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

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1 Fitzgerald Health Education Associates, Inc. s Preparing for NP Certification: Setting the stage for success Developed and presented by: Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, F, CSP 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 ANP, FNP, GNP certification American Nurses Credentialing Center ANP, FNP, GNP, ACNP, PMHNP certification 2011 Fitzgerald Health Education Associates, Inc. 2 and 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 Certification is the process by which a nongovernmental agency or an association grants recognition to an individual who has met certain predetermined qualifications Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 4 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 ed role and clinical area of practice, based on pre-determined standards. Source Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 6 1

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- Per 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 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 8 Age Parameters for Practice per, FNP, ANP Certification (150 questions) Family NP Lifespan Adult NP Gero NP Per Age =>55 y Age 13 y- elder Per Age =>65 y Domains of Practice Theoretical Foundations of Advanced Nursing Practice (Foundations of Advanced Nursing Practice) Examples- Therapeutic communication, health promotion, influences affecting care of individuals and families (psychosocial, socioeconomics, cultural/spiritual), teaching/guidance # items FNP ANP (25%) (~23%) 2011 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 10 FNP, ANP Certification FNP, ANP Certification Domains of Practice Professional Role Examples- Healthcare ethics, scope and standards of advanced practice nursing, advocacy, legal, safety and ethical issues # items FNP ANP (15%) (14%) Domains of Practice Healthcare Policy and Delivery Examples- Documentation, regulatory and reimbursement issues, informatics, access to care and healthcare policy Clinical Assessment (Health Assessment) Examples- Clinical assessment (health assessment), risk analysis, advanced diagnostic reasoning # items FNP ANP (10%) (~11%) 30 (20%) 34 (~23%) 2011 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 12 2

3 FNP, ANP Certification Domains of Practice Clinical Management Examples- Evidence based practice, advanced clinical decision-making, pharmacotherapeutics, clinical therapeutics, coordination of care, health promotion/maintenance and disease prevention # items FNP ANP (30%) (30%) % of total examination (135 questions) Assessment= 33% (~45 questions) Obtain subjective patient information including relevant medical, social and family history, chief complaint, history of present illness, and review of systems to determine health needs and problems. Interviewing patient/family/ appropriate others, reviewing records, identifying health and medical risk factors 2011 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 14 Assessment continued Obtain objective information based on patient age and health history to further define health needs and problems. Performing physical examination, ordering/ performing/supervising diagnostic tests, ordering/performing/ supervising appropriate screening tests Diagnosis= 26% (~35 questions) Formulate differential diagnoses. Synthesizing and analyzing subjective/objective information, prioritizing potential diagnoses 2011 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 16 Diagnosis (continued) Establish definitive diagnoses. Ordering, performing, supervising, and interpreting additional diagnostic tests Performing and interpreting additional physical examinations, synthesizing and analyzing additional information Plan= 23% (~31 questions) Establish the plan of treatment/care in order to address the diagnoses. Ordering, performing, supervising, and interpreting further tests 2011 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 18 3

4 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 Plan (continued) Providing for appropriate follow-up, including patient/family/appropriate others as active participants 2011 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 20 Evaluate= 18% (~24 questions) Determine the effectiveness of plan of treatment/care teat e t/caebased on outcomes by: Reviewing patient responses(s), collecting additional subjective/objective information as needed Evaluate (continued) Modify the plan of treatment/care based on outcomes Ordering, conducting, supervising, and interpreting further tests, adjusting therapies 2011 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 22 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 Computer-based, year-round Test availability Computer-based, year-round 2011 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 24 4

5 175 questions including 25 sample items, 3.5 hour time frame. Additional 30 mins allotted for check in, time for practice tutorial to learn about computer system. Length of test 150 questions including 15 sample items, 3 hour time frame. Additional mins allotted for check in, time for practice tutorial to learn about computer system. Availability of results Results provided, Results provided, pass or fail, at end pass or fail, at end of the examination of the examination 2011 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 26 National recognition for licensure Yes Yes According to area of certification; FNP-BC, ANP-BC, GNP-BC Credential For all areas of certification, NP-C 2011 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 28 Passing score =>350/500 =>500/800 Typical percentage of examinees who pass the examination Historically, ~ 82-91%, depending on area of certification Translates to a score of 350 (minimum passing score) = ~9 th %tile to 18 th %tile ~ 88% for ANP, 93% for FNP (2009). Translates to a score of 500 (minimum passing score) = ~7 th %tile for FNP, 12 th %tile for ANP 2011 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 30 5

6 Procedure if failure Recertification every 5 years Apply to retest after 60 days (formerly 90 days) Apply to retest, 15 h CE prior to retesting Practice hours plus CE hours and select professional activities Practice hours plus CE hours 2011 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 32 NP certification True or false? Certification part of APN licensure in nearly all of the US states Exceptions Colorado (issue with Rx authority) Kansas New York North Dakota Oregon California On the national NP certification exam, you should expect to find specific questions on your state ss APN practice act Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 34 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 or, this person can now practice as a nurse practitioner Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 36 6

7 With All Certification Exams With All Certification Exams Think Entry-level NP practice Evidence-based practice Nationally and (EBP) defined- The delivery internationally of individualized healthcare recognized standards of on the basis of an awareness care and clinical of the impact and strength of guidelines, evidence- related scientific evidence* based practice (EBP) Examples - ADA for DM - NAEPP EPR-3 for asthma - JNC-7 for HTN - NCEP ATP III for dyslipidemia * The broad stroke of practice Not the mix you see in a typical clinical day Common Not an diseases examination of occur the esoteric commonly For ANP, FNP, GNP - As much thyroid as DM - As much male GU as female GYN For ANP - As much teen as elder Most nursing practice at the RN level is one of exceptions rather than rules Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 38 The NP certification examination tests your ability to know Why a patient is at risk for a problem. How a clinical problem has developed. What is the most likely clinical presentation of the condition? 2011 Fitzgerald Health Education Associates, Inc. 40 Why a given intervention is effective. 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 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 42 7

8 Therefore What is the role of the NP on the overall health of the nation and beyond? A poor approach to preparing for the exam and practice is to Memorize information so you know what to do but not why you are doing it, in both the exam room and as part of the larger healthcare system Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 44 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 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 46 Subjective History-taking skills Symptom analysis Focus your study on Objective Normal PE findings Abnormal PE findings Focus your study on 2011 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 48 8

9 Focus your study on Assessment Differential diagnosis Focus your study on Plan Broad strokes of intervention Drug classes rather than specific products ACEI (-pril) - Lisinopril vs. trandolapril Fluoroquinolones - Ciprofloxacin vs. moxifloxacin Progestins - Levonorgestrel vs. desogestrel 2011 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 50 Broad strokes of intervention (cont.) Across drug classes and lifespan Pharmacodynamics (PD, what the drug does to the body and/or disease) does not differ but pharmacokinetics (PK, what the body does to the drug including absorption, distribution, biotransformation {metabolism}, and elimination) does differ. 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 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 52 Focus your study on 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 Consider all the roles an NP fulfills Clinician, coach, teacher, healthcare leader Think micro and macro healthcare principles Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 54 9

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 Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 56 Important additional study resources Frequently asked questions, study recommendations and sample exam questions to aid in preparing for certification including archives of Margaret Fitzgerald s Certification Issues Articles Available free of charge at Important additional study resources Archived FHEA electronic newsletters Timely information on pharmacology Clinical issues of interest to advanced practice nurses Available free of charge at Fitzgerald Health Education Associates, Inc Fitzgerald Health Education Associates, Inc. 58 Important additional study resources Fitzgerald Health Education Associates, Inc. Nurse Practitioner Certification Exam Review and Advanced Practice Update FNP, ANP, ACNP, PNP and WHNP review courses available More than 50 dates and locations this year For details and to enroll, go to Fitzgerald Health Education Associates, Inc