A Day in the Life of an Acute Care NP - Interviews with Two Experts

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The ACNP position is the critical communication and coordination link between all aspects of patient care of the acute and critically ill patients.
Nancy Munro, Senior Acute Care NP, National Institutes of Health (NIH)

Acute care nurse practitioners (ACNP) are integral to the American healthcare landscape. These highly skilled professionals work in a wide range of settings to provide high quality care to patients as part of robust, specialized healthcare teams. The ACNP is trained to make difficult, life-altering decisions that are in the best interest of patients, making it a challenging and rewarding career path.

As their title suggests, acute care NPs work with patients who experience often sudden, critical illnesses or injuries. ACNPs not only serve important roles addressing urgent needs in intensive care units and emergency rooms, but they also embrace other duties, from collecting detailed patient health histories to performing invasive procedures such as placing central lines, performing lumbar punctures, or introducing intubation.

As the ACNP role has grown and diversified, these nurse practitioners have continued to be certified by the American Association of Critical Care Nurses (AACN). The ACNPC-AG certification is a consensus model-based credential for graduate-level educated nurses to "provide advanced nursing care across the continuum of healthcare services to meet the specialized needs of adult-gerontology patients with complex acute and/or chronic health conditions." To become certified, nurses must submit an verifying their eligibility and sit for a rigorous exam.

Overall, ACNPs play a pivotal role in the care of acute and chronic illnesses and injuries. To learn more about the daily responsibilities of this NP specialization, NursePractitionerSchools.com interviewed two experienced ACNPs—including one of the first professionals certified in this field—and is grateful for their valuable insights into this specialization.

Interviews with Two Exceptional Acute Care NPs

Please note that the following interviews have been lightly edited for length and clarity.

Recognizing the Importance of ACNPs

Becoming active members of organizations that advocate for the ACNP role—e.g., the American Association of Critical-Care Nurses (AACN) and the American Association of Nurse Practitioners (AANP)—is a major way to address the challenges to practice for nurse practitioners.
Ellen Prewitt, Acute Care NP, Cleveland Clinic

It is evident from these interviews that working as an ACNP means making choices that are critical to providing excellent patient care. As the scope of the ACNP role has grown, so too have the healthcare settings in which ACNPs most commonly practice. Whereas the acute care label once applied largely to nurses who worked in hospitals, these days acute care nurse practitioners work in more diverse settings, including:

  • Emergency care
  • Procedurale and interventional settings
  • Home care
  • Ambulatory care
  • Urgent care
  • Long-term care
  • Rehabilitative facilities
  • Hospice
  • Air and ground ambulances
  • Telehealth

In closing, the ACNPs interviewed for this feature touched on two important (and interrelated) challenges in their profession: being able to bill for services and achieving full practice authority. To the first point, Ms. Munro stated that, “The main legislative challenge for the ACNP is recognition of the role through the ability to bill for the services that the ACNP provides.” As it stands, ACNPs and other APRNs are not able to bill directly for services in all states and have varying disbursement procedures. These rules are complicated and can lead to confusion among patients, healthcare providers, and insurers. These convoluted billing regulations are related to the issue of practice authority, which Ms. Prewitt summarized succinctly: “Currently, not all states have full practice authority, which means practicing to the fullest extent of their training and education. Some states mandate an agreement with a physician in order for an ACNP to practice, or they have cumbersome formularies restricting what a nurse practitioner can prescribe.”

NursePractitionerSchools.com has interviewed more than 40 NPs about expanding full practice authority across the country. To find out how to get involved to help ACNPs and others, please check out the FPA legislative toolkit.


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