Agencies offering NP certification. American Academy of Nurse Practitioners. American Nurses Credentialing Center. AANP and ANCC question style

(1)

Preparing for NP Certification: Setting the stage for success

Developed and presented by:

Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP President

Fitzgerald Health Education Associates, Inc.’s

President

Fitzgerald Health Education Associates, Inc.

Family Nurse Practitioner

Adjunct Faculty, Family Practice Residency Program Greater Lawrence (MA) Family Health Center Editorial Board, The Nurse Practitioner Journal, Medscape

Nursing, The Prescriber’s Letter, American Nurse Today

Agencies offering NP

certification

• American Academy of Nurse Practitioners

– www.aanpcertification.org

• ANP FNP GNP certification • ANP, FNP, GNP certification

• American Nurses Credentialing Center

– www.nursecredentialing.org

• ANP, FNP, GNP, ACNP, PMHNP certification

 2011 Fitzgerald Health Education Associates, Inc. 2

AANP and ANCC question style

• Four option test items- A stem

(question itself) and four possible

choices or options

• No multiple- multiples, true-false,

match, penalty for guessing

How do the certifying organizations describe certification and the NP

certification examination?

• Per the ANCC

–“

Certification is the process by

which a nongovernmental agency

g

y

or an association grants

recognition to an individual who

has met certain predetermined

qualifications

.”

How do the certifying organizations describe certification and the NP certification examination (cont.)?

• “Certification can be used for entry

into practice, validation of

competence, recognition of

excellence, and/or for regulation. It

can be mandatory or voluntary.”

How do the certifying organizations describe certification and the NP certification examination (cont.)?

• Certification validates an

individual’s knowledge, skills, and

abilities in a defined role and

ab t es

a de ed o e a d

clinical area of practice, based on

pre-determined standards.”

(2)

How do the certifying organizations describe certification and the NP

certification examination?

• “The Nurse Practitioner (NP)

certification examination tests the

knowledge, skills, and abilities needed

for entry into advanced practice.”

• Source- www.nursecredentialing.org/Certification.aspx

Per AANP

www.aanp.org

• “…The purpose of the American

Academy of Nurse Practitioners

National Certification Program is to

provide a valid and reliable program

for

entry-level nurse practitioners

to recognize their education,

knowledge and professional

expertise.”

Age Parameters for

Practice per AANP, ANCC

• Family NP

– Lifespan

• Adult NP

• Gero NP

– Per ANCC • Age =>55 y

– Age 13 y- elder – Per AANP

• Age =>65 y

ANCC FNP, ANP

Certification (150 questions)

Domains of Practice _{FNP ANP}# items

Theoretical Foundations of Advanced Nursing Practice (Foundations of Advanced Nursing Practice)

37

(25%) (~23%)34

Advanced Nursing Practice) Examples- Therapeutic

communication, health promotion, influences affecting care of individuals and families (psychosocial,

socioeconomics, cultural/spiritual), teaching/guidance

ANCC

FNP, ANP Certification

Professional Role

Examples- Healthcare ethics, scope and standards of advanced practice

23

(15%) (14%)21

and standards of advanced practice nursing, advocacy, legal, safety and ethical issues

ANCC

FNP, ANP Certification

Healthcare Policy and Delivery Examples- Documentation, regulatory and reimbursement issues informatics

15

(10%) (~11%)16

and reimbursement issues, informatics, access to care and healthcare policy Clinical Assessment (Health Assessment)

Examples- Clinical assessment (health assessment), risk analysis, advanced diagnostic reasoning

30

(20%) (~23%)34

(3)

ANCC

FNP, ANP Certification

Clinical Management

Examples- Evidence based practice, advanced clinical decision making

45

(30%) (30%)45

advanced clinical decision-making, pharmacotherapeutics, clinical therapeutics, coordination of care, health promotion/maintenance and disease prevention

AANP Domain

% of total examination (135 questions)

Content Assessment= 33% (~45

questions)

Obtain subjective patient information including relevant medical social and family

Interviewing patient/family/ appropriate others, reviewing records

medical, social and family history, chief complaint, history of present illness, and review of systems to

determine health needs and problems.

records,

identifying health and medical risk factors

AANP Domain Content

Assessment continued Obtain objective information based on patient age and health

Performing physical examination, ordering/ performing/supervising diagnostic tests, ordering/performing/ patient age and health

history to further define health needs and problems.

