Adult Gerontology Acute Care vs. Primary Care: Comparing Two Specializations

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A senior patient sitting in a wheelchair by a window smiles at a nurse while receiving care.
Integral to our health care system, nurse practitioners perform work that’s vital to maintaining and improving patient health. Nurse practitioners assess patients, order tests, make diagnoses, and prepare treatment plans, among other duties. In some states, they can even prescribe medication.

Exploring various aspects of health care, such as by specializing in an area like adult gerontology, can help nurse practitioners narrow their focus to the types of care they wish to provide. Within adult gerontology, nurse practitioners can choose to focus on acute care vs. primary care. All nurse practitioners working in both acute care and primary care strive to provide optimal care, but the patients they tend to, the types of care they deliver, and the settings in which they work are quite different. Specifically:

  • Primary health care nurse practitioners work with patients who have chronic conditions in settings such as clinics and private physician offices.
  • Acute health care nurse practitioners work with patients who have complex conditions in settings such as intensive care units or trauma units.

Individuals who pursue an advanced degree, such as an online BSN to Doctor of Nursing Practice degree can enhance their knowledge and skills to become nurse practitioners focusing on a specialization area such as gerontology in either acute care or primary care.

What Is Primary Care in Nursing?

According to the American Association of Nurse Practitioners, 75% of nurse practitioners work in primary care. Providing care to both individuals and families, they diagnose and manage their patients’ conditions while also promoting health and the prevention of disease.

What Is Primary Care?

The range of primary care services a nurse practitioner can provide is extensive. Examples include:

  • Taking the patient’s history
  • Performing an examination
  • Ordering tests and procedures
  • Diagnosing, treating, and managing diseases
  • Writing prescriptions
  • Coordinating referrals
  • Educating patients on disease prevention and healthy living
  • Conducting certain medical procedures

Often, nurse practitioners give continuous care to patients with chronic conditions.

When working in clinical settings, nurse practitioners can work with patients to develop individualized care plans for longer-term issues, such as disease prevention, health education, and health and lifestyle choices.

Importance of Primary Care in Rural Communities

The importance of nurse practitioners in providing primary care in rural communities is noteworthy.

According to the American Association of Nurse Practitioners, 18% of nurse practitioners work in communities with fewer than 25,000 residents. Rural communities affected by health care provider shortages can benefit significantly from having access to nurse practitioners.

However, the scope of services that a nurse practitioner can provide is dependent on the laws and regulations of each state. Therefore, the extent to which a nurse practitioner can alleviate provider shortages in a rural area depends on the state in which the nurse practitioner works.

Types of Primary Care in Adult Gerontology Nursing

The types of primary care that nurse practitioners who choose to specialize in adult gerontology provide span the treatment of chronic illnesses, polypharmacy management, palliative care, and the provision of services that involve end-of-life considerations.

Importance of Long-Term Relationships with Patients

Nurse practitioners’ ability to provide primary care to patients over the course of several years puts them in a unique position to build trust with their patients. Establishing that trust is key to encouraging adult patients to modify health risk behaviors and implement self-management strategies.

In long-term care facilities, nurse practitioners can play a critical role in risk assessment and screening of patients for issues such as frailty, depression, and cognitive dysfunction. The employment of nurse practitioners in long-term care facilities has been shown to improve the management of chronic conditions; decrease hospitalizations, costs, and resident mortality; and improve the satisfaction levels of the residents and their families.

Role in Palliative Care

Nurse practitioners are particularly suited to providing a number of services within palliative care. For example, they can offer symptom management care and assist in planning for advance care or hospice care. They also can educate patients and their families about the patients’ treatment and prognosis.

What Is Acute Care in Nursing?

Determining what acute care is in terms of a nurse practitioner’s role centers around the complexity of a patient’s condition. Nurse practitioners in acute care help patients who have critical illnesses, physiological instability, dependency on technology, or a vulnerability to complications.

Severity of Patients’ Conditions and Need for Interpersonal Skills

Patients in acute care settings have experienced a sudden, severe condition such as a heart attack, broken bone, or asthma attack.

Because patients in acute care often have life-threatening conditions, nurse practitioners who work in acute care must have the interpersonal skills necessary to communicate with patients and their families in intense situations.

