Question: What is the difference between primary nursing care and acute nursing care?

Answer: Rather than think of advanced practice nursing care as being divided into primary and acute care, it is more accurate to categorize nursing care into primary, secondary, and tertiary care.

A common misconception is that acute medical care refers to caring for patients suffering from severe health conditions, while primary care is defined as providing patients with low-level preventative care that does not address serious medical problems. While this definition of primary care is generally accurate, the conflation of acute care with specialized intensive care is incorrect.

Medical services are divided into primary, secondary, and tertiary care. While primary care focuses on general care for overall patient education and wellness, secondary care and tertiary care treat more severe conditions that require specialized knowledge and more intensive health monitoring. Some types of nurse practitioners, such as family nurse practitioners, can serve across all three levels if they obtain the necessary training, certifications, and professional experiences.

How is Acute Care Nursing Different from Primary Care Nursing?

In contrast to primary, secondary, and tertiary care, acute care does not refer to the level of care; rather, it refers to the sudden onset of the patient’s condition, and the duration of the care provided. Thus, acute care can be provided in primary care settings such as retail health clinics and outpatient clinics for conditions such as a common and non-life-threatening illness or a minor injury. However, acute care can also refer to the short-term and intensive care provided in emergency rooms and ICUs to patients after a heart attack or a life-threatening allergic reaction. Hence, acute care is in fact a subset of primary, secondary, and tertiary care.

Despite this distinction, nurse practitioners who are board certified in acute care (for example, adult acute care nurse practitioners and pediatric acute care nurse practitioners) tend to care for patients in need of secondary and tertiary (that is, specialized and intensive) care. Acute care nurse practitioner program concentrations also typically focus on training nurses to provide secondary and tertiary care.

An Overview of Primary, Secondary, and Tertiary Nursing Care

Primary, secondary and tertiary care refer to the complexity and severity of health challenges that are addressed, as well as the nature of the patient-provider relationship (i.e. whether it is an ongoing, long-term relationship or a short-term relationship aimed at addressing an acute condition). As mentioned previously, lower-level, longer-term care is generally classified as primary care, whereas more specialized and intensive medical care and treatments fall into the categories of secondary and tertiary care, depending on the severity of the condition being treated.

Primary Care Nursing

Primary care is the first level of care that patients receive, and is focused on patient wellness and the prevention of severe health conditions. Primary care providers are typically patients’ first point of contact when they have medical concerns or needs. The relationship between patient and provider is also much longer term in primary care settings versus secondary and tertiary care settings, with providers often following a patient’s development and medical history for several years. Primary care is also delivered in outpatient settings, as the low-level care and consultations provided to patients do not require hospitalization.

Nurse practitioners who typically work in primary care settings include family nurse practitioners, adult primary care nurse practitioners, and pediatric primary care nurse practitioners. However, nurse practitioners who are board certified in acute care can work in primary care settings depending on their background and

Secondary Care Nursing

Secondary care is more specialized and focuses on helping patients who are struggling with more severe or complex health conditions requiring the support of a specialist. Secondary care is typically delivered in inpatient settings, and is best defined as care for patients who require intensive specialist care but whose vital signs are stable. Examples of medical situations needing secondary care services include cancer treatment, medical care for pneumonia and other severe and sudden infections, and care for broken bones. Adult gerontology acute care nurse practitioners, adult acute care nurse practitioners, and pediatric acute care nurse practitioners tend to work in these settings; however, certified primary care nurse practitioners can also work in secondary care settings depending on their previous work experiences, the regulations in their state, and the specific needs of their employer.

Tertiary Care Nursing

Tertiary care is another form of specialized care that is a level above secondary care in that it involves supporting patients who are encountering life threatening illnesses and whose vitals are not stabilized. Tertiary care is delivered in settings such as the intensive care unit (ICU), emergency room, trauma, organ transplant, and critical care units. In general, nurse practitioners who are board certified as acute care nurse practitioners work in tertiary care settings; however, board certified primary care nurse practitioners may also work in these settings if they have accrued sufficient relevant experiences and meet relevant state licensing requirements.