When Do the NP Certification Exams Change?

Note: This blog post was updated on March 4, 2019, to reflect a significant change in the blueprint for the ANCC exam for FNPs that will take effect May 22, 2019.

The concerns surface every year: questions about rumored “new” versions of the AANP and ANCC certification exams for FNP and AGNP candidates. Worried students want to know whether it’s true that a completely new exam will be introduced—and even more importantly, whether this “new” exam will reflect the material they have been studying. If you’re one of these frantic students, stop and take a breath. We’re here to clear things up.

The FNP and AGNP exams from AANP and ANCC contain questions that are evaluated for validity and reliability on an ongoing basis. In any given year, the questions contained on the certification exams undergo a validation process using currently available references and clinical guidelines.

For example, AANP’s FAQ document for certification states that AANP exam questions used in 2018 were written in 2017. Thus, the questions on the 2018 exams were referenced with clinical guidelines available at the time of exam question preparation in 2017. So, for the 2019 AANP exams, it follows that questions were referenced with clinical guidelines available at the time of exam question preparation in 2018. An important reminder: new guidelines are NOT published annually for many health conditions, and thus changes may not be substantive on some topics. Remember, too, that standards for the treatment of common diagnoses such as diabetes are updated annually.

Let’s take a closer look at how each certifying body constructs its exams.

How Are AANP Exams Developed?

The AANP Certification Board (AANPCB) is an independent nonprofit entity that administers board certification exams for FNPs, AGNPs and emergency nurse practitioners. As reported in the AANPCB FNP & AGNP Certification Candidate Handbook, exams administered to FNP and AGNP candidates are developed and maintained by AANPCB in partnership with a contracted test development organization. This organization’s program director and psychometric consultants help ensure that psychometric principles and best practices for testing are used, and that national accreditation standards for certification programs are met.

Of importance to NPs preparing to sit for an AANP exam, the handbook states: “New examinations are developed annually for the following year using the current year’s therapeutic guidelines and references.” Appendix D of the handbook edition published in March 2018 provides a reference list of 37 sources. These sources include:

• American Academy of Pediatrics Red Book: 2015 Report of the Committee on Infectious Diseases (2015)
Seidel’s Guide to Physical Examination (2015)
Berkowitz’s Pediatrics: A Primary Care Approach (2014)
Bates’ Guide to Physical Examination and History Taking (2017)
Advanced Practice Nursing Procedures (2015)
Current Practice Guidelines in Primary Care 2017
Ferri’s Clinical Advisor 2017
Sanford Guide to Antimicrobial Therapy 2017
Clinical Dermatology: A Color Guide to Diagnosis and Therapy (2016)
Advanced Practice Nursing in the Care of Older Adults (2014)
Current Medical Diagnosis & Treatment, 2016 and 2017 editions
Mosby’s Diagnosis and Laboratory Test Reference (2015)

The list of references is available in the free handbook available the following link: https://www.aanpcert.org/resource/documents/AGNP%20FNP%20Candidate%20Handbook.pdf

The AANPCB creates panels of certified adult, family, gerontologic and adult-gerontology primary care NPs to serve as subject matter experts and assist in question development for the FNP and AGNP exams. Subject matter experts work in clinical practice and academic environments and are from diverse geographic areas. These panelists must meet requirements for impartiality in education, training and certification. The rigor of the entire exam development process “guarantees quality competency-based certification examinations,” the handbook states.

How Are ANCC Exams Developed?

ANCC is the certifying body associated with the American Nurses Association, and it credentials nurses at many levels and in many specialties. The ANCC certification handbook for FNPs and AGNPs states that ANCC certification exams are updated approximately every 3 to 5 years. The ANCC exam blueprint for FNPs was last updated in 2019, and the ANCC blueprint for AGNPs was last updated in 2017. This means that a new blueprint for AGNP candidates will likely be published between 2020 and 2022.

Test content for the ANCC exams for nurse practitioners is developed using a content expert panel composed of experts in advanced practice nursing. The panelists analyze the necessary professional skills and abilities of FNPs and AGNPs from role delineation studies, which provide evidence for the test content outline.

As reported by ANCC, test questions are written by nurse practitioners and interprofessional content experts who have received training by ANCC staff in writing test items (questions). The items are then reviewed by the content expert panel with the ANCC staff and pilot tested to ensure validity and psychometric quality. Then, they are used as scored items on actual examinations. ANCC follows a variety of guidelines during the development of questions to ensure that they are appropriate for the specialty and certification level (e.g., APRN vs. RN). This includes editing and coding items, referencing items to the approved test content outlines and published references, and screening questions for bias and stereotypes.

Questions for the certification exams are selected based on how well they reflect the test content outline and the recommended item (question) distributions. The validity and reliability of the exams are monitored by ANCC staff members on an ongoing basis.

In March 2019, ANCC’s published reference lists for exam content consisted of 23 published works for the FNP exam and 44 published works for the AGNP exam. These lists included:

  • American Diabetes Association Standards of Medical Care in Diabetes, 2018
  • American Psychiatric Association Diagnostic & Statistical Manual of Mental Disorders, 5th edition
  • ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, 2018

Find the complete reference lists provided for ANCC exam questions at the following links: 
Note the important caveat from ANCC at the start of each of these reference lists: “A number of authoritative texts, such as those listed, are used to develop this certification examination. This list is provided to help you prepare for the examination and is not intended to be all-inclusive.”

Use Blueprints to Guide Your Study

The best way to prepare for the ANCC or AANP exam is to carefully study the blueprint or content outline for the exam you will take. Each certifying body provides this helpful outline on its website. Use these documents to focus your pattern of study: 

• Find the AANPCB blueprint for the FNP exam here: https://www.aanpcert.org/certs/fnp
• Find the AANPCB blueprint for the AGNP exam here: https://www.aanpcert.org/certs/agnp 
• Find the ANCC test content outline for the FNP exam to be used until May 18, 2019, here: https://www.nursingworld.org/~4acd24/globalassets/certification/certification-specialty-pages/resources/test-content-outlines/familynp-tco.pdf
• Find the ANCC test content outline for the FNP exam effective May 22, 2019, here:  https://www.nursingworld.org/~48f9cc/globalassets/certification/certification-specialty-pages/resources/test-content-outlines/familynp-tco-may-222.pdf
 • Find the ANCC test content outline for the AGNP exam here: https://www.nursingworld.org/~4acbba/globalassets/certification/certification-specialty-pages/resources/test-content-outlines/adultgerontologyprimarycare-tco.pdf

The AANP certification handbook explains that the exam blueprints identify the proportion of test questions related to each of the domains and tasks that appear on the certification exams. Exam items on AANP exams are distributed across two domains:
  1. Practice (assessment, diagnosis, plan, evaluate) 
  2. Patient age (developmental parameters). 
The ANCC certification handbook also directs candidates to the ANCC test content outline (blueprint). The ANCC exams for FNPs administered until May 18, 2019, are organized along three domains:
  1. Foundations for advanced practice (37%)
  2. Professional practice (17%) 
  3. Independent practice (46%). 
Starting May 22, 2019, the ANCC exams for FNPs will be organized along these four domains:
  1. Assessment (31 questions, 21% of the exam)
  2. Diagnosis (39 questions, 26% of the exam)
  3. Clinical Management (65 questions, 43% of the exam)
  4. Professional Role (15 questions, 10% of the exam)

The ANCC exams for AGNPs are organized along four domains:
  1. APRN core competencies (16%)
  2. Clinical practice (46%)
  3. Role/professional responsibility (33%)
  4. Healthcare systems (5%). 
Preparation Is Key

In summary, the AANP exams for FNPs and AGNPs are changed to some degree every year. The ANCC exams for FNPs and AGNPs are changed to some degree every 3 to 5 years. Both certifying bodies continually evaluate the validity and reliability of questions. You should examine the test blueprint and reference list for the exam you are taking and organize your study around that information. Consider attending a review course that will help solidify your knowledge in key areas, and use a question book or question bank to practice answering questions written in the style of the exams. Such preparation will serve you well on test day.

For further questions, we encourage you to contact your certifying body. AANP: 512-637-0500 or certification@aanpcert.org. ANCC: 800-284-2378 or certification@ana.org

Do you have a suggestion for a blog topic? Send an email to askamelie@apea.com to let us know. Thanks for reading!

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