Importance of Acute Care to Rural Communities

As with primary care, the presence of nurse practitioners working in acute care in rural communities has become increasingly important.

Residents of rural areas are more likely than residents of urban areas to visit emergency rooms, but the closure of rural hospitals across the U.S. has made it more difficult for rural residents to obtain emergency care.

Nurse practitioners help address the shortage in acute care providers in underserved areas. As with nurse practitioners in primary care, however, the scope of services an acute care nurse practitioner can provide depends on their state’s laws and regulations.

Types of Acute Care in Adult Gerontology Nursing

The types of acute care that nurse practitioners who specialize in adult gerontology provide vary widely.

Diagnosis

Examples of acute care diagnosis responsibilities in adult gerontology nursing include:

  • Diagnosing behavioral and mental health and substance use or addictive disorders and diseases
  • Prioritizing diagnoses during rapid physiological or mental health deterioration
  • Identifying comorbidities and the potential for rapid physiological or mental health deterioration

Interventions, Treatments, and Therapies

Examples of acute care interventions, treatments, and therapies in adult gerontology nursing include:

  • Employing interventions to enable patients to achieve physiological and psychological goals
  • Employing treatments and therapeutic devices such as oxygen, mechanical ventilation, prosthetics, and adaptive equipment
  • Performing diagnostic and therapeutic interventions such as EKG interpretation, respiratory support, hemodynamic monitoring, and lumbar puncture

Assessment and Management

Examples of acute care assessment and management in adult gerontology nursing include:

  • Conducting a pharmacological assessment
  • Monitoring adults and older adults at risk for urgent and emergent conditions

Education and Discussion

Examples of acute care education and discussion in adult gerontology nursing include:

  • Educating patients, their families, and their caregivers on aging and mental and physical disorders
  • Discussing sensitive issues, such as advance directives and end-of-life decisions with patients, their families, and their caregivers

Influence of COVID-19

The COVID-19 pandemic has changed how nurse practitioners can treat patients. Recognizing that nurse practitioners have the training and experience to help COVID-19 patients, several states have modified the authorized scope of practice for nurse practitioners, permitting them to diagnose patients, interpret test results, and start patients on prescription and nonprescription treatments.

Adult Gerontology Careers for Nurses

The outlook for adult gerontology careers is promising for both nurse practitioners who specialize in primary care and those who specialize in acute care.

The U.S. Bureau of Labor Statistics projects 45% job growth for nurse anesthetists, nurse midwives, and nurse practitioners from 2019 to 2029, which is much faster than the average projected growth rate of 4% for all occupations. Job growth will be spurred by a growing emphasis on preventive care and an increasing demand for health care throughout our aging population.

Careers for Adult Gerontology Nurse Practitioners in Primary Care

Adult gerontology nurse practitioners who work in primary care usually work in settings such as long-term care facilities, hospital-based clinics, and private practices.

To become certified in adult gerontology primary care, nurse practitioners demonstrate knowledge in areas such as patient assessment, diagnosis, planning, and evaluation.

Assess

To assess a patient, adult gerontology nurse practitioners in primary care can do the following:

  • Interview the patient and family
  • Review the patient’s records
  • Identify health and medical risk factors
  • Evaluate caregiver competence
  • Obtain information based on patient age, health history, and comorbidities
  • Perform physical examinations
  • Order, perform, and supervise diagnostic tests and procedures
  • Order, perform, and supervise screening tests

Diagnose

To diagnose a patient, nurse practitioners in adult gerontology primary care can do the following:

  • Synthesize and analyze subjective and objective information
  • Prioritize potential differential diagnoses
  • Differentiate between normal and abnormal changes associated with development and aging
  • Order, perform, and interpret additional diagnostic tests
  • Perform and interpret additional physical examinations
  • Synthesize and analyze additional information

Plan

To develop a treatment plan for a patient, nurse practitioners in adult gerontology primary care can do the following:

  • Prescribe, order, and administer pharmacological and nonpharmacological therapies
  • Provide relevant education
  • Coach the patient and caregiver
  • Make referrals to and consultations with other health professionals and community resources
  • Provide for appropriate follow-up
  • Consider comorbidities
  • Encourage advance care planning
  • Serve as a patient and family advocate
  • Manage transitions between health care settings