g/p g/

supervising appropriate screening tests

AANP Domain Content

Diagnosis= 26% (~35 questions) Formulate differential diagnoses. Synthesizing and analyzing subjective/objective information, prioritizing potential diagnoses po e a d ag oses

AANP Domain Content

Diagnosis (continued) Establish definitive diagnoses. Ordering, performing, supervising, and interpreting additional diagnostic tests Performing and interpreting additional physical examinations, synthesizing and analyzing additional information

AANP Domain Content

Plan= 23% (~31 questions)

Establish the plan of treatment/care in order to address the Ordering, performing, supervising, and interpreting further tests to add ess t e diagnoses.

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AANP Domain Content Plan (continued) Prescribing/ordering/

administering pharmacological and/or non-pharmacological therapies, providing relevant education

Making appropriate referrals to, and consultations with, other health professionals and community resources

AANP Domain Content

Plan (continued) Providing for appropriate follow-up, including patient/family/appropriate others as active

others as active participants

AANP Domain Content

Evaluate= 18% (~24 questions) Determine the effectiveness of plan of treatment/care based Reviewing patient responses(s), collecting additional subjective/objective information as needed t eat e t/ca e based

on outcomes by:

AANP Domain Content Evaluate (continued)

Modify the plan of treatment/care

Ordering, conducting, supervising, and

interpreting further tests, adjusting therapies based on outcomes

AANP Domain Content

Evaluate (continued) Modify the plan of treatment/care based on outcomes Providing additional education, making appropriate referrals/ consultations

Providing for appropriate ongoing follow-up, including patient/family/ appropriate others as active participants

Test availability

ANCC

AANP

Computer-based,

year-round Computer-based, year-round

(5)

Length of test

ANCC AANP

175 questions including 25 sample items, 3.5 hour time frame.

150 questions including 15 sample items, 3 hour time frame. Additional

Additional 30 mins allotted for check in, time for practice tutorial to learn about computer system.

15-20 mins allotted for check in, time for practice tutorial to learn about computer system.

Availability of results

ANCC

AANP

Results provided,

pass or fail, at end

Results provided,

pass or fail, at end

of the examination

pass or fail, at end

of the examination

National recognition for

licensure

ANCC

AANP

Yes

Credential

ANCC

AANP

According to area of

certification; FNP-BC,

For all areas of

certification, NP-C

ANP-BC, GNP-BC

Passing score

ANCC

AANP

=>350/500 =>500/800

Typical percentage of examinees

who pass the examination

ANCC AANP Historically, ~ 82-91%, depending on f tifi ti ~ 88% for ANP, 93% for FNP (2009). T l t t area of certification Translates to a score of 350 (minimum passing score) = ~9th_{%tile to 18}th_%tile Translates to a score of 500 (minimum passing score) = ~7th_{%tile for FNP,}

(6)

Procedure if failure

ANCC

AANP

Apply to retest after

60 days (formerly 90 Apply to retest, 15 h CE prior to retesting

y ( y

days) p g

Recertification

every 5 years

ANCC

AANP

Practice hours plus

CE hours and select Practice hours plus CE hours

CE hours and select

professional activities hours

NP certification

• Certification

part of APN

licensure in

• Exceptions

– Colorado (issue with Rx authority)

nearly all of the

US states

– Kansas– New York – North Dakota – Oregon – California

True or false?

• On the national NP certification

exam, you should expect to find

specific questions on your state’s

specific questions on your state s

APN practice act.

True or false?

• You plan to sit for the certification

exam in a state where NPs have

limited or no controlled substance

prescribing authority. As a result,

your certification exam will not

contain questions about prescribing

opioids.

True or false?

• Once an NP has achieved nationally

recognized certification from ANCC

or AANP, this person can now

practice as a nurse practitioner.

(7)

With All Certification Exams

Think Entry-level NP practice Nationally and internationally recognized standards of care and clinical guidelines,

evidence-Evidence-based practice (EBP) defined- The delivery of individualized healthcare on the basis of an awareness of the impact and strength of related scientific evidence* guidelines, evidence

based practice (EBP) Examples - ADA for DM

- NAEPP EPR-3 for asthma - JNC-7 for HTN

- NCEP ATP III for dyslipidemia

*www.encyclopedia.com/doc/1O62-evidencebasedpractice.html

With All Certification Exams

The broad stroke of practice

Not the mix you see in a typical clinical day For ANP, FNP, GNP - As much thyroid as DM - As much male GU as female GYN F ANP For ANP

- As much teen as elder

Common diseases occur commonly Not an examination of the esoteric

Most nursing practice at the RN level is one of exceptions rather than rules.

