Credentialing & Privileging

Nurse Practitioners: Specialties and Scope of Practice

By Judi Kuric, DNP, ACNP-BC, FNP-BC, ENP-C

Nurse practitioners (NPs) play a vital role in modern healthcare, providing specialized care across diverse patient populations. Their education, certification, and scope of practice are guided by the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education (LACE), established in 2008. This model ensures consistency in the education and regulation of Advanced Practice Registered Nurses (APRNs), defining their roles, specialties, and population foci to maintain high standards of patient care.

Education and Certification Requirements

To become an NP, individuals must obtain a graduate degree (MSN or DNP) in advanced nursing practice. The LACE model requires that APRNs practice within the scope defined by their specific role, population focus, and educational background.

It is important for medical services professionals (MSPs) who manage NP credentialing to review and understand the education, scope, and specialty of each NP applicant to ensure that NPs become privileged to provide care in the appropriate setting, facilitating high-quality patient care. There are six APRN specialty areas. This article will discuss five nurse practitioner specialty areas.

Adult-Gerontology Acute Care Nurse Practitioner (AGACNP)

The Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) specializes in managing acute and complex conditions in patients aged 13 years and older. Their primary focus is on high-acuity and critical care patients, requiring rapid assessment and intervention.

AGACNPs work primarily in hospital-based or specialty settings, including intensive care units (ICUs), step-down units, emergency departments, and specialty practices (e.g., cardiology, neurology, pulmonology, surgery).  

The curriculum for AGACNP includes care of medically complex patients with acute life-threatening conditions. Interventions such as mechanical ventilation, multidrug infusions, blood transfusions along with procedures such as intubation, central line placement, and chest tube placement are part of the curriculum for AGACNPs. Almost all the clinical experiences in AGACNP programs are completed in inpatient, high-acuity settings.

Family Nurse Practitioner (FNP)

The Family Nurse Practitioner (FNP) is a versatile healthcare provider educated to care for patients across the lifespan, from infancy to older adulthood. Their focus is on primary care, making them essential providers in family medicine, outpatient clinics, and some urgent care settings.

FNPs primarily work in ambulatory and primary care settings, including family practice clinics, community health centers, urgent care centers, retail health clinics, schools and college health clinics. FNP education covers a broad spectrum of low-acuity acute, chronic, and complex health conditions.

The curriculum includes health promotion and disease prevention, management of chronic diseases, acute care management (minor injuries, minor illness), and coordinating care for patients with complex health issues. Almost all the clinical experiences in FNP programs are completed in outpatient settings.

Role Confusion: AGACNP vs. FNP

The difference between low-acuity acute illness and high-acuity acute illness lies in the severity, complexity, and urgency of medical intervention required.

• Acute Illness Management: While FNPs manage many acute conditions, they are not trained for high-acuity inpatient care like acute care NPs.
• Low-acuity acute illnesses are mild to moderate conditions that do not require immediate or intensive medical interventions. They can usually be managed in primary care, urgent care, or outpatient settings. Examples include flu, ear infection, strep throat, and minor sprains and strains.
• High-acuity illnesses are severe, complex, and potentially life threatening. They often necessitate treatment in emergency departments, intensive care units, or specialized inpatient settings. Examples include heart attack, stroke, sepsis, respiratory failure, and major trauma.

Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP)

The Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP) specializes in the care of patients 13 years of age and older. Unlike FNPs, AGPCNPs do not provide pediatric care, focusing instead on adult and older adult populations.

AGPCNPs work in ambulatory and community-based settings, including primary care and internal medicine clinics, specialty outpatient clinics, and long-term care facilities. They may also work in assisted living centers, occupational health and wellness programs, and some urgent care centers. AGPCNP education covers a broad spectrum of low-acuity acute, chronic, and complex health conditions.

The curriculum includes health promotion and disease prevention, management of chronic diseases, acute care management (minor injuries, minor illness), and geriatric-focused care.

Pediatric Nurse Practitioner (PNP)

The Pediatric Nurse Practitioners (PNP) specializes in caring for infants, children, adolescents, and young adults (ages 0-21). There are two separate education programs for PNPs — primary care and acute care. These specialties are similar to the difference in education and population foci of the AGACNP vs. the FNP.

PNP Primary Care (PNP-PC) providers are educated in outpatient and community settings and focus on preventative care, health promotion, and the management of common pediatric illnesses. PNP-PCs work in ambulatory and primary care settings, including pediatric primary care clinics, school-based health centers, public health clinics, and specialty outpatient clinics (e.g., asthma, endocrinology, cardiology). 

PNP-PCs are trained in comprehensive pediatric care, including health promotion, disease prevention, management of low-acuity acute pediatric illnesses, chronic disease management, and coordinator complex pediatric care.

PNP Acute Care (PNP-AC) providers primarily work in hospital-based and acute care settings, including pediatric intensive care units, neonatal intensive care units, pediatric emergency departments, or specialty inpatient units (cardiology, oncology, neurology, surgery, etc.).

PNP-AC education includes advanced medical interventions for critically ill children, covering complex patients with life-threatening conditions. Interventions such as airway management, mechanical ventilation, multidrug infusions, sedation, and blood transfusions along with procedures such as intubation, central line placement, and chest tube placement, are part of the curriculum for PNP-AC.

PNP vs. FNP: Key Differences

While PNPs specialize exclusively in pediatric patients, FNPs are trained to care for patients across the lifespan, including children and adults. However, PNPs receive more in-depth, pediatric-specific training, especially for managing complex and high-risk pediatric conditions.

Psychiatric-Mental Health Nurse Practitioner (PMHNP)

The Psychiatric-Mental Health Nurse Practitioner (PMHNP) specializes in the diagnosis, treatment, and management of mental health disorders across the lifespan. PMHNPs provide comprehensive psychiatric care, including medication management, psychotherapy, and crisis intervention.

PMHNPs work in various mental health settings, including inpatient psychiatric units, outpatient clinics, community mental health programs, group therapy and counseling centers, and substance abuse treatment centers. 

PMHNPs are trained in comprehensive psychiatric care, focusing on psychiatric assessment and diagnosis, severe mental illness management, pharmacologic management, psychotherapy techniques, substance use disorders, and crisis intervention.

Emergency Nurse Practitioner (ENP)

The Emergency Nurse Practitioner (ENP) is a specialized NP who provides acute and emergent care for patients of all ages in emergency and urgent care settings. Before pursuing the ENP credential, candidates must first be certified as a Family Nurse Practitioner (FNP). This requirement ensures that ENPs are educated to manage patients across the lifespan.

ENPs work in fast-paced, high-acuity environments, including emergency departments, urgent care clinics, walk-in clinics, and occupational health settings. ENPs are educated to assess, diagnose, and treat a full range of emergent conditions. Their education includes rapid assessment and intervention, trauma and injury management, cardiac and respiratory emergencies, and emergency procedures such as airway management, wound management, and orthopedic procedures.

Conclusion

Nurse practitioners are essential to healthcare, increasing access to quality patient care. The Consensus Model for APRN Regulation provides a standardized framework for licensure, education, and practice, ensuring that NPs deliver safe and effective care. As the healthcare landscape evolves, the role of NPs will continue to expand, enhancing accessibility and quality of care for diverse populations.