Evaluate

To evaluate a patient’s treatment plan, nurse practitioners in adult gerontology primary care can do the following:

  • Review patient responses
  • Collect additional subjective and objective information
  • Order, conduct, supervise, and interpret further tests
  • Adjust therapies
  • Provide additional education
  • Make appropriate referrals and consultations
  • Provide for appropriate follow-up treatment

Guidance, Counseling, and Resources

Nurse practitioners in adult gerontology primary care understand how to access the following resources:

  • Health promotion, disease prevention, and anticipatory guidance
  • Patient, family, and caregiver education and counseling
  • Therapeutic communication
  • Community resources

Knowledge of Certain Theories and Principles

Nurse practitioners who work in adult gerontology primary care understand relevant theories and principles, such as:

  • Biopsychosocial principles and theories
  • Principles of epidemiology
  • Principles of risk management

Knowledge for Examination and Diagnosis

Nurse practitioners who work in adult gerontology primary care have knowledge related to examination and diagnosis, such as:

  • Health history
  • Signs and symptoms
  • Physical examination
  • Diagnostic and therapeutic tests and/or procedures
  • Differential diagnosis
  • Clinical decision-making
  • Anatomy, physiology, and pathophysiology

Knowledge of Therapies and Care

Nurse practitioners who work in adult gerontology primary care carry out specific therapies and care, such as:

  • Pharmacological therapies
  • Polypharmacy
  • Nonpharmacological, complementary, and alternative therapies
  • Palliative and end-of-life care

Knowledge of External Factors

Nurse practitioners who work in adult gerontology primary care understand external issues that affect patient care and well-being, including:

  • Legal and ethical issues
  • Ethnocultural and spiritual competence

Salary

According to PayScale, the annual salaries of adult gerontology nurse practitioners range from $74,000 to $110,000. Their median salary is around $91,000.

Careers for Adult Gerontology Nurse Practitioners in Acute Care

Adult gerontology nurse practitioners in acute care usually work in settings such as emergency and operating rooms, intensive care, trauma, or acute care units, but they also can work in specialty clinics and long-term care facilities.

To become certified in adult gerontology acute care, nurse practitioners need to demonstrate core competencies in specific areas. These areas illustrate the types of job duties that nurse practitioners are responsible for performing.

Management and Assessment Responsibilities

Nurse practitioners in adult gerontology acute care have specific management and assessment responsibilities, including:

  • Managing complex acute, critical, and chronically ill adult and older adult patients at risk for urgent and emergent conditions
  • Assessing risks associated with the care of acute, critical, and complex chronically ill patients
  • Managing geriatric syndromes and changing conditions using evidence-based guidelines

Diagnosis Responsibilities

Nurse practitioners in adult gerontology acute care have responsibilities related to diagnosis, such as:

  • Diagnosing behavioral and mental health and substance use or addictive disorders and diseases in the presence of complex acute, critical, and chronic illness
  • Prioritizing diagnoses during rapid physiological or mental health deterioration or life-threatening instability
  • Using specific diagnostic strategies and technical skills to monitor and sustain physiological function and ensure patient safety
  • Identifying comorbidities and the potential for rapid physiological or mental health deterioration or life-threatening instability
  • Differentiating between normal and abnormal changes in physiological, psychological, and sociological development and aging

Therapy Responsibilities

Nurse practitioners in adult gerontology acute care are responsible for specific therapies, such as:

  • Employing certain treatments and therapeutic devices
  • Performing therapeutic interventions to stabilize acute and critical health problems
  • Evaluating the effect of therapies, such as physical therapy, occupational therapy, and speech therapy
  • Implementing interventions to support patients with rapidly deteriorating physiological conditions

Pharmacological Responsibilities

Nurse practitioners in adult gerontology acute care perform certain pharmacological responsibilities, though their ability to prescribe medication independently varies according to state laws. Their pharmacological duties may include:

  • Conducting pharmacological assessments
  • Prescribing medications
  • Using pharmacological and nonpharmacological management strategies

Areas of Clinical Judgment

Nurse practitioners in adult gerontology acute care demonstrate clinical judgment in specific areas, such as:

  • Cardiovascular care, such as inserting arterial pressure catheters, interpreting echocardiograms, and performing ultrasound-guided diagnostic and therapeutic procedures
  • Pulmonary care, such as initiating mechanical ventilation, interpreting pulmonary function tests, and performing extubation
  • Gastrointestinal care, such as inserting small-bore feeding tubes
  • Renal/genitourinary care, for example, managing renal replacement therapies
  • Neurology care, such as interpreting cerebrospinal fluid results, performing brain-death testing, and performing lumbar puncture

In acute care settings, nurse practitioners also demonstrate clinical judgment in broad areas, such as:

  • Integumentary care, such as administering local anesthetic, prescribing wound care, and suturing wounds
  • Behavioral care, such as using de-escalation techniques and managing patients in restraints
  • Multisystem care, such as interpreting diagnostic imaging, prescribing pharmaceutical interventions, and providing nonpharmacological interventions for pain

Factors That Influence Health Status

Nurse practitioners in adult gerontology acute care demonstrate their knowledge of factors that influence patient health and well-being, such as:

  • Advance care planning
  • Cancer prevention and screening
  • Caregiver burden
  • Comorbid risk reduction
  • End-of-life care
  • Pain prevention and management
  • Palliative care
  • Secondary prevention, such as smoking cessation, cardiac rehabilitation, and pulmonary rehabilitation

Salary

According to PayScale, the annual salaries of adult gerontology nurse practitioners specializing in acute care range from $88,000 to $113,000. Their median salary is around $96,000.

Striving Toward Optimal Care Delivery

Nurse practitioners who specialize in adult gerontology, whether in primary care or acute care, play a critical role in addressing challenges faced by the health care industry. They can fill gaps in care availability, alleviate health care access issues in rural areas, and help reduce costs.

Do you want to take steps toward a rewarding career and make a difference in patients’ lives? Regis College’s online BSN to Doctor of Nursing Practice degree program prepares registered nurses who have a bachelor’s degree in nursing with critical knowledge and skills to become specialized gerontology nurse practitioners in primary care or acute care.

Recommended Readings:

The Growing Need for Adult Gerontology
The Science of Nursing: What Is Gerontology?
Nurse Safety and Prescribing Medications: A Delicate Balance

Sources:

American Academy of Emergency Nurse Practitioners, “Acute Care Delivery Within Emergency Care Settings: An Executive Summary”
American Academy of Nurse Practitioners, Adult-Gerontology Primary Care Nurse Practitioner (A-GNP)
American Association of Critical-Care Nurses Certification Corporation, “Adult-Gerontology Acute Care Nurse Practitioner Certification: Exam Handbook”
American Association of Nurse Practitioners, “Are You Considering a Career as an Adult-Gerontology Acute Care Nurse Practitioner?”
American Association of Nurse Practitioners, “Are You Considering a Career as an Adult-Gerontology Primary Care Nurse Practitioner?”
American Association of Nurse Practitioners, “Nurse Practitioners in Primary Care”
American Association of Nurse Practitioners, “What’s a Nurse Practitioner (NP)?”
American Journal of Managed Care, “Nurse Practitioners Play an Increasing Role in Primary Care”
Center for American Progress, “Rural Hospital Closures Reduce Access to Emergency Care”
DailyNurse, Acute Care Nurse Practitioner
Health Resources and Services Administration, Nurse Practitioners Overview
Journal of Nutrition, Health & Aging, “Involvement of Advanced Practice Nurse in the Management of Geriatric Conditions: Examples from Different Countries”
MedlinePlus, Acute vs. Chronic Conditions
MedlinePlus, Nurse Practitioner
National Rural Health Association, “Preparing Nurse Practitioners for Rural Practice”
The Nurse Practitioner, “Underutilizing Highly Trained Nurses Amid a Public Health Crisis”
PayScale, Average Adult Gerontology Acute Care Nurse Practitioner Salary
PayScale, Average Adult-Gerontology Nurse Practitioner (AGNP) Salary
Staff Care, “How Nurse Practitioners Are Filling the Gaps in Healthcare”
U.S. Bureau of Labor Statistics, Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners