ANCC and AANP

Specialties NP

Published

So, I have sent off my application for the ANCC exam and I'm awaiting my approval to schedule my exam. However, should I sign up for BOTH certifying bodies and just risk losing $120 for a cancellation fee from AANP? My husband says no, but the worry wart in me says I should.

I have used three different study guides and test questions to prepare. What do you guys think?

I am envious of your time in OB!

Realistically, around here none of the family docs do OB; if an established female pt shows up with a missed period we can do a urine test, maybe a pelvic, then she is shipped off. We do not do anything related to the pregnancy. We do encourage her to come in for other stuff, so it is nice to know about what may be going on in her body.

I don't mean to be flip; I think it is a shame that care is fragmented the way it is, and hope that things are different in other parts of the country. Several of my classmates had NO hours in OB/gyn. Several had NONE in peds, picked up as much as they could in the family practice setting. It is our loss.

I am envious of your time in OB!

Realistically, around here none of the family docs do OB; if an established female pt shows up with a missed period we can do a urine test, maybe a pelvic, then she is shipped off. We do not do anything related to the pregnancy. We do encourage her to come in for other stuff, so it is nice to know about what may be going on in her body.

I don't mean to be flip; I think it is a shame that care is fragmented the way it is, and hope that things are different in other parts of the country. Several of my classmates had NO hours in OB/gyn. Several had NONE in peds, picked up as much as they could in the family practice setting. It is our loss.

The family docs are educated in OB, they even have to deliver babies in their training. What I really don't get is that some FNP's didn't train in pedes. I guarantee you that every PA program requires clinicals in pedes and OB, so why wouldn't FNP programs? If all these programs can't find enough preceptor sites, then they shouldn't accept so many students into their programs. This is detrimental to the health of our patients.

I didn't have to train in OB or pedes in my Adult NP program and it sounds like the program you're describing is really an ANP program - unbelievable! Where are the certifying bodies? Where are the Boards of Nursing? Why isn't something being done about this? :no:

I think I must have misstated the situation. The program specified experience with pediatric pts (and other groups), however, this could be done in non-specialty settings such as family practice. Adult track students needed to spend time with adolescents and older, which included teens and pregnant women.

My experience was that having the extra edge of a pediatrician as opposed to a family doc was helpful in learning the field. This is true in any field. However, for a basic, entry-level education it was not required.

I maintain that standardization of training would only improve our profession.

I think I must have misstated the situation. The program specified experience with pediatric pts (and other groups), however, this could be done in non-specialty settings such as family practice. Adult track students needed to spend time with adolescents and older, which included teens and pregnant women.

My experience was that having the extra edge of a pediatrician as opposed to a family doc was helpful in learning the field. This is true in any field. However, for a basic, entry-level education it was not required.

I maintain that standardization of training would only improve our profession.

I guess it depends on the patient population seen by the family practice doctors. I work 3 days a week with a large family practice group (4 docs and 2 midlevels). I've been there over a year and the youngest patient I've seen was in his teens and that was for a sports physical. One of the docs saw a 9 year old last week, but only because her mother was sick and she didn't want to take her child to the pediatrician. It's very rare that we even see teens, much less kids. However, I see a lot of adolescents in urgent care, but very few kids (this would be different if there weren't pediatric urgent care clinics located nearby) and we don't see patients under the age of 3. I used to work PRN for a family practice doc and she only saw ages 15 and up, which surprised me, but I'm told this is the case in quite a few family practice settings. I don't know of any family practice doctor who sees OB cases, we refer them out. I've been treating pregnant women in the urgent care setting, but I was recently told that we would no longer see pregnant women for illnesses.

When I attended the FNP program, we were specifically told that we had to work in each specialty b/c they knew we wouldn't be able to get enough training in pedes or OB in family practice (I suppose it's different in rural areas though). From what I've seen, the old time "general practitioner" is a thing of the past.

Regarding the Adult NP program you mentioned, that program included OB? I've never heard of that, both schools I attended had large ANP programs and neither covered OB, only GYN. In fact, that's why I went into the ANP program in the first place, b/c I didn't want to see OB patients or kids!

