Please note that the generalized acute care certification (ACNP-BC) is being phased out by the American Nurses Credentialing Center (ANCC). The ANCC will accept its last application for the certification exam on Dec. 31, 2015 with test administration being allowable through Dec. 31, 2016. The ANCC will continue to provide the adult-gerontology acute care (AGACNP-BC) certification. Additionally, the American Association of Critical Care Nurses (AACN) and the Pediatric Nursing Certification Board (PNCB) offer population-specific (i.e., pediatric or adult gerontology) acute care certifications for nurse practitioners. The reason for the shift is that the APRN consensus model, which now governs NP certification and licensure, organizes NP licensure by patient population and does not recognize "acute care" as a distinct patient population. Therefore, new pediatric and adult gerontology nurse practitioners interested in practicing acute care nursing will now work towards the appropriate population-specific acute care certification.
Acute care—a term referring to short-term healthcare services—aims to get patients the stabilizing care they need during medical emergencies, illnesses, or accidents. Acute care nurse practitioners are increasingly being divided into two specialized subfields—pediatric and adult—and typically work in hospitals, rehabilitation facilities, urgent care clinics, birthing centers, and other healthcare environments.
According to the the University of New Mexico College of Nursing, acute care NPs are highly trained to minimize patient complications from acute illness; stabilize incidents of acute illness (or accidents); evaluate risks; treat acute events and develop a treatment plan for maintenance of long-term health; advocate for patients; and use evidence-based knowledge in their practice.
No matter the population focus (pediatric or adult gerontology), acute care nurse practitioners generally need to complete at least a master’s of science in nursing (MSN) degree. Candidates with master’s degrees in nursing specializing in other patient populations (e.g., family, women’s health, psychiatric mental health, neonatal) may pursue a post-master’s certificate. And for candidates interested in the terminal degree of the discipline—one that is recommended for aspiring leaders, managers, and other top-level professionals—a doctor of nursing practice (DNP) is becoming the new gold-standard in acute care. In fact, the American Association of Colleges of Nursing (AACN) recommends that the DNP be the new benchmark for advanced practice preparation by the end of 2015.
That said, most practicing acute care NPs have master’s degrees and a majority of the national certifications—including those offered through the American Nurses Credentialing Center (ANCC), the American Association of Critical Care Nurses (AACN), and the Pediatric Nursing Certification Board (PNCB)—accept master’s degrees as the highest degree achieved by candidates. Furthermore, CareerOneStop (2015)—a research organization sponsored by the U.S. Department of Labor—found that that 77.8 percent of all NPs have master’s degrees, while 12.7 percent have doctoral (or professional) degrees.
Read on below to discover the steps to becoming an acute care NP in the two growing subdisciplines—pediatric and adult gerontology—as well as certifications, accreditations, and sample programs for each field.
There are varied academic paths to becoming an acute care nurse practitioner, but as mentioned above, pursuing a graduate degree (MSN or DNP) is the most common way to join this growing subfield of nursing. Please note that any differences between becoming a pediatric acute care NP (PNP-AC) and an adult gerontology acute care NP (AG-ACNP) are noted within the steps.
With program accreditation and certification information covered below, here is one possible path to becoming an acute care NP:
1. Graduate from high school. Aspiring PNP-AC and AG-ACNP candidates generally perform well in secondary school science classes such as biology, chemistry, physiology & anatomy (where offered), and statistics. At this stage, students may be advised to volunteer in medical settings to get exposure (and valuable letters of recommendation) for the competitive college admissions process.
