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AANP vs ANCC: Nurse Practitioner Certification

AANP vs ANCC: Nurse Practitioner Certification

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When Nurse Practitioners graduate, they must take a national exam that certifies them to practice in their specific specialty. Once they have this board-certification and obtain their state licensure – they can legally practice as a Nurse Practitioner.

These exams can be likened to the NCLEX-RN that RNs have to take to become a  certified Registered Nurse. The only difference with nurse practitioner certification is that there are TWO to choose from, from two different certifying bodies – so you must choose between the AANP vs ANCC. But what exactly are they?

If you’d rather watch the full video, click the image below!

American Nurses Credentialing Center (ANCC)

The American Nurses Credentialing Center (ANCC) is an independent credentialing branch of the American Nurses Association (ANA) which certifies nurses to become advanced practiced registered Nurse (nurse practitioners!) This is the largest nurse credentialing organization in the U.S. and is not limited to Nurse Practitioners. They also certify nurses in informatics, professional development, case management, and various nursing specialties.

ANCC Exams

Regarding Nurse practitioner certification, the ANCC provides certification for the following specialties:
  • Family Nurse Practitioner (FNP-BC): 175 questions (150 graded)
  • Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP-BC): 150 questions (135 graded)
  • Adult-Gerontological Acute Care Nurse Practitioner (AGACNP-BC): 200 questions (175 graded)
  • Psychiatric-Mental Health Nurse Practitioner (PMHPNP): 175 questions (150 graded)
  • Pediatric Primary Care Nurse Practitioner (PPCNP-BC): 200 questions (175 graded)
The ANCC exams questions will have a majority of clinical assessment, diagnosis, and management, but will have about a 25% or more of non-clinical questions. This means questions on research, ethics, professional responsibility, leadership, the scope of practice, regulatory guidelines, etc. Time allotted is generally about 4 hours – including time for check-in, instructions, and a practice session on the computer. If you fail an ANCC exam, you can retake the exam in 60 days, but you cannot test more than 3 times in 12 months.

Cost

The cost for the nurse practitioner certification exam through the ANCC is $395 for non-members of the ANA, and $295 for members.

ANCC Pass Rates (2018)

The following pass-rates for each ANCC exam are as follows:
  • FNP = 86.2%
  • AGACNP = 89.5%
  • AGPCNP = 79.0%
  • Peds = 85.7%
  • Psych = 88.5%

American Academy of Nurse Practitioners (AANP)

The American Academy of Nurse Practitioners (AANP) is a relatively new organization formed in 2013 for the nurse practitioner certification. Their certification board offers examinations for Nurse practitioners similar to the ANCC, however, there are significant differences between the AANP vs ANCC.

AANP Exams

The AANP currently only has the following three nurse practitioner certification exams:
  • Family Nurse Practitioner (FNP-C)
  • Adult-Gerontology Primary care Nurse Practitioner (A-GNP)
  • Emergency Nurse Practitioner (ENP)
Unlike the ANCC (and a major plus in my personal opinion) is the fact that the AANP exams are 100% clinical. This means it will focus on the assessment, diagnosis, plan, and evaluation of various clinical scenarios and patient cases. The only difference is that the Emergency Nurse Practitioner certification exam does have some non-clinical content, including a small percentage of professional, legal, and ethical practice questions. All three exams have 150 questions, 135 of which actually count toward your grade.

Cost

The AANP exam costs $315 for non-members of the AANP, and $240 for members.

AANP Pass Rates (2018)

The 2018 pass-rates for the AANP nurse practitioner certification exams are as follows:
  • FNP = 85%
  • AGPCNP = 83%
  • ENP = 87%

AANP vs ANCC: What’s the difference?

Both the AANP and the ANCC exams are taken on the computer at a testing center. Every few years new editions of the tests are created, and multiple alternate versions exist. These exams differ from the NCLEX-RN in that they do not finish based on your score (i.e. it won’t shut off at 75 questions). You must complete the entire test.

The Number of Questions

The number of questions is going to differ depending on which exam you are taking. ANCC exams vary from 150-200 questions over 3-4 hours, and all AANP exams are 150 questions. Both tests will have 15-25 “pretest” questions – meaning they won’t count for your grade – they’re just testing the questions to see if they’re okay to add to future versions of tests.

The Question Style

The style of the test questions is another major difference. ANCC exams will have four different question formats: multiple-choice, multiple response questions, drag and drop, as well as “hot spot” questions. AANP is 100% multiple choice with 4 possible options (aka NO select all that apply!).

The Question Content

The content of the questions is also a major difference between the AANP vs ANCC. It’s going to vary depending on which exam you’re taking, but the ANCC exams tend to have a lot more “non-clinical” questions related to topics like nursing research, legal and ethical considerations, scope of practice, regulatory guidelines, etc. AANP is 100% clinical, so it is going to focus on assessment, diagnosis, treatment, and evaluation. As stated above, the ENP test is a bit different and does have some non-clinical questions.

The Difficulty

There have been some rumors that AANP is easier than the ANCC – although there really is no way to truly know. The pass-rates used to be lower for the ANCC so people just assumed it’s harder. However, now if you look at the most recent data for FNP (2018), the AANP actually had a lower pass rate (85% VS 86.2%). I think it’s going to depend on the individual which one is easier based on their preferred testing style and testing content. The only true way to know is to take both yourself which I do not recommend!

