Upon completion of the Nurse Practitioner program, the NP has to sit for a national certification examination to become licensed to practice as an NP. There are two certification examination available: the AANP and ANCC certification exams. Graduating NPs can sit for either exam. Both are recognized, but they do differ in content and focus. The American Association of Nurse Practitioners is the certifying board for the AANP exam. The American Nurses Credentialing Center offers the ANCC exam. The American Nurses Association (ANA) is the governing body behind the ANCC.
The AANP exam is newer and was considered by many to be “easier” as evidenced by a higher passing percentage in the past, but the ANCC being older was considered by some to be the “better” exam. It was also considered to be “harder,” as the pass rate was slightly lower. The rates have changed in the past 2 years. In 2018, the ANCC pass rate was 86.2% and the AANP rate was 85%. Approval rates judged by those who took the exams are also very close. In 2019, the AANP approval rate for FNPs was 86% and the ANCC approval rate for FNPs was 87.1%.
The focus of the AANP exam is competency and clinical application. It is comprised of 150 questions with the score based on 135 questions. The other 15 questions are being tried out for future exams and are not scored. They are also not recognizable as pre-test questions. The test is scored on a range from 200 to 800 and 500 is considered passing.
The AANP exam is all multiple choice, with only one right answer. It is more focused on clinical knowledge and competency. FNP (Family Nurse Practitioner), A-GNP (Adult Gerontology NP) and ENP (Emergency Nurse Practitioner) certifications are available with the AANP certification exam. The AANP exam is best recommended to those who will be practicing in clinical settings as opposed to research or education, where theoretical knowledge would be the strength.
For the FNP and A-GNP specialties, the questions on the AANP exam will be entirely clinical and cover competency in Assessment, Diagnosis, Plan and Evaluation. For the ENP, the certifying exam will also include questions on medical screening, patient management, medical decision making (DDx), patient disposition and professional, ethical and legal practices. All other NP specialties must take the ANCC exam.
The AANC offers the ANCC certification exam for NPs. In 2019, the ANCC exam was updated to include more clinical questions and fewer focused solely on nursing theory and the professional role of the NP. There are 175 questions and again 15 are pre-test questions that are not scored. The exam is given over 3.5 hours. The updated exam covers 10 knowledge areas and 13 skill areas in four content domains: assessment, diagnosis, clinical management and professional role.
The ANCC exam is also multiple choice, but some questions will have only one answer and others will be a “select all of the options that apply.” Additionally, there will be some “hot-spot” questions which require marking a specific area on an image. This exam also includes images such as EKG strips or physical symptoms and the NP is expected to interpret them and explain what course of action to take and why.
Renewal of the Certification
Both certifying boards require recertification every 5 years. However, the requirements vary and specify continuing education units as well as clinical practice hours. The ANCC requires 75 CE hours with a minimum of 25 CE hours in pharmacotherapeutics. The NP must also complete one or more of the following: minimum of 1000 practice hours in the specialty, take academic credits in the specialty area, provide presentations in the specialty area, participate in publication or research in evidence-based practice or quality improvement, provide professional services as a volunteer, a minimum of 120 preceptor hours, or retake (and pass) the exam.
The AANP certification is also good for 5 years and offers 2 options for additional requirements to recertify. The first option is to complete 1000 clinical hours as an NP and a minimum of 100 CE hours in advanced practice courses including a minimum of 25 CE in pharmacology. The clinical hours can be completed as an employee, a volunteer or as a faculty member. Preceptor hours (125 hours) can be exchanged for a total of 25 CE credits. The second option is to take (and pass) the exam again.
The educational preparation required is the same for all NPs. The choice for certification exam is somewhat optional depending on the specialty. Both exams meet qualifications for working in a Magnet facility as well as meeting the reimbursement guidelines for insurance companies, Medicaid and Medicare. Dedicated study and test prep is a must which ever test you choose or are required to take.