Decoding Nurse Practitioner Specialty Grey Areas

How do you choose the right specialty?

Even if you’re confident in the setting in which you plan to work, choosing a nurse practitioner specialty is a major gray area. There’s significant overlap between broader NP specialties, which can be confusing for students planning to further their nursing education. If you want to work as a hospitalist nurse practitioner, for example, should you choose the family, acute care, or adult NP specialty? If your dream is to work in the emergency department, is family or acute care the right path towards achieving your dreams?

In most cases, if it seems your career aspirations fall into a nurse practitioner specialty gray area, there is not one ‘right’ answer when it comes to specialty selection. If you’re having difficulty in the nurse practitioner specialty selection process, here’s a little insight into specialties that commonly cause confusion for NPs to-be. 

Family Nurse Practitioner

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Typically, the family nurse practitioner (FNP) specialty is reserved for nurse practitioners looking to work in the outpatient, primary care setting. Think community health clinics, family practice clinics, and internal medicine practices. FNPs are certified to care for patients of all ages, from newborns to elderly individuals. Family nurse practitioners are essentially Jacks (and Jill’s) of all trades. From managing chronic disease to treating patients with acute illness, and promoting healthy lifestyles, FNPs know a little bit about everything. When patients with complex medical processes present, family nurse practitioners may refer the patient to a healthcare provider more with more specialized knowledge in a specific area. 

While FNPs traditionally work in primary care, they are used in a variety of settings. The broad clinical background family nurse practitioners receive, as well as the ability to treat patients of all ages, allows FNPs to work in the hospital setting in places like the emergency department, as part of hospitalist groups, and in specialty inpatient and outpatient practices, as well as long-term care settings. Becoming a family nurse practitioner does not exclude one from working in the inpatient hospital or specialty setting. And, it doesn’t necessarily mean that the nurse practitioner must work with children. 

Adult-Gerontology Nurse Practitioner

Adult gerontology nurse practitioners (AGNP) are more limited than their family nurse practitioner counterparts. AGNP certification does not allow these nurse practitioners to treat children. So, in most cases, they cannot work in settings like the emergency department or urgent care clinics. Traditionally, adult-gerontology nurse practitioners work in settings like internal medicine practices, long-term care facilities, and specialty practices. Another popular employment option for adult nurse practitioners is to work doing home visits for Medicare patients, often patients recently released from the hospital. Most AGNPs work in the outpatient setting, although they may work in the inpatient hospital setting as well. 

Some nurse practitioners get themselves into trouble by choosing the adult-gerontology education route. If you would like to work in the primary care, urgent care, or emergency setting, restrictions on the age of patients you may treat limit employment options. Keep in mind that just because you can see pediatric patients as an FNP doesn’t mean you must. Family nurse practitioners may work in all of the same areas as AGNPs and more. Think twice before limiting yourself with the AGNP specialty

Acute Care Nurse Practitioner

Acute care nurse practitioners work primarily in the inpatient hospital setting. ACNPs may work in the ICU, trauma, critical care unit, surgical specialties, internal medicine specialties such as cardiology, and more. Some ACNPs do work in the outpatient specialty setting, or may work partially in the hospital and partially in the clinic as a result of varied job responsibilities. Unless specializing in pediatric acute care, in most cases, ACNPs cannot treat children under the age of 13. This means that acute care nurse practitioners have limited utility in the emergency department, for example, as providers working in this area of the hospital must be able to treat patients of all ages. Many aspiring NPs go astray here as they assume that acute care is the optimal specialty for a career as an emergency NP. If your heart is set on working in the inpatient setting with critically ill patients, then selecting the acute care nurse practitioner specialty is for you. 

If you still can’t decide which specialty to choose, ask others around you. Job shadow nurse practitioners employed in the setting where you see yourself working. What specialty would these NP suggest you pursue? Consider other practical factors such as ease of movement within your nurse practitioner career. If you aren’t quite sure where your passion lies, then choosing a broader specialty, like family, might be the best option for you. 

The good news is, that it is relatively easy to obtain an additional nurse practitioner specialty degree later in your career should you choose. It’s always best to make the right choice the first time, but don’t put too much pressure on yourself. Nurse practitioner specialties are pretty broad overall, and will afford you a number of options regardless of your selection. 

Which nurse practitioner specialty will you choose?


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7 thoughts on “Decoding Nurse Practitioner Specialty Grey Areas”

  1. I disagree with your statements indicating that FNPs (primary care) can work in emergency rooms & inpatient settings. While some do, they are limited by scope of practice to diagnosis & treatment of common acute/chronic conditions commonly seen in primary care practice across the lifespan. Additionally, malpractice insurance covers for your specialty area only – ie. what you were educated to do, certified in and licensed to do. There are may liability risks for primary care FNPs practicing in settings other than primary care.

  2. Informative but a little condescending, “think twice before limiting yourself with AGNP speciality”. I think most of us who are starting off our MSN program and chose AGNP, have put thought into the decision, and I’m sure most of us do not feel we have in any way limited ourselves. Personally, I have no desire to work with kids and love working with the adult population, especially geriatrics. I think in the future, leaving personal bias behind while writing an article, would be a good idea. Thanks for the information! Love the site!

  3. Michelle Langston

    I am currently in a family nurse practitioner program. I really wanted to work with geriatrics as I have spent much of my career in long term care. However, after consulting with two geriatric specialists, they advised me not to limit my specialty. The rural area where I live would be best served by a generalist. I was advised to do FNP first for the broader education and not limit employment opportunities.

  4. FNPs who work in the ER are most certainly working outside of their scope – in your line of words, I would say think twice before you work in the ER with an FNP degree. It is not the age groups that matter here but the practice setting and the type of training the FNPs received, which has nothing to do with acute care. AGNPs are typically choosing their specialty not because they are not aware of the age groups they can treat but because they don’t want to deal with kids plus they get more training in treating chronic conditions compared to FNPs. It is almost like saying think twice before you become internal medicine physician vs. family physician – apples and oranges.

  5. I have a FNP and many years of working both ER and Family Practise. I have not practiced outside my scope of practise for the past 7 years. I have worked 27 years prior as a ER nurse. The knowledge of both practises have helped me provide for my patients in either settings.

  6. This article is very biased towards FNPs. As an Adult Gerontology Primary Care Nurse Practitioner, I have been employed in 2 family practice clinics as well as a GI clinic. I am currently employed as an Inpatient Hospitalist. In the Primary Care setting I treated patients ages 13 and up. Please look at the ANCC standards to see the limitations of this certification. I also did Nursing Home rounds and cared for the Geriatric population, which is one of my favorite populations of people to work with. My Hospitalist group doesn’t admit patients under the age of 18 or Care for them.

  7. This article is slightly biased, but obviously well intentioned. I am currently working on my master’s with an FNP specialty, and my professors constantly remind us that if we want to work in a hospital, we should not choose the FNP specialty. It is simply outside our scope of practice. Yes, FNP’s are trained to treat patients from the cradle to the grave, but not in an acute care setting. I think it is more important to protect your license by not practicing outside your scope. A Family Medicine physician would not work as an Emergency Department physician without completing a second residency.

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