Acute Care Nurse Practitioner (ACNP)

Medical professionals skilled in acute care are responsible for treating brief, but severe, episodes of illness, injury, or trauma, such as heart attacks or respiratory distress. As such, acute care usually consists of emergency medical interventions performed in hospitals, ambulatory care facilities, or short-term stay settings. Unlike chronic care, which involves treatment for an extended period of time, acute care, also referred to as secondary care, often involves the diagnosis and treatment of emergency medical conditions through an active and immediate process.

Acute care nurse practitioners (ACNPs) are also involved in the assessment, stabilization, and management of patients recovering from surgery, typically within an inpatient setting. When caring for both pre- and post-operative patients, acute care nurse practitioners often perform therapeutic and pharmacotherapeutic interventions in collaboration with specialists. In addition to postoperative in-patient settings, ACNPs are also found in the following settings:

  • Emergency Departments
  • Intensive Care Units
  • Neonatal Intensive Care Units
  • Ambulatory Surgery Centers
  • Operating Rooms
  • Specialty Labs
  • Acute and Sub-Acute Care Wards
  • Long-Term Care Facilities
  • Home Healthcare Settings

Acute care nurse practitioners are skilled in providing care across a continuum of medical care services, from trauma and intensive care to emergency care. Acute care nurses may be skilled and certified in a number of specialty areas specific to patient population, including pediatrics, geriatrics, and neonatology, and often further specialize by setting, condition, and disease type:

  • Cardiology
  • Nephrology
  • Emergency Care
  • Neurology
  • Surgery
  • Cardiopulmonary
  • Trauma
  • Oncology

An acute care nurse practitioner may be responsible for:

  • Examining and assessing patients and developing care plans based on those assessments
  • Diagnosing and managing acute medical conditions
  • Ordering and interpreting diagnostic tests
  • Providing support to patients and their families regarding how to best manage symptoms and conditions
  • Prescribing medications to manage and treat an acute illness
  • Collaborating with specialists and multidisciplinary team members to provide direct patient care

Education and Degree Options

Acute care nurse practitioners are recognized by their state Board of Nursing as certified nurse practitioners with specialty certification in acute care.  Acute care NPs start by obtaining their RN license and gain experience as acute care RNs for a few years before beginning an advanced degree program.

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From there, acute care nurses pursue an advanced degree, usually a Master of Science in Nursing (MSN) with an acute care concentration or major. Many nurses choose to pursue a general MSN, and then complete a post-graduate certificate in acute care. Some pursue doctorate programs leading to the highly regarded DNP degree. BSN to MSN and BSN to DNP bridge programs for acute care nurse practitioners also exist. Programs are often available specific to patient population foci, including pediatrics, adult-gerontology, and neonatology.

Graduate level programs are often combined to include curricula and clinical exposure that incorporate the principals of emergency and critical care nursing with acute care nursing. These blended programs prepare graduates who may wish to be licensed as clinical nurse specialists, and nationally certified as acute care clinical nurse specialists (CCNSs) through the American Association of Critical Care Nurses.

The curriculum commonly included in acute care nursing graduate programs incorporates diagnostic reasoning and clinical decision-making, and commonly covers the following subjects:

  • Nursing research
  • Nursing theory
  • Pathophysiology
  • Leadership for advanced practice nursing
  • Management of acutely ill adults
  • Pharmacology
  • Physical health assessment


National Certification

Upon completion of a graduate or post-graduate education focused on acute care nursing, applicants are then eligible for national certification. National certification is essential, as most states require it as a precursor to licensure.

The American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association, offers the acute care nurse practitioner (ACNP-BC) certification. To qualify for this certification, applicants must:

  • Hold an active RN license in a state or territory of the United States (or the equivalent in a foreign country)
  • Hold a master’s, post-graduate or doctorate degree from an acute care nurse practitioner program accredited by either the Commission on Collegiate Nursing Education (CCNE) or the National League for Nursing Accrediting Commission (NLNAC)
  • Provide proof of at least 500 faculty-supervised clinical hours in an acute care nursing program. Courses must include: advanced physical/health assessment, advanced pharmacology and advanced pathophysiology, as well as content in health promotion and disease prevention, and differential diagnosis and disease management.

After applying for certification, applicants have up to 90 days to take the exam through a local Prometric Testing Center. Recertification is required every 5 years, during which time certificate holders must meet specific clinical practice and continuing education requirements.

The Pediatric Nursing Certification Board offers a pediatric nurse practitioner acute care (CPNP) certification that is designed to evaluate a nurse’s ability to meet the specialized physiologic and psychological needs of children with complex acute health conditions. To qualify for certification, applicants must:

  • Hold an active RN license in a state or territory of the United States or Canada
  • Hold a master’s, post-graduate or doctorate degree from a pediatric nurse practitioner program accredited by either the Commission on Collegiate Nursing Education (CCNE) or the National League for Nursing Accrediting Commission (NLNAC)

After applying for certification, applicants have up to 90 days to take the exam through a local Prometric Testing Center. Recertification enrollment takes place every year between October 1 and December 31. To recertify during this time, CPNPs must complete an online application and document their competency maintenance requirements (15 hours of accepted activity must be documented every year). In addition, CPNPs must also complete specified pediatric-specific refreshers during a 7-year tracking period.

The American Association of Critical Care Nurses offers the following certifications:

  • Certification for Adult, Neonatal and Pediatric Acute and Critical Care Clinical Nurses Specialists (CCNS)
  • Certification for Adult Acute Care Nurse Practitioners (ACNPC)
  • Subspecialty Certification in Cardiac Medicine (CMC)
  • Adult Tele-ICU Acute/Critical Care Nursing Certification (CCRN-E)
  • Certification for Adult, Pediatric and Neonatal Critical Care Nurses (CCRN)
  • Certification for Progressive Care Nurses (PCCN)

To qualify, applicants must:

  • Hold a current RN or APRN license
  • Hold an advanced practice graduate degree (MSN or higher) with an acute and/or critical care specialization or concentration
  • Provide proof of curriculum in biological, behavioral, medical and nursing sciences, including pathophysiology, pharmacology, physical assessment; legal, ethical, and professional responsibilities; and supervised clinical practice relevant to the acute/critical care specialty
  • Provide proof that the curriculum:
    • Is consistent with competencies of acute/critical care practice
    • Includes at least 500 supervised clinical hours in the applicant’s instructional track/major
    • Includes supervised clinical experience that is directly related to the role of the acute/critical care NP or CNS
    • Includes at least 500 hours in direct clinical practice with one patient population within the master’s program
    • Includes a minimum of 2 didactic courses that are specific to the care of acutely or critically ill patients


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Acute Care Nurse Salaries

According to the 2011 National Salary Report published by Advance for NPs and PAs, nurse practitioner salaries differed based on patient population and work setting:

  • Emergency $103,722
  • Gerontology $94,485
  • Surgery $91,023
  • Hospital $96,124
  • Internal Medicine $87,950
  • Women’s Health $82,183
  • Pediatrics $82,101
  • Neonatal Unit $99,810

A 2011 survey of 3,812 NPs conducted by the American Academy of Nurse Practitioners showed that the average, full-time base salary for a nurse practitioner was $91,310, while the average, full-time base salary for an acute care nurse was $105,200. Acute care NPs in emergency/urgent care settings earned an average of $115,070.

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