ANCC or AANP NP Certification Exam

The American Nurses Credentialing Center (ANCC) and the American Association of Nurse Practitioners (AANP) are the two organizations that administer the tests to become board certified as a nurse practitioner. There are several tests depending on your educational qualifications. Tests areas include Family, AGNP, Peds, Midwifery and Psychiatric, and tests can then be Acute or Primary care, again depending on your degree. You only need to be certified by one, but I took the primary care test from both organizations. Why both, well I got cocky and failed the AANP the first time. That made me focus and get serious. I also said to hell with this and registered to take both the ANCC and AANP tests in the same week. Logic told me I can’t fail both, luckily I passed both and I am now 2 for 3.

Most of my classmates were taking the ANCC test and I started hearing people saying it was easy and not what they expected. First mistake, do not listen to people. I should have looked at the websites and noticed that about 80% pass both tests. That means next time you're in a lecture count off your classmates and realize that on average every 5^th person is going to fail. Like those awful group project, count off 1, 2, 3, 4. . (Shit it’s me).

Mistake number two is I studied wrong. You need to use more than one resource, and especially do not get stuck on practice test questions for your studying. Master your material from school and clinicals. Because although Fitzgerald and others books are decent, not one question from those books are on the tests. They may be similar enough to confuse you, but they are not the same.  

You will hear that it does not matter which test you take, which is true. The ANCC has been around longer than the AANP test, and there was a time when organizations like the Veterans Administration only recognized the ANCC. Today because they are both certifying boards, companies cannot discriminate against one or the other or they would probably be sued. 

The AANP is 150 timed questions and the ANCC is 175 timed questions. Some of the questions for both tests do not count, and you do not know which ones. They mix sample questions into the tests to see how people will answer them, and if they are viable test questions then they can be added in the future. This testing is also not like the NCLEX test, where the computer might turn off at 75 questions, or adjust based on how you are doing. You will answer all questions, and they are all random multiple choice. I did hear that they might be adding some pictures in the future, which would have been nice with those dermatology questions. For example reading erythematous scattered raised papules could be a couple things, give me a picture please.  

Truthfully, I really wanted to like the AANP test, because their organization seems geared towards Nurse Practitioners, and they have local and state chapters for NPs to network. The ANCC on the other hand is all over the place and seems to certify everything and anybody including the hospital itself. They are the ones behind the whole Magnet Hospital certification. Magnet status cost hospital a lot of money and research is showing Magnet status has not improved patient outcomes, but it does look good in the advertising and on the letterhead.

 Having now seen 475 of the board questions it is true, the AANP test is concentrated more on assessment, diagnostic and treatment based questions. While the AANC, while still having assessment, diagnostic and treatment questions, also includes therapeutic communication, research, policy, cultural issues, epidemiology, psychology and some regulatory questions mixed in. I liked this format, because as an NP only part of your business is assessing and treating patients. Also, look at your program it may be pushing you towards one or the other test. Besides the core curriculum our program had lots of research and cultural components.

It might be my background, but the ANCC seemed easy compared to the AANP. Since I took the AANP test twice their questions seemed redundant and they like to play word games. For example instead of checking your knowledge base, they would ask several questions on one topic like TSH, T3 and T4, or COPD and only change some words in the question or answer looking to trick you. 

Have to renew in 5-years, but for hundreds of dollars each it will not be with both organizations. We will see who does a better job of supporting and promoting NPs and probably renew with them.
 

85 vs 3,500,000,000

I found it shocking that the richest 85 people in the world, and many of them are in the pharmaceutical and various healthcare industries, now have the same wealthy as 3.5 billion or half the world's population. Will be hard not to think of that as I treat some of my patients who are struggling between the cost of food and housing, versus paying for healthcare services

http://business.time.com/2014/01/20/worlds-85-wealthiest-people-as-rich-as-3-5-billion-poorest/

http://www.nbcnews.com/business/worlds-85-richest-have-same-wealth-3-5-billion-poorest-2D11958883

In all parts of life, practice makes perfect.

Video of 20 day old Husky puppy learning to howl.

Probably won't be as cute when it is a 110 lbs.

What nursing shortage?

