1. Henson, Autumn DNP, GNP-BC
  2. Peacock, Amanda DNP, RN, AGPCNP-C, WC
  3. Blakely, Kala DNP, NP-C, FAANP
  4. Maes, Cheryl PhD, APRN, FNP-BC
  5. DiGiulio, Mary DNP, APN, FAANP
  6. Henderson, MJ MS, RN, GNP-BC


Whether certified in acute or primary care, AGNPs are prepared for many practice settings.


Article Content

As NPs and program directors, we often hear misconceptions about the NP roles and opportunities available for students. Family NPs (FNPs) are often identified as having a wider range of patient care and clinical skills in multiple areas of health care than adult-gerontology NPs (AGNPs). Nursing students often fear that job opportunities are not as easily available for AGNPs. In addition, many FNP students with interests more in line with the care of older adults are unaware of the AGNP option prior to applying to programs. The similarities and differences in education and scope of practice between AGNPs and FNPs are not well understood, and it's important to clarify and increase knowledge about the roles and benefits AGNPs bring to a variety of practice settings.


As part of the process of further delineating the FNP role in response to the shortage of primary care providers in the 1970s, adult NP programs were developed. The gerontological NP role was later established to meet the specialized care needs of a growing older adult population. In 2008, the certifying bodies combined these two certifications into the AGNP certification in order to manage a larger population of adults and older adults. The AGNP certification is offered in both primary care and acute care roles. The current certifications are adult-gerontology primary care NP (AGPCNP) and adult-gerontology acute care NP (AGACNP).


Across the continuum of care, AGNPs provide care for adolescents to older adults, with emphasis on caring for older adults and those with multiple comorbidities. Primary care AGNPs are educationally prepared to provide preventive and primary care to those with chronic and acute illnesses, while acute care AGNPs are prepared to provide care to the critically ill, the unstable, or those at high risk for complications. Alternately, FNPs provide preventive care, treatment, and management of acute or chronic illnesses to individuals of all ages, from infants to children, teenagers, adults, and older adults.


All NPs share core competencies based on the American Association of Colleges of Nursing Essentials, but there are more population-specific competencies for AGPCNPs and AGACNPs than for FNPs and the curriculum content necessary to support these competencies is more detailed. FNPs, AGACNPs, and AGPCNPs can become board certified through the American Nurses Credentialing Center and/or the American Academy of Nurse Practitioners (AANP) certification board. However, the AGNP exam is weighted more heavily on caring for the older adult than the FNP exam and addresses topics ranging from the normal aging process to atypical conditions, multimorbidity, advance care planning, and palliative care management. Indeed, 55% of the AGPCNP exam covers the care of older adults, compared to only 30% of the FNP exam.


There is a misconception among the public that FNPs have a more comprehensive education because they treat patients of all ages and AGNPs only care for older adults. But AGNPs are academically prepared to care for patients for over more than two-thirds of their lives, starting with adolescence, as early as age 10. With the largest number of primary care patients older than age 18, AGNPs are well suited to address the health care needs of most age groups in the United States.


Further misconceptions are that FNPs have greater flexibility in terms of job settings and opportunities and are more diverse in their area of practice. But AGPCNPs practice in a variety of settings, from primary care to specialty clinics. According to the AANP, the most common practice areas for AGPCNPs are primary care and geriatrics. Hematology oncology is also a common area of specialization for AGPCNPs. AGACNPs, on the other hand, are educated to care for acutely ill hospitalized patients. The most common practice areas for AGACNPs are ICUs and inpatient services, with cardiology the most common specialty area. Salaries of FNPs and AGNPs are comparable in comparable practice settings.


As the U.S. population continues to age, the value of AGNPs should be recognized and AGNPs utilized more broadly in the health care marketplace for their expertise in geriatrics and complex disease management. By highlighting the additional older adult competencies found in AGNP programs and recognizing the in-depth knowledge AGNPs have in caring for adolescents through older adults, we can strengthen the health care workforce and reduce the primary care provider shortage.