The cost

The cost is also slightly different. Non-members will end up paying $315 for the AANP vs ANCC paying $395, making AANP $80 cheaper. If you are members of the ANA, the ANCC will only be $295. On that same note, members of the AANP will pay only $240 for an AANP exam.

AANP vs ANCC: Factors to Consider?

Which exam you choose will depend on your specific professional goals as a future NP.
  1. Which Specialty is your program in?

  2. This one is great because all the work is done for you. In order to apply for certification, you have to have graduated or will be graduating from an accredited Nurse practitioner program in that specific specialty. So, if you’re program was FNP – you need to apply for FNP certification. Obvious right? For certain specialties – this choice will be made for you because both the ANCC and the AANP have certification exams that the other does not. If your program is for Acute care, Psych, or Peds – you must go through the ANCC. If your program is an Emergency NP program   – you must go through the AANP. Where the real choice lies is if you went to a Family Nurse Practitioner (FNP) program or an Adult Primary Care (AGPCNP) program. And if that’s the case, then the next question you’re going to want to ask yourself is what your specific testing preferences are. What do I mean? Keep reading!
  3. What are your testing preferences?

  4. The AANP vs ANCC has very different test styles and question content as stated above. If you’re someone like me who HATED research, ethics, leadership (insert more fluff classes here), then you are more likely to want to take the AANP. In fact, that’s the main reason that I chose to certify through the AANP! If you are really good at non-clinical questions like that – maybe you should take the ANCC! Additionally, the AANP is 100% multiple choice with four possible answers. The ANCC exams are multiple-choice, but do include alternate questions including the dreaded multiple response questions, drag and drop, as well as “hot spot” questions.
  5. Which facilities are you planning on applying to?

  6. So nowadays most facilities and locations look at AANP vs ANCC certified NPs as pretty much the same. This is because both are nationally recognized and reimbursed by Medicare and Medicaid in any clinical setting in almost all states. Think of this like DO vs MD – both are now considered equally great. So, most facilities don’t’ really care – they just want to see that you passed your boards. However, rarely there are facilities that prefer ANCC candidates because it’s older, more established, and isn’t 100% clinical. So if by the rare chance that the facility you want to work in only accepts ANCC – consider taking that exam instead. In general, magnet hospitals do NOT require ANCC over AANP.
  7. What are your future career goals?

  8. The last consideration is what are your future career goals? Do you plan on obtaining any post-master certifications? You totally can be certified in one specialty by the AANP and certified in the other by the ANCC – but this just might complicate things a bit. You’ll likely feel more comfortable with the certification process if you have already done it once. So, if you’re in an FNP program and want to one day become ENP certified – AANP might be the more logical choice for you. On the other hand, if you want to one day get your ACNP or PMHNP post-masters certifications, consider the ANCC! Additionally, if you plan on getting into academics – some universities may prefer ANCC NPs. However, to teach at the nurse practitioner level, you will need to be pursuing or have obtained your doctorate degree anyway.

    What did I choose?

    I chose the AANP exam. What it came down to was the fact that I love clinical questions and really did not like all the other types of questions (research, ethics, etc). I also don’t like alternative question formats, so a normal multiple-choice exam sounded perfect to me. I didn’t foresee any problems with having my AANP nurse practitioner certification vs an ANCC certification, and I haven’t experienced any drawbacks. There is one local hospital system that prefers ANCCs, and they explicitly state so on their job applications. But – who wants to work there anyway. If you are in NP school and about to graduate, I want you to check out my NP certification steps, where I walk you through the process of getting licensed, certified, and credentialed as an NP! Heads up – it can take longer than you think!

Welcome!

Will Kelly, MSN, FNP-C
Thank you for visiting my site! I help nurses and nurse practitioners improve their clinical knowledge by providing high-quality content to turn their nursing education into practical application!  Read More

Related Posts

Tips for New Nurse Practitioners

Tips for New Nurse Practitioners

No matter what setting you start in, utilize the resources you have available to you, work your butt off, and constantly be open to learning – and you will succeed! But to help you on your journey – here are 6 of my best tips for clinical practice!

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Nurse Practitioner vs Physician Assistant

Nurse Practitioner vs Physician Assistant

Advanced Practice Providers (APPs) are an integral part of the healthcare team. They both perform very similar jobs, oftentimes the same one! But what exactly is the difference between them? In this article, I am going to walk you through and compare the education and training, job role, physician collaboration, as well as the salary of both NPs and PAs.

If you’d rather watch the full video, click the image below!

Education and Training

Both Nurse practitioners (NPs) and Physician Assistants (PAs) are considered Advanced Practice Providers or APPs, and they both often work alongside physicians in many facilities and practice settings. This tends to lead to some confusion over what the difference actually is.

Please note that there are various alternative methods of obtaining your NP including direct-entry programs and RN-MSN bridge programs, but I will not be going over these within this article. Additionally, this article compares master’s prepared NPs vs master’s prepared PAs. Of course, there are many NPs who obtain their Doctorate of Nursing Practice (DNP), but that will not be talked about in this article.

Related content: “NP vs MD: Which one is better?”

Undergraduate Degree

PAs will first obtain an undergraduate bachelor’s degree in a whichever degree they desire, but they must complete their prerequisites for PA school. At the same time, a future NP will typically obtain their Bachelor’s of Science in Nursing (BSN). Both of these undergraduate degrees typically take about 4 years to complete, although some direct-entry PA programs complete the Bachelor’s degree portion in closer to 3 years.

