Steps to become ER NP?

BostonRN13 · Jan 26, 2014

1. Get a job in ER as an medical assistant/ nurses aide during nursing school

2. Get a job as RN in ER with your connections

3. Get into NP school ( I would say get FNP since you can treat across lifespan) and try to find an MD or NP in your ER that will be willing to precept you for clinicals.

I'm not familiar with ER certifications but apply for theses and obtain. Attend conferences..

Good luck..

jamiejo05 · Jan 26, 2014

I worked in an ICU and CVICV for 6 yr while getting my BSN and MSN as an FNP. Three months before graduation I applied to ERs in the area and was hired. After practicing for two years as an ER NP (ENP-BC) I can apply.

Per the ANCC; Have practiced the equivalent of 2 years full time as a nurse practitioner in the past 3 years

Have a minimum of 2,000 hours of advanced practice in the specialty area of emergency care in the past 3 years

Have completed 30 hours of continuing education in advanced emergency care in the past 3 years

Fulfill two additional professional development categories, to be selected from the following list:

Academic Credits

Presentations

Publication or Research

Preceptor

Professional Service

Good luck!!

nomadcrna, DNP, CRNA, NP · Jan 27, 2014

I would absolutely not recommend the ANCC portfolio review. It need some major changes.

as it is, it means squat. You don't need it to practice and it certainly does not validate your capabilities as an ER provider.

MedictoRN · Jan 27, 2014

I would absolutely not recommend the ANCC portfolio review. It need some major changes. as it is it means squat. You don't need it to practice and it certainly does not validate your capabilities as an ER provider.[/quote']
While you don't need it to practice, in fact you need two years of practice before applying, I would highly recommend it. It shows dedication, and clinical expertise in your area of practice expertise. Follow the directions in the ENP content outline and you will do fine. Just be sure to address each topic to the best of your ability.

nomadcrna, DNP, CRNA, NP · Jan 27, 2014

It is a waste of money for a couple of reasons.

1. You don't need it to practice

2. It does more to validate issues that have no bearing on how you are as an ER practitioner.

3. Do you even want a validation that that does not have any measurement of YOU, as a ER provider?

Simply putting in time (2 years) does not make you a ER provider. If that were the case, how many NPs working in an urgent care attached to the ER are able to do the portfolio review?

I had hopes for it but the ivory tower people screwed it up. We need something that DOES validate us as quality ER providers.

Maybe MedictoRN would tell us why he thinks this portfolio review validates someone? Why does he think it validates your clinical expertise as a ER provider? Does it show in any way, shape or form that you can manage a trauma? How about treating an acute MI? CVA? How about using US to check for pericardial tamponade? Finger thoracostomy for blunt chest trauma, why?

Current best practice for managing fluids in a septic patient?

The Pas also have to put in 2 years but then actually take a test. Maybe the ANCC should offer that has well? This would do a much better job of validation.

The ANCC places more emphasis on being culturally sensitive and narrative essays than your actual quality and knowledge.

I was totally surprised to receive so many personal PMs and emails from NPs who had the same issues and feel the same way about the ANCC review and cert.

MedictoRN · Jan 27, 2014

It is a waste of money for a couple of reasons. 1. You don't need it to practice 2. It does more to validate issues that have no bearing on how you are as an ER practitioner. 3. Do you even want a validation that that does not have any measurement of YOU as a ER provider? Simply putting in time (2 years) does not make you a ER provider. If that were the case, how many NPs working in an urgent care attached to the ER are able to do the portfolio review? I had hopes for it but the ivory tower people screwed it up. We need something that DOES validate us as quality ER providers. Maybe MedictoRN would tell us why he thinks this portfolio review validates someone? Why does he think it validates your clinical expertise as a ER provider? Does it show in any way, shape or form that you can manage a trauma? How about treating an acute MI? CVA? How about using US to check for pericardial tamponade? Finger thoracostomy for blunt chest trauma, why? Current best practice for managing fluids in a septic patient? The Pas also have to put in 2 years but then actually take a test. Maybe the ANCC should offer that has well? This would do a much better job of validation. The ANCC places more emphasis on being culturally sensitive and narrative essays than your actual quality and knowledge. I was totally surprised to receive so many personal PMs and emails from NPs who had the same issues and feel the same way about the ANCC review and cert.[/quote']
I respectfully disagree.
By your logic no certification is of any value. How does a test evaluate anything any better than the portfolio? It certainly doesn't validate your ability to manage a critically ill multi system trauma patient any better.
Portfolio review is a scientifically and psychometrically validated process that involves actual content experts (practicing Emergency Nurse Practitioners)
that has been shown to be as good at evaluating candidates for certification as a written test.
I'm sorry you weren't successful in your application. I would be disappointed too. But just because you didn't submit sufficiently rigorous documentation doesn't invalidate a psychometrically sound certification process.