The NP certification

examination tests

your ability to know

your ability to know…

• Why

a patient is at risk for a

problem.

• How

a clinical problem has

• How

a clinical problem has

developed.

• What

is the most likely clinical

presentation of the condition?

• Why

a given intervention is

effective.

• How

that intervention works

• How

that intervention works.

• What

is the most likely clinical

outcome?

• Why

this clinical problem is of

significance to the overall

healthcare system.

• How

this problem can be

approached from both a macro

and micro healthcare viewpoint

.

(8)

• What

is the

role of the NP

on the overall

health of the

nation and

beyond?

Therefore…

• A poor approach to preparing for

the exam and practice is to…

–Memorize information so you know

y

what to do but not why you are

doing it, in both the exam room and

as part of the larger healthcare

system.

Therefore…

• A better approach to preparing for

the exam and practice is to…

–Understand concepts and apply

knowledge so you know what to do

and why you are doing it at both

the micro (exam room) and macro

(public) healthcare level

.

Focus your study

• The material from your certifying

body that is sent via mail or

available on the agency’s website

– Outlines exam content in detail – At the same time, you will not be

tested on every topic area listed.

• Be well prepared to exercise the

full scope of NP skills.

Focus your

study on…

• Subjective

–History-taking

skills

–Symptom

analysis

Focus your

study on…

• Objective

–Normal PE

findings

–Abnormal PE

findings

(9)

Focus your

study on…

• Assessment

–Differential

diagnosis

Focus your study on…

• Plan

–Broad strokes of intervention

•Drug classes rather than specific

products p

–ACEI (-pril) - Lisinopril vs. trandolapril –Fluoroquinolones - Ciprofloxacin vs.

moxifloxacin

–Progestins - Levonorgestrel vs. desogestrel

50  2011 Fitzgerald Health Education Associates, Inc.

Broad strokes of intervention

(cont.)

• Across drug classes and lifespan

– Pharmacodynamics (PD, what the

drug does to the body and/or disease)

does notdiffer but pharmacokinetics p (PK, what the body does to the drug including absorption, distribution, biotransformation {metabolism}, and elimination) doesdiffer.

Broad strokes of intervention

(cont.)

• Across drug classes (cont.)

– Major drug adverse effects tend to be found consistently across a given drug class and are often consistent with the drug’s mechanism of action.

Focus your

study on…

• Safety issues in medication use

–Who should take

–Who should not

–Consideration in special groups

•Elders

•Pregnancy and lactation •Infants and children

Focus your study on…

• Consider all the roles an NP

fulfills

–Clinician coach teacher

Clinician, coach, teacher,

healthcare leader

–Think micro and macro

healthcare principles.

(10)

Information on exam…

• At least 6

months old!

• “Hot off the

press” issues

not likely

included

Additional resources

• Fitzgerald, M.A. (2010) Appendix:

Answers to Your Most Common

Test-Taking Questions, Nurse

Practitioner Certification

Examination and Practice

Preparation, 3rd Edition,

Philadelphia: F. A. Davis.

Important additional

study resources

• Frequently asked questions, study

recommendations and sample exam questions to aid in preparing for

certification including archives of Margaret certification including archives of Margaret Fitzgerald’s Certification Issues Articles

– Available free of charge at

www.fhea.com/certificationcols/certfaqfhea.shtml

Important additional

study resources

• Archived FHEA electronic

newsletters

– Timely information on pharmacology – Clinical issues of interest to advanced – Clinical issues of interest to advanced

practice nurses

– Available free of charge at

www.fhea.com/ezine_archive.shtml

Important additional

study resources

• Fitzgerald Health Education Associates, Inc. Nurse Practitioner Certification Exam Review and Advanced Practice Update

– FNP, ANP, ACNP, PNP and WHNPFNP, ANP, ACNP, PNP and WHNP review courses available

– More than 50 dates and locations this year

– For details and to enroll, go to www.fhea.biz/nprlive.aspx?BC=home