During this part of their education, PA students won’t typically perform any formal clinical, but will often have to complete between 1000-4000 hours of direct patient healthcare experience which is required for PA school. This is usually experience being an EMT or paramedic, a patient care technician or Certified Nurses Assistant (CNA), or a medical scribe. BSN students, on the other hand, will complete between 800-1000 clinical hours on average within the hospital learning how to be a bedside nurse.

After Graduation

Upon graduation, PAs should have already applied and been admitted to a PA program to obtain their Master’s degree, and they will immediately move on to their graduate education. The NP, however, will pass their board certification once they graduate, the NCLEX-RN. They then begin working as a bedside nurse. There are some RNs who immediately go right into their NP studies, but most will work for as little as a year to as long as 20+ years before pursuing their master’s degree.

The PA/NP Programs

PAs  will complete a Master’s degree in any of the following, depending on their program:

  • Master of Physician Assistant Studies
  • Master of Health Science
  • Master of Medical Science (MMSc)

NPs will complete a Master of Science in Nursing (MSN). During their program, PAs are trained as generalists, so they can essentially work in any clinical setting so long as they have appropriate physician supervision. Instead, NPs must choose a specific patient population to focus on. When entering the program of their choice, the NP will have to choose one of the following patient populations:

  • Family (across the life-span)
  • Adults and Geriatrics (ages 13 and up)
    • Primary Care
    • Acute Care
  • Behavioral/Mental Health
  • Pediatrics (ages 0-18)

Program Structure:

Most PA programs last about 2 full-time years of study (24-26 months). The first half they’ll go through didactic material learning in-depth medical sciences. Think of this as the first half a medical school but compressed into only 1 year. In the last half, they’ll complete clinical clerkships in pediatrics, OBGYN, family practice, general surgery, and emergency medicine, totaling about 2,000 hours of clinical experience.

NP programs are structured differently and usually have Full-Time, Part-time, and online options. Most programs will start out with solely didactic material including advanced pathophysiology, advanced pharmacology, and advanced health assessment. You’ll then start clinicals but at the same time continue didactic material simultaneously. It’s common to have to complete 16 hours per week fo the semester in clinical, so two 8-hour days each week.

Where you do your clinicals is going to depend on the program specialty, so FNPs will do rotations in primary care clinics, women’s health clinics, and pediatric clinics, whereas Acute care NPs would do most of their rotations within the hospital in the ICU. Some programs offer optional specialty rotations, where you can get experience in something other than your “typical” locations (like the ER for FNPs). NPs will complete an estimated 600-800 hours of clinical by graduation.

Licensure

Once they graduate from their APP programs, PAs must pass the PANCE (Physician Assistant National Certifying Examination) in order to become a certified PA. NPs will have to pass their board certification exam in their specific specialty (either through the AANP or the ANCC). They both then apply for state licensure and can start practicing as APPs once credentialed

Related content: “Nurse Practitioner: Steps after graduation”

Job Role

The actual job role of an NP and a PA regarding what they actually do is VERY similar if not the same at almost any location and specialty.

Both PAs and NPs:

  • Obtain health histories from patients
  • Perform a physical assessment
  • Order diagnostic tests and interpret them
  • Prescribe treatments such as medications and therapies
  • Perform bedside procedures
  • Consult appropriate specialists

They both work in pretty much every specialty including:

  • Outpatient primary care
  • Outpatient and inpatient specialty offices
  • Inpatient hospitalists or ICU
  • Emergency Department or Urgent Care Clinics
  • Home Health / Hospice
  • Surgery
  • More!

Regarding surgery, NPs can become a first-assist with a surgeon but its much less common – usually they’ll do admissions and discharges for the surgical team instead of actually scrubbing in. PAs are more likely to scrub in and assist with surgery. NPs generally do not receive any surgical rotations throughout their program, so this just makes sense.

Collaboration/Supervision

APPs often work in close collaboration with physicians – but this is where the main difference lies between the two.

NPs have full practice authority (FPA) in 23 states and counting. What this means is that State practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing.

This means there is no required supervision or collaboration with a supervising physician. They practice medicine under their own license without any oversight. However, just because an NP might practice in an FPA state, this does not mean that they do not consult or collaborate with other experienced NPs and physicians when appropriate – it just means they have the legal authority not to.

NPs who do not live in an FPA state will require varying degrees of physician collaboration depending on their state and practice setting. This degree of physician collaboration is explicitly stated in a collaborative agreement, which outlines joint practice protocols, documentation review/oversight, and prescriptive authority. In practice, this often just involves occasional chart reviews and availability for consultation via electronic consultation via text or phone call. This doesn’t require an on-site physician.

Alternatively, PAs are always required to work under the direction and supervision of a physician or a group of Physicians. However, State-level laws influence more specific aspects of supervision including prescriptive authority, prescription co-signatures, collaborative agreements, and other various aspects of scope of practice.

So what does this mean?

Basically, PAs have more required oversight by physicians, but this does not mean that the physician is looking over their shoulder. Typically, this may involve the PA consulting the doctor with medical management of a complicated case, and the physician co-signing their charts and prescriptions for controlled substances. But this will look different in every State and practice setting, and the physician often won’t be required to even be on-site – just usually needs to be reachable.

All states will vary for both NPs and PAs in terms of who is legally able to sign death certificates, POLST forms, and/or order physical therapy.

As a general rule, the NP career offers more opportunity for autonomy. This is especially useful if you plan on opening your own practice or clinic, especially in an FPA state. PAs, at this time, are more limited in their ability to perform medicine autonomously.

Both NPs and PAs are a great part of the healthcare team, and both are very competent and able to take care of their patients within their respective scope of practices.

Salary

When looking at salary – both NPs and PAs make similar salaries and many locations and facilities will pay their counterparts the same. However, when looking at national data – NPs make on average $117,292, and PAs make $107,179 (Glassdoor). Keep in mind that this is national data. The fact that some NPs have the autonomy to open up their own practices typically means higher revenue, which will skew the national NP salary upwards.

Related content:

And that is basically the difference between PAs and NPs. They are both very different paths, but essentially perform the same job role and have similar career outlooks. Some physicians and hospitals will prefer one type of APP over the other, and I’ve seen this go both ways. However, most places of employment will recognize the value of both an NP and a PA as integral members of the healthcare team.

 

NP vs PA

Calling the Doctor – Giving Nurse to Provider report

Calling the Doctor – Giving Nurse to Provider report

*This post may contain affiliate links. Please see my affiliate disclosure for more information*

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When I first started working as a bedside RN, one of the aspects of the job that gave me a deep sense of anxiety was having to call the doctor on a patient. Sure – some of them were super nice – but many of them were impatient and rude. Not giving the correct phone report in a format that the physician or Advanced Practice Provider (APP) is looking for can create tension and miscommunication. If you utilize my technique for giving phone report to the physician – the patient’s situation will be more effectively communicated and the encounter will go much smoother.

In this article, I am going to share with you all an effective method for giving a quick report to the physician or APP when you call them in the inpatient setting! I am uniquely positioned to help with this because I work as a Nurse Practitioner in the hospital and receive 20-30 calls per night from floor nurses. I have noticed many improvements that can be made to improve communication – so keep reading!

Step 1: Introduce yourself and the patient

“Hi, My name is Michelle and I’m calling from 1G. I’m the nurse taking care of Anita Lopez in 230-2. Are you familiar with her?”

First you need to introduce who you are, where you’re calling from, and who you’re calling about. I can’t tell you how many times the nurse has called me and launched into a full explanation about the patient and then I have to ask “Who is the patient!?” Oftentimes the inpatient Provider is at the computer and can look up the patient’s chart while the nurse is talking.

Sometimes over the phone it is difficult to understand last names – especially if accents are involved. When you say the patient’s name, it helps if you say “Anita Lopez, that’s L-O-P-E-Z”. Spell out the last name because oftentimes we have censuses pulled up from each floor or hospital which are ordered alphabetically. We usually do not need the spelling of the first name.

It also can be helpfult to include where they are located – their unit and room number. Additionally – the Provider you are calling may only cover certain attending physicians (as is the case at my job). If this is so – give the attending physician as well.

The next step is to ask if they are familiar with the patient. If I just admitted the patient – I don’t need a full explanation of why they’re here and what their medical history is. However, many specialists or Providers who are on call may not be very familiar with the patient yet. It always helps to ask and most Providers won’t give you an issue by asking.

Step 2: Brief Medical History

“She’s a 78 year old female who came in on 11/28 for a COPD exacerbation. She has a PMHx of COPD, Smoking, Hypertension, Hyperlipidemia, and afib which she’s on Coumadin for”

In the inpatient setting – I always want to know why the patient was admitted. This gives some context to the patient’s situation. If a patient who came in for COPD exacerbation is complaining of a headache – that typically deems less investigation than a patient who came in for a TIA or a mechanical fall and is now having a headache.

Additionally, a brief overview of their medical history should be given with emphasis on important/related diseases. Hit the following:

  • Cardiac: HTN, CAD (any stents or CABG?), Afib (anticoagulants?), CHF
  • Pulmonary: COPD, asthma, Lung cancer
  • Renal: AKI, CKD, ESRD (on dialysis?)
  • Vascular: DVT/PE, PAD/PVD

You usually don’t need to go into any details regarding surgical history unless it is directly relevant to this admission in some way.

Step 3: Why You’re Calling (SITUATION)

“The patient is complaining of increased SOB”

This is pretty simple. Why are you calling the Provider in the first place? Usually this is due to :

  • A new complaint: Chest pain, SOB, Headache
  • A medication need: sleeping medication, breathing tx, pain medicine
  • A change in the patient’s status: Respiratory distress, Unresponsive, confusion
  • A critical lab value : elevated troponin, elevated lactic, positive blood cultures

No matter why you’re calling – simply state it and then jump into the following step – the background of the situation.

Step 4: Situation Background

“They are ordered duonebs q6h but has nothing ordered PRN”

By this point you already given the important information such as who you are, who the patient is, where they are, why they were admitted, and why you’re calling. Now you can get to the heart of the call and give context to the situation at hand.

In this instance, the patient is SOB and has COPD. Are they ordered breathing treatments and how often? No matter why you’re calling, it helps to ask these questions:

  • Has this happened before and what was done? Did it help?
  • Are they currently on any medication for the situation?
  • What trends have been occurring (i.e. if you’re calling for high BP, how have their BPs been?)

Investigating the background of the situation can really help communicate the correct need to the Provider.

Step 5: Assessment

“The patient’s RR is 24 rpm and SPO2 is 90% on 2L NC. They’re breathing is non-labored, lung sounds show expiratory wheezes throughout”

As the nurse, you are responsible for assessing the patient first when there is a change in their status. This doesn’t mean you need to do an entire nursing assessment and report that, but get their vital signs and a do a quick physical assessment of the systems involved (I.e. If you’re calling for SOB – tell me how they are breathing and what their lungs sound like).

Please make sure you get an UPDATED set of vital signs whenever there is a change in patient status. Their vital signs from the 3-4 hours ago are not helpful to the current situation (depending on why you’re calling). That’s just good practice.

Step 6: Recommendations

“Can you please add albuterol PRN for inbetween scheduled duonebs”

Nurses are the eyes, ears, and hands of health care. They are on the front lines, are well-educated, and usually have great recommendations to help their patient. Maybe you know just what the patient needs to feel better.

Another important recommendation is asking if the Provider can evaluate the patient in-person. Sometimes it is difficult to convey your uneasiness about how a patient looks – even if their “numbers” look fine. Asking the Provider to personally evaluate the patient (if needed and indicated) is a great way to ensure the patient is in good hands.

Related Content: Tips for New Nurse Practitioners

– – – – – –

So Yes, it is SBAR, but with some important introductory steps beforehand. But what if you’re a Provider and need to know how to call consults to other Providers? I’m going to let you in on a secret – these steps are exactly what I do when I call a Provider for a consult as an NP. There really is no difference between a good nurse-to-provider report or a provider-to-provider SBAR.

As long as all the relevant information is conveyed in a concise and organized manner, you will be sure to impress the Providers you are calling, and ensure that proper communication is maintained – giving your patient the best possible care.

Welcome!

Will Kelly, MSN, FNP-C
Thank you for visiting my site! I help nurses and nurse practitioners improve their clinical knowledge by providing high-quality content to turn their nursing education into practical application!  Read More

Related Posts

Tips for New Nurse Practitioners

Tips for New Nurse Practitioners

No matter what setting you start in, utilize the resources you have available to you, work your butt off, and constantly be open to learning – and you will succeed! But to help you on your journey – here are 6 of my best tips for clinical practice!

Share on Pinterest!

Tips for New Nurse Practitioners

Tips for New Nurse Practitioners

*This post may contain affiliate links. Please see my affiliate disclosure for more information*

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While I’m no expert NP, I do know what its like to be a new one! After all – that was just a little over a year ago! Being so fresh in my mind – I have some valuable tips to share with new NPs or NPs to be. No matter what setting you start in, utilize the resources you have available to you, work your butt off, and constantly be open to learning – and you will succeed! But to help you on your journey – here are 6 of my best tips for clinical practice!

1

Use UpToDate Religiously

If you haven’t heard of UpToDate – I don’t know how you made it through NP school! This medical reference database is the GOLD STANDARD of medical information for Providers. While I’m working, I often use this to quickly reference drug dosing information and renal dosing considerations. On the spot, the algorithms are SUPER useful. You can just scroll down to the bottom, check out the algorithm section, and viola – suddenly you know just what to do for your patient with hyponatremia of unknown etiology. No but really – there is SO much useful information. If you have a bit more time on your hands – you can read through articles more in-depth related to literally whatever medical topic that is relevant to your clinical practice. Keep a list throughout the day of symptoms and diagnosis that you don’t feel 100% comfortable with, and make a habit of reading up on those topics on UpToDate at the end of the day.

Unfortunately, UpToDate is expensive, but most hospitals provide free access for it’s providers. If you create an account, you just have to login once every 3 months on the hospital’s network to maintain access – and you can download the easy-to-use app for your smartphone.

There are other reference apps out there – but UpToDate is by far my favorite and the gold standard. Check out my top 5 medical reference apps for more information!

2

Templates, Templates, Templates

When you’re a new NP – you are going to be overwhelmed – especially in a new hospital or office environment. You are going to forget to ask basic questions to the patients, and you are going to feel dumb plenty of times. You likely won’t have the most confidence when conducting you’re history and physical. That’s why templates are SUPER important in being your back-up. Find templates such as History/Physical or SOAP note templates, and use them with every patient. This will ensure that you don’t forget to ask about surgical history, family history, smoking status, even something as easy as allergies. If you can’t find a template that works for you – make one yourself! Get a system down, write down information in the same place when you’re doing your chart reviews, and this will help you know where to always find the information you need on your patient – especially in high-stress situations.

Since working as an inpatient hospitalist NP, I’ve been using the same H&P template since I started. I’ve made some small tweaks along the way, but this ensures I don’t forget to ask about anything important, and I always know where to look for the information on my patient. (You can get access to my templates here)

3

Master Verbal Report

As an NP – you will be communicating with physicians and other colleagues much more frequently, and mastering verbal report is essential. Sure – you might have been a nurse for years and know how to give a good NURSING report, but NP-to-Physician report is much different. Physicians are trained specifically to give and get report in a certain way, and unfortunately they can get a bit… testy if we take too long to get to the point or leave out crucial information. The idea it to be concise, but also include the relevant clinical information.

In general – start with their Age, Sex, relevant PMHx, Admission diagnosis, relevant findings, physical assessment, and any recommendations.

Since I work in the hospital, an example of this would be the following:

“86yo Female with a PMHx of HTN, HLD, T2DM, and COPD presenting with cellulitis of right lower extremity calcaneal wound. Initial XR does not indicate Osteomyelitis, MRI is pending, WBC  13, Lactic normal, Blood cultures pending. Patient was started on Zosyn and and vancomycin in the ED.”

