It is a common occurrence that NPs who I talk with personally or read about in forums indicate they do not understand the possible roles they can serve as an adult gero acute care nurse practitioner. Most people see that certification and think “I don’t want to be an ICU NP; not choosing that path.” The purpose of this article is to highlight the many, many different pathways you can take with your AGACNP certification. Obviously, being an acute care NP I possess some bias, especially given my personal job acquisition experience (more on that later). Having disclosed that, I do want to add that I speak with around 50 NPs a year who represent primarily FNP and ACNP certifications and am aware of the national trends in hiring. Trust me when I say, I’d be willing to bet there are far more possibilities out there for you as an ACNP than you realize.

Before I get to the giant list of specialties I need to address the elephant in the room - the where are we allowed to work argument. This hotly debated topic is the delight of many well intended, opinionated forum members who know that because they are practicing a certain way - well it must be true for everyone. No sarcasm there friends. The reality is that many layers of direction exist to determine how and where you can practice and these vary greatly. There is very little federal standardization in regards to our training and scope of practice. It is left to the state board of nursing which is super grey (at best) and then filters down to the culture of the region, needs of the community, and the highly variable preferences of your employer / managing team. This explains that why in Georgia you will not likely be practicing in the ICU as an FNP, you could be doing so in South Dakota. And vice versa, you may be practicing inpatient in Georgia with your AGACNP but not likely serving in a primary care role.

First, let me define a few terms that might make this discussion easier to follow.

• Certification: The board certification you obtain after passing your exam which demonstrates to employers and the public that you have the necessary knowledge base to support your education and training. As NPs we narrow our training and therefore based on the program we choose, have differing credentials.

• Degree: MSN vs DNP. That’s pretty much it for NPs.

• Population: The focus of who you are treating. Think of this as your ideal client. For and AGACNP this is older adolescents, adults, and geriatirics. For FNP this is any age, across the lifespan including pregnant moms, babies, children, etc. For a NNP this would be neonates. For sub-specialized foci the associated clientele would apply. For example PMHNP would focus on care of the patient with psychiatric/mental health conditions and this could be any age.

• Role: The role in which you will be serving patients. This is where I believe most people get confused. Role indicates the type of care you will deliver and does not speak to either setting or population. This is the way you work and the type of patients you care for. For the two most confusing NP credentials (FNP v AGACNP) this indicates the difference. FNPs will treat patients who have acute and chronic illnesses that are not life threatening nor have health that is actively deteriorating. Their focus is on primary care and preventive medicine but often work in settings that treat minor but acute illnesses/injuries like urgent care. AGACNPs on the other hand care for patients with acute, possibly life threatening illnesses and typically this occurs in the setting of the hospital. However, specialty clinics such as orthopedics and oncology centers treat patients with acute illnesses and therefore they can work in these settings. They may not work in any setting in which primary care (aka anywhere that could be considered a patients medical “home”) is rendered.

• Specialty: This is the sub category underneath the certification that further narrows your focus. For example: GI, cardiology, bariatric surgery, critical care, primary care, dermatology, and so forth. Different types of NPs can work in each of these. In an oncology clinic you will see both FNPs and AGACNPs as they each bring different training, skills, and capabilities to the table.

• Work Setting: This is how people default to categorizing NPs: inpatient vs outpatinent. If you look at statistics you will see the majority of NPs do fall into the stereotypical settings. However, this report indicates that as many as 13% of FNPs practice in the inpatient setting. Particularly in rural settings or critical access hospitals; I see this from my clientele as well. Inversely, according to this report 14% of acute care nurse practitioners work in an outpatient setting. As you can see, the lines get blurred when you consider the career options in this capacity. So it’s better to think of the possible populations and roles you can practice as an AGACNP.

So, here is the biggest list I can compile

These include inpatient units/teams as well as the outpatient counterpart

• ICU

  • Medical, surgical (with plenty of sub sub specialty surgical ICUs like ENT, trauma, cardiovascular surgery, etc), cardiac, neuro-critical care, pulmonary, hepatology, transplant

• ER

• Rapid response/Critical alert/Emergency inpatient response/Code team

• Trauma team

• Neurology

• Hospital medicine (hospitalist)

• Pre surgical sites

• Interventional teams

  • radiology, pulmonology, cardiology

• Observation units

• Gastroenterology

• Hematology/Oncology

• Orthopedics

• Rheumatology

• Urology

• Endocrinology

• Nephrology

• Pulmonology

• Cardiology

  • Inpatient sub categories: cardiac observation unit, cardiac telemetry floor, cardiac stepdown, electrophysiology services, heart failure, cardiothoracic, surgery, transplant unit

• Palliative medicine

• Infectious diseases

• Inpatient rehab

• Outpatient rehab

• Long term acute care facilities

• Surgical teams of varied focus

  • bariatric, general, trauma, orthopedics, vascular, cardiovascular, etc

• Dermatology (primarily clinic)

What did I miss? I know there is something. The options are so vast.

The takeaway I want to impart is this: do not let the dialogue out there about what you can and can’t do as an AGACNP deflate your sails. If I had a dollar for every time an acute care NP came my way and had no clue they could practice in an outpatient setting - I’d retire. Your options are vast, and no you don’t have to just desire working in an ICU to be AGACNP. And no, you are not “limiting” yourself by opting for AGACNP over FNP. (I hear this sooooo much)

*** I applied for a clinic oncology position at a well known university health system. They offered me 15% more in base salary because as an AGACNP I offered them the versatility of rounding in the hospital should they need that. ***