Acute Care Nurse Practitioner (ACNP)


Photo credit: Mercer University

Do you want to find a career to amplify your nursing skills? Are you passionate about the fast pace of the hospital?

What is an Acute Care Nurse Practitioner (ACNP)?

Acute Care Nurse Practitioners are experts in the field of acute care, critical care, and caring for complex medical conditions. Acute care is usually given in an inpatient setting by specialized personnel for a short time, unlike chronic care.  

Acute care may or may not involve specialties like intensive or emergency care.  It may take place in a specialty clinic as an outpatient. An Acute Care Nurse Practitioner will choose the type of patients that they want to care for to select which kind of ACNP degree program that they wish to pursue.

  1. There are Acute Care Nurse Practitioners that care for children called Acute Care Certified Pediatric Nurse Practitioners (link Pediatric Nurse Practitioners).  The Pediatric Nursing Certification Board credentials them. CPNP-ACs work with the acute pediatric specialization and focus on children from infancy to 21 years old.
  2. There are Nurse Practitioners that work with the geriatric population, called Acute Care Nurse Practitioner Certification Adult-Gerontology (ACNPC-AG).  They are board certified by the American Association of Critical Care Nurses and accredited by the NCCA. 
  3. Then there are those who work with everything in between, the Adult-Gerontology Acute Care Nurse Practitioner-Board Certified (AGACNP-BC) by the American Nurses Credentialing Center. The NCCA and the Accreditation Board for Specialty Nursing Certification (ABSNG) accredits this ANCC certification.

This discipline provides the opportunity for APRNs to become hospitalists and first assists, and also includes subspecialties like cardiology, pulmonology, neurology, hematology/oncology, ENT, surgical services, palliative care, and pain management.

If you are looking to become an Acute Care Nurse Practitioner, stop right there. There are two retired ACNP certifications:

  • Adult Acute Care Nurse Practitioner (ACNP-BC and ACNPC)
  • AGACNP-BC has replaced the ACNP-BC.

Keep in mind that the ACNP encompasses several different APRN titles. No matter the title, an Acute Care Nurse Practitioner is an important member of the healthcare team. 

The Acute Care Nurse Practitioner is an independent Board Certified Nurse Practitioner that provides care across the lifespan to patients with acute, critical, and complex chronic medical conditions. However, they offer a range of services like health exams, patient education, diagnostic tests, diagnosing health conditions, and prescribing medication. 

The Acute Care Nurse Practitioner is a Registered Nurse (RN) who has graduated from an accredited educational program that prepares them to be an Acute Care NP with a graduate degree (Master of Science in Nursing) or higher (Doctorate of Nursing Practice or Doctor of Philosophy).  

Recently, more Nurse Practitioners (NPs) are obtaining a Doctorate of Nursing Practice (DNP) or Doctor of Philosophy (Ph.D.) as admission to practice.  A terminal degree is not yet required.  Someday, the doctorate is the gold standard for entry to becoming a Nurse Practitioner.  In the past, Nurse Practitioners who obtained a Bachelor of Science in Nursing (BSN) were grandfathered in.  However, entry-level Nurse Practitioners are no longer permitted to start practicing as an NP with a BSN.

Nurse Practitioners provide their patients and families with a unique focus on health maintenance and preventative care.  While many practitioners concentrate on only diagnosing and treating disease, NPs generally focus on promoting health maintenance.  

Since Acute Care NPs have a greater focus on the patient with an acute or critical illness, they provide a distinctive comfort in the inpatient setting. These practitioners must be ambitious and compassionate.

The Acute Care Nurse Practitioner works with hospitalists, specialists, physician assistants, nurses, and ancillary staff. The ACNP may practice autonomously, collaborate with a doctor under a required agreement, or have a supervisory relationship with an overseeing physician. Some states restrict the amount of independence that  Advanced Practice Registered Nurses possess, but a growing number have pending legislation that will increase their autonomy. The scope of the Acute Care NP is directly related to state-specific rules and regulations.  

Why do we need Acute CareNurse Practitioners?

Care provided by Nurse Practitioners has repeatedly been shown to be equal or superior to the care provided by resident physicians and fellows. A study that focused on all of the research available on the effects of advanced practice providers in acute care found that the results were the same or better. 

The nation is facing a shortage of medical specialists and primary care doctors. The ACNP cares for children, adults, and seniors with complex disease states.  ACNPs can help fill in the gaps where physicians are not present.