There was also a similar problem with the FNP exam. They audited a number of FNPs and found out they had not completed all the age range requirements for FNP. One FNP had done their entire clinicals in an aesthetics practice. The consequence was that Texas BON threatened to revoke the certifying agency for NP certification if they didn't check the clinical hours. In reality this is a consequence of not having a specific NP program certifying authority. The consequences to a program that graduated a student like this should be probation at the very least.

David Carpenter, PA-C

Interesting. I know a number of FNP's who didn't get the appropriate training in school. One of them spent the majority of her clinicals with a neurologist who didn't see kids. I'm glad the state of TX has stepped up to the plate and threatened that certifying agency...was it the AANP?

One of the online programs I know of has over 200 students currently enrolled and they aren't even required to precept with board certified physicians (the docs just have to be licensed and they leave it up to the students to get this information). I bet there aren't any online PA programs out there and I bet the PA students aren't required to get their own preceptors either. This whole online NP business is ruining our profession and worse, it puts the public at risk.

Interesting. I know a number of FNP's who didn't get the appropriate training in school. One of them spent the majority of her clinicals with a neurologist who didn't see kids. I'm glad the state of TX has stepped up to the plate and threatened that certifying agency...was it the AANP?

The Texas BON didn't say which one it was, but if you follow the threads here its pretty easy to guess which one clamped down suddenly.

One of the online programs I know of has over 200 students currently enrolled and they aren't even required to precept with board certified physicians (the docs just have to be licensed and they leave it up to the students to get this information). I bet there aren't any online PA programs out there and I bet the PA students aren't required to get their own preceptors either. This whole online NP business is ruining our profession and worse, it puts the public at risk.

There are two programs with a substantial online component (both still require students to find their own preceptors). There was a change in ARC-PA regulations that put in a rule that students should not be required to find their own preceptors. To those unfamiliar with the language this means that this is at odds with the requirements for program certification and extreme measures must be taken to show why this is justified. Usually this precedes a change in policy which says the practice is prohibited. One of the programs is coming up for reaccredidation in 2009 and I'm guessing they are not going to be happy with the result (although both programs now state they will find preceptors if the student is unable to). That being said there is a tremendous problem of being able to find OB sites for male PA students. This is not only a problem for PAs but also medical students and from what I've heard NP programs. I was fortunate to have a good site but most of my male classmates did not. This is one of the areas being examined in the PA content blueprint.

The ARC-PA has very little hesitation to put a program on probation if they don't feel the program is meeting expectations. They also don't hesitate to shut a program down if they are unable to remediate (although this was a problem in the past). The next area that they are probably going to look at is the program length and whether there should be a minimum program length and minimum clock hours in each clinical area (there are two significant outliers here).

Clinical sites are always problematic for programs. With the growth of PA programs, additional number of medical students and NP programs its always competitive. My program had 4 full time faculty (all PAs) whose job it was to find new sites and check on students at their clinical site (this is an ARC-PA requirement). The other thing that argues against students finding their own clinical sites is there is a requirement that students at all clinical sites have the same access to resources and that all policies apply to the student regardless of where they are. If you look at the ARC-PA policy manual it is incredibly specific in what must be taught in the didactic time and what must be covered in clinicals (although not as specific).

The principal problem that I see in NP education to be honest is the student protection. You see a lot of posts here about issues with NP programs that should never happen (although I'm sure there is reporter bias). I'm sure that this happens to in PA programs but its a much smaller problem. A majority of the PA programs that go on probabtion are because of failure to safeguard students rights. The ARC-PA has two missions. The first is to make sure that students are taught the required items and have the required experience. The second part is to make sure that the process of education is fair.

Pinoy alluded to this in his post. If there was a single accrediting agency that looked at the process of NP education then a lot of these problems would disappear. This is also my principal objection to online programs. They allow the program to grow past their ability to provide quality education to the students. This is readily apparent in brick and mortar programs. They also isolate the students which gets in the way of shared experience but also inhibits discussion among the students about problems with the program. Also I don't see the online programs (and to some extent the brick and mortar programs) putting resources that I would expect given the cost of the programs. The 200 person NP program that you mentioned has PA equivalents (ie class size >100 for each year). However the recommended clinical coordinators alone for a class size that larger would be 8-12. This is in addition to all the other suppor staff.

Finally there are three barriers to unsafe practice. The school should not graduate anyone who cannot safely practice, the certification board should not certify anyone who cannot safely practice and the state should not license anyone who cannot safely practice. By eliminating face time in the educational model, you make it difficult if not impossible to to get a good evaluation of the student (in my opinion). This has the potential to let more poor providers into the profession to the detriment of the profession.

