If you’re considering becoming a nurse practitioner (NP), you’ll have likely come across a few different career routes to take. For many nurses, the family nurse practitioner (FNP) role provides them with challenges across various medical concerns affecting all ages.
For those who prefer a more specialized challenge, however, working as an adult-gerontology acute care nurse practitioner (AGACNP) may provide the focus and variety they desire. It’s probably obvious that working as an AGACNP means that you’ll treat a specific demographic.
However, there are a few key differences between this role and that of an FNP. For example, are there any benefits you should know about when choosing between the AGACNP and FNP career paths? Let’s take a look at the key differences you need to know before starting your studies.
FNPs are the first point of contact for many people
As mentioned briefly, FNPs cover various demographics and care demands. In many cases, you’re working in community centers, or even behind your own private practice. The word ‘family’ in ‘family nurse practitioner’ means that you care for all ages. This means that you’re also likely to be the first point of medical care and contact in a specific area or health center.
As an FNP, you’ll likely handle thousands of patient records, diagnose and treat patients, and prescribe medication where necessary. For the patient, a comfortable relationship with their FNP is very important. If you’re their sole point of contact, they’ll rely on you to soothe their worries, supply medication and provide all-around advice. People rely on AGACNPs in much the same way, but their work concentrates on one main demographic, which we’ll explore below.
They treat different people
An AGACNP, by definition, treats older people who are at higher risk of developing acute or chronic conditions. The term ‘gerontology’ refers to the aging process in relation to medical needs. It’s similar to the term ‘geriatric’, which refers to the treatment of older people. This means that, unlike FNPs, AGACNPs typically work with people aged 50 and over, though this may vary depending on the position and employer.
Ultimately, AGACNP trains to care for people as they start getting toward middle age and older, where chronic conditions are more likely to arise. FNPs, meanwhile, care for everyone – older people included – but provide medical support for patients from birth through all stages of life.
AGACNPs are more specialized
As mentioned, the work of an AGACNP focuses on older people and those at risk of developing age-related conditions and illnesses. This means that they’re generally much more specialized in chronic conditions likely to impact their specific patients and their families.
For example, an AGACNP will likely specialize in supporting patients with type 1 and 2 diabetes, hypertension, arthritis, and heart disease. As with FNPs, they will also help to support people with cholesterol problems, depression, and kidney failure. However, as these problems appear more prevalent as we age, AGACNPs are much more focused on treating these conditions than others.
Both FNPs and AGACNPs develop treatment plans to help ensure that their patients receive adequate medication and care for their illnesses. Both are invested in preventive care, but AGACNPs work specifically to prevent conditions and diseases that may cause mortality in the elderly.
FNPs work hard to develop disease prevention plans and care strategies. However, their focuses are often much broader to accommodate additional demographics. What’s more, the treatment plans and care guidelines they develop consider younger, fitter bodies as well as older patients. Ultimately, we all have different care needs, and you don’t have to be over a specific age to suffer from a certain condition. That said, AGACNPs work specifically with the aging process in mind.
They have different certifications
As you may expect, FNPs and AGACNPs pursue slightly different career paths and certifications to treat their patients. However, in both cases, full qualification will typically take around seven years to achieve. In the case of an AGACNP, you’ll typically need proven experience in practical, clinical experience. You can start studying to move into this career path if you’re already a nurse with a Bachelor of Science in Nursing (BSN), and there will typically be two certification choices available upon graduation.
Ultimately, once you graduate from a BSN, you’ll need to seek out a specialized post-graduate qualification to take you via either the FNP or the AGACNP route. The seven years quoted above take into account around three years in your bachelor program.
While certifications certainly make the difference when it comes to proving whether you’re AGACNP or FNP material, practical experience is just as important. You should never expect to enter an AGACNP role without considerable work experience diagnosing and treating people with age-related chronic conditions, under supervision from a fully licensed practitioner.
If you’re considering AGACNP vs FNP routes at a university such as Rockhurst, for example, you’ll typically find that you need to allow for hours of practical training alongside theory study. In fact, Rockhurst University recommends hundreds of practice hours with real patients and in real facilities before you take your certification into a work setting.
The certifications available for FNPs and AGACNPs will also differ greatly in scope, focus and recommended reading materials. In many cases, FNPs will need to cover a broader spectrum of learning in a similar space of time as to what you would expect on an AGACNP course.
This doesn’t make AGACNP study any less important or less intensive. If anything, it’s likely to be more intensive surrounding acute and chronic care. There are likely to be staple reading choices and practice exams that may fit both roles, but this is likely as far as the education similarities stretch. That said, both routes are wide open to BSN graduates, and we’ll explore why you may choose one route over the other a little further down.
They work in different locations and settings
While working locations may overlap for FNPs and AGACNPs, the former is more likely to work in clinic settings or as part of community care operations. FNPs will also work in family practice settings, in pediatric care, and in urgent care operations. They also help to provide support and expertise in settings such as government buildings and public-facing businesses.
AGACNPs, due to their demographic focus and specialism in chronic conditions, typically work in emergency and ICU settings. They operate on-site at hospitals and may also intervene in emergencies via ER. You’ll also find AGACNPs working in specialist care settings, should the conditions they’re treating require the insight of oncologists or cardiologists, for example. Both AGACNPs and FNPs work in hospitals, albeit with different patients. There may be an overlap working with older people, particularly if chronic conditions are present or there is a risk of their development.
There are slightly different salary expectations
One key difference that many BSN graduates look for when specializing is salary – and when it comes to comparing FNP and AGACNP salary expectations, AGACNPs are likely to demand more money. However, the gap is not as large as many might expect. FNPs can expect to earn roughly $117,000 per year (upper bracket), while AGACNPs may expect to earn $125,000 (again, upper bracket). That’s a difference of $8,000 per year, or between $600 and $700 monthly, before taxation.
