Questions about FNP and ACNP roles

by Nurse Beth Nurse Beth, MSN (Columnist) Educator Columnist Innovator Expert Nurse

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

Hi Nurse Beth,

I recently have been researching FNP and ACNP online programs. I am having difficulty in differentiating on what you can and cannot do with each role. I am someone who likes options when it comes to a career and do not want to be stuck in one place/specialty. I would like to get my FNP being that you are more likely to get a job placement in the ER after specific certification. My NP goals and interests include: ER, critical care, acute hospital setting as well as possibly outpatient, or specialization in cardiology or pediatrics. If you hold an FNP, my question is can you still work in an acute care hospital setting and obtain specific certifications if needed without going back and having to repeat for your ACNP? Also, any advice on good online FNP programs? Any help is appreciated. Thank you!

Dear Wants to be a Nurse Practitioner,

What an exciting goal! You are wise to consider where you want to eventually practice and select the right program for you.

Current Status

An FNP can work in inpatient care, and is trained in primary care. With their Peds training, they can also find placement in ED and urgent care settings. There are regional variations, and some hospitals do not use FNPs in critical care, but FNPs are definitely marketable.

By contrast, an Acute Care Nurse Practitioner (ACNP) works directly with critically ill patients in the hospital setting.

Future Status: Consensus Model

The consensus model for advanced practice registered nurse (APRN) regulation supports four APRN roles:

  • Nurse Anesthetist/ Certified Registered Nurse Anesthetist (CRNA)
  • Nurse-Midwife/Certified Nurse Midwife (CNM)
  • Clinical Nurse Specialist/(CNS)
  • Nurse Practitioner/Certified Nurse Practitioner (CNP)
    • prepared for acute care competencies
    • prepared for primary care competencies

According to the American Nurse Credentialing Center (ANCC), the scope of practice is not defined by setting but by patient needs.

However, the primary care certified nurse practitioner (PCNP) is trained to deliver comprehensive, continuous care for patients with chronic disorders. By contrast, the acute care certified nurse practitioner (ACNP) is trained provide care for patients who are unstable and in critical condition.

So the upshot may be that PCNPs will work less and less in the hospital and ACNPs will be confined to the hospital setting.

If you are fairly certain you are going to work in critical areas, then ACNP is suited for you.

There are also some very well informed practicing NPS here online as well APRN forum

Best of luck to you,

Nurse Beth


ghillbert, MSN, NP

Specializes in CTICU. Has 26 years experience. 3,792 Posts

The consensus model does not mention location of practice, but only patient population - ACNPs can work anywhere there are "acutely ill" patients - most of these are in hospital, but they are not restricted to the hospital. However if primary/preventative care is your interest, definitely do FNP. You can always add post-masters ACNP later if needed.

seanpdent, ADN, BSN, MSN, APRN, NP

Specializes in ICU. Has 17 years experience. 2 Articles; 187 Posts

GREAT question with accurate answers. I encourage to hone in on what patient population you see yourself caring for, and be as specific as possible. If you are unsure, then try and decide on where you know you DON'T want to work.

The consensus model supports the specialization of Advanced Practice Nurses, which strengthens are individual practice and presence.

You need to choose a specialty (direction) before you enroll in school, but keep in mind in the worse case scenario you could always attain a dual role certification with a post-degree certificate in another specialty area. I am an ACNP, but if I had a change of heart.. or a new interest in practicing in primary care I could return to school and attain my FNP certification (usually 18months-3yrs depending on your student status full-time vs part-time). Of course this option costs more money and more time.

I would highly suggest shadowing an NP, shadowing various roles in various settings in various institutions to get a 'feel' for what their day is like, what their job is like so you can make an informed decision about your career direction.

Message me if you have any further questions.

[P.S. Ironically I just released a podcast episode about this decision - it's how I found this post thread]

Thanks for sharing this post Beth!


favthing, APRN

Has 5 years experience. 87 Posts

The group of sub-acute care practitioners (of which I dream of joining one day as a NP!) state they are looking for ACNP-trained NPs because the acuity of care is increasing in their setting. I have sub-acute care and med-surg in-patient experience, but most of the ACNP programs require ICU RN experience of at least 2 years. I have applied and am still waiting to hear from the few programs to which I applied that do not require ICU or other high-acuity experience. I anticipate completing a primary care NP program (I have been admitted), and then go on for my acute care post-grad certificate. My concern and question for anyone who is informed about this detail, do the post-grad ACNP programs also require ICU experience? I have applied to ICU and other high-acuity jobs, but I seem stuck in the med-surg identity when it comes to hospital hiring. ICU managers seem to hire new grads at my hospital system, or very experienced ICU-trained nurses. Thanks.