The hospital system where I pick up shifts as an RN recently went through a round of asking nurses and other staff to take ”voluntary severance packages”, or more accurately early retirement. They needed more than 200 people to accept this offer or they would need to start layoffs soon. This is not unusual as many hospitals including one of the largest systems in the country, Kaiser Permanente, has been recently been doing the same thing at their 37 hospitals and asking people to take severance packages and leave.

This is a good and a bad thing for nursing. Why is getting rid of RN’s a good thing? Because a lot of these retirement packages were aimed at nurses and staff who were hanging on, and needed encouragement to leave. I can’t blame them when in the bay area a nurse can easily make over six figures. But, healthcare is a business in this country and money will always be a factor in how decisions are made. It is hard to see some of them go because of the wealth of knowledge they had for newer nurses. However, maybe in a few years this will open up jobs again for new grads in this area.

The bad is if there was a nursing shortage do you think they would be getting rid of nurses, even expensive ones? You can Google nursing shortage myth or not, and get many reasons for the pros and cons of whether there is a nursing shortage now or in the future. All I know is around here new grads are not finding jobs. This may be different other parts of the country, but if you are going into nursing do some research. Because nursing schools will cry shortage, but they need students and their money. People need to make sure nursing is what you want to do and not because it is a job or you can’t think of anything else. 

Nurses are sick people, it keeps us sane

Floated to a floor with a nurse who was taking early retirement. Her daughter and a friend made two cakes to say goodbye. I had to take a picture and add an appropriate caption.

Preface: Nurses work with body fluids on a daily basis, and most have a sick sense of humor to go along with this type of work. We do not laugh at patients, but we do laugh at some of the things we have to put up with (OK, we do laugh at some patients), it is a pressure valve for a job most could not do.

Anyway, this is one of the cakes. It is a carrot cake with blue fondant icing in the shape of a bedpan, mango syrup in a colostomy bag, and a Baby Ruth candy bar in mango syrup filling the bedpan. Although tasty many could not eat it after the realism.

What to do?

I have been MIA on this blog for a while getting through the paperwork of both the state and federal government of my NP license. Now that I am an NP and have furnishing privileges , I wonder. No longer about the journey to get here or that I can write scripts. But what should I do now?  I need a job and to get experience. A minimum of 2-years if I want to practice in one of the independent states.
I see many independent practice state are trying to lure NPs away from restricted states (as in the article below), but the pay rate is about the same. I would love to be independent but the comfort of a doctor's availability and knowledge is invaluable.
I need to stop thinking about what if's and just get a job.

"New Mexico governor wants to recruit Oklahoma's nurse practitioners by Jaclyn Cosgrove

Governor Martinez wants to market New Mexico beyond its ski vacations, hot air balloons, beautiful desert sunsets and art museums.

Simply put, Martinez wants Oklahoma's nurse practitioners. Unlike Oklahoma, New Mexico allows nurse practitioners to practice with “full authority,” not requiring them to have a physician sign off on care in order for them to have prescriptive authority. Martinez specifically mentioned Oklahoma in her recent announcement of the campaign, adding that she hopes to further reform her state's laws to remove any barriers that nurse practitioners moving to New Mexico might face when opening their practices. “The full implementation of (New Mexico's Medicaid program), coupled with Medicaid expansion, will further increase the demand for highly trained and qualified health care professionals in New Mexico,” Martinez said in a news release. “By streamlining the requirements for nurses seeking to bring their talents and skills to New Mexico, we can further ensure that more New Mexicans, especially in rural and underserved areas, will have access to the high quality of health care our families and communities deserve.”

Time to move?
Moving to a state like New Mexico was, at least for a moment, in the back of nurse practitioner Damarcus Nelson's mind. Nelson graduated about two years ago and was thinking about where he wanted to practice medicine. But he had family in Oklahoma and a wife, pregnant with twins. Moving wasn't an option at the time. “I feel like if we stay here, we can push the envelope better to get independent practice here, as opposed to trying to run to another state,” Nelson said.
Nelson, who has a doctor of nursing practice degree, works near Yukon with Toni Pratt-Reid, the first nurse practitioner in Oklahoma to open a private practice more than 10 years ago.
Under Oklahoma law, a nurse practitioner cannot practice medicine unless he or she has a physician willing to supervise him or her for that prescriptive authority. However, the law doesn't require physician supervisors to review patient charts or even practice in the same building.
At Pratt-Reid's office, there is not a medical doctor or doctor of osteopathic medicine who works in the office with them. “We wouldn't practice any differently if we had full autonomy,” Pratt-Reid said. “Nothing that we did here would be different, other than we wouldn't have to jump through extra hoops to get the same amount of care ... . The sooner we get to where New Mexico is, the better.”