Unfortunately, there is an unequal number of physicians throughout the country.  Poor urban and rural settings have fewer doctors and a concentration of patients of low socioeconomic status.  Acute Care Nurse Practitioners act to help fill the void left in disparate medical areas by seeing patients in hospitals and clinics.  When An Acute Care Nurse Practitioner cares for these patients, it enhances the health outcomes of underprivileged populations.  

The benefits go beyond filling holes in the medical system.  When ACNPs are engaged members of the healthcare system, they provide valuable health outcomes to the community.  ACNPs provide quality care, and in some cases, better attention to populations who may not access care.

What does an Acute Care Nurse Practitioner do? 

An Acute Care Nurse Practitioner follows the state laws that define the type of care that a Nurse Practitioner may lawfully provide.  The job description for an Acute Care Nurse Practitioner depends on the kind of occupation.  

There are many options for the ACNP to practice in, like:

  • Hospitals
  • Outpatient Clinics
  • Doctor Offices
  • Nursing Homes

Even within each area, ACNPs can choose to specialize.  For example, in the inpatient setting ACNPs work in the ICU, critical care, medical-surgical, or emergency department.  

Whichever subspecialty the ACNP chooses will further define their specific role.  Overall, Acute Care Nurse Practitioners give healthcare to patients with critical medical conditions.  Depending on their degree and licensure, they may care from the age of infants as an acute Pediatric provider (CPNP-AC) to the geriatric population as an acute geriatric provider(ACNPC-AG). The ACNPs who work with adults through senior adults are the Adult-Gerontology Acute Care Nurse Practitioner-Board Certified (AGACNP-BC)

Job Description

Acute Care Nurse Practitioners provide care for acutely, critically, and chronically ill patients.  Their population depends on what they are licensed in (pediatric, adult, or geriatric populations).

ACNPs focus on patient-centered interventions like encouraging healthy families, proper developmental, and lifestyle changes. All Acute Care Nurse Practitioners have the clinical expertise to diagnose medical conditions and prescribe medications for acute, chronic and complex patients. ACNPs communicate with other healthcare professionals, work closely with patients and families, use clinical judgment, and provide compassionate care.

An Acute Care Nurse Practitioner works closely with the acutely ill population and orders the appropriate tests (e.g., laboratory samples, blood tests, and radiology tests) and diagnoses, while simultaneously providing families and patients with education and empowerment. ACNPs complete history and physicals, diagnose medical conditions, order diagnostic tests, and medications, and refer patients to other professionals and services as needed.

Acute Care Nurse Practitioners provide critical services for complicated and ill patients. ACNPs diagnose acute conditions, order intensive hospital diagnostic tests (e.g., MRI, ultrasound, laboratory tests), and assess for contraindications, differential diagnoses, and risk factors for disease and chronic health conditions. 

ACNPs typically work in hospitals, offices, and clinics but may work in other roles, like education as a clinical instructor or professor.  While you may think an Acute Care NP would work only in hospitals, nearly half of all ACNPs work outside of the hospital.

Scope of Practice

The scope of practice for an Acute Care Practitioner varies by state in their freedom to practice independently or directly under a supervising physician.  However, all ACNPs provide acute care to medically complicated patients.

How much does an Acute Care Nurse Practitioner make?

Nursing is a beloved and demanding career that calls for fair pay.  Acute Care Nurse Practitioner’s posses even more medical knowledge and risk for liability than a Registered Nurse.  Due to this growing responsibility, ACNPs command an increase in salary corresponding with their increasing expertise and responsibility.  The good news is that the outlook is fantastic or future ACNPs.  

The Bureau of Labor Statistics (2017) forecasts that the job market for all Nurse Practitioner specialties and subspecialties will increase by 36%, outshining the typical job growth rate for many other careers in the U.S.  The need for ACNPs will continue to grow as the average age of the United States population increases.  Acute Care Nurse Practitioners will have the perks of a necessary and rewarding job with a reassuring career outlook and an attractive salary. 

According to the Bureau of Labor Statistics (2017), the annual salary for a Nurse Practitioner is $107,480 on average.  The mean hourly wage is $51.86 while the median hourly wage is $49.94. ACNPs make an average of $97,000 per year. According to Glassdoor, NPs make between $96,000 to $131,000 annually. 

