Defining the Acute Care Role for the Advanced Practice Provider
Lisa Mathis MSN-FNP-BC
Opportunities are endless in the arena of advanced care roles in 2025. You can pick from being a surgical PA, to a neonatal nurse practitioner. Options to own your own practice and working in office and hospital settings make the health care profession an exciting and rewarding endeavor. There are many similarities between the Physician Assistant and the Nurse Practitioner but requirements for certain positions do vary.
The first Family Nurse Practitioner (FNP) program was established in 1965 at the University of Colorado by Loretta Ford and Henry Silver. This program was created in response to a shortage of primary care providers and aimed to expand the role of nurses to better serve the healthcare needs of communities. (1)
The first physician assistant (PA) program in the United States was established at Duke University in 1965. Dr. Eugene A. Stead Jr. founded the program, which was designed to train former military corpsmen to extend the capabilities of physicians and address a shortage of healthcare providers. The first class of four students, all former U.S. Navy hospital corpsmen, graduated in 1967. (2)
The FNP has been split into many different areas of concentration over the past years. The American Association of Nurse Practitioners (AANP) recognizes 11 core specialties. These include : Family, Adult, Adult-Gerontology Primary Care, Psychiatric/Mental Health, Acute Care, Pediatrics-Primary Care, Adult-Gerontology Acute Care, Women's Health, Gerontology, Neonatal, and Pediatrics-Acute Care. (3)
The Physician Assistant does not break into specialty areas like the Nurse Practitioner. The education requirements for PA school includes all specialty areas, however the PA can do a residency or fellowships if they so choose.
The key difference between an Acute Care Nurse Practitioner (ACNP) and a Family Nurse Practitioner (FNP) lies in their scope of practice and patient population. ACNPs focus on providing care to patients with acute, critical, or complex illnesses, typically in inpatient settings like hospitals and emergency departments, while FNPs provide comprehensive primary care to patients of all ages, from infants to older adults, in a variety of settings including clinics and doctor's offices. (4)
This article discusses the expanding role of the Acute Care providers whether PA or ACNP.
In hospital medicine, Advanced Practice Providers (APPs) such as nurse practitioners (NPs) and physician assistants (PAs) are increasingly utilized due to factors like an aging physician workforce and increasing patient volume. These providers play a crucial role in delivering patient care, often working in tandem with physicians, to manage a wide range of medical conditions.
In the Acute care setting, ICU, CCU and ER the APP requires more extensive training in caring for the acute care patient. Specialized skills are needed when putting in lines, intubations, and administration of specialty medications. While some APPs prefer the office setting, many crave the adrenaline rush from the critical patients.
The beautiful thing about being an APP is that when burnout occurs there are always opportunities to pivot and go into a new area of medicine. Burnout in healthcare is a state of emotional, physical, and mental exhaustion caused by prolonged exposure to occupational stressors. It's a serious issue affecting healthcare professionals, impacting both their well-being and the quality of care they provide. (5) Burnout is especially high in the acute care settings. Factors contributing to this is the stress of the seriously ill patient, hours and work demand.
Even though it is a tough area to practice medicine due to the factors stated above, the rewards can be quite gratifying. The APP often excels in this role as the NP and PA are well known for being thorough and having better communication skills when compared to physician providers. Often time when attending family meetings and explaining the critical patient, the APP is the “go to” person. The attention to detail that the APP offers sets them apart from the intensivist and provides optimal patient care. In past years the nurse practitioner could work in the hospitalist program alongside the PA. However, most hospital programs have changed policies that require NPs to have their ACNP and PAs to complete an internship to make rounds in the intensive settings. To some APPs this is daunting especially if you have been a FNP for 20+ years that has no desire to go back to school for another degree. This is a very understandable emotion, however if you intend to continue in hospital medicine it may be your only option in the years to come.
While the exact number of ACNP programs fluctuates, there are hundreds of programs offered across the United States, with many available online. These programs can be found at various universities and institutions, offering both Master of Science in Nursing and Doctor of Nursing Practice degrees.
As APPs the possibilities are endless, and everyone should do what makes them happy and creates a satisfying work life. Overall, the APP is a wonderful asset in the arena of acute care medicine and should not fear taking that step.
The field of medicine is evolving rapidly so keeping current and staying up to date on changes is imperative to be the best acute care provider one can be. Unfortunately, there are not many continuing education options for this field and the acute care APP must attend events that are meant for the intensivist.
Always strive to be the best provider you can be and do not fear a challenge and facing a new area with confidence.
NPACE offers an Acute Care event in September at the beautiful Sheraton at Wild Horse Pass in Arizona. It is tailored especially for the APP in the acute care setting, to get the latest and best up to date education in caring for the acute patient.
Click here to explore this amazing event and please join APPs from all over the US! [Link]
**‘That which does not kill us makes us stronger.’ – Friedrich Nietzsche**
References:
1)https://www.aanp.org/about/founders#:~:text=At%20the%20University%20of%20Colorado,the%20nation's%20first%20NP%20program.
2)www.patientcare.va.gov/PA/Historical_Physician_Assistant.asp#:~:text=The%20PA%20profession%20came%20into,the%20VA%20are%20veterans%20themselves
3)https://onlinenursing.cn.edu/news/np-specialties-role-of-fnp
4)https://www.herzing.edu/faq/fnp-vs-acute-care-np#:~:text=acute%20care%20NP:%20what's%20the%20difference?,-Answer&text=There%20are%20two%20primary%20differences,and%20more%20severe%20health%20issues.
5)https://www.bmj.com/content/366/bmj.l4774#:~:text=Burnout%20has%20become%20a%20big,systems%20approach%20to%20the%20problem.&text=The%20link%20between%20burnout%20and,results%20i