Specialty Spotlight: Adult-Gero Primary Care Nurse Practitioner

By: Evelyn Fleider

If there's a nurse practitioner (NP) specialty often misunderstood, it's Adult-Gerontology Primary Care (AGPC).

"A lot of people believe we only take care of geriatric patients, because of the specialty's name. The name is really a recognition so we don't forget the need to care for the growing population of older patients, but our population focus is people 13 years old and up," says Christine Colella, DNP, APRN-CNP, FAANP, professor and interim associate dean. Colella works as a primary care NP at a federally qualified health center in Cincinnati.

For years, adult health NPs and gerontological NPs were educated and certified separately. In 2008, when education regulations specified six population foci for advanced-practice nursing, the two paths merged as adult-gerontology. The scope of practice for adult-gerontology NPs can be either acute care or primary care. Adult-Gero Acute Care NPs are inpatient/hospital-based and focus on treating illnesses, whereas AGPCNPs are community-based and focus on illness prevention, health promotion and management of chronic health conditions.

"Because I worked as a registered nurse in a hospital, my initial choice for my graduate degree was the acute care program. When I learned more about adult primary care, I switched programs because I wanted to be community-based," says Kim Mullins, DNP, APRN-BC, AOCNP, associate professor and AGPCNP online program coordinator. Mullins also works as an NP at Oncology Hematology Care (OHC) in Cincinnati.

"Through my NP career, I worked in neurology and GI (gastrointestinal) research and have worked for 16 years in an outpatient setting treating radiation/oncology patients. I do see some patients in the hospital for consultations, but I don't manage their care in the hospital," Mullins says.

AGPCNPs work in community-based settings assessing, diagnosing, prescribing medications, ordering and evaluating labs and referring patients to specialists when needed. They consider the environmental, occupational, social and economic background of patients and can work in a wide range of areas, such as primary care, dermatology, cardiology, endocrinology, neurology and many more. Some of these areas require additional certification through specific boards.

"Although I'm taking care of patients with cancer, I couldn't do my job without the primary care background. So much of what I do is grounded in primary care," Mullins says. "When they get to me, I'm not just treating their cancer, I'm treating the whole person, which may include helping manage other comorbidities."

While AGPCNPs enjoy a high level of autonomy and independence, they also bear a lot of responsibility.

"We do a lot of what physicians do and, although I need to have a collaborating physician, I make my decisions independently. It's an incredible amount of accountability and responsibility," Colella says. "If you went to an urgent care or the emergency department tomorrow, the last sentence you would hear before you left is, 'Follow up with your primary care provider.' That's me. We're the ones that manage them after they've had the acute episode."

While the number of Americans ages 65 and older is projected to nearly double from 52 million in 2018 to 95 million by 2060, and the 65-and-older age group's share of the total population will rise from 16% – 23%, only about 7% of the advanced practice registered nurse (APRN) workforce is certified in AGPC, according to the 2020 American Association of Nurse Practitioners' National Nurse Practitioner Sample Survey. This means demand for AGPCNPs who can care for the aging population will continue to increase.

"A lot of nurses hear that becoming an FNP (Family Nurse Practitioner) makes them more marketable. This perception has been driven by retail clinics, but the reality is that if you have no interest in working with a population under 13 years old, AGPCNP is the right specialty for you," Mullins says. "AGPCNP students have higher exposure to adult and women's health care during their clinicals than FNP students do, since they don't need to complete clinicals in pediatrics."

To get a deeper understanding on the breadth of AGPCNP opportunities, we asked four UC alumnae about their journey before and after becoming AGPCNPs.