The AACN states that there are 256 Acute Care Nurse Practitioners (ACNPCs) and 916 ACNPC-AG in the United States. The Pediatric Nursing Certification Board (2017) states that there are 1,758 CPNP-ACs.

CPNPs are health professionals that work in a variety of settings.  They work in health settings like physician's offices, outpatient facilities, hospitals, schools, and public health departments.  They function as nursing clinical and didactic instructors at colleges, universities, and professional schools.

ACNPs work in a variety of settings.  Their primary employment is in hospitals, but they also work in outpatient clinics. The Acute Care Nurse Practitioner manages the health care needs of the acutely, critically, or chronically ill patient in many different settings (inpatient to outpatient).

Acute Care Nurse Practitioner Certification

Acute Care Nurse Practitioners must first become a Registered Nurse before applying to an ACNP degree program. To become an RN, they should earn a Bachelor’s of Science Degree in Nursing (BSN) from a state-approved institution.  Next, the BSN graduate must pass the NCLEX-RN examination and become a Registered Nurse.  

The future ACNP must decide between a Master of Science of Nursing (MSN) and Doctorate of Nursing Practice (DNP) degree program for Acute Care Nurse Practitioners.  Most Nurse Practitioner programs prefer that applicants have practiced as a Registered Nurse before admission. 

After completing an ACNP program and graduating with an advanced degree, they qualify to sit for the certification exam. The benefits of this certification ensure that all board-certified ACNPs maintain the minimum professional standards.  This protects the legitimacy of the career for Acute Care Nurse Practitioner, no matter the population

The AACN provides the Acute Care Nurse Practitioner Certification Adult-Gerontology (ACNPC-AG) certification exam, accredited by the NCCA.  The PNCB administers the CPNP-AC exam, accredited by the NCCA.  

The American Nurses Credentialing Center certifies the Adult-Gerontology Acute Care Nurse Practitioner-Board Certified (AGACNP-BC).

Let’s review the two expired exams.  The ANCC issued the certification for the retired Acute Care Nurse Practitioner Certification (ACNP-BC). The AACN published the Acute Care Nurse Practitioner (ACNPC). You can no longer take these exams.

The National Certification Exam

Certification occurs from passing a national certification exam that signifies that the Acute Care Nurse Practitioner have met the minimal standards of their specialty.  The ACNP has the skills and education required for professional practice in acute care.  You instantly learn the results of the ACNP certification exam. 

You will either pass or fail the ACNP exam.  

Based on the 2017 rates, the average pass rate was 80% for the Acute Care Certified Pediatric Nurse Practitioner exam.  If you fail, you will receive the detailed test results two to three weeks after completion.  You can reapply for the exam after receiving this score report.  

You will receive a 90-day window in which to begin the test scheduling process and can repeat the exam up to four times in one year.  If you fail two or more times, the PNCB requires you to contact customer service for additional instructions at 

The ACNPC-AG is put on by the AACN, and the exam covers 175 items, 150 test questions and 25 that are used to evaluate statistics for future exams.  If you’re unsure of an answer, you can skip it and mark it to return to later.  You will have 3.5 hours to complete the exam (ACNPC-AG Exam Handbook). Pass rates (2018) are 80.6%, and 1,296 NPs took the exam last year.

The Adult-Gerontology Acute Care Nurse Practitioner-Board Certified (AGACNP-BC) replaces the ACNP-BC exam to align with the APRN consensus model to promote a uniform model of NP licensing,  certification and accreditation.  

The AGACNP-BC certification is longer than the ACNPC-AG exam at 175 scored questions and 25 pretest questions.  Candidates have four hours to complete the exam.  Pass Rates (2016) were 88.3%.

If you pass the certification exam, congratulations!  You may now join the ranks of ACNPs nationwide.  You must apply to the state board for licensure.  If you wish to practice in more than one state, you will have to submit an application to each separate state.  Each state will have their specific guidelines that regulate the scope of your advanced nursing practice.

New Acute Care Nurse Practitioners can only test into the Acute Care Nurse Practitioner specialization for pediatrics, adult to geriatrics, and geriatrics (ACNPC-AG, AGACNP-BC, and CPNP-AC).

Since their certifying body has retired them, the Adult Acute Care Nurse Practitioner (ACNPC, ACNP-BC) specialty is available for renewal only.