Return to table of contentsFor NPs, it began awarding certification in 1980, 207 andit is the only certifying organization for those who havecompleted an NP program with a specialty in women’shealth care or neonatal care. The credential conferredby passing the exam is “registered nurse certified”(RNC). The ABNS has not accredited NCC’s exams, 208but NCC is accredited by the NCCA. Because thisscope-of-practice module focuses on primary care qualifications,this section discusses NCC’s women’s healthcare NP certification exam only.In 2007 the NCC heightened its standards for thoseseeking NP certification for women’s health care andfor the NP programs from which they graduated. 209Previously, the NCC would certify those who hadreceived their NP training through a post-RN certificateprogram; now all exam applicants must be graduatesof a master’s, post-master’s or DNP program. Furthermore,the program from which they graduate must beaccredited by either NLNAC or CCNE, whereas NCCformerly accepted graduates of programs accredited bythe National Association of Practitioners in Women’sHealth. 210 As of Jan. 1, 2005, women’s health NP programsmust incorporate standards set forth in Criteria forEvaluation of Nurse Practitioner Programs, second edition(2002). These programs must also file a program compliancedocument with NCC. Women’s health NPs whohave not graduated from such a program and who havelet their certifications expire will now have to returnto school and attain a master’s or DNP. It appears thatthose certificate-only NPs who keep their certificationup to date by meeting NCC’s continuing educationrequirements will retain NCC certification.Today’s applicants for the NCC’s women’s health NPcertification exam must hold current licensure as anRN in the United States or Canada. They must provideproof of graduation from a graduate-level NP program(master’s, post-master’s or DNP) that is accredited byeither CCNE or NLNAC, and they must have graduatedfrom that program after Jan. 1, 2005. Further, in theirNP program, they must have completed 600 clinicalhours. 211 To maintain certification, every three yearsthese NPs must either (1) pass a recertification examinationor (2) provide proof of 45 continuing educationcredit hours, 30 of which relate to the women’s healthspecialty; beginning in 2009 all 45 hours must be in thespecialty. 212 Interestingly, graduates of nurse midwiferyor FNP programs are not eligible to take the NCC women’shealth exam.NCC’s women’s health NP (WHNP-RNC) certificationexam is administered over three hours and contains160 questions (10 of which are unscored). 213 The examcontent is as follows:• Physical assessment and diagnostic evaluation(10–15 percent) addressing health history and physicalexamination; diagnostic studies, laboratory testsand procedures• Primary care (5–10 percent) addressing recognition,basic management and/or referral, common healthproblems, health promotion and patient counseling• Gynecology (35–40 percent) addressing gynecologicalnormal;gynecological deviations; fertility control• Obstetrics (25–30 percent) addressing physiology ofpregnancy; prenatal care, assessment of fetal well-being,complications of pregnancy and postpartum care• Pharmacology (15–20 percent) addressing pharmacokinetics/dynamics;indications, side effects, druginteractions and contraindications; patient education• Professional issues (less than 2 percent), addressingbasic research principles; ethical and legal issues 214In 2006, of those who took the exam, 96 percent passed. 215The variability in specialty certification exam pass rates207. Web. National Association of Nurse Practitioners in Women’s Health. March 30, 2006, letter to NCSBN regarding its 2006 draft vision paper. www.npwh.org/files/public/oppose%20vision%20paper.pdf. Retrieved April 1, 2008.208. Web. American Board of Nursing Specialties. 2008. List of ABNS accredited certification programs. www.nursingcertification.org/exam_programs.htm.Retrieved March 30, 2008.209. NCC decided on this change in 2002 and began publicizing it then to give the NP programs not already in compliance time to change their curricula.210. NPWH’s Web site on March 30, 2008, listed only one institution it had accredited. www.npwh.org.211. Web. NCC. 2008 Nurse Practitioner Exam Registration Catalog, p. 6. www.nccnet.org/public/pages/index.cfm?pageid=68. Retrieved March 30, 2008.212. Web. National Certification Corporation. Maintaining your RNC. www.nccnet.org/public/pages/index.cfm?pageid=102. Retrieved March 30, 2008.213. Web. Fitzgerald Health Education Associates Inc. 2008. Frequently asked questions about NP certification. www.fhea.com. Retrieved March 30, 2008.214. Web. NCC. 2008. The National Certification Corporation 2008 nurse practitioner examination registration catalog. p. 9. www.nccnet.org. RetrievedMarch 30, 2008.215. Web. NCC News, Fall 2007, p. 11. www.nccnet.org. Retrieved March 30, 2008.Scope of Practice Data Series: Nurse practitioners • VI. NP specialty certification42
Return to table of contentsis evident and provides evidence that the NP certificationprocess is fractured, producing separate classes ofNPs without recognized standardized minimum levelsof competence. One need only look to see that in 2006,NP examinees in adult medicine passed their certificationexams at very different rates: 79.7 percent (for theANCC exam) vs. 92.8 percent (for the AANP exam).Furthermore, with more than one agency offering specialtycertification, exam content varies. Indicatorsof psychometric reliability from one exam cannot beconferred to examinees of another exam. Issues suchas these would not be alarming if the NP certificationexam were optional. However, NP specialty certificationis the cornerstone requirement not only for NPlicensure, but also to define the scope of practice withinwhich an NP practices. Therefore, it is of the utmostimportance that NP certification exams be as accurateand reliable a predictor of clinical competency as possible.The refusal of the NP profession to remove barriersto competency assurance—such as unifying existingcertification exams or instituting a national licensingexam—indicate an unwillingness to address the largescaleassurance of NP competency.Organizations in nursing do not offer a response as tohow the current certification process—with its multipleboards and varying exam content and pass rates—benefitspatients or the public. Given the significant patientcare responsibilities NPs seek to obtain, shouldn’t NPsbe subject to uniform standardized testing and scrutiny,as physicians are? Without such standardized competencytesting, how are patients assured that the NP oftheir choice has acquired the basic knowledge and skillsrequired to competently provide care?Scope of Practice Data Series: Nurse practitioners • VI. NP specialty certification43
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