What Is an Acute Care Nurse Practitioner (ACNP)?

An acute care nurse practitioner (ACNP) is an advanced practice nurse (APRN) trained to provide care to high-acuity patients, typically those receiving hospital-based care in intensive care units (ICUs), step-down units, emergency rooms (ERs), or other high-intensity settings. 

The average annual salary for ACNPs across the United States is about $118,000, though this can vary depending on location and facility. While there is no official count for how many ACNPs there are in the U.S., the American Association of Nurse Practitioners (AANP) reports that there are more than 325,000 nurse practitioners nationwide, with ACNPs representing one of several specialties in this group. 

ACNP vs NP

A nurse practitioner (NP) is an APRN with advanced training and education who can assess, diagnose, and treat patients either independently or under the supervision of a doctor. There is a range of specialities under the umbrella of NP, one of which is ACNP. Some other specialties can focus on specific patient populations, such as family medicine, pediatrics, and adult-gerontology, as well as specific areas, such as women’s health or psychiatric mental health.

An ACNP is an NP with specialized training focused on acute and critical care, as opposed to primary care. ACNPs generally care for patients in high-acuity settings, like an ICU or ER, while a primary care NP is more likely to work in a clinic or doctor’s office.

What Does an ACNP Do?

Like all NPs, ACNPs assess patients, order and interpret diagnostic tests and lab work, develop treatment plans, and generally manage patient care. As mentioned, the primary difference between an ACNP and other specialties is that ACNPs care for patients in high-acuity environments. Their responsibilities may include managing complex medications, life support systems, and ventilators, and ensuring continuity of care as patients are transferred to lower-acuity floors, such as step-downs or general medicine floors.

ACNP Responsibilities

ACNPs perform a broad range of tasks. While these can vary depending on where they work, responsibilities can include:

• Managing and assessing critically ill patients
• Ordering and interpreting diagnostic tests, including bloodwork and imaging, and adapting care accordingly
• Prescribing medication
• Managing intensive treatment plans, which could involve titrating medications, managing ventilator settings, and monitoring electrolyte levels
• Being a part of the rapid response or code teams and participating in emergency life-saving procedures
• Managing and directing other staff, including RNs

Scope of Practice

As with all NPs, an ACNP’s scope of practice varies by state. Some states grant NPs full-practice authority, meaning they can practice independently without the supervision of a doctor. In contrast, other states limit their scope of practice in various ways, such as requiring collaborative agreements or physician oversight. That said, because ACNPs work in high-acuity settings, each facility may have its own rules regarding the level of autonomy and the procedures they can perform.

Where Do Acute Care Nurse Practitioners Work?

ACNPs primarily work in high-acuity settings that require advanced assessment and overall skills. Typical workplaces include hospitals’ ICUs, step-down units, telemetry units, and emergency departments or specialty clinics that monitor patients with complicated but stable health conditions.

ACNP Salary & Career Outlook

The average annual salary for ACNPs across the United States is about $118,000, though this can vary depending on location and facility.

Broadly, the career outlook for NPs is strong, with job growth expected to increase by 35% between 2024 and 2034, a rate much faster than the average.

How to Become an Acute Care Nurse Practitioner

Becoming an ACNP requires several steps, including becoming an RN and completing advanced education, which requires hundreds of hours of hands-on clinical experience. After completing an ACNP program, graduates must obtain certification and state licensure to practice.

Become an RN

There are multiple ways to become an RN. For nurses who wish to pursue an advanced education, a BSN program can be a good choice because it provides the necessary foundation for master’s or doctoral-level programs. That said, associate- or diploma-prepared nurses have options as well, such as second-degree or RN-to-MSN programs.

Obtain nursing experience

Every ACNP program is different, but it may require one to two years of prior nursing experience in a high-acuity setting, such as an ICU, step-down, or ER. This type of experience can be integral in preparing ACNPs for their professional responsibilities. 

Complete an ACNP program.

Choose an MSN or DNP program with a focus on acute care. These programs can include courses in critical care management, advanced pharmacology, and diagnostics, and typically include hands-on clinical experiences in high-acuity settings. 

Pass the certification exam and secure state licensure

After completing an ACNP program, candidates must pass the certification exam. There are two options, one offered by the American Nurses Credentialing Center (ANCC) and one from the American Association of Critical-Care Nurses (AACN). After getting certified, candidates can apply for state licensure. The specific requirements vary from state to state.

FAQs about ACNPs