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Return to table of contentsVI. NP specialty certificationOf great frustration to state nursing boards and theirprofessional association—the NCSBN—has been therefusal of NP organizations, nursing specialty societiesand educational programs to support the creationand administration of a standardized national exam tolicense or certify NPs. 167 Since the early 1990s, whenthe NP profession at last began establishing standardsfor competencies and promulgating scopes of practicefor NPs in the specialties for which they trained, disagreementsover certification have prevailed. Issueshave included who should be in charge of writing theexam(s) 168 and whether state boards of nursing wouldrecognize any or all specialties. In the 1990s, when theNCSBN proposed that it create a national exam, someNP interests accused it of attempting to profit from theproposed exam. 169 NCSBN provoked another uproarin 2006 as it again advocated a single exam that wouldassess whether the newly emerging DNP candidateswould have a breadth of knowledge for licensure, justas all physicians take one national licensure exambefore pursuing separate specialty and/or subspecialtycertification. 170The NCSBN’s 2006 draft Vision Paper: The FutureRegulation of Advanced Practice Nursing sought to radicallyredefine advanced practice nursing by callingfor NPs to receive broad-based education covering allpatient age groups, take a core licensure examinationand complete a residency. 171 Specialty certifications,such as pediatrics or geriatrics, would be obtained bysubsequently attaining competency in the specialty area.The AANP called the NCSBN’s vision paper a “verydestructive document” in its response, 172 and insistedthat “A core examination for NPs will test nothing.Master’s preparation is specialty-oriented and shouldbe evaluated as such.” 173 The AANP argued that theNCSBN’s paper set double standards for the APN communityby recommending significant changes in NPeducation and licensing (noted above), yet not requiringthe same for approaches for nurse anesthetists andnurse midwives. 174 The AANP, claiming that all APNsshould be regulated in the same manner, protests institutinga single standardized examination to validate thebasic competence of all NPs regardless of their specialties.In fact, the AANP describes this proposed examas a “double standard” since nurse midwives and nurseanesthetists would not be subject to the same examunder the NCSBN’s 2006 vision paper.The AANP fails to recognize that the many specialtyareas available to NPs in their educational programs andcertifications may in fact contribute to variability in NPcompetence. Undeniably, were this controversy broughtinto the public eye, patients may well be upset to findthat NPs do not share basic across-the-board competenciesas determined by an examination commensurate totheir NP education, as physicians do to their education.Advanced practice, with its attendant privileges in thecare of patients, including examination, assessment,diagnosis and the development of appropriate treatmentplans for patients, requires basic fundamental knowledgeand skills, which can and should be tested in order toassure patients of the minimum competency level oftheir health care provider.167. See, for example, Louisiana State Nursing Board, Credentialing Committee meeting minutes, April 28, 2004. Under the section “General review of transcriptsfor APRN licensure” is the statement, “P. Griener discussed with the Committee the difficulty of reading transcripts and determining what specialtythe individual is eligible to be recognized as. The Committee directed P. Griener to continue to make determinations based on her judgment and if she isunable to determine the specialty then the application should be brought to the Committee for review.” p. 2. www.lsbn.state.la.us/documents/Agenda/credmin042804.pdf. Retrieved April 1, 2008.168. Web. NCSBN. Using Nurse Practitioner Certification for State Nursing Regulation: A Historical Perspective. 1998. www.ncsbn.org/938.htm. RetrievedApril 1, 2008.169. Id.170. Nelson R. NCSBN vision paper ignites controversy. American Journal of Nursing. July 2006, Vol. 106, No. 7, 25–26. www.nursingcenter.com/library. RetrievedApril 1, 2008.171. National Council of State Boards of Nursing. Executive Summary, Vision Paper: The Future Regulation of Advanced Practice Nursing (2006) [draft].Interestingly, this paper cannot be located on the NCSBN Web site, but can be found on several nursing organization Web sites, including the NationalCertification Corporation site, www.nccnet.org/public/files/APRNVisionPaper.pdf. Retrieved March 31, 2008.172. Web. American Academy of Nurse Practitioners comment on NCSBN Vision Paper. http://aanp.org/NR/rdonlyres/6798FC8F-09F9-4D59-A048-916257226E67/0/NCSBNVisionCertStatement.pdf#search=”vision paper” Retrieved March 1, 2008.173. Id.174. Id.Scope of Practice Data Series: Nurse practitioners • VI. NP specialty certification35