David Carpenter, PA-C

David, what do you mean by "protection"?

In addition to phone conferences with preceptors, my school sent out an instructor for site visits once a semester. We also worked with SPs (simulated patients) on the visits to campus and these interactions were videotaped and also evaluated by instructors and the SPs themselves. We got to watch the videotapes and read all the comments.

In terms of being able to "safely practice" it is a matter of where you set the minimum. I get the sense with the nursing profession that it is still trying to establish what it is practicing (specifically, not just "the art and science of nursing"), let alone what an acceptable minimum is.

And I am reminded of the joke about what you call the person who graduates last in his medical school class...

We also worked with SPs (simulated patients) on the visits to campus and these interactions were videotaped and also evaluated by instructors and the SPs themselves. We got to watch the videotapes and read all the comments.

We've had 2 NP students within the past few months at the family practice clinic I work and both of them attend the local online NP program. They also trained on SP's. Trust me, this is not a substitute for the real thing.

One of the students was inserting (more like shoving) open speculums into the lady parts, because she didn't know better. There were complaints from patients and MA's, so the doctor called the school and complained. He just assumed that she knew how to examine a patient and he certainly didn't have time to teach her the basics, so he's no longer willing to serve as a preceptor. At both schools I attended, we practiced on live surrogates and we were checked off on pelvics, PAP's, prostate/rectal exams, full body exams, etc BEFORE we were sent off to work with preceptors. I can't imagine doing it any other way.

Another student with over 25 years of ICU experience had no idea what a carotid bruit was nor where to locate them. She also didn't know anything about heart murmurs or how to grade them. She was precepting with one of the PA's and that PA would give me a detailed report of what she didn't know everytime she was there...I was embarrassed for MY PROFESSION!

All this information is getting around to the physicians, our potential employers, and our profession is getting trashed. Just the other day one of the docs pulled me aside and told me that his patient had seen a NP at a walk in clinic a few days before. The patient had prostatitis and the NP gave him a 3 day course of Bactrim. I reminded him that I would have treated the patient differently and he admitted he knew that I would, but he said, "Look at the REST of those NP's!"

Something else, the ANCC & AANP need to make their exams a lot tougher and they definitely need to ask a lot more questions before they determine whether we're safe to practice on the public. I believe the AANP gives you 3.5 hours to answer 150 questions and that's just ridiculous. There should be more like 500 questions on those exams.

David, what do you mean by "protection"?

As part of the accreditation process the school should be required to show clear standards of expectations and the treatment of students should have defined standards. If the instructor deviates from these standards then there should be a clear route of appeals. This is marginally addressed by the accrediting agencies that credential NP programs but not to the standards of the agencies that address other health care providers (all of which have the sole purpose of accrediting programs for that profession). NP education is unique and different from other nursing education. Shoehorning accreditation within the norms of other nursing accreditation does not serve the profession well.

The other issue of protection is knowledge of the students prior to joining the program. Most professions publish data on graduation rates and board pass rates. I will admit that some of the data is not easily accessible but it is there. Nursing is unique I believe in not collecting much less publishing this data. You can sort of figure out the graduation rates from some of the published data but its very difficult (and fuzzy based on the variable time to finish NP programs).

In addition to phone conferences with preceptors, my school sent out an instructor for site visits once a semester. We also worked with SPs (simulated patients) on the visits to campus and these interactions were videotaped and also evaluated by instructors and the SPs themselves. We got to watch the videotapes and read all the comments.

This should be the expectation. However, none of this is required for an NP program. The better programs do this but what percentage is that? SPs are becoming the standard. How do you do SPs with an online curriculum? All of these elements of assessment are missing for a number of NP programs but the product (students) have the same ability to take the certification exams.

In terms of being able to "safely practice" it is a matter of where you set the minimum. I get the sense with the nursing profession that it is still trying to establish what it is practicing (specifically, not just "the art and science of nursing"), let alone what an acceptable minimum is.

And I am reminded of the joke about what you call the person who graduates last in his medical school class...

