FNP VS. ACNP - 15 Key Differences Between FNP And ACNP

Written By: Pattie Trumble, MPP, MPH

Nurse practitioners (NPs) are advanced practice RNs who assess, diagnose, treat and manage illnesses and injuries, often with a great deal of autonomy. Each NP specialty focuses on one of six specific patient populations; within each specific NP concentration, there may be further specialization into primary care and acute care roles. Primary care can include the management of both acute and chronic conditions so long as they aren’t life-threatening; acute care refers to the management of more severe episodes of illness that frequently require hospitalization.

The best way to think about FNP vs. ACNP is this: Family nurse practitioners (FNPs) provide primary care to individuals across the lifespan while acute care nurse practitioners (ACNPs) provide care in hospital and other institutional settings. What sets these two different types of practitioners apart is the level of care they offer and the complexity of the cases they’re trained to handle. FNP vs. ACNP is a choice most aspiring nurse practitioners consider when they are trying to decide upon a specialty. Keep reading to find out more about the 15 key differences between FNP and ACNP.

What Does An FNP Do?

The American Association of Nurse Practitioners (AANP) is the professional organization that represents all NP specialties. The AANP defines FNPs as advanced practice RNs who provide a broad range of family-focused services to infants, children, adolescents, adults and senior citizens. The FNP scope of practice involves physical exams, diagnosis and treatment, including the prescription of medications. Within this broad scope of practice, family nurse practitioners can choose to specialize by obtaining certifications in the more in-depth treatment of diabetes, obesity, pain management or other health-related areas.

Preventative care is one of the most important services that FNPs provide. By educating patients on healthy lifestyle choices and counseling patients to follow treatment recommendations, family nurse practitioners help reduce the number of repeat ER visits and hospitalizations per patient, which helps reduce the overall costs associated with providing medical care.

As of April 2021, more than 200,000 advanced practice RNs were certified to work as family nurse practitioners.

What Does An ACNP Do?

The essential difference between FNP and ACNP is that ACNPs are less occupied with the management of ongoing health conditions than they are with the treatment of medical issues that evince suddenly and progress quickly to become potentially life-threatening. They provide this type of specialized care in hospital emergency rooms and intensive care units as well other settings where critically ill patients are treated.

In 2014, the American Nurses Credentialing Center (ANCC) retired the Acute Care Nurse Practitioner certification exam. If you’re an advanced practice nurse who’s interested in providing acute care, FNP vs. ACNP is now only one of your concerns. You must now choose as well between two specialties with a specific population focus. Adult-gerontology acute care nurse practitioners (AG-ACNPs) work with adults and senior citizens while pediatric acute care nurse practitioners (PACNPs) work with children and adults affected by health issues like cystic fibrosis that are generally associated with pediatric populations. NPs who are already certified as acute care nurse practitioners, however, can continue to renew their certifications.

Another one of the differences between FNP and ACNP is that there are far fewer acute care nurse practitioners than there are family nurse practitioners. As of April 2021, just under 12,000 advanced practice RNs were certified as general acute care nurse practitioners. Another 8,400 were certified as adult-gerontology acute care nurse practitioners, and slightly more than 2,000 were certified as pediatric acute care nurse practitioners.

Where Does An FNP Work?

You’ll find FNPs working in any health care setting where primary care is delivered. These settings include:

• Their own private practices:

Twenty-eight states and the District of Columbia have provisions for granting FNPs full practice authority.

• Physicians’ offices:

FNPs work closely with doctors, administering tests, diagnosing ailments and developing treatment plans.

• Community clinics:

In community clinics, FNPs often work with patients who face barriers to care in other healthcare settings, such as language difficulties, insurance issues or prohibitive costs.

• Hospitals:

FNPs can be found in hospital emergency rooms where they perform initial assessments, order diagnostic tests and prescribe treatments for patients whose health issues are not acute.

Where Does An ACNP Work?

One of the most important differences between FNP and ACNP is the work environment. ACNPs work in every setting where patients come to be treated for severe injuries, or for illnesses with severe symptoms and a rapid onset. These include:

• Emergency rooms:

In emergency rooms, adult-gerontology and pediatric acute care nurse practitioners coordinate triage efforts, provide medical services and oversee patient admissions to hospital units.