2. Earn a bachelor of science in nursing (BSN), or a similar degree (4 years). There are varied academic paths to becoming an acute care NP. Some choose two-year associate degree programs and work for a few years before applying for competitive RN-to-MSN or RN-to-DNP programs. Many PNP-AC and AG-ACNP students, however, choose to get a BSN degree. BSN programs offer both hands-on training (i.e., clinical experiences) and didactic instruction in both general education topics and nursing-specific areas such as genetics in healthcare, nursing care of childbearing families, and medical microbiology. For many graduate programs—PNP-AC or AG-ACNP—having a BSN is a prerequisite for admission, especially for the online program options. Students are advised to ensure their undergraduate programs are accredited by one of two established bodies: the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing, Inc. (ACEN). These groups weigh criteria such as comprehensiveness of curricula, quality of facilities, and prestige of faculty (e.g., number of awards or publications) in order to evaluate nursing programs. Accreditation is not only crucial as an indicator of a program’s caliber, but it’s also necessary to qualify students for the NCLEX-RN exam (see below), the test for licensure as a registered nurse (RN).
3. Become an registered nurse (RN) and get experience working in acute care (1 – 3 years). As part of undergraduate programs in nursing, students typically receive clinical instruction for licensure and take the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Aspiring acute care NPs in both subfields are advised to seek out clinical opportunities in intensive care units (ICUs), emergency rooms, neonatal intensive care units (NICUs), and other medical settings to grow accustomed to acute care. PNP-AC and AG-ACNP graduate programs typically call for one to three years of clinical experience. Finally, aspiring professionals in acute care may also choose to get certified at this stage after garnering enough experience. The American Association of Critical Care Nurses (AACN) offers the CCRN® specialty certification to RNs with at least 1,750 hours of experience working with critically ill neonatal, pediatric, and/or adult patients over the previous two years. While this is not the terminal certification for the discipline, it can enhance one’s employment and graduate school prospects.
4. Pursue a graduate degree in acute care or in one of the growing subspecialties: PNP-AC or AG-ACNP (2 – 3 years). Following at least one year of experience in acute or critical care settings, RNs generally apply to a graduate program in their chosen specialty. Although there are generalized acute care programs still available, this piece focuses on the two growing subspecialties of acute care for nurse practitioners: pediatric and adult gerontology. To gain admittance to a graduate program, both PNP-AC and AG-ACNP admissions committees may ask for:
PNP-AC students may also be advised to seek out graduate programs recognized by the Pediatric Nursing Certification Board (PNCB). These programs offer courses such as:
AG-ACNP students may also be advised to seek out programs approved by the American Association of Critical Care Nurses (AACN), which offer classes such as:
In addition to academic coursework, prospective acute care NPs in both subfields garner at least 500 clinical hours of experience in intensive care clinics, hospitals, emergency rooms, and other healthcare settings.
5. Obtain national and state board certification (timeline varies). Following graduation from a PNP-AC or AG-ACNP program, people typically seek national certification and licensure, registration, or certification from state boards of nursing. There are varied organizations which provide these certifications. For PNP-AC candidates, the Pediatric Nursing Certification Board (PNCB) provides a CPNP-AC certification which must be renewed annually. For AG-ACNP candidates, the American Nurses Credentialing Center (ANCC) provides two certifications: acute care NP (last exam registration for ACNP-BC credential will be offered 12/31/15), and AGACNP-BC. These must be renewed every five years following the completion of continuing education (CE) hours. The American Association of Critical Care Nurses (AACN) has two acute care NP certifications: adult (ACNPC) and adult-gerontological (ACNPC-AG). Prerequisites for these certifications include having an MSN or higher from a program accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing, Inc. (ACEN); completing specific coursework; RN licensure; showing proof of at least 500 faculty-supervised clinical hours; and passing an exam. Finally, states have differing rules governing the scope of practice and licensure, registration, or certifications necessary for all NPs in acute care. The National Council of State Boards in Nursing (NCSBN) offers a full list of state boards of nursing for reference.
6. Maintain NP licenses, registrations, and certifications (timeline varies). Each certification provides a timeline and list of procedures in order to maintain it. Generally candidates must submit an application; a licensing fee; and proof of having completed continuing education (CE) hours. Check certifying agency websites for details.
