in a hospital setting or ACNP in a purely out-pt role).

I don't know of any FNP's who spent any of their student clinical hours in the hospital setting. Considering that most NP programs only require 500 clinical hours, I'm surprised that hospitals would even hire FNP's. It also doesn't make sense for an ACNP to practice in the primary care setting. Is this legal in your state?

Advanced Practice Columnist / Guide · Jan 2, 2007

I don't know of any FNP's who spent any of their student clinical hours in the hospital setting. Considering that most NP programs only require 500 clinical hours, I'm surprised that hospitals would even hire FNP's. It also doesn't make sense for an ACNP to practice in the primary care setting. Is this legal in your state?

My state only grants a generic "NP" title to every nurse practitioner regardless of specialty. The state's SOP for NP's is very broad in its language use and does not cover the specialties. Most physicians in my state who hire nurse pracitioners are really unaware of what the different NP specializations are. A nurse practitioner who finishes an FNP program but worked in the CCU setting as an RN, and then applies for an in-patient cardiology NP position will likely get hired in my state.

Whether there's legal repercussions of such practice, I am not aware of any. Honestly, I have never bothered to look it up for myself. However, I am aware that an NP who is not practicing in his/her specialty can have problems with recertification. That is the reason why I stuck with my ACNP roots and sought work in a critical care setting.

In the metro area where I live, a lot of open positions for NP's are in the acute care environment. I have known many ANP's and FNP's end up working in hospitals in specialty positions. I also know of an ACNP graduate in our school who works for an internist in his clinic. Her role does not involve hospital rounds.