Many states open to practice
Oklahoma is one of about 12 states that requires a nurse practitioner to have a team leader or management from an outside health discipline — such as supervision from a medical doctor — in order for that nurse practitioner to provide care, according to the American Association of Nurse Practitioners. About 15 states — some that require stringent restrictions and some that simply curtail one element — have bills in 2014 that would reduce restrictions, according to the group.
No bill has been discussed or announced in Oklahoma. New Mexico and Oklahoma face similar problems, with large shortages of medical professionals across both states. Thirty-two of New Mexico's 33 counties are designated by the federal government as Health Profession Shortage Areas, according to the governor's office. Only four of 77 counties in Oklahoma are not designated as Health Profession Shortage Areas, according to the state Health Department.
Rep. Doug Cox, R-Grove, has focused many of his efforts at the Capitol on Oklahoma's doctor shortage. Cox, a medical doctor for more than 30 years, said medical “extenders” — nurse practitioners or physician assistants who extend the care medical doctors provide — are a necessary part of the health care system. Cox is the physician supervisor for a nurse practitioner in Grove, a city of 6,600 in northeast Oklahoma. More than 1,200 doctors in Oklahoma are supervising about 1,000 nurse practitioners, according to data from the state medical board.
Cox said he saw a need for a medical professional to help treat people, and he felt like supervising a nurse practitioner would be a way of doing his part to address the provider shortage in his area.
“The No. 1 reason I see people in the ER is because they can't get into a doctor's office,” Cox said. “There just aren't health care providers to serve the need, but our nurse practitioners have liberal prescribing authority.” Nurse practitioners in Oklahoma are not allowed to prescribe certain drugs, including oxycodone, a strong pain medication, and Adderall, a drug prescribed to children with attention deficit hyperactivity disorder.
Tulsa nurse practitioner Mindy Whitten said such restrictions regularly create a problem at her job.
Whitten works at an urgent care medical office, a setting where health care providers regularly prescribe Schedule II drugs like oxycodone. If a medical doctor isn't at the office when a patient who is allergic to codeine and hydrocodone comes in suffering pain, there aren't many other options for her to prescribe.
“I don't have a pain medicine I can write for them because the next one is oxycodone, and that is a Schedule II drug,” Whitten, the legislative chairwoman of the Oklahoma Nurse Practitioners, said. “I have to tell them, ‘I'm sorry, I can't write a prescription for you. You'll have to go over to the ER.'” Another obstacle that nurse practitioners face is in paying physicians for signing off to supervise them, she said.
For example, some physicians charge nurse practitioners between $2,000 and $3,000 each month, she said. It's a charge they wouldn't have to pay if they lived in states like New Mexico.
“Nurse practitioners are starting their own clinics in rural and underserved communities,” she said. “If I'm going to pay $24,000 a year, I can live in New Mexico and not worry about it and own my own practice.”

Dr. Gabriel Pitman, a trustee on the board of the Oklahoma Osteopathic Association, said if a doctor is playing a role and is available to a nurse practitioner, they deserve compensation for participating in the nurse practitioner's practice. Under Oklahoma law, a physician supervising a physician assistant is required to be on site at the clinic for a certain amount of time each week, whereas with nurse practitioners, a physician isn't required to be at the clinic.
Pitman, an Oklahoma City neurologist, said a physician is necessary to supervise a nurse practitioner or physician assistant because they aren't as rigorously trained as medical doctors and doctors of osteopathic medicine. In Oklahoma, nurse practitioners are required to have a master's degree along with clinical hours. Requirements are expected to change in 2015 to require a doctorate.

The Oklahoma Osteopathic Association supports nurse practitioners and physician assistants in the roles they serve in the health care system — just not without supervision, he said.
“We feel that a physician must always serve as the team leader, as they are the only comprehensively trained health care professional prepared to make a diagnosis and establish a treatment plan,” he said. “We feel direct access to nonphysician health care professionals endangers patients' health. We feel direct access also puts the patient in the unfortunate and confusing position of being forced to choose among the series of health care professionals, not all of whom are adequately trained to make well-informed diagnoses.”

