FNP vs. ACNP in 2023

FNP vs. ACNP in 2023

As nursing practice continues to evolve, a shortage of primary care providers nationally has created an excellent opportunity for registered nurses to advance their careers by securing advanced professional nursing qualifications to become nursing practitioners.

For these positions, one would need a master’s degree or postmaster’s certificate in nursing. Family nurse practitioners (FNP) and acute nurse practitioners (ACNP) are some of the top nurse practitioner (NP) specializations in high demand. Read on to discover more about these two subspecialties.

Differences between FNPs and ACNPs

Before choosing whether to become a family nurse practitioner or an acute nurse practitioner, it’s crucial to understand the similarities and differences between the two. Although with both you must have a minimum of a Master of Science in Nursing (MSN), the roles and responsibilities are different. As we explore each role deeper, you’ll have a clear distinction between the two.

What is an FNP?

An FNP is a nursing practitioner who works independently or collaborates with other healthcare professionals to offer family-focused nursing practice. These nurses provide healthcare services designed for the family unit, including disease prevention and health promotion. Family-focused healthcare services target all ages, including seniors, adolescents, and adults. Some of the core tasks of a family nurse practitioner include:

  • Developing treatment plans
  • Maintaining patient records
  • Prescribing medication
  • Performing diagnostic tests
  • Conducting physical exams
  • Treating acute and chronic illnesses

Since FNPs hold a graduate-level education and clinical training in family medicine, they can diagnose and treat complicated conditions of the mind and body. Their advanced education and training qualify them to serve as policymakers and clinic and hospital administrators.

The American Association of Nurse Practitioners (AANP) describes FNPs as the most populous subspecialty of NPs. The scope of FNPs includes pediatrics, neonatal care, gerontology, and women’s health, among other patient populations.

Where do FNPs work?

FNPs work in different settings. Although some may opt to work independently, most of them work in hospitals, outpatient clinics, and schools. In private outpatient clinics, FNPs offer primary care to patients. In retail clinics, they attend to a huge number of walk-in patients.

FNPs also work in urgent care centers and attend to patients in need of non-emergency care, such as allergic reactions, sprains, and minor fractures. In hospital settings, they offer primary care services. A considerable number of FNPs work in schools where they provide primary care to students.

What is an ACNP?

An ACNP is a clinical nurse specialist who offers services to patients in need of healthcare for a short time frame. Here, ACNPs attend to patients briefly, but for severe disease episodes, illness, recovery from surgery, or trauma.

ACNPs possess advanced skills, knowledge, and experience in nursing theory, practice, and evidence-based practice. They also specialize in emergency care techniques, diagnostics tests, and interviewing procedures to let them handle patients suffering from trauma, severe symptoms, or even life-threatening conditions.

Where do ACNPs work?

ACNPs possess a variety of skills that allow them to work in different healthcare environments. Most ACNPs work in urgent care centers, acute care settings, or hospitals, where they attend to injured or acutely ill patients. Here, they diagnose health conditions and prescribe treatments and medications to assist the patients recovering from exacerbated chronic conditions or sudden illness/injury.

They also offer care to patients dealing with long-term, chronic, and complicated medical issues. ACNPs share training with general NPs to enable them to provide quality patient care in different care scenarios.

What education and certifications do ACNPs require?

Like FNPs, the route to becoming a critical care nurse starts with attaining a bachelor’s degree. The most common program is the BSN-MSN, but you can get other alternatives if you hold a nursing diploma or are a registered nurse. It’s vital to research the options and know whether the course is available on-campus or online.

After completing your MSN, you can sit for the acute care nurse certification exams to get certification from the relevant nursing body.

What are the key roles of an acute care nurse practitioner?

The roles and responsibilities of ACNPs depend on their work environment. For instance, those working in critical care or emergency settings can assess patients and establish the most appropriate course of treatment. They also handle acute care-related treatment and medication in these settings. In addition, they collaborate with other healthcare professionals, such as physicians, to offer appropriate medical care to patients.

Besides these fundamental acute care nursing skills, an emergency nurse practitioner should also effectively communicate with patients and families. They should embrace teamwork and attention to detail as they discharge their duties.

What are the core differences between acute care and primary care?

Primary care acts as the first point of interaction for patients with the healthcare system. It also serves as the basis of continuing focal points for all the healthcare needs of the patient. These services are offered by a team that includes a physician, primary care nurse practitioner, and other healthcare professionals, including family nurse practitioners working as physician assistants.

