Online Doctor of Nursing Practice (DNP) Degrees for Adult-Gerontology Nurse Practitioners in Acute and Primary Care

You’d be right in calling AGNPs the ultimate authority when it comes to providing primary and acute care to adults and senior citizens in the U.S.

That’s because whether focused on primary or acute care, AGNPs have swooped in to rescue a healthcare system that’s been overwhelmed by an aging population with complex and co-morbid conditions, at a time when we’re also seeing a growing physician shortage, particularly in notoriously underserved rural parts of the country.

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With a focus on providing healthcare to patients in a demographic that spans adolescence to old age, AGNPs fulfill an increasingly vital role in our healthcare system. This is largely thanks to their broad scope of practice and expertise in dealing with a wide range of health conditions affecting both the young and old.

These pros work collaboratively with the interdisciplinary healthcare team and assume vital roles in specialty clinics, long-term care facilities, acute care units, and more.

Adult-gerontology nurse practitioners are meeting the needs of adult patients, providing evidence-based care and optimizing patient outcomes, all while improving the quality of healthcare in America, one patient at a time.

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Acute or Primary Care? … Understanding the Difference Between the two AGNP Specialties

As a nurse practitioner in adult-gerontology you’ll specialize in either primary or acute care. (In years’ past, nurse practitioners could choose to earn more general certification in acute care. However, this certification exam was retired in 2014 and replaced with certifications that deal with specific patient populations: adult-gerontology acute care and pediatric acute care.)

Of course, there’s a lot of similarities between the acute and primary AGNP role since they serve the same patient population, but as the names imply, the difference comes in the type and level of care they provide these patients, and the settings in which they typically work:

Acute Care Adult-Gerontology Nurse Practitioners (ACAGNP)

ACAGNPs provide care for patients with chronic, complex, illnesses and critical, acute illnesses. Providing care for adult patients suffering from acute traumatic injuries and medical emergencies like stroke and heart attack, and those experiencing worsening conditions as a result of chronic diseases or illnesses is the hallmark of the ACAGNP.

For ACAGNPs, care is episodic in nature, meaning a complex, acute traumatic event or condition has prompted the patient’s need for care. Their expertise is therefore at home in tertiary care settings, such as surgical, intensive care, trauma, and acute care units, although these nursing professionals are valuable assets to long-term care facilities, nursing homes, and other skilled nursing facilities, which are home to the oldest patients who require complex, multifaceted treatment plans focused on preventing future complications.

One of the distinguishing characteristics of ACAGNPs is their expertise in both emergent and non-emergent situations, and in acute, onset physiologic instability. ACAGNPs may specialize in a specific area, such as cardiovascular, pulmonary or neurological disease or they may treat a wide array of injuries, illnesses and diseases in general medical or surgical ICU settings.

Primary Care Adult-Gerontology Nurse Practitioners (PCAGNP)

PCAGNPs, on the other hand, are focused on providing comprehensive, continuous care in a long-term patient-practitioner relationship. They specialize in health promotion and screening, along with diagnosing and treating common acute and chronic medical diseases and conditions.

PCAGNPs are the stars of the show in primary care settings, such as private practices, outpatient clinics, women’s health clinics, and specialty practices. These advanced practice nursing professionals are highly valued in rural and undeserved areas where physician-based care is either lacking or non-existent. In fact, PCAGNPs have become lifelines for large populations in sparsely population parts of the country.

Immunizations, routine checkups, assessments, and one-on-one counseling are part and parcel of their scope of duties, so on any given day you might find PCAGNPs counseling patients on healthy lifestyle and disease prevention plans…performing annual wellness checkups…overseeing a patient’s medication needs for the treatment of chronic diseases such as high blood pressure and diabetes…and performing routine women’s health services, such as pelvic exams.

The Path to Becoming an Adult-gerontology Nurse Practitioner: Your Education and Certification Options

Adult-gerontology nurse practitioners, whether focused on acute or primary care, must hold an APRN license in the state in which they live. To achieve a state license to practice as either a PCAGNP or ACAGNP, you’ll need to earn, at a minimum, an RN license and an MSN degree in your chosen APRN role and focus. You’ll also need to take a pass the appropriate APRN exam through a nationally recognized certification board.

