When Do the NP Certification Exams Change?

APEA staff
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Note: This blog post was updated on Dec. 28, 2021.

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 family nurse practitioner and adult-gerontology primary care nurse practitioner 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 scientific literature and clinical guidelines.

For example, the AANPCB’s FAQ document for certification shows that AANP exam questions take at least a year to develop: "New exams are developed annually, validated by panels of clinical experts during the year, and released for administration in January." This means that questions on the 2022 exams were referenced with clinical guidelines available at the time of exam question preparation in 2020 and perhaps early 2021. 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 AANPCB 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.

The certification handbook from AANP is updated annually. In late December 2021, the posted handbook contained the blueprints for the 2022 FNP and AGPCNP exams. Separately, the AANPCB posts a reference list that reflects the substantive works that support the content in these exams. Find it here.

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 exam blueprint for primary care AGNPs was last updated in 2019.

Find the reference list for the FNP exam from ANCC here. Find the reference list for the AGPCNP exam from ANCC here. 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.”

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.

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:

The AANPCB certification handbook explains that the FNP and AGPCNP 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 for family and adult-gerontology primary care NPs are distributed across four domains:

  1. Assess
  2. Diagnose
  3. Plan
  4. Evaluate

The ANCC certification handbook also directs candidates to the ANCC test content outline (blueprint). The ANCC exams for FNPs are organized along four domains:

  1. Assessment
  2. Diagnosis
  3. Clinical Management
  4. Professional Role

The ANCC exams for AGPCNPs are organized along three domains:

  1. Patient Assessment Process
  2. Plan of Care
  3. Professional Practice

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. Your study questions should be presented in a multiple choice format and include detailed rationales. This type of 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


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APEA staff