Primary care practices comprise diagnosis and treatment of acute and chronic health conditions, health maintenance, patient education, and counseling. Primary care practices are offered in settings with a high patient population, providing access to healthcare while maintaining a broad range of institutional and specialty and referral relationships for various care needs.

Acute care refers to active treatment to address short-term needs. It’s a branch of secondary healthcare where-by patients receive short-term treatment for an episode of illness, severe injury, recovery from surgery, or an urgent medical condition. In simple terms, we can refer to acute care as the opposite of long-term or chronic care.

Acute care services are offered by a team of healthcare professionals, including acute care nurse practitioners. Acute settings include intensive care unit, emergency department, cardiology, coronary care, and other general areas where the patient receives acute treatment and stabilization and transfers to a high dependency unit for further treatment.

Cost of certifications for FNPs vs. ACNPs

Family nurse practitioner certification

Certification is mandatory to become an FNP. Most family nurse practitioners acquire certification via one of two national nursing boards; the American Nurses Credentialing Center (ANCC) and the American Association of Nurse Practitioners (AANP).

How to become an FNP?

If you wish to become an FNP, the path will depend on whether you already have background training in nursing, such as a diploma. You can follow this route.

  1. Earn an MSN: If you already have a BSN, or you’re a registered nurse, you can register for an MSN, which you can earn in 20 months. Some universities allow you to study at your own pace. This means you can continue working and raising your family as you learn. If you don’t have any training in nursing, you can start by earning a BSN or ASN, then work towards your MSN.
  2. In addition to an MSN, you need to be an excellent communicator and critical thinker. As an FNP, you’ll be liaising with other healthcare professionals and patients to make valuable decisions about plans of action for your treatments.
  3. Get licensed: After earning your MSN, you need to be licensed in the state you plan to work in. The licensure requirements differ from state to state. Check with the specific state board of nursing for accurate information.
  4. After securing your license, you’re ready to get a clinical placement as an FNP.

What’s the cost of FNP certification?

Before learning about the cost of FNP certification, let’s get the difference between FNP-BC and FNP-C. The core differences between these two certifications are that FNP is acquired through the American Nurses Credentialing Center (ANCC), while the American Academy of Nurse Practitioners offers FNP-C.

The good news is both organizations are reputable, and their certifications are credible and respected. However, the tests from the two bodies have minor differences in the content covered. For instance, ANCC’s includes 175 questions against AANP’s 150 questions. ANCC’s test is mainly biased towards professional topics, nursing theory, and policy, making it ideal for those wishing to get into academia.

Clinicians prefer AANP’s FNP-C. Also, costs may come into play, considering FNP-BC is more expensive than FNP-C. It’s advisable to gather sufficient information about the two certifications before deciding which to go for. After passing your exam, you can apply for state licensure from the relevant state nursing board.

Where can I get my FNP certification?

Different organizations offer FNP certifications. Check with your state board of nursing to establish what is acceptable in your state.

The accreditation AANP offers is referred to as FNP-C. Members pay $240 to acquire the certification, while non-members pay $315.

Requirements for FNP-C include:

  • US or Canadian RN license
  • Graduate from an accredited master’s, doctoral, or post-graduate nursing program
  • Complete at least 500 hours of direct clinical patient care supervision
  • Have completed the needed APRN main courses, such as advanced physiology, pharmacology, and advanced health assessment.

You can also apply for FNP-BC offered by ANCC. Members pay $270, while non-members pay $340 for the certification.

Eligibility and certification requirements include:

  • Have a current RN license
  • Complete a master’s or doctoral degree specializing in family medicine
  • At least 500 hours of direct clinical patient care supervision
  • Complete APRN main courses, including advanced physiology, pharmacology, health assessment

Steps to becoming an ACNP

You can become an acute care nurse practitioner through the following steps:

  1. Become an RN: You should finish your BSN and become an RN before registering for your MSN. A majority of graduate programs will require you to have experience as a registered nurse.
  2. Enroll in a graduate program (MSN): If you want to become an ACPN, you must first earn an MSN or a doctoral program that focuses on acute care.
  3. Obtain certification: After earning your MSN, apply for the certification exam with the American Association of Critical-Care Nurses (AACN) or any other body that offers an ACPN license in your state.
  4. You can also get state licensure, such as Advanced Practice Registered Nurse (APRN).

What’s the cost of ACNP certification?

Mainly, ACPN’s practice under a general NP license, but they require additional certification in acute care. If you wish to acquire an ACPN certification, you can obtain it from various organizations based on your practice area.

