April 6, 2020
Nurse practitioner with older patient and husband in hospital room
Kathleen Gaines
By: Kathleen Gaines MSN, RN, BA, CBC

Many nurses have a longterm career goal of becoming a nurse practitioner, but what kind of nurse practitioner to become is a decision every nurse has to make. In this guide, we'll explain what an Acute Care Nurse Practitioner does, how to become one, and hopefully help you determine if it's the right career path for you. 

Part One What is an Acute Care Nurse Practitioner?

Acute Care Nurse Practitioners (ACNPs) are advanced practice registered nurses that provide care to patients in acute care and/or hospital settings. This type of advanced practice provider is different from a Primary Care Nurse Practitioner. 

Acute Care NPs see patients when they are sick, admitted to the hospital, or after a surgical procedure and/or trauma. Their focus is solely on caring for the adult population (young, middle, and older adults, ages 13 and older) with complex diseases.

>>Related: Top 4 Highest Paying Specialties for Nurse Practitioners

Part Two What Does an Acute Care NP Do?

Acute Care NPs provide care for everything from disease prevention to acute care management. Often, practitioners will continue to follow patients from the hospital setting to the outpatient setting.

Acute Care NPs specific duties include:

  • Order and interpret tests and laboratory values
  • Develop treatment plans
  • Collaborate with physicians and other specialists
  • Provide direct patient management from admission to discharge
  • Stabilize patients in critical care areas
  • Diagnosis of medical conditions
  • Assist medical team with bedside procedures
  • Develop follow-up care
  • Monitoring hospitalized patients and tracking progress
  • Setting patient goals to lead patients towards discharge
  • Collaborating with physicians to ensure patient care needs are met
  • Collaborating with discharge planners to ensure adequate placement and follow-up is arranged upon discharge
  • Prescribe medications
  • Provide education to patient and family
  • Perform procedures, such as:
    • Intubation & extubation
    • Lumbar puncture
    • Casting and splinting injuries
    • Administering conscious sedation
    • Wound debridement
    • Performing incision and drainage
    • Place central venous catheters
    • Insert chest tubes

Part Three How Long Does it Take to Become an Acute Care NP?

Acute Care NP programs typically take 2-3 years depending on the specifics of the program and if they are full-time or part-time. Students can complete a program in as little as two years if they follow the full-time progression plan and are able to obtain clinical placements without delay. 

Since most will have to work during the program, students generally complete the program in 3 years. Ultimately, students have five years to complete the APRN program. Students can work during the didactic courses, but it is difficult and it is generally not recommended to work during the clinical portion of the program. 

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Part Four Acute Care NP Salary: How Much Do They Make?

According to the Bureau of Labor Statistics, the average pay for nurse practitioners in 2019 was $115,800. Unfortunately, the BLS does not differentiate between different types of Nurse Practitioners. However, Glassdoor reports that the average Acute Care Nurse Practitioner salary in the U.S. is $110,076 per year. 

As with any employment situation, Acute Care NPs should think about many factors when looking at any job offer, such as local cost of living and total benefits package including health and dental insurance, retirement benefits, and tuition reimbursement options. Search for positions in the location where you want to work to find out more about the specific Acute Care NP salary ranges in your area.

Map depicting mean wages for nurse practitioners by area

The BLS reports that in May 2019 the highest paying states for nurse practitioners were:

  • California: $138,660
  • Washington: $126,920
  • Hawaii: $124,000
  • New Jersey: $123,810
  • Minnesota: $122,850

The top five states with the highest concentration of jobs and locations for CRNPs include:

  • Mississippi
  • Tennessee
  • Maine
  • Kansas
  • Alabama

The BLS also reported that the top five metropolitan cities for nurse practitioner pay were:

  • Vallejo-Fairfield, CA: $175,060
  • Spokane-Spokane Valley, WA: $160,110
  • San Francisco-Oakland-Hayward, CA: $157,150
  • Longview, CA: $150,520
  • Sumter, SC: $147,210

The top five non-metropolitan cities for nurse practitioner pay, according to the BLS, were:

  • Eastern Sierra-Mother Lode Region of California nonmetropolitan area: $137,450
  • Central Louisiana nonmetropolitan area: $136,910
  • Connecticut nonmetropolitan area: $136,580
  • Middle Georgia nonmetropolitan area: $133,800
  • Coastal Plains Region of Texas nonmetropolitan area: $130,480

Part Five How to Become an Acute Care NP

Step 1.) Earn your BSN

To become an ACNP, you must first have your Bachelor’s Degree in Nursing (BSN). If you only have an Associate’s Degree in Nursing (ADN), you must first obtain a bachelor’s degree. This is a must before any graduate program can be started. 

