What's the point of the ACNP?

allnurses Guide · Jan 21, 2009

ANP/FNP are not educationally prepared to work in acute care. Period. Historically they have, but some states are now cracking down and requiring post-MSN certificates.

Trauma Columnist · Jan 22, 2009

You could go back to one of your previous ideas of CNS. As an adult health CNS, I had courses in chronic, acute and geriatric care.

Joe NightingMale, MSN, RN · Jan 22, 2009

Still a bit unclear...is it that only ACNPs can work in hospitals, or that only ACNPs can do care for acute conditions? It's something I want to clear up, because if I go the NP route I don't want to do primary care.

CNS is a possiblity, but I'm increasingly thinking not. I suspect I'm eventually going to want to work in an office instead of the floor. And it'd be nice to be directing patient care...I find myself looking at charts and wondering if they're getting the right meds, or if the abnormal lab values are being adequately treated.

Trauma Columnist · Jan 22, 2009

Joe - I know you live in IL and so far (fingers crossed) IL has not chosen to decide what specialty can see what pt population except as imposed by your licensing, ie a peds NP or CNS can't see adults and vice versa. However, IL has not decided that an ACNP can only work in the hospital and the FNP can only work in a clinic.

core0 · Jan 22, 2009

ANP/FNP are not educationally prepared to work in acute care. Period. Historically they have, but some states are now cracking down and requiring post-MSN certificates.

Its a little more complicated than that. The states that have been enforcing this have differentiated between the education of the FNP and the ANP. These states (mostly Texas) look as the FNP as a outpatient based primary care specialty involving all lifespans. There is some overlap in that FNPs are also trained in acute outpatient ambulatory medicine. They tend to look at the ANP as adult specialty involving specialty and primary care in both the inpatient and outpatient settings. They further divide the inpatient role into acute and critical care. The differentiation between the ACNP and ANP roles tend to be at the critical care point. So if you divide the adult care spectrum you would get something like this:

|--Primary care--|--Acute care--|--critical care--|

|--FNP---------------|

|----------ANP--------------------|

........................|---------ACNP--------------------|

With the FNP acute care component being limited to acute outpatient ambulatory care.

The difficulty comes in putting this into practice as the Texas BON is finding. Some things are easy. They have stated that an FNP cannot manage an inpatient pediatric ICU patient for example. On the other hand they have ruled that FNPs can manage nursing homes and acute rehab patients. The real confusion comes in the critical care role. Based on their publications it would appear that an ANP could not staff an ICU. On the other hand could an ANP working for a cardiology group consult on an ICU patient for their cardiovascular needs? The ER seems to be another area of contention.

To top it all off you have one nursing group telling BONs that FNPs are outside of their scope of practice in any inpatient role.

To the OP, depending on your location it is likely that you can get any position either inpatient or outpatient with an FNP. However, as has been stated here and by a number of nursing leaders you run the risk of suddenly losing your job at any time due to changes in BON or hospital policy.

David Carpenter, PA-C

UVA Grad Nursing · Jan 22, 2009

If you do not want to do primary care, then do not aim for a FNP/PNP role. Those programs focus on the treatment of clients in primary care settings. The National Organization of Nurse Practitioner Faculties (NONPF) has been working with state boards of nursing to urge/require ACNP certification and preparation to practice in settings with high acuity and complexity.

One of my recent FNP graduates was hired by a Cardiology doctors group here in Charlottesville. Her practice is both inpatient and outpatient. She was required to obtain her ACNP certification within 12 months of her hire date.

If your love is acuity, complexity, and inpatient care - then I recommend that you aim for an ACNP.

allnurses Guide · Jan 22, 2009

It totally depends on your state. The role is not meant to be defined by location (clinic, hospital etc) but by patient acuity.

Edit: I think David and UVAGradNursing said it much better than I did :)

Advanced Practice Columnist / Guide · Jan 22, 2009

Interesting analogy David but that pretty much sums up the differences.