  1. You can obtain your ACNP license from ANCC at a fee of $275 if you are a member. Non-members pay $375.
  2. If you get your certification for adult-gerontology (ACNPC-AG) from ANCC, you’ll pay $255 if you’re a member. Non-members pay $360.
  3. Other bodies that offer ACNP certification include The American Nursing Credentialing Centre that offers the adult gerontology acute care nurse practitioner certification (AGACNP-BC) and the Pediatric Nursing Certification Boards that provides the certified pediatric nurse practitioner-acute care (CPNP-AC).

Career outlooks for FNPs and ACNPs

ACNP job outlook

If you’re in search of an advanced nursing career with unlimited future job prospects, ACNP could be an ideal choice. It allows you to work as an advanced practice nurse. According to data from the Bureau of Labor Statistics, the projected growth for NPs through 2029 is estimated at 52%.

The growth is higher than all other occupations. This means the demand for ACNPs will surpass supply in the foreseeable future. If you have the qualifications of an acute care NP, you’ll be at an advantage when applying for jobs or switching positions. Specializing in this field will help set you apart from fellow job candidates.

What’s the job outlook for FNPs?

The job outlook for FNPs is bright. This status is mainly fueled by the increasing shortage of primary care physicians. According to the Bureau of Labor Statistics, over 110,700 NPs jobs will come up by 2029. This increased demand for NPs is because of an increasing population of senior citizens who need primary health care.

The greater earning potential for FNPs will also lead to a significant increase for nurses specializing in this arm of NP. The U.S Bureau of Labor Statistics estimates the average salary of FNPs to be $117,670, unlike a median of $70,000 for RNs. A focus on preventive healthcare and an aging population are the primary drivers for this demand for FNPs.

Where is the greatest demand for FNPs and ACNPs?

The expected physician shortage by 2030 and the changing perception about the efficacy of NPs in delivering high-quality primary healthcare are some of the significant contributors to the increased demand for NPs. The Association of American Medical Colleges (AAMC) projects a shortfall of about 54,100 to 139,000 physicians by 2030.

Another factor accounting for the increased demand for NPs is that it takes five or six years less to train an NP than a physician, while about 90% of NPs are certified to offer primary healthcare. Also, because NPs are more likely to serve rural, underinsured, and underserved populations, most healthcare organizations will prefer hiring them over physicians.

Different states add varying numbers of NPs to their workforce. New York is the leading state with 1,450 NP jobs added annually, followed by California with 1,200 and Florida with 950 new NPs added to the state workforce each year. Other states with a high demand for NPs include Illinois, Ohio, Massachusetts, and Tennessee.

NPs have been continuously ranked among the top 5 occupations in the U.S. due to low-stress levels, a decent salary, and work-life balance.

The aging population & gerontology NPs

NPs are a crucial part of healthcare providers offering primary care to Medicare beneficiaries. According to AANP, the increased number of baby boomers eligible for Medicare has increased the demand for NPs with expert knowledge and skills in gerontology. These nurses help seniors become independent and enhance their health and well-being.

Pediatric care

NPs are also increasingly offering pediatric primary and acute care. Although general NPs can offer high-quality pediatric care, those with specialized training in pediatric care are better placed to provide dependable services.

They offer disease treatment, disease prevention, and health promotion to children of less than 21 years. These NPs also have specialized skills to handle children who are physiologically unstable and highly vulnerable to complications.

Other job trends for NPs

NPs are in high demand in retail clinics, outpatient care centers, ambulatory surgery centers, and urgent care centers. They are also needed for in-demand specialties like diabetes care. Nursing schools searching for new tutors or replacing their aging faculty members are other avenues where NPs are in high demand.

How to determine whether you should become an FNP or ACNP

Choosing whether to specialize in FNP or ACNP can be challenging. The decision you make will affect your future career, thus the need to make the right choice. When choosing between the two, consider the following:

Your area of interest

If you’re already in the nursing profession, you must have specific areas of interest. For instance, if you can’t stand the sight of ventilators, then the ICU should be a no-go zone for you. The same applies if you dislike screaming children, you can’t make an excellent pediatric nurse.

When choosing whether to be an FNP or an ACNP, develop a list of your good and bad experiences in your nursing career and select the specialty that includes overwhelming positives and a few or no negatives. That way, you’ll enjoy delivering services to patients.

Employment outlook

Although all specialties of NPs are in high demand, some are in higher demand than others. Both FNP and ACNP have an excellent job outlook, meaning you can choose any provided you’re interested in the specialty. Also, these specialties are more general and offer broader opportunities compared to more specialized NPs such as dermatology or cardiology.

The career opportunities in ACNP are fewer compared to FNP, so you should consider specializing in family nursing if you want to secure a job faster. Alternatively, you can work as an RN until you spot your dream job as an emergency nurse practitioner.