nomadcrna, DNP, CRNA, NP · Jan 27, 2014

Lol. I was waiting for that. Nice try at a dig. I have a thick skin.

So here you have someone who:

1. Has a doctorate

2. CRNA and FNP certification

3. ER education which includes a 2 year certificate program taught through a medical school. Students are MDs, PAs and NPs

4. way over the requirements. Anotherwards score high in all areas but one (exemplar telling how good you are).

5. Way, way over the requirements for semester hours, ceus and even public service years.

yet you say this test validates you as a ER provider? You seem to have your feelings hurt because I posted my experience with the process. I think people need to know and understand the process and what it's deficiencies are. This is how it will change and improve so that it will actually validate us as emergency medicine providers. We are being laughed at by the MDs and yes even the PAs who have to validate by taking a test.

Have you been through the process? Do you have any vested interest in the process? If you have been through the process, we can debate the pros and cons. It is very black and white in my eyes.

we need to do what is best for our profession. I am very passionate about this. This validation process hurts us more than helps.

MedictoRN · Jan 27, 2014

Lol. I was waiting for that. Nice try at a dig. I have a thick skin. So here you have someone who: 1. Has a doctorate 2. CRNA and FNP certification 3. ER education which includes a 2 year certificate program taught through a medical school. Students are MDs PAs and NPs 4. way over the requirements. Anotherwards score high in all areas but one (exemplar telling how good you are). 5. Way, way over the requirements for semester hours, ceus and even public service years. yet you say this test validates you as a ER provider? You seem to have your feelings hurt because I posted my experience with the process. I think people need to know and understand the process and what it's deficiencies are. This is how it will change and improve so that it will actually validate us as emergency medicine providers. We are being laughed at by the MDs and yes even the PAs who have to validate by taking a test. Have you been through the process? Do you have any vested interest in the process? If you have been through the process, we can debate the pros and cons. It is very black and white in my eyes. we need to do what is best for our profession. I am very passionate about this. This validation process hurts us more than helps.[/quote']
I'm sorry you thought it was a dig. That was not my intention in any way. You seem well qualified, so the only assumption I can make us that you didn't present these qualifications clearly enough for the reviewers.
Do I think some things could be tweaked, yes. Do I think these tweaks invalidate the process, absolutely not.
I have been through the process and present this and all of my certifications proudly. This certification will be sought after by managers and employers much like CEN and other certifications are for RNs.
I would like to see what specifically the outline is asking for that you think aren't important parts of being an ENP? That probably needs it's own thread as we've sort of derailed this one.

nomadcrna, DNP, CRNA, NP · Jan 27, 2014

Happy to oblige when I get home and off this ipad.

no offense but your previous post in another thread made me think that you did not really understand the process. Would you mind if I verify your ENP certification? You can pm me if you like.

on the managers looking for a portfolio assessment. It will probably help bit to the the uninformed but to our peers, other nps, pas and md, they will know it for what it is. It is NOT an objective test that measures your knowledge.

Anyway, more when I get home

nomadcrna, DNP, CRNA, NP · Jan 28, 2014

Until they change it, I will continue to recommend against it. Hopefully the AANP will come out with an objective evaluation such as a test.

It is a waste of $470 at this point.

It is meaningless as it does not evaluate your competency as a ER provider.