After you present the initial basic information, you can specify exactly why you are calling and tailor it to their specific specialty – so obviously if you are calling a nephrologist you would focus on their renal function, blood pressure, electrolytes – etc.

I’m planning on doing a more detailed blog about presenting a patient to another provider whether or as NP or as an RN, so be on the lookout next week!

4

When in Doubt – Cheat!

When I began as a new NP in the hospital setting, I brainstormed the top 20 common diagnosis in my specific specialty. I sat down and made cheat sheets for each diagnosis including information on the etiology, pathophysiology, clinical manifestations, diagnostic findings, and clinical management. You can use textbooks and online resources to find uptodate information – as I said before I recommend UpToDate!

Making these cheat sheets can really help you narrow down specific need-to-know information for your exact clinical role. Making them yourself can help you retain the information. However, if you can’t find the time, the following books have some pretty solid cheat sheets:

These cheat sheets are going to help you look up relevant need-to-know information on the spot while you are at work. Personally, my sheets that I made on Acute kidney injury and hyponatremia have been especially handy in the inpatient setting.

5

Follow the Paper Trail

Whether you work inpatient or outpatient, there will be specialist consultation notes for you to read. You can learn a TON from these notes. These guys are literally specialists, and if you’re a generalist –  you’re kind of the jack of all trades and the master of none. Simply following the paper trail and reading up on your patient’s after you have seen them can help expand your knowledge tremendously.

But don’t only read specialist notes. Working inpatient, theres often medical students and medical resident notes which are very detailed and provide rationale – which Attending physician’s notes often do not have. Don’t write them off simply because they are not attendings. They learn so much in school that unfortunately, we as NPs do not. Reading these notes can be invaluable!

6

Have the Right Attitude

As a new NP, you are the new kid on the block. You need to be humble, ready to learn, confident in yourself but willingly admit when you don’t know. Trust your insticts, but check your ego at the door. We are dealing with patient’s lives here and nothing is more important than hard work, communication, and collaboration with our patients and our knowledgeable colleagues.

There are so many more tips to help new NPs, but I wanted to keep this list short and practical – things that will help you succeed in the clinical setting.

Something that I know will help you guys out as new NPs is signing up for my email list and getting access to my free NP resource library! You’ll be sent a folder with my templates for History and physicals (both inpatient and outpatient), Soap notes, and pronouncement notes. I plan on adding more useful information as time passes, so be sure to check back often!

Welcome!

Will Kelly, MSN, FNP-C
Thank you for visiting my site! I help nurses and nurse practitioners improve their clinical knowledge by providing high-quality content to turn their nursing education into practical application!  Read More

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Tips for New Nurse Practitioners

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No matter what setting you start in, utilize the resources you have available to you, work your butt off, and constantly be open to learning – and you will succeed! But to help you on your journey – here are 6 of my best tips for clinical practice!

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NP vs MD – Which One is Better?

NP vs MD – Which One is Better?

[social_warfare]

Working as a Nurse Practitioner (NP), I frequently am asked: “What exactly is the difference between an NP and a doctor?”. While there definitely are differences between them, both function similarly in within many specialties, so it is not always an easy question to answer.

The education and training of physicians is very different than that of an NP. Additionally, their job role and the autonomy/scope of practice with which they practice will vary depending on the state and facility of practice.

If you’re trying to decide which path you want to take, or maybe you are a patient who’s wondering which Provider you should be seeing – this article should help clear up any confusion.

Comparing the Education and Training

To compare NPs with physicians, we must first look at the differences in their education and training.

Physician Education and Training

The Physician education pathThe path to becoming a physician is a long and difficult. First, they must obtain their undergraduate bachelor’s degree – usually in a science such as chemistry or biology. However, the actual degree does not usually matter, so long as they complete the pre-requisites for Medical school. This can be ensured by enrolling in a Pre-med track. During this part of their education, they are not learning any specific medical information. While the science courses that they take will invariably help them in medical school, they are not gaining exposure to the medical field directly. However, most students will obtain a decent amount of shadowing or “real-world” experience with healthcare exposure – whether working as a patient care assistant, EMT, medical scribe, etc. 

Upon graduation, they attend medical school which is typically a 4-year degree. They learn in-depth medical sciences as well as clinical information for practice. During the final 1-2 years, they also complete clinical clerkships in just about every specialty there is. This provides well-rounded medical knowledge, and the depth of knowledge obtained is unmatched. By graduation, they have performed an estimated 6,000 hours of clinical experience, directly learning how to be Providers. Upon graduation, they receive their MD or DO degrees, and are officially “Doctors”. But their training doesn’t stop there.

After graduating from medical school, a physician will then match into a residency – which is on-the-job training for a set amount of years depending on their specialty. This usually is 3-4 years but can be as long as 7+ years with some specialties (i.e. Neurosurgery), and physicians can choose to perform a fellowship year that offers an additional year of specialized training. In general, residencies will provide an averaging of at least 10,000 hours of training. During this time, resident physicians are working in close collaboration with other senior residents as well as attending physicians. They have to take certain board certifications along the way, but once they complete their residency – they are officially attending physicians. This means that they are officially independent providers and can practice without any oversight.