The issue of safety for practice is a hard one to define. The best way from the medical model seems to be progressive supervised practice. The person that graduates last in medical school still has at minimum another year of supervised practice before they can be independently licensed. A lot of the medical boards are lookning at progressive supervision models for PAs. More co-signature requirements for new grads decreasing as the PA gains more experience.

David Carpenter, PA-C

You bring up a number of interesting points.

In terms of accreditation it would be nice to have similar and high standards to the other health care professions. I am not advocating kowtowing to another group, but if they do something better I'm all for adopting the model. Plus, some standardization would make other professions more comfortable with nursing. My 0.02.

I guess I am extremely naive when it comes to knowing what other programs do, especially online.

Progressively less supervised practice would be a great idea. I remember talking to a DO who was precepting for me and asking her if she was nervous when she took her boards... then she told me she'd been practicing for a year already. Hmm, I thought, why doesn't that work for NPs? Of course, that would mean finding more preceptors in what seems to be a pretty tight market already.

Joan

You bring up a number of interesting points.

In terms of accreditation it would be nice to have similar and high standards to the other health care professions. I am not advocating kowtowing to another group, but if they do something better I'm all for adopting the model. Plus, some standardization would make other professions more comfortable with nursing. My 0.02.

I guess I am extremely naive when it comes to knowing what other programs do, especially online.

You don't have to kowtow to anyone. NPs simply need to take control of their own profession (OK not really that simple). One NP certification organization and one accreditation organization all with sufficient independence to have credibility. Of course this would take a degree of agreement previously unknown in nursing:rolleyes:. In the end it may end up out of your hands anyway. Medicare has been discussing this, the state BONs have been discussing this, individual states have been discussing this. Eventually someone will make a decision that will force nursing to deal with this (in my opinion).

Progressively less supervised practice would be a great idea. I remember talking to a DO who was precepting for me and asking her if she was nervous when she took her boards... then she told me she'd been practicing for a year already. Hmm, I thought, why doesn't that work for NPs? Of course, that would mean finding more preceptors in what seems to be a pretty tight market already.

Joan

You don't have to have a residency to have progressive supervised practice. For example in my previous practice with a new doc one of the senior docs would go over a set number of charts with them and discuss management and documentation. New docs would frequently consult with the more senior docs on cases. Although even the senior docs would seek out other opinions on complicated cases.

For PAs we used a similar system on chart audits.In Colorado new grads had 100% cosignature for the first six months and 500 hours. There was also a requirement for onsite physician presence for the first 1000 hours. For experienced PAs new to the practice all charts had to be cosigned for the first three months. For other PAs the physician had to meet twice a year and conduct a preformance assessment (no consignature required). This mandated more oversight at the point when the PA was more likely to make a mistake and lessened the oversight as the PA became more comfortable (and presumably more competent).

The problem is not the PA (or NP) its physicians that don't understand the need to collaborate and be available (especially for a new grad).

David Carpenter, PA-C

Specializes in ER, PM, Oncology, Management.
How timely this discussion is occuring now. I graduated from the Univeristy of Illinois in May, with MS, in the FNP track. I mailed my application to ANCC on June 11. I had my transcripts sent directly from the U of I. Didn't hear anything back until the begining of August when I got a letter saying that ANCC had not recieved my transcripts. So I sent them again, this was August 11. I kept waiting, (keep waiting). I had a fellow student that received her letter and has a test date already scheduled. She said that she began calling ANCC two times a day and finally they called her and gave her the confirmation number so she could schedule her test. So I started calling daily.

Wedensday I spoke with the manager of the registars. I was told that she was unable to verify from my transcripts the population focus of the program (across the lifespan primary care). I freaked! I sent her course descriptions and actually contacted the dean of my program. The dean had to fax all the syllabi to ANCC. She told me that ANCC is beinging a more diligent review process.

I am thankful for that, but wonder if it might be better for review to be done between the ANCC and the university in question. This would help new APN graduates in an already stressful time. So here it is nearly 4 months after graduation, no letter, no confirmation number, job waiting for me. The ANCC was really good about cashing my $390.00 check though:banghead:

I just wanted to let you know that I was in a very similar boat. I also had to send extra documents and jump through several hoops to verify my FNP track. Thank goodness I kept all of my clinical logs from my rotations. I have several classmates that didn't.

I graduated early May 2008 and I finally received my authorization to test around the 18th of August. It took 3 1/2 months to receive the authorization.

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