It is laughed at by our PA and MD peers when they find out what it entails to get it. I don't blame them. Ask the PAs what they have to do to get their ER certification.

So, the worthless items in this portfolio review.

1. Presentations

2. publication or research

3. preceptorship

4. Professional service.

This is why I failed.

EXEMPLAR

The applicant’s narrative provides evidence of innovation and excellence in his or her specialty practice area

related to the four domains. Narratives must relate to the client population for the certification specialty area.

Applicants should provide specific aspects of their practice to describe the criteria listed in the domains below.

The exemplar should incorporate aspects of reflective practice in the exemplar that highlights areas of their

practice as it relates to the domains. A detailed description of the performance evaluation requirements for

each specialty can be found on the ANCC website at http://www.nursecredentialing.org/certification.aspx#specialty.

Applicants must include evidence of all of the criteria for the Professional and Ethical Nursing Practice, Team

Work and Collaboration, and Quality and Safety domains listed below. The applicant can include additional

information to enhance the Professional Development domain; however, it is not required in the narrative.

Applicants must use the Exemplar Template in the online application.

Note: The exemplar narrative cannot exceed 8,000 characters (approximately 1,250 words)

Do you really think this makes much difference as a ER practitioner? I don't.

I know many very competent ER NPs who have no interest in community service or publication. Should they be dinged because they don't want to teach and give presentations?

Does this measure your capability as a ER provider? Absolutely not.

In my case, you have someone who very educated in ER medicine as well as other specialties which obviously help. Score HIGH in all areas except the exemplar. The exemplar is scored at 52% of the total score. REALLY? Why not score academics, CEU or actual issues that affect practice?

I put this out there so they will hopefully improve it. It is very obvious that the ivory tower educators developed this. None of the ER NPS actually doing ER medicine agree or had anything to do with it.

I'm going to post what I applied with.

CEU

[TABLE=width: 714]

[TR]

[TD]Diagnosis and Treatment of Atrial Fib in the Acute care setting[/TD]

[TD]AANP[/TD]

[TD]May 09, 2012[/TD]

[TD=align: right]1.00[/TD]

[TD=align: left][/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[TR]

[TD]New Onset Severe Headache, assessment, diagnosis and treatment[/TD]

[TD]AANP[/TD]

[TD]Feb 05, 2012[/TD]

[TD=align: right]0.75[/TD]

[TD=align: left][/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[TR]

[TD]COPD: Diagnosis and Management[/TD]

[TD]AANP[/TD]

[TD]Feb 05, 2012[/TD]

[TD=align: right]1.00[/TD]

[TD=align: left][/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[TR]

[TD]Swollen Hand - Assessment, diagnosis, treatment[/TD]

[TD]AANP[/TD]

[TD]Feb 05, 2012[/TD]

[TD=align: right]0.75[/TD]

[TD=align: left][/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[TR]

[TD]Diarrhea - Assessment, diagnosis, treatment[/TD]

[TD]AANP[/TD]

[TD]Feb 05, 2012[/TD]

[TD=align: right]0.75[/TD]

[TD=align: left][/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[TR]

[TD]Type II DM - Assessment, treatment[/TD]

[TD]AANP[/TD]

[TD]Nov 29, 2011[/TD]

[TD=align: right]0.75[/TD]

[TD=align: left][/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[TR]

[TD]Asthma - Assessment, Diagnosis, Treatment[/TD]

[TD]AANP[/TD]

[TD]Nov 29, 2011[/TD]

[TD=align: right]0.75[/TD]

[TD=align: left][/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[TR]

[TD]Diabetes - Assessment, treatment[/TD]

[TD]AANP[/TD]

[TD]Nov 27, 2011[/TD]

[TD=align: right]0.75[/TD]

[TD=align: left][/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[TR]

[TD]Pharmacologic Agents for Type 2 Diabetes[/TD]

[TD]AANP[/TD]

[TD]Jun 22, 2011[/TD]

[TD=align: right]1.25[/TD]

[TD=align: left][/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[TR]

[TD]Pharmacology for the Acute Care NP[/TD]

[TD]Drexel University[/TD]