Nurse Practitioner Education and Training

The Nurse Practitioner education pathThe path of a Nurse Practitioner looks very different from that of a physician. Nurses dive right into learning clinical information and medical treatment in their undergraduate nursing education, where they obtain a Bachelor of Science (BSN) in Nursing. During nursing school, they complete a set number of clinical hours within the hospital learning how to be bedside nurses. This will depend on the program, but most will complete around 800 -1000 hours of clinical.

Once they graduate and pass their board certification (the NCLEX-RN), they begin immediately working as a bedside Registered Nurse (RN). If they make the decision to obtain their NP degree, most will choose to begin after an estimated 5-15 years of bedside nursing experience – however for most programs, there really is no minimum years of experience required for matriculation. The NP program will be population-specific. This means that instead of rotating through each specialty – they will obtain 600-800+ clinical hours in their specific specialty under an experienced NP or physician. Most will complete their master’s degree in 2-3 years, and many are able to work at least part-time while doing so. Some choose to get their Doctorate of Nursing Practice (DNP), which instead takes about 4 years to complete. Once they graduate, there is no required residency program. While some residencies are available, this is by far not the norm. Once they pass their board certification (via ANCC or AANP), they can immediately begin practicing as an NP. In most states, they will be working in close collaboration with experienced NPs and physicians, at least until they get more experience as a practicing NP. 

Side by Side

Both routes are difficult – but I won’t deny that the physician route is more rigorous and definitely offers more hours of education, training, and supervision. However, I won’t completely disregard the benefits that the NP route can have.

Firstly, there’s earlier exposure to healthcare and medical conditions through education and clinicals during their undergraduate nursing degree. Pre-med students usually have little if any healthcare exposure. Additionally, NPs usually have years of bedside nursing experience. As previously stated – this should not be equated with formal education, but shouldn’t be ignored either. This experience exposes them to medical conditions and management, improves their assessment skills, and helps improve their communication not only with their patients but also with their medical colleagues. Those of us working in the hospital system can see firsthand just how smart and capable good bedside nurses can be.

When directly looking at them side-by-side, please keep in mind that these are all general estimations as each program, specialty, and specific situation is going to impact the amount of formal education and training.

To illustrate the difference in education between Nurse Practitioners and Physicians.

Looking at these numbers, it is clear that our formal education and training is less than that of a physician. However, I do believe our education is sufficient for us to provide great care to our patients. While an NP is not equivalent to a physician, we have proven ourselves to be knowledgeable and capable Providers in various specialties.

Comparing the Actual Job Role

The actual job role of NPs and physician will vary greatly depending on state and facility. However, usually the specific job duties are very similar.

Both physician and NPs:Provider Job Role

  • Obtain health histories from patients
  • Perform a physical assessment
  • Order diagnostic tests and interpret them
  • Order treatments such as medications and therapies
  • Consult appropriate specialists

In some locations – you will have a difficult time telling the difference based on their job role. This is especially true in primary care or outpatient offices. In many settings and locations, NPs work in close collaboration with physicians. This means they usually work with them and consult them if they have any questions. This is especially true for new NPs, as even in states with full practice authority, new NPs still have so much to learn.

21 states offer full practice authority for NPs. While I do support full practice authority, I also recognize the need for close collaboration with other NPs and physicians, especially as new providers. The health and wellbeing of our patients are more important than anyone’s egos.

Overall, either path is commendable and offers excellent education and training, but the differences in each cannot be ignored. Physicians clearly have extensive education and training, starting out very broad and narrowing down to their specific patient population within residency. They are continuously learning under other knowledgeable physicians and have a rigorous and long-standing educational format. This is no easy path.

 NPs first get great bedside nursing experience – connecting with patients and being exposed to medical conditions and treatment plans. Then they choose a specialty and focus on their specific patient population. So no, they may not be able to tell you in-depth information about virology or the cytokine p450 system. However, they are educated and trained to treat their specific patient population appropriately. Any research studies comparing and contrasting NPs and physicians show that NPs have not been found to provide inferior care.

The best thing for all of us to work together, swallow our egos, work within our scope and capabilities, and provide top-notch care to all our patients.

Welcome!

Will Kelly, MSN, FNP-C
Thank you for visiting my site! I help nurses and nurse practitioners improve their clinical knowledge by providing high-quality content to turn their nursing education into practical application!  Read More

Related Posts

Tips for New Nurse Practitioners

Tips for New Nurse Practitioners

No matter what setting you start in, utilize the resources you have available to you, work your butt off, and constantly be open to learning – and you will succeed! But to help you on your journey – here are 6 of my best tips for clinical practice!

How Much Do Nurse Practitioners Make?

How Much Do Nurse Practitioners Make?

[social_warfare]

If you are thinking about or working towards becoming a Nurse Practitioner, the thought of an increased salary has probably crossed your mind. Advancing your nursing career not only can have a positive impact on your job satisfaction, but also tends to positively impact your pay. When I was a broke college student, I would obsess about my future and how much money I would be making as an NP. While money should not be the only factor to consider – it is an important one! Besides – Grad school costs a lot of money – it better be worth it on the other end.

When I would constantly try to figure out how much money I would be making as a future NP, I had trouble finding the right answers that I was looking for. Online forums gave inconsistent answers. Some salaries would seem much too low, and others seemed so high it was unrealistic. I needed an open, honest answer – and I honestly feel as though I never really found it.

Now that I am a practicing NP, I hope to be able to give exactly what I was looking for as a future NP – an honest answer! Not only will I tell you how much I make as an NP, I am going to highlight 4 factors which can help you determine how much you can make as a new graduate NP in your specific situation.