• Critical care units:

In intensive care units, pediatric intensive care units and critical cardiac care units, adult-gerontology and pediatric acute care nurse practitioners diagnose and manage illnesses and exacerbations of chronic conditions. They may perform procedures like intubation and the insertion of central lines, particularly if they are working in non-teaching hospitals that don’t have medical interns and residents.

Operating rooms:

Depending on the licensing regulations in the states where they work, acute care nurse practitioners may assume responsibility for preoperative and postoperative care until a patient is discharged to a non-surgical inpatient unit.

What Is The Salary Of An FNP?

Family nurse practitioner salaries vary according to the geographic location where the FNP works, but their average salary is just over $96,000 a year, which comes to $46.20 per hour or $8,000 a month. California, New York, New Jersey, Massachusetts and Alaska are the states where FNPs command the highest salaries.

Per Hour $46.20
Per Month $8,010
Per Year $96,092
(Source: Payscale.Com)

What Is The Salary Of An ACNP?

Although wages are one of the differences between FNP and ACNP, the average salary differential between family nurse practitioners and acute care nurse practitioners is not that large. On average, ACNPs only make 7 percent more than FNPs: their average yearly salary is $103,010, which amounts to around $50 an hour and $8,580 per month. Additionally, family nurse practitioners in states like California and New York may earn more money than acute care practitioners in Alabama and other parts of the south. Salary, then, should not be given a lot of consideration when you’re considering the advantages of FNP vs. ACNP.

Per Hour $49.52
Per Month $8,580
Per Year $103,010
(Source: Payscale.Com)

What Education, Certification & Licensure is Required To Become An FNP?

Family nurse practitioners are registered nurses who have either earned a Master of Science in Nursing (MSN) degree or a Doctor of Nursing Practice (DNP) degree. In 2018, the National Organization of Nurse Practitioner Faculties (NONPF) announced that all entry-level nurse practitioner programs would have to shift their focus from the MSN degree to the DNP degree by the year 2025; however, FNPs who are practicing with MSN degrees will be grandfathered in.

After they’ve completed their academic education, prospective FNPs must pass a certifying exam administered either by the ANCC or by the American Academy of Nurse Practitioners (AANP).

NPs who want to acquire FNP certification but who earned their academic degree in another NP specialty also have the option of earning a post-master’s certificate with an FNP population focus.

What Education, Certification & Licensure is Required To Become An ACNP?

One big difference between FNP and ACNP is that acute care nurse practice is no longer an advanced practice nursing specialty; it has been replaced by adult-gerontology acute care nurse practice and pediatric acute care nurse practice. Like FNPs, AG-ACNPs and PACNPs must either complete an MSN or a DNP degree, or earn a post-master’s certificate in their chosen specialty. Entry-level requirements for these specialties are also set to switch from MSNs to DNPs by the year 2025.

In order to be certified, AG-ACNPs must pass an exam administered either by the ANCC or by the American Association of Critical Care Nurses (AACN) while the PACNP test is administered by the Pediatric Nursing Certification Board (PNCP).

How Many Years Does It Take To Become an FNP?

It takes between six and eight years to become a family nurse practitioner. Completion of a registered nurse program is the essential first step, and that will take two years if your training consists of an associate degree or a hospital diploma, or four years if you pursue a Bachelor of Nursing Science (BSN).

Thereafter, you will have to complete an MSN (two to three years) or a DNP (one to two years for students who’ve already completed an MSN; two to four years for students who have not.) Keep in mind that many graduate nursing programs require applicants to have at least one year of professional experience before they can be considered for admission.

How Many Years Does It Take To Become an ACNP?

AG-ACNP and PACNP graduate programs typically take a few months longer than FNP programs to complete. Other than that, if you’re looking at the length of time it takes to become an FNP vs. ACNP, the timelines are similar.


(Following are the 15 key differences between FNP and ACNP.)

1. Scope of practice: FNP vs. ACNP

The APRN Consensus Model defines the differing scopes of practice for FNPs, AG-ACNPs and PACNPs. AG-ACNPs and PACNPs both care for critically ill patients with complex and often unstable conditions. FNPs, on the other hand, care for patients who have health issues but who are essentially stable from a medical point of view. This is the key difference between FNP and ACNP.