[TD]Jan 16, 2013[/TD]

[TD=align: right]45.00[/TD]

[TD=align: left]University Pharmacology Course. 3 semester hours.[/TD]

[TD=align: left][/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[TR]

[TD]Antibiotics: Pharmacology Review[/TD]

[TD]AANP[/TD]

[TD]Jun 23, 2011[/TD]

[TD=align: right]3.00[/TD]

[TD=align: left][/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[TR]

[TD]Pediatric Dermatitis[/TD]

[TD]AANP[/TD]

[TD]Jun 24, 2011[/TD]

[TD=align: right]1.25[/TD]

[TD=align: left][/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[TR]

[TD]Antibiotic resistant pathogens: Acute Care[/TD]

[TD]AANP[/TD]

[TD]Jun 25, 2011[/TD]

[TD=align: right]1.25[/TD]

[TD=align: left][/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[TR]

[TD]Chronic Heart Failure: 2011[/TD]

[TD]AANP[/TD]

[TD]Jun 26, 2011[/TD]

[TD=align: right]1.25[/TD]

[TD=align: left][/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[TR]

[TD]Acute Respiratory Distress syndrome[/TD]

[TD]AANP[/TD]

[TD]Jun 26, 2011[/TD]

[TD=align: right]1.25[/TD]

[TD=align: left][/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[TR]

[TD]Chronic Cough[/TD]

[TD]AANP[/TD]

[TD]Nov 20, 2010[/TD]

[TD=align: right]1.00[/TD]

[TD=align: left][/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[TR]

[TD]Chest Pain- ER presentation: assessment, diagnosis, treatment[/TD]

[TD]AANP[/TD]

[TD]Oct 23, 2010[/TD]

[TD=align: right]0.75[/TD]

[TD=align: left][/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[TR]

[TD]Cardiovascular and Hematologic emergencies[/TD]

[TD]West Virginia University[/TD]

[TD]Sep 10, 2012[/TD]

[TD=align: right]30.00[/TD]

[TD=align: left]West Virginia University Emergency Medicine program. 2 credit hours[/TD]

[TD=align: left][/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[/TABLE]

Academic Credits - This is only part of the program. There were more academic credits as part of the ER program.

Subject Matter/Course ContentName Of Sponsors/ Institutuion ProvidersOffered DateAcademic CreditsSpeciality Focus Neurologic, Psychiatric, Eye, and ENT emergencies West Virginia University Emergency Medicine program 8/13/20122.00 NoEditDelete

Cardiovascular and Hematologic Emergencies West Virginia University Emergency Medicine program 8/13/20122.00 NoEditDelete

Environmental Emergencies West Virginia University Emergency Medicine program 8/26/20132.00No EditDelete

Toxicology and Dermatologic Emergencies West Virginia University Emergency Medicine program8/26/20132.00 NoEditDelete

Evidences Based Emergency Medicine West Virginia University Emergency Medicine program8/26/20131.00 NoEditDelete

Community Service

[TABLE=width: 714]

[TR]

[TD=align: left]Organization[/TD]

[TD=align: left]Type Of Service[/TD]

[TD=align: left]Start Date[/TD]

[TD=align: left]End Date[/TD]

[TD=align: left] [/TD]

[/TR]

[TR]

[TD]Ronan Police Dept.[/TD]

[TD]Tactical Medicine Support[/TD]

[TD]10/1/2007[/TD]

[TD]9/1/2013[/TD]

[TD]Edit[/TD]

[TD]Delete[/TD]

[/TR]

[/TABLE]

MedictoRN · Jan 28, 2014

Until they change it, I will continue to recommend against it. Hopefully the AANP will come out with an objective evaluation such as a test.
It is a waste of $470 at this point.
It is meaningless as it does not evaluate your competency as a ER provider.
It is laughed at by our PA and MD peers when they find out what it entails to get it. I don't blame them. Ask the PAs what they have to do to get their ER certification.