If you’re working as an RN with an ADN, there are two programs that would help you achieve your goals. They are an RN-BSN bridge program and an online BSN program. Each program has its own requirements and it’s important to determine which programs you qualify for before applying. Furthermore, decide if you are a distance education learner or need hands-on classroom instruction.  

  • RN-BSN bridge programs are ideal for nurses who completed an ADN program or are diploma RNs and now need to further their education. This program is ideal for working individuals with families and life commitments because it provides more flexibility with a heavy emphasis on online learning. Prospective BSN bridge program students should first reach out to their Human Resources department to inquire about tuition reimbursement through the healthcare system. Some hospitals have strong associations with certain online universities. This will allow employees to have a direct point of contact for the program, a streamlined application process, and they may receive a higher level of tuition reimbursement. 
    • Basic requirements: Applicant must possess an RN license in good standing with no disciplinary action. An ADN degree is required. Applicants need to be working a minimum of 30 hours per week or pass an equivalency exam. Have to pass a criminal background check.
  • Online RN-BSN programs are great for busy, working professionals. These programs allow the student to work when their schedule permits and can be completed at their own pace.
    • Basic requirements: Applicant must possess an RN license in good standing with no disciplinary action. An ADN degree is required. Must be working a minimum of 30 hours per week or pass an equivalency exam. Have to pass a criminal background check. 

Most programs have a progression they like their students to take. This is because each course builds upon the previous course. Programs are generally expected to be completed within two to three years. It is suggested to take two courses per semester. Some programs will allow students to take up to three courses in one semester but special consideration may need to be given.

If you know that you want to become an ACNP, it is important to start classes for your BSN as soon as possible. This education will take several years to complete, depending on the program and will ultimately delay applying for your ACNP courses. 

Step 2.) Complete an Acute Care Nurse Practitioner Program

For nurses that have a BSN, there are three types of NP programs offered both in-person and online: 

  • MSN-NP: One of the most common options for NP programs, the MSN-NP is for students who already have their BSN and enroll directly into the program at the graduate level. 
    • Basic requirements: Applicant must possess a BSN degree. 
  • DNP: Doctorate Nurse Practitioner programs allow students to receive their doctorate degrees while meeting the requirements to become an NP. The DNP is generally suited for nurses who plan on working more in an academic or research-based setting, 
    • Basic requirements: Applicant must possess a BSN degree.
  • Post-graduate certificate. If you have a graduate degree that is different from the area that you wish to specialize in now with your NP, you can search for a school that offers a post-graduate certification option to allow you to enroll directly in the program. 
    • Basic requirements: Post-grad certificate programs require you to either possess your Master’s Degree of Science in Nursing (MSN) or have a Nurse Practitioner qualification in another specialty.

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Step 3.) Pass the Certification Exam

The American Association of Critical-Care Nurses offers board certification to acute care nurse practitioners. AACN Certification Corporation exams are accredited by the National Commission for Certifying Agencies.

In order to be eligible for the exam, candidates must, 

  • Graduate from a level advanced practice education program as an adult-gerontology ACNP at a nationally accredited school of nursing
  • Current, unencumbered licensure as an RN
  • Both direct and indirect clinical supervision must be congruent with current AACN and nursing accreditation guidelines.
    • The curriculum includes, but is not limited to:
      • Biological, behavioral, medical and nursing sciences relevant to practice as an ACNP, including pathophysiology, pharmacology and physical assessment
      • Legal, ethical and professional responsibilities of the ACNP
      • Supervised clinical practice relevant to the adult-gerontology ACNP role.
    • The curriculum meets the following criteria:
    • Curriculum is consistent with the competencies of adult-gerontology ACNP practice.
    • Instructional track/major has a minimum of 500 supervised clinical hours overall.
    • The supervised clinical experience is directly related to the knowledge and all role components of the adult-gerontology ACNP.