2. Population focus

AG-ACNPs work with adults and senior citizens who are critically ill, while PACNPs work with critically ill infants and children younger than 18. FNPs work with patients of all ages from newborns to the elderly.

3. Professional responsibilities: FNP vs. ACNP

Another area where there are differences between FNP and ACNP is professional responsibilities. Family nurse practitioners’ professional responsibilities entail the provision of primary care. In addition to the treatment of non-life-threatening health conditions, their area of proficiency lies in the realm of preventative care, which includes education and working with patients to become more compliant with treatment regimens.

Acute care nurse practitioners work with patients affected by complex diseases that have the potential to become life-threatening. In addition to diagnosing patients and developing treatment plans, ACNPs are trained in complex procedures such as intubation and central line insertion that may be necessary to stabilize their patients.

4. Work settings: FNP vs. ACNP

Acute care practitioners typically work in specialized hospital units such as intensive care units, pediatric intensive care units, pediatric intensive care units, trauma units, emergency rooms and specialty wards inside hospitals such as neurological and pulmonary units. Their skills are also utilized in subacute settings such as cardiac step-down units and rehabilitation facilities.

Family nurse practitioners work in facilities that deliver primary care. These include their own private practices (in states where practice regulations allow this), physicians’ offices, community health clinics, hospital wellness clinics and other ambulatory settings. Frequently, they also lend their expertise as consultants to health maintenance organizations and other managed care systems, healthcare-related businesses and governmental agencies.

5. Salary: FNP vs. ACNP

As discussed above, ACNPs tend to earn slightly higher salaries than FNPs although this can vary a great deal according to the city and state where the NP is working. On average, FNPs earn $96,092 annually while ACNPs earn $103,010. The salary variance is probably due to the fact that ACNPs most often work in hospital and medical center settings where salaries are typically higher.

6. Working hours

As noted, AG-ACNPs and PACNPs most often work in hospitals and medical facilities, which are open 24 hours a day, seven days a week. That means practitioners of these two acute care nursing specialties may be called upon to work swing shifts (3 p.m. – 11 p.m.), night shifts (11 p.m. – 7 a.m.) and every other weekend. They may also be drafted to work holidays.

In contrast, the workplaces where FNPs are found are more likely to adhere to traditional 9-to-5 business hours.

7. Education

FNPs, AG-ACNPs and PACNPs must all complete either an MSN, a DNP or a certificate in their chosen field of specialization in order to be eligible to sit for their respective certification examinations. While the curricula they study will have some overlaps, prospective acute care NPs will delve more deeply into advanced pathophysiology and collaborative management while their clinical preceptorships will take place in the types of acute care settings they will one day work in. In contrast, aspiring FNPs are more likely to do their clinical rotations at community agencies and ambulatory care settings.

8. Number of schools offering specialty

Almost twice as many schools in the U.S. offer accredited FNP programs as offer accredited AGNP programs. You can pursue an FNP degree at more than 400 institutions, but just 223 schools offer AG-ACNP prep.

9. Qualifications

FNPs, AG-ACNPs and PACNPs are all registered nurses who’ve completed either an MSN, a DNP or a certificate in their chosen field of specialization. They take different certification examinations, however. FNPs sit for tests administered either by the ANCC or by the AANP while AG-ACNP exams are given either by the ANCC or by the AACN. PACNPs take a certification exam overseen by the PNCB.

10. Employment outlook

The relative ease of finding future employment is one of the factors aspiring nurse practitioners weigh seriously when they’re considering the FNP vs. ACNP question. Family nurse practitioners have far more employment opportunities than acute care nurse practitioners. A great deal of this is due to the fact that there is a tremendous shortage of primary care providers in the U.S. A 2020 report published by the Association of American Medical Colleges projected that the shortage of primary care physicians in this country will grow to 55,000 by the year 2033. Family nurse practitioners can function as excellent, lower-cost substitutes for primary care physicians, particularly in states where they’re permitted to practice without physician oversight.