Portfolio review is an objective evaluation that has been psychometrically validated. While it may not validate that you are a good ER provider (no measure short of actually watching you work does), it does demonstrate rigorous expertise and leadership as an Emergency Nurse Practitioner. None of my MD or PA peers have laughed at it. I hardly think that the requirements for the PA CAQ are any more rigorous than the ENP portfolio. Again, tests are not the end all and be all of validating proficiency.

So, the worthless items in this portfolio review.
1. Presentations
2. publication or research
3. preceptorship
4. Professional service.
This is why I failed.

You said you failed the Professional and Ethical Nursing Practice section.

If you read the quote below you will see that the evidence for certification can come from the CV, certifications, professional development record AND/OR exemplar for all but one of these sections. The section that says that it can only come from the exemplar and not elsewhere is highlighted below. This is the case study. The rest of this section discusses such things as prioritization, regulatory guidelines, ethics, developmentally appropriate care, public health, prehospital care, peer review, process improvement, rapidly changing physiologic status, MSE, decompensation, etc.

These all seem pretty important for an ENP to have the ability to demonstrate sufficient achievement in at least a majority of.

II. Professional and Ethical Nursing Practice

The ENP is to provide evidence in certifications, professional development record, resume, and/or exemplar of:
 Using current best practice in providing developmentally appropriate, culturally sensitive emergency care of acute and chronically ill and injured emergency patients
 Managing and preparing for emergency involvement in public health using current knowledge and local/regional/national guidelines (e.g., disasters, pre-hospital care, divert situations, ER violence)
 Prioritizing patients' immediate needs to provide initial care and respond to the rapidly changing physiological status of emergency care patients (e.g., medical screening examination, risk stratification, decompensating patient)
The ENP is to provide evidence in exemplar (e.g. case study) of:
Assessing, treating and dispositioning emergency patients using current Knowledge and skills including rationale

Performing a history based on chief complaint/presenting problem
Utilizing a review of systems inclusive of pertinent positives and negatives

Performing a physical examination

Formulating appropriate differential diagnoses
Initiating, performing, and interpreting diagnostic tests/procedures
Prescribing evidence-based treatments, therapies, and procedures weighing risk and benefits
Systematically re-evaluating patient status and responses to treatment
Recognizing and initiating appropriate and timely consultations

Utilizing complex data and information obtained during interview, examination, and diagnostic procedures in identifying diagnoses

Determining a diagnosis at the time of disposition

Developing an appropriate discharge plan considering patients, families, groups, communities, and institutions
The ENP is to provide evidence in certification, professional development record, resume, and/or exemplar of:
 Participating on an on-going basis in self and peer evaluations to determine strengths and opportunities for improvement in the context of career development and continuous professional development related to emergency care (e.g., peer review, annual review, credentialing letter, chart audits)
 Modeling behaviors that support ethical decisions and actions in emergency care (e.g., participating in IRB, participating in ethics committees, considering ethics in problem solving within emergency care situations, advanced directives)
 Demonstrating and integrating regulatory guidelines in the context of emergency care (e.g., patient management, documentation, compliance training, forensic evidence, EMTALA, COBRA)

Do you really think this makes much difference as a ER practitioner? I don't.
I know many very competent ER NPs who have no interest in community service or publication. Should they be dinged because they don't want to teach and give presentations?
Does this measure your capability as a ER provider? Absolutely not.
In my case, you have someone who very educated in ER medicine as well as other specialties which obviously help. Score HIGH in all areas except the exemplar. The exemplar is scored at 52% of the total score. REALLY? Why not score academics, CEU or actual issues that affect practice?
I put this out there so they will hopefully improve it. It is very obvious that the ivory tower educators developed this. None of the ER NPS actually doing ER medicine agree or had anything to do with it.
I'm going to post what I applied with.

I agree you seem well qualified.

The exemplar is NOT 52% of the total score. Professional and Ethical Nursing Practice is. Again this can come from a variety of areas in the application and not just the exemplar, in fact only a small part of it seems to come from there.

As for the AANP creating a certification exam, I highly doubt it. The ENA and ANCC considered this and found that the demand was insufficient to warrant the costs associated with test generation. I doubt the AANP will find differently.

I fully support this certification.