I also made a YouTube video about this above – if you’re not into reading articles the video might be more your style!

Four Factors in Determining NP Salary

Many variables will determine your salary in the healthcare field. I attempt to simplify these into four factors that can help you determine a good estimate on just how much you can get paid as an NP.

  1. Experience

  2. This one is pretty much a no-brainer. As in all professions, the more experience you bring to the table – the more value your company will perceive. This tends to mean higher pay. You have put in the work, you company recognized your experience and knowledge, and they reward that.

    Glassdoor will tell you that the average NP salary with 0-5 years of experience is approximately $105,000 per year. At the same time, NPs with greater than 15 years of experience make approximately $122,000 per year. This is a $17,000 per year difference. While Glassdoor is a great way to estimate salary, it shouldn’t be looked at alone. Medscape released a 2018 NP Compensation Report which actually supported these numbers. Average NP with 1-5 years of experience had a salary of $106,000, whereas those with 11-20 years of experience had an average salary of $123,000.

    This can sometimes be a little frustrating when those who have “put in their time” do lower quality work than you – who might be new but who works very hard. Unfortunately, this is life. You too can reap the benefits in 10-20 years down the road. While the above numbers are great averages to go by, these do not factor in anything other than experience. Instead of how long you’ve been working as an NP, what type of work you do will impact your salary even more.

  3. Clinical Setting

  4. Where you work as a nurse practitioner – as in which type of clinical setting – will have a major impact on your salary as a Nurse Practitioner. Acute hospital settings – such as the Emergency Department or Inpatient care – have the highest salary of all the clinical settings. These sites tend to have less desirable hours, higher stress levels, and a worse schedule overall. At the same time – they bring in more revenue. Due to this, Nurse Practitioners working within these acute settings tend to have higher pay. According to the same MedScape Compensation report, in 2017 NPs in these settings made an average of $120,000 per year, whereas those in non-hospital affiliated outpatient offices made an average of $108,000. Even lower paid are academic professionals (education or research), who make $105,000. The lowest setting appears to be college health, which makes $95,000. In general, if you are planning on working for outpatient offices you can estimate $10-15,000 less than you would make if working ED/inpatient.

    Each clinical setting has its pros and cons. College health may have the lowest paying salary, but they also tend to have great hours, holiday breaks, and tuition assistance perks. Knowing which clinical setting you want to work in will definitely help you estimate how much you can make as an NP. However, another important factor to consider is what area you will be working in.

    In some instances, pay may be higher in rural areas who have trouble maintaining staffing – so keep that in mind.

  5. Location

  6. Where you work – as in what geographical location – is another major factor to consider in determining your NP salary. According to MedScape, the best areas for the highest NP salary is the Pacific coast, where it averages $130,000. The more central, generally the less pay you can expect. The lowest paying area is East South Central, which includes Tennessee, Kentucky, Mississippi, and Alabama – averaging $103,000.

    Something to keep in mind is that where you work will also determine your cost of living. When I used to work as a Nurse in Western Pennsylvania, my 1-bedroom apartment cost me $435/month. Now I live in Urban New Jersey, 1 hour south of NYC. That same 1-bedroom apartment would cost me TRIPLE what it did in rural PA. Food, drinks, property taxes, and events (such as weddings) can all add up. So while you may be making a higher salary, you may not be earning more effective income.

  7. Contract

  8. What type of employee you are will definitely play a part in your overall pay. Full-time employees have standard pay, but they also have many benefits which increase their overall package. They often receive Paid Time Off (PTO) for vacations and holidays, Medical, dental, and vision insurance, malpractice insurance, Continued Medical Education allowance, life insurance, retirement, license reimbursement, etc. These all really add up. As a Part-time employee, you may receive some of these benefits, but your pay will likely not increase.

    As a Per-Diem employee, your hourly pay will likely be somewhat more than Full-Time employees. This is because the company is not contributing any benefits to you, but you basically just work occasionally. Locum Tenens, which is basically just a temporary travel NP, has the greatest opportunity to make money. Rates can be $75-150/hr – however the latter being more rare. These usually require you to be willing to travel often, be very confident in your skills, and to be comfortable working alone. Many critical access hospitals will pay big bucks for you to be the solo Provider for a limited amount of time.

    How Much Do I Make as an NP?

    I hope the above information you found useful and can use to help you determine your future NP salary. To give you some reference, I will share my salary as an NP.

    When interviewing for jobs last year, I had offers of about $100,000/year plus benefits for outpatient primary care offices. However, I ended up taking a job as an inpatient hospitalist working nightshift. I work in urban NJ, three 12-hour shifts per week, 7P-7A, and do receive shift differential. I do get paid hourly, but my yearly salary ends up being between $110-120,000/year. This is great pay for a new graduate NP. Keep in mind though that I do live and work in a high-cost area and I work in the acute inpatient setting. These two factors are really the main reasons why my salary is what it is. I am a FT employee and do receive hospital benefits as well.

    I hope you found this article useful! I just know that when I was an aspiring NP, reading something like this would have been motivational and would have offered clarity and perspective. Hopefully this can do the same for you!

     

Welcome!

Will Kelly, MSN, FNP-C
Thank you for visiting my site! I help nurses and nurse practitioners improve their clinical knowledge by providing high-quality content to turn their nursing education into practical application!  Read More

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