The exam includes:

  • 175 multiple-choice items, 150 of which are scored; the remaining 25 items are used to gather statistical data on item performance for future exams.
  • Computerized testing
  • Candidates are allowed 3½ hours to complete the exam.
  • Cost: 
    • AACN Members: $255 
    • Non-members: $360

Renewal requirements include,

  • ACNPC-AG certification is recognized for a period of 5 years. Renewing candidates may complete one of the following renewal options.
    • Option 1 - 1,000 Practice Hours and 150 CE Points
    • Option 2 - 1,000 Practice Hours, Exam and 25 Pharma CE
    • Option 3 - 150 CE Points and Exam

Step 4.) Apply for an APRN License

After passing the certification exam, individuals must apply for an APRN license from the state board of nursing. Individuals can hold several state board licenses (similar to RN) but these can only be applied for after passing the initial board certification. Each state has different requirements regarding initial certification and recertification. It is important to check the state board of nursing website for additional information. 

Part Six What Schools Have the Best Acute Care Nurse Practitioner Programs?

According to the U.S. News and World Report, the top acute care nurse practitioner programs of 2020 are:

  1. Duke University
  2. University of Pennsylvania
  3. Vanderbilt University 
  4. Johns Hopkins University
  5. Emory University
  6. University of California - San Francisco

Part Seven What is an Acute Care NPs Scope of Practice?

Acute Care Nurse Practitioners are granted the same rights as all other NPs throughout the country. Specializing doesn’t exclude them from any of the laws for this profession. Because of where acute care NPs work, they often practice on their own with full practice authority.

In 23 states, nurse practitioners have “full practice authority” which means they do not have to work under the supervision of a doctor. Full practice states include Oregon, Maine, Alaska, Hawaii, Washington, and Iowa. 

In states with reduced practice (Ohio, Pennsylvania, and Utah) and restricted practice (Texas, California, and Florida), NPs must have a medical doctor sign certain medical patient care decisions. NPs have prescriptive privileges in all 50 states and can administer controlled substances in 49 states.

Acute Care NP practice authority by state map

Nurse Practitioners evaluate their patients holistically, including both the emotional and mental aspects of the patient’s condition and not just the physical. For this reason, a great deal of time is spent on the education aspect of patient care.

CRNPs provide teaching and supportive counseling and refer patients and families as appropriate. They focus on health education, health promotion, and disease prevention

Part Eight Where Can Acute Care NPs Work?

Acute Care NPs can work in a variety of settings. They are most likely to work in an:

  • Emergency Room
  • Trauma Unites
  • Sub-acute units
  • Intensive care Unit
  • Medical or Surgical Unit
  • Urgent Care Clinic
  • Operating Room
  • Outpatient or Inpatient Subspecialty Practice
    • Cardiology
    • Pulmonology
    • Neurology
    • Interventional radiology
    • Cardiothoracic surgery
  • Nursing home or skilled nursing facility

Part Nine What is the Career Outlook for Acute Care NPs?

According to the U.S. Bureau of Labor Statistics (BLS), the career outlook for NPs is excellent. As of 2019, there were 200,600 Nurse Practitioners in the United States, while in 2028 there is an expected need of 242,400 providers. This is a 28% growth projection. 

While the BLS does not differentiate between the different types of NPs, acute care NPs will always be in need as the baby boomer generation continues to age. Furthermore, the National Center for Workforce Analysis (NCHWA) reported an estimated 20,000 primary care physician shortfall by 2025. Acute Care NPs will help fill this void. 

The idea of working independently of physicians is a great incentive for some people to move into the nurse practitioner career. In fact, the profession rates #5 as the best job in health care and No. 7 job overall in the top 100 jobs, according to the U.S. News & World Report 2019.

Part Ten Other Nurse Practitioner Specialties

  1. General Nurse Practitioner
  2. Family Nurse Practitioner
  3. Aesthetic Nurse Practitioner
  4. Psychiatric Nurse Practitioner
  5. Pediatric Nurse Practitioner
  6. Neonatal Nurse Practitioner
  7. Women's Health Nurse Practitioner
  8. Orthopedic Nurse Practitioner
  9. Emergency Nurse Practitioner
  10. Adult-Gerontology Nurse Practitioner
  11. Oncology Nurse Practitioner

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