Do you think all practicing NPs are nationally certified? Think again. The majority of states mandate national certification as a requirement for NP practice, but nine do not. These states include the three with the highest number of NPs – California, Florida and New York.
The result is that thousands of NPs in legal, active and productive practice have not yet earned certification. The days of practicing without certification could be numbered, however, because more third-party insurers and other entities are requiring it. In addition, many non-certified NPs are seeking the same documentation of professional achievement as the majority of the nation’s NPs.
At first glance, the professional experience of the seasoned NP appears to be an advantage for the certification candidate. However, since the exams are tests of entry-level NP knowledge, the NP with years of practice may actually find the exam quite challenging. Here are some common questions I hear from practicing NPs who are in the process of preparing for certification.
I have practiced in a specialty area for years. Shouldn’t my depth of knowledge in this area help me while taking the exam?
All NP certification exams are entry-level generalist exams. As a result, in-depth knowledge in one specific area can lead the candidate to look for the “worst case scenario” of a disease state, rather than how it would present in the most common NP practice setting, primary care. For example, the NP in a neurology practice may be most accustomed to seeing the patient with particularly debilitating and difficult-to-treat headache who now requires a complex regimen of abortive and prophylactic intervention. When encountering a certification exam question on headache management, the experienced neurologic NP may be reluctant to choose acetaminophen (Tylenol) as a response to a question about intervention for infrequent, tension-type headache, since this medication is often implicated in analgesic rebound headache when used excessively. Yet, with occasional use, acetaminophen provides a safe, inexpensive and effective headache treatment.
In my NP practice, I can quickly assess a situation and take action. I should get through the exam in no time.
Just like any other candidate, the experienced NP will apply clinical decision-making skills to the test question. However, the speed and ease with which you approach decisions in daily practice may be lacking when you are staring at a test question, a situation that will likely feel artificial to the seasoned NP.
If this were a real clinical scenario, I would need more information before I could come up with a diagnosis and plan. How am I expected to answer a question with what feels like an inadequate database?
This is a particularly vexing problem for the experienced NP. We are accustomed to having a patient record, replete with information, and depend on well-honed history-taking and assessment skills to help pull together the pieces of the clinical puzzle. On an exam, you will encounter a fairly terse clinical scenario containing what the test writers believe is an adequate amount of information to make a decision and choose an answer. Usually, every word of the question has some significance and impacts your choice.
Take a close look at the exam question and reflect on the certifying agency’s test domains. Its purpose is likely to test knowledge of the components of the nursing process – assessment, planning, intervention or evaluation of a health issue. Once you have decided which of these components is being tested, ask yourself, “ Is this question a test of the ability to gather subjective or objective information? Or is the question a test of the ability to develop a diagnosis or to plan a course of intervention?” Your answers will help focus your thought process as you chose the answer.
In my practice, I sometimes treat a given condition in one patient with a particular intervention, while a different intervention is more appropriate for another patient with same condition. How can I know what is the “right way” to develop a plan of care for the NP certification exam?
Become familiar with nationally recognized standards of care for common primary health care problems such diabetes mellitus (American Diabetes Association, www.diabetes.org) and dyslipidemia (NCEP ATP III, www.nhlbi.nih.org). These standards are based on evidence and expert opinion and should guide your practice as well as your exam question responses.
In my practice, I see that a single disease can present in a variety of ways. How can a test question possibly be written to reflect this?
Because the certification exam is written to test the knowledge base of the novice NP, the exams tend to focus on the classic, rather than the atypical, presentation of disease. Reviewing a health assessment text can help refresh your memory on the classic presentation of disease.
Facing an NP certification exam as a seasoned provider can be seem daunting, but passage can lead to additional professional credentials and is a measure of higher achievement.
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This article originally appeared in my quarterly certification column in Advance for Nurse Practitioners and is made available here by the courtesy of Advance. For other articles of interest to Nurse Practitioners, be sure to subscribe to this outstanding journal.