Nurse Keith: Acute Care or Primary Care? APRNs Have Choices

Nurse Keith: Acute Care or Primary Care? APRNs Have Choices

When seeking nursing education and credentialing as an Advanced Practice Registered Nurse (APRN), nurses have a plethora of choices in the 21st century. Nurse practitioners can focus on families, adults, or children, as well as areas of specialized practice such as anesthesia. The opportunities for APRNs are burgeoning; savvy nurses see the writing on the wall that the day of the APRN is here.

Those nurses on the APRN journey face the important career decision of whether to hang their hat in primary/ambulatory care or the acute inpatient setting. Working in a family practice setting as a Family Nurse Practitioner (FNP) is worlds apart from inpatient advanced practice as an Acute Care Nurse Practitioner (ACNP); nurses committing to their education and career must do their due diligence before seeking to advance their nursing education and credentialing.

Outpatient and primary care

Outpatient care and primary care can look very different for NPs who choose from the many avenues available to APRNs outside of the acute hospital setting.

Some nurse practitioners join medical groups of varying sizes, working closely with physicians in specialty practices (e.g.: orthopedics or gastroenterology). Meanwhile, if an NP lives in one of the growing number of states allowing full autonomy for APRNs, he or she may choose to open a private primary care office or another form of solo independent entrepreneurial nursing practice; he or she may also partner with other APRNs or physicians in offering primary care to particular patient populations.

Enterprising nurse practitioners with great interest in geriatric health may choose to create concierge practices geared towards the elderly; this may involve house calls, office hours, or any number of practice configurations.

The outpatient world is ripe for the picking for nurses who wish to pursue APRN status and the ability to serve patients outside of acute care.

Acute care opportunities

In acute care, advanced nursing practice is also growing in depth and breadth. The Acute Care Nurse Practitioner or Clinical Nurse Specialist may focus on critical care in the ICU or other critical setting, whereas some ACNPs may provide care in more general acute care roles, such as that of the Adult-Geriatric ACNP who serves a broad array of hospitalized patients in a multidisciplinary setting.

Although there is anecdotal evidence that certain physicians and medical groups are resistant to APRNs making inroads within acute care, the utilization of advanced practice nurses in hospital settings is likely to grow significantly.

Acute care practice is not for everyone, but for those APRNs who enjoy the pace and nature of the hospital setting, this is a viable choice.

Personal preferences count

Nurses who are uncertain whether to choose inpatient or outpatient APRN education and certification should look closely at their own preferences and disposition. A nurse practitioner who dislikes collaborating with physicians and prefers treating chronic illness would be intelligent to choose a path through which she or he can “hang a shingle” as an independent outpatient provider. Meanwhile, the future APRN who enjoys the camaraderie of multidisciplinary practice and the challenge of treating acutely ill patients would likely do well as an Acute Care Nurse Practitioner.

Consider environment, practice style, the pace of work, opportunities for multidisciplinary practice, level of autonomy, and other factors when choosing between acute care and outpatient practice as an APRN. The nurse must choose an advanced practice path that feels right, that honors his or her aspirations, and that allows for an advanced nursing practice that is gratifying and fulfilling.

Keith Carlson, RN, BSN, NC-BC is a holistic career coach for nurses, award-winning nurse blogger, writer, podcaster, speaker, author, and popular career columnist for With two decades of nursing experience, Keith deeply understands the issues faced by 21st-century nurses. Keith’s two podcasts, RNFM Radio and The Nurse Keith Show, offer inspiration and practical support to nurses seeking to create meaningful, satisfying lives and careers. Keith’s message of savvy career management and professional satisfaction reaches tens of thousands of nurses worldwide. He can be found at

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