Primary Care trained NP's are FNP, ANP, GNP, WHNP, and PNP-PC

Acute Care trained NP's are ACNP, PNP-AC, and NNP

... and then there are PMHNP's who do not necessarily fit in any of the above.

There is a nurse practitioner track that trains providers to care for patients across the lifespan but not across the spectrum of primary care to acute care. This is FNP where the focus is primary care alone.

ANP training does include some in-patient management depending on the program. However, there is absoultely no critical care component in the ANP program. Interestingly, ANP programs train providers in adolescent health care and this is a content included in ANCC's ANP certification. Hence, ANP's are able to care for ages 13 and up.

ACNP programs include critical care component. This content is included in the certification exam in all the acute care tracks. Many of Adult ACNP programs do not include adolescent health care content.

Clearly, there is no such thing as an NP who is trained across the spectrum of primary care all the way to critical care.

Although the BON in the State of Texas seems to be among a few with clear distinctions between what specific NP's are competent in, much confusion still exist among other BON's in other states. There is no uniform rule being followed. NP's themselves confuse each other and tell prospective NP students to pick the tracks they have chosen without consideration of the fact that each NP tracks have a specific focus of training.

Ask yourself, did your NP training and certification provide you with at least the basic competency to assume care for the acuity of the patient population you are taking on as a nurse practitioner? If the answer is no, how are you going to justify within reason that you are capable of caring for that population without having to claim that this is the setting you worked in as a Registered Nurse. If all it takes for a nurse practitioner to be competent in the care of a particular acuity of patients is to claim years of experience within a specific population, then why would we have to go to NP school? why not call us NP's by virtue of years of experience in the setting we worked in as a Registered Nurse? That certainly defeats advanced practice nurse training doesn't it?

Fortunately, there is hope in the horizon as far as clearing the confusion. The concensus model by NCSBN states:

The certified nurse practitioner (CNP) is prepared with the acute care CNP competencies and/or the

primary care CNP competencies. At this point in time the acute care and primary care CNP delineation

applies only to the pediatric and adult-gerontology CNP population foci. Scope of practice of the

primary care or acute care CNP is not setting specific but is based on patient care needs. Programs may

prepare individuals across both the primary care and acute care CNP competencies. If programs prepare

graduates across both sets of roles, the graduate must be prepared with the consensus based

competencies for both roles and must successfully obtain certification in both the acute and the primary

care CNP roles. CNP certification in the acute care or primary care roles must match the educational

preparation for CNPs in these roles.

Exceprt taken from: http://www.aacn.nche.edu/Education/pdf/APRNReport.pdf

core0 · Jan 22, 2009

It totally depends on your state. The role is not meant to be defined by location (clinic, hospital etc) but by patient acuity.
Edit: I think David and UVAGradNursing said it much better than I did :)

The problem is that acuity has no standard definition. Is by how sick the patient is, or how many resources that the patient is using. Both are common uses. The bigger problem is the patient has no idea of their acuity when they present. If a patient with chest pain presents to a family practice clinic the FNP would be expected to treat and stabilize the patient before sending them to the appropriate facility. If you talk about acuity in terms of patient illness, there are a lot of specialty areas that are not acute at all. For example Dermatology rarely has associated acuity. Is it therefore the domain of the FNP or the ANP not the ACNP? The training of the ACNP really isn't based on acuity, but is instead based essentially on the lack of primary preventive care training (by design).

David Carpenter, PA-C

Trauma Columnist · Jan 22, 2009

David, Ghilbert, UVA - all of you have very logical thought processes on this. Thanks much.

Joe NightingMale, MSN, RN · Jan 23, 2009

Wow, quite a thread I've started.

Thanks, all of this is helpful.

Guess I'm going to plan for the ACNP route for now. It's not that I want to work in a hospital necessarily, it's just that I'd rather work on some more complex illnesses...as opposed to URIs and UTIs and HTN.....