Post-school

Because of school a bunch of people I would never have been friends with in the real world, I now consider friends. However, reality is only a few of us will stay in touch now that it is over and most go on their way with family and professional life.

Still studying and jumping through hoops of paperwork, verifications and government regulations so I can finally sit and write my boards. After a vacation I should be able to write the boards by the end of October.

This blog helped me get through school and in its current form I think this blog has run its course. I have other ideas to explore, like Twitter which seemed interesting for about 2-weeks. However, other sites and platforms will work better for what I am thinking.  

NPO

Kaiser Permanente Profits versus Patients

Kaiser Permanente the largest private managed care organization in the U.S. and only second in size to the Veterans Administration.  Over the past decade Kaiser Permanente has also gone from a reasonably priced alternative for health care to one of the most expensive in the country.  KP offers no explanation for the increased costs, only that this is part of doing business. Decades ago Kaiser was a non-profit that helped all people, then they changed to a for profit model, using wording that still claims non-profit status. Although, KP did reported almost $3 billion in non-taxed profit last year, and CEO George Halvorson’s annual compensation was $6.7 million.

Here is the problem; Kaiser Permanente is a private company owned and run by doctors. This is not unusual many hospitals and health systems are owned and run by doctors. But companies like Southwest Airlines are also owned by their employees, but Southwest tries to keep their costs to the customers low.  However, at Kaiser it is only the doctors getting annual profit sharing. So when making a decision about a patient’s medical care does the doctor also think about saving money, costly procedures, and those annual profit-sharing checks. Face it, the more profitable the company, the bigger those bonuses. Sounds like a big conflict of interest when your doctor is deciding between patient care and their bank account.            

Next Chapter

Clinicals are completed and my final project handed in.  Which means I am finally done with school, well unless I go back for my DNP or PhD, and that will not be happening this year.  Board certification and a resume will be the next projects.  Now that I have started looking at jobs, it feels good to see so many available. I have physicians and NPs that I worked with willing to give me references.  You always want doctors you worked with for your references, but always wonder what they really thought about your skills. The medical and nursing models are different ways of working and caring for patients.  

One doctor is trying to get me a job where she works, but I don't know if that is a good fit. I would like to stay here, but the other day Las Vegas sounded good, now that Nevada has passed the bill for NP independence. The only bad thing about Vegas is I do not like the desert climate.  

Anyway, maybe for the next chapter in life I should start a new blog. Especially one not connected to the Google platforms. Although nothing is going to happen for a few weeks while I rest first.   

AMA Decides Obesity is a Disease

The American Medical Association (AMA) decided, and it is their opinion, that obesity is a disease. Like every profession the AMA is an association that can be joined by doctors and medical students, but they have absolutely no authority to officially classify a disease. The World Health Organization and CDC can actually classify a disease, but so far they have not agreed that obesity is a disease. 

So, at the AMA’s annual convention this year, and against their own counsel’s advice, the majority voted to say obesity is a disease. Even after the AMA Council on Science and Public Health, which had examined the subject over the last year, declared that obesity should not be classified as a disease because the measure that is used to categorize obesity is flawed.  However, at their meeting the majority of physicians voted to say obesity was a disease. Therefore, it is now their opinion that 78 million or 1/3 of the US population has a disease.

Is calling a disease less of a stigma than telling a patient they have a serious risk factor they can influence.

Instead of doctors pushing for lifestyle changes does this open the door to more surgery, medications, and insurance reimbursement for obesity treatment?

For many years the CDC has recognized that the two biggest preventable causes of death are using tobacco products and obesity. Obesity is not a disease, but a risk factor for other diseases, like cardiovascular disease, diabetes, hypertension, metabolic syndrome, etc.  

Should we now say smoking is a disease or is it still the cause of a disease? 

I am waiting for my first primary care patient to tell me they have the disease obesity. 

Yes obesity is serious, but instead of running for the knife lets first try:

Dietary changes

Exercise and activity

Behavior change

And if needed prescription weight-loss medications.