RESUMEN
BACKGROUND: The Consensus Model specifies distinct education preparations for acute care and primary care nurse practitioners (NP), but incomplete implementation and employer hiring practices risk misalignment of certification and practice. PURPOSE: Report the prevalence of acute care certification among NPs working in acute care, investigate the factors associated with alignment, and explore the impact of alignment on nurse outcomes. METHODS: Using the 2018 National Sample Survey of Registered Nurses, we selected NPs practicing acute care and compared employment, education, and nurse outcomes by certification alignment. FINDINGS: A minority of NPs (44.5%) held acute care certification. Controlling for NP characteristics, those practicing in states that restrict a NP's practice to their area of certification had 47% higher odds of acute care certification. DISCUSSION: Understanding patterns of alignment in the NP workforce and the factors that produce them is critical to an appropriate regulatory framework for advanced practice nursing.