Although the MSN remains the minimum educational requirement to practice as an adult-gerontology nurse practitioner, many nurses have found value in earning the DNP – the highest practice-based nursing degree. Greater earning potential, increased professional opportunities, and greater respect among other doctorate-prepared colleagues in the interdisciplinary healthcare team are just a few of the reasons the DNP has become the degree of choice for adult-gerontology nurse practitioners. And for currently practicing APRNs, the DNP is the ideal path to an additional certification as a WHNP.

There are a variety of DNP programs available today, with programs designed specifically for post-BSN students, post-MSN students, and even for career changers who have previously completed a bachelor’s degree in a non-nursing field.

BSN-DNP programs consist of about 73 credits and three years of full-time study, while MSN-DNP programs consisting of about 36 credits and two years of full-time study and may be designed for both APRNs and non-APRNs alike. Direct-entry DNP programs—those programs designed for students who have completed a bachelor’s degree in a non-nursing major—consist of between 65-80 credits, four and a half years of study, and all components necessary to earn the MSN, an RN license, and a DNP.

The DNP includes:

  • Coursework covering the AACN’s 8 DNP Essentials
  • Courses covering the chosen APRN role and focus that prepare you to take the required national certification examination. Examples of these specialty courses include:
    • ACAGNP
      • Pharmacotherapeutics Acute Care
      • Management: Adult/Gerontology
      • Management: Adult/Gerontology Acute & Critical Illness
      • Quality & Safety for the Aging Adult
    • PCAGNP
      • Women’s Healthcare
      • Management of Adults
      • Diagnostic Management and Decision Making
      • Pharmacotherapeutics for Older Adults
      • Common Adolescent Health Problems
    • About 500 clinical hours (achieved through clinical immersion experiences and formal internships)
    • A final DNP project that involves taking what you’ve learned and applying it to a real-world project focused on improving patient outcomes

Professional certification, achieved by passing a nationally recognized certification board exam, is available through the following organizations:

American Academy of Nurse Practitioners National Certification Board (AANPCB)

  • Adult-Gerontology Primary Care Nurse Practitioner Certification (A-GNP)

The American Nurses Credentialing Center Certification Program (ANCC)

  • Adult-Gerontology Acute Care Nurse Practitioner Certification (AGACNP-BC)
  • Adult-Gerontology Primary Care Nurse Practitioner Certification (AGPCNP-BC)

American Association of Critical-Care Nurses Certification Corporation (AACN)

  • Acute Care Nurse Practitioner Certification Adult-Gerontology (ACNPC-AG)

Most states recognize all of the above national certifications for APRN licensure; however, some states have a preference, so it’s important to check first with your state board of nursing.

The Road to Full Practice Autonomy and Prescriptive Authority: Where Adult-gerontology Nurse Practitioners Stand

The fight for full practice autonomy and prescriptive authority among the nation’s APRNs holds particular significance for adult-gerontology nurse practitioners, who often serve as the sole practitioners for millions of Americans living in rural and medically underserved areas.

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Currently, 28 states and Washington D.C. allow PCAGNPs and ACAGNPs to practice independent of a physician. About 14 of these 28 states require the completion of a specific number of hours/years of experience under physician oversight before they can serve as independent practitioners. The remaining states require PACGNPs and ACAGNPs to practice under a collaborative physician agreement or other type of physician oversight.

Salary Expectations for Adult-gerontology Nurse Practitioners

A 2019 Medscape Compensation Report revealed that adult-gerontology nurse practitioners enjoyed some of the highest salaries among nurse practitioners: $114,000 for AGACNPs and $111,000 for PCAGNPs—much higher than the average salary of $107,000 for family nurse practitioners.

Some of the highest paid nurse practitioners were in hospital in-patient settings, where they earned an average salary of $116,000 and hospital-based outpatient settings or clinics, where they earned an average salary of $109,000.

About 5% of all NPs owned their own practices during this time. Those that did earned about 9% more than non-owners. NPs that held DNP degrees earned about $7,000 more annually than their MSN-prepared counterparts.