According to PayScale, FNPs earn an average of $96,478/year compared to $103, 548/year for ACNPs. Although the difference in pay is not as pronounced as in physician specialties, the difference can affect your income. If you want to earn more, choose to be an ACNP.

Responsibilities and specialties

When choosing your specialty, it’s also vital to consider the roles and responsibilities of the two. ACPNs offer immediate help to patients in acute care and collaborate with physicians to take care of patients. Because of the immediacy of most acute medical conditions, the decisions ACNPs make are crucial to the patient’s life.

FNPs assume roles that are like those of physicians. They attend to patients of all ages to prevent diseases and promote health. They can screen patients, perform diagnostic procedures, and carry out physical exams. FNPs also create long-term treatment plans for patients and help build relationships with patients. As you choose between FNP and ACNP, you need to be comfortable discharging the responsibilities of the specific specialty.

Work environment

Although ACNPs work in different parts of the hospital, you’ll mainly find them in the emergency or operating rooms, offering advanced care to patients in critical conditions. They are also present in ambulatory clinics and intensive care units (ICUs).

Because FNPs offer primary care to patients, they are common in private offices, clinics, or operating as independent practitioners. You can also find them in hospice centers or other primary care settings. Choose your specialty based on the working environment you desire.

Career flexibility

Some NPs choose more specialized nursing careers, while others gravitate towards more general specialties. With FNP and ACNP, the latter is more specialized and comes with fewer options. If you want an advanced nursing career with more options, you can choose to be an FNP.

Skillsets required for FNP or ACNP

Your skill-set and personality define the success of your nursing career. When pursuing a career in FNP, you should have a specific set of skills and personality, just like any other career. FNPs are the first line of defense for overall health, wellness, and chronic conditions.

As an FNP, you work closely with patients over a long period at different stages of their lives. Some of the core competencies and skills you must have as an FNP include:

  • Empathy
  • Effective communication
  • Organizational skills
  • Attention to details for effective prescriptions and decision making
  • Team player since you often collaborate/interact with other healthcare professionals
  • Stress management, especially when dealing with frightened patients
  • Entrepreneurial spirit because you may opt to work as an independent practitioner
  • Flexibility: FNPs have a wider scope of duties and also work in a broader range of environments and geographical regions

Ideal skills and competencies for ACNPs

If you dream of becoming an ACPN, you must be willing to work under pressure. You offer care to patients during critical moments, and every decision you make is crucial to the patient’s life. This calls for excellent problem-solving skills and a calm attitude.

You should also possess extensive knowledge about the best medical technology and treatment needs for emergency care. Your communication skills should be superb to ensure you can relate well with your team members, patients, and their families.

You must also be compassionate since acute conditions call for this. ACNPs need to have the mental, physical, and emotional strength to handle patients and family members effectively as they deliver their services.

Other main strengths and skills ACNPs require include:

  • Ability to multitask
  • Perseverance
  • Teamwork
  • Expertise and experience in managing critically ill patients
  • Interpersonal skills
  • Technical competency

Career advancement opportunities for FNP and ACNPs

With your advanced nursing education and experience as an FNP or ACNP, you can still pursue an advanced career in healthcare or education.

Three common options include:

Chief nursing officer

If you work in a hospital setting, you can consider applying for the chief nursing officer (CNO) position. In this position, you’re in charge of a hospital nursing team. Your major roles include budgeting, tracking clinical hours, purchasing, monitoring equipment and supplies, and ensuring compliance with hospital policies. You need a minimum of MSN and managerial experience for this role.

Director of nursing

In this role, you handle training, recruitment, and scheduling of nursing teams, office staff, and other healthcare professionals. You’re also in custody of sensitive medical records and managing budgets. You’ll also oversee compliance with healthcare laws. Besides an MSN, you must be good at delegating duties, an excellent communicator, and a brilliant manager.

Postsecondary nursing instructor

As an FNP or ACNP, you can advance studies in your field and earn a doctoral or postdoctoral qualification. This allows you to become a nursing instructor for a nurse practitioner program in a medical college or university. Your core duties in this position involve training nursing students about patient care, both in clinical or classroom settings.

As a nursing instructor, you can work in both part-time and full-time faculty positions. You also have the opportunity to work in NP program research and publication. This is one of the desirable career opportunities for FNPs and ACNPs, especially those with zeal for passing knowledge to the next generations of nurses. This position offers endless opportunities to FNPs and ACNPs. Previous teaching experience is an added advantage for this position.

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