Finally, there is a wealth of professional organizations for acute care NPs in both the pediatric and adult subspecialties. These can provide resources such as job postings; conferences; networking opportunities; CE seminars; and more. They include:
Here are three featured online and hybrid acute care programs, one pediatric (PNP-AC) and two adult (AG-ACNP):
Duke University offers a distance-based, 43 credit-hour PNP-AC program with courses such as advanced physiology across the lifespan, physical assessment & diagnostic reasoning, and specialty seminars in advanced pathophysiology for neonatal & pediatric health. This MSN program typically takes seven semesters to complete, and is the only program of its kind in North Carolina. Duke also boasts the Center for Nursing Discovery, an innovative simulation center to help students build confidence with their medical techniques in a safe environment.
Johns Hopkins University (JHU)—tied for second place among U.S. News & World Report’s (2015) top nursing programs in the country—offers a hybrid AG-ACNP program to BSN-prepared candidates. This program takes 16 months to complete with courses such as applications of research to practice, clinical pharmacology, and health promotion & disease prevention taught by world-renowned, clinically experienced faculty.
Rutgers University hosts a three-year, hybrid DNP program for aspiring adult-gerontology acute/critical care NPs. This 66-credit program has classes such as advanced human physiology & pathophysiology, epidemiology & population health, and the social determinants of health. It is designed for BSN-prepared nurses with at least two years of experience working in acute care, and involves the completion of more than 1,000 patient care clinical hours.
In addition to the online ACNP programs, here are schools with predominantly campus-based coursework, two from each subspecialty:
The University of California, San Francisco (UCSF)—tied for second place among U.S. News & World Report’s (2015) best nursing programs in the country—provides a one-of-a-kind PNP-AC program which focuses on palliative care. With an emphasis on the acute, chronic, and critically complex health conditions, this program offers instruction in nutritional & pharmacologic management, ethical issues in an acute care setting, and professional role development for PNP-AC professionals.
The University of Florida (UF) in Gainesville provides a DNP program for PNP-AC professionals. Designed for BSN-prepared nurses, UF’s 76-credit program involves at least 1,007 hours of supervised clinical practice at preceptors and courses such as advanced pediatric procedures & diagnostics, organizational & systems leadership, and applied statistical analysis. Please note that UF also offers a DNP program for AG-ACNP.
Colorado State University (CSU) in Pueblo hosts an adult/geriatric acute care nurse practitioner MSN program. CSU boasts a first-time passing rate of 80 percent on the national certification exam, providing comprehensive coursework in health promotion, advanced pathophysiology, healthcare informatics, and diagnostic reasoning. Please note that this program also accepts RN candidates seeking to complete a BSN degree en route to the MS.
The University of Maryland in Baltimore—ranked #8 in the AG-ACNP specialty among U.S. News & World Report’s (2015) top nursing programs—has a practice-focused DNP program which blends AG-ACNP and clinical nurse specialist (CNS) competencies. With a mix of precepted clinical experience, lab work, and courses such as pathological alterations of the critically ill, UMaryland’s three-year program prepares NPs to work in trauma, critical care, and emergency healthcare settings. Please note that this school also features a DNP for the PNP-AC specialty
There is a wealth of accreditation organizations, but they are not all created equal. Prospective students in undergraduate nursing are advised to seek out programs accredited by the Accreditation Commission for Education in Nursing, Inc. (ACEN) or the Commission on Collegiate Nursing Education (CCNE). These two agencies accredit many of the NP programs available, thoroughly assessing them to ensure they provide a quality education that meets or exceeds specific educational standards with respect to curriculum, faculty, facilities, and student outcomes.
Furthermore, as mentioned above, it’s advisable to seek out graduate programs recognized by one of two national organizations in order to qualify for certification: the Pediatric Nursing Certification Board (PNCB) for PNP-AC programs, and the American Association of Critical Care Nurses (AACN) for AG-ACNP programs.