It’s reasonable to expect a higher salary from AGACNP roles as they can demand more intensive study and more critical care scenarios. That said, this isn’t always the case, which is likely why there’s not a huge difference in wages. In many cases, people will want to work as AGACNPs as the specialism particularly interests them.
Alternatively, they may look for a particular type of challenge that’s not always available through the community care route. Salaries will vary from one hospital or care facility to the next. Again, the figures quoted above are averages fixed at the highest brackets, so don’t make assumptions on this data alone if you’re weighing up your options.
Very few people work as AGACNPs compared to FNPs
Interestingly, the proportion of NPs working as FNPs compared to those working as AGACNPs is starkly different. It’s thought that around 65% of NPs choose the FNP route, while 3.4% choose to work as AGACNPs. A reason for this may be the specialization. Working as an FNP delivers a broad range of challenges and cases, and therefore regular variety. This route may also appeal to NPs who wish to keep their career options open further down the line.
AGACNPs, meanwhile, likely choose this route as they know that they want to care specifically for older people and chronic conditions long term. It’s a highly specialized area of nursing that doesn’t always provide specific routes into other healthcare niches. This is why there continues to be a drive to recruit specialized AGACNPs across the US. The country is in dire need of new nursing talent, and those who can specialize in care for our increasingly elderly population are all the more sought after!

Why choose to become an FNP?
Many nurses choose to go down the FNP career path as it provides them with a huge amount of day-to-day variety and experience. It’s also the perfect route to take if you wish to work closely with people in a community and build strong relationships with people who need your support the most.
The work of an FNP also goes beyond that simply caring for others one after the other. Many FNPs pursue better medical standards for the communities they work in. Others may work tirelessly to raise awareness of health concerns affecting the people they care for.
It’s the perfect career route for a qualified nurse who wishes to practice medicine in community settings and in various scenarios. If you’re keen to produce healthcare plans and provide care for all people of all ages, then working as an FNP can be highly rewarding. You’ll likely work in hospital and community care centers, as well as in health clinics for specific groups of people (such as women or children).
As mentioned, some NPs choose the FNP path over the AGACNP path because of its flexibility. They will develop skills that they can use in multiple other niches and specialisms. It’s a great route to take if you still wish to explore other niches in the future.
Why choose to become an AGACNP?
These nurses work tirelessly to help support people who may be in extreme pain or discomfort. What’s more, the best nurses care deeply about finding solutions to problems specifically affecting older people. This is a role that requires a great deal of compassion and attention to detail. Unfortunately, it is also a role that’s likely to have a higher patient mortality rate compared to other specializations.
Therefore, it’s the perfect nursing niche for those who can build caring relationships with patients while removing themselves emotionally from their cases when needed. AGACNP roles will also appeal to those nurses who wish to move into end-of-life care or nursing home facility positions. Frequently, AGACNPs will work in care home facilities to support elderly patients with chronic conditions that may be causing discomfort.
Some nurses may become AGACNPs through personal experience. For example, some may choose this career path if their parents or grandparents suffer in later life. For all that working as an AGACNP may be challenging, it’s a great career opportunity for nurses who wish to focus intensively on one demographic. This is a demographic that needs increasing help and care as time goes on.
What’s more, as the general population across the US is aging more and more, this is a role that’s likely to grow in demand in the years to come. While the general push for FNPs and nurses is unlikely to shift gears anytime soon, it’s highly likely that we’ll see an increase in demand for experienced AGACNPs soon enough.
Are there any differences in job security between FNPs and AGACNPs?
As a result of the nursing shortage across the US, both FNP and AGACNP roles are in high demand, meaning that security is only likely to increase over the next five years. In fact, it’s thought that both career paths are likely to grow in demand and popularity up to the end of the decade, by between 40% and 50%. This is an unprecedented increase, meaning that now really is the time to take advantage.
Are there any skill differences between working as an FNP and working as an AGACNP?
Both FNP and AGACNP roles require nurses to be empathetic, self-motivated, and excellent communicators. In particular, they will need to demonstrate ‘power skills’ (also known as ‘soft skills’) while providing exceptional care standards for all their patients.
Depending on the career path you choose, you’ll have the opportunity to learn specific skills and decision-making techniques to help you navigate your working days. However, you’ll benefit from entering studies of either route with a caring attitude, lots of patience, and the ability to remove yourself emotionally from patient cases.
While many FNPs and AGACNPs work solo on cases and patient files, these are also roles that demand that you work in teams. Not only that, but you’ll also need to be highly adaptable and organized, working with different people from one day to the next. This means that you’ll need to be willing – and able – to communicate different ideas and case advancements to your peers and supervisors. Given that you’ll work closely with patients, you need to be able to condense or rephrase certain medical terminology. Crucially, you need to build up a ‘bedside manner’. This is especially vital if you’re working as an AGACNP and are caring for elderly people who may be in pain and/or scared of what’s ahead.
Conclusion
While there are many differences between the FNP and AGACNP roles, you’re still at the heart of a medical center or hospital’s operations. The main difference is that in the latter, you’ll specialize in working with older patients and providing care for chronic conditions.
Both career roles actually carry many similarities, such as in the day-to-day skills you’ll need to demonstrate. It’s also important to remember nursing work-life balance tips if you wish to succeed in either role! In any case, think carefully about the route(s) you wish to take in nursing and whether or not you would like to specialize. With either of the routes explored here, you’ll still support people in dire need of your care – and you may even save lives.