In contrast, most acute care nurse practitioners are employed in hospital settings, and the 26 percent of American hospitals that are teaching hospitals are unlikely to have a high demand for their services since medical interns and residents carry out many of the functions assigned to AG-ACNPs and PACNPs in non-teaching hospitals.

11. Versatility

AG-ACNPs and PACNPs are more versatile than FNPs because their education qualifies them to work in primary care as well as in acute care. Acute care protocols and procedures, however, are not part of the family nurse practitioner educational curriculum.

12. Recertification: FNP vs. ACNP

All nurse practitioners must recertify their practice credentials every five years either by meeting clinical practice and continuing education requirements or by retaking a certification exam. Since the generic acute care nurse practice specialty was abolished in 2014, ACNPs no longer have the option of taking a qualifying certification exam. They can recertify, however, by proving they’ve performed a minimum of 1,000 hours of clinical practice within their specialty.

13. Percentage of nurses in specialization

Family nurse practitioners comprise the largest faction of all nurse practitioners by far. Nearly 70 percent of all NPs are FNPs, and another 19.2 percent are certified in other NP specialties that involve the provision of primary care.

In contrast, only 7.7 percent of all NPs are involved in the provision of acute care. This includes AG-ACNPs (2.9 percent), PACNP (0.7 percent) and acute care generalists (4.1 percent.)

14. Professional organizations

Organizations that advocate and provide access to professional development as well as networking opportunities for family nurse practitioners include the American Nurses Association (ANA), the American Association for Nurse Practitioners, Doctors of Nursing Practice (DNP) and the digital resource American Family Nurse Practitioner (AFNP).

AG-ACNPs and PACNPs also participate in the ANA, the AANP and DNP. Other organizations that may be of professional interest to AG-ACNPs include the American Geriatrics Society (AGS), and the Gerontological Advanced Practice Nurses Association (GAPNA). The interests of pediatric acute care nurse may be served by the National Association of Pediatric Nurse Practitioners (NAPNAP), the Society of Pediatric Cardiovascular Nurses (SPCN) and the Association of Pediatric Hematology/Oncology Nurses (APHON).

15. Marketability

Because they serve a far more diverse population than either AG-ACNPs or PACNPs do, FNPs must be considered more marketable. FNPs have more flexibility in their scope of practice, and that frequently means that outside of a critical care setting, they’re often more attractive to prospective employers. For many aspiring nurse practitioners weighing the FNP vs. ACNP question, this is the deciding factor.

AG-ACNPs are hampered by the fact that they have no training in treating children. While children may not make up a large part of the patient load in a hospital emergency department or an urgent care clinic, such places do treat children upon occasion, and the optimal employee will have pediatric care among his or her skill sets. Similarly, when seeking employment outside a pediatric intensive care unit, PACNPs are hampered by their inability to treat adults.

Conclusion - FNP VS. ACNP: Which One Should You Choose?

As these 15 key differences between FNP and ACNP point out, if the job market is your main consideration in choosing a nurse practitioner specialty, then pursuing a family nurse practitioner degree may have advantages over pursuing a degree related to the provision of acute care. True, FNPs earn slightly lower salaries than AG-ACNPs and PACNPs, but considerably more employment opportunities are open to them at this time. Of course, that is likely to change as aging Baby Boomers come to require more and more geriatric healthcare services.

Family nurse practice is also a broad practice area. If your professional interests narrow or change over time, you may find it easier to accommodate a new practice specialty if your initial nurse practitioner training was as an FNP.

In the final analysis, however, if working in the fast-paced acute care environment is something that excites you, then pursuing one of the ACNP options is the way to go. The right choice when considering FNP vs. ACNP is to pursue the specialty that most interests you.

Pattie Trumble, MPP, MPH
Pattie Trumble is a nurse who worked in both California and New York for many years as an emergency room nurse. She holds a Bachelor’s Degree in Economics from the University of California, Berkeley, and an Associate Degree in Nursing from the Samuel Merritt Hospital School of Nursing. After 10 years of providing direct care, she went back to school and earned concurrent Master’s degrees in both public policy and public health from the University of California, Berkeley. Thereafter, she worked for various public health agencies in California at both the community and state levels providing economic and legislative analysis.