I have a section here entitled "All About Nurse Practitioners." I recently posted some basic information about Collaborative Agreements and state-to-state variability in practice requirements. Check it out here.
One of the most important things you must do as job seeker is Google yourself. Along with your resume, prospective employers are viewing your online reputation when you apply for a job.  Execunet.com, a company that has been tracking statistics since 2004, found that 86% of employers use social media to determine if an applicant would be a good hire.  Your online identity, or lack thereof, can significantly impact your ability to get a good job. It is called a "digital footprint" and can range from neutral (you don't exist) to toxic (you're tainted). Ignoring your digital footprint can be lethal. If you haven't done so already, type your first and last name into Google.com or Bing.com and see what pops up.

Don't lose heart if what what you find isn't all good. You can improve your online identity and significantly increase your chances of getting the job you want. It's (fairly) easy and positive results can be seen pretty quickly. Personally, I am an avid fan of Amazon.com and purchase a wide variety of products from their site. I began using Amazon to buy textbooks for school and have purchased hundreds of books and other items over the years. When I first googled myself in 2008 or so, one of the first things that popped up was a review that I had written for a foot cream that I had purchased. Negative? No. Embarrassing? Definitely. Is that what I want employers to know? That I have dry feet? Yikes!  (In my defense, New England winters are brutal on your skin. I have to prepare myself for sandal season just like everyone else!) 

The first step improving or establishing your digital footprint involves looking a little deeper into your online identity. I would highly recommend using the FREE Online ID Calculator available at www.onlineidcalculator.com to evaluate your status. After answering some questions, such as: How many results did you get? How many results on the first three pages actually pertain to you? You will be able to calculate where you stand in the digital world. 

The next step is deciding what you want to convey to the outside world. This is known is your "personal brand" and should reflect your unique strengths as well as your personal and professional goals. Are you active in professional organizations such as SNA or your state NP association? Do you mentor others or spend time volunteering? Do you have a passion or desire to work in a specific area? These are some of the elements of a personal brand should all be reflected in your online identity. 

The final step is getting the word out.  Consider building an online portfolio by setting up your own website. You can post your resume, bio, papers you've written, projects you've worked on, or any other self-promotion materials you feel will reflect your personal brand. It is very easy and can be done for free. For this website, I used Weebly which can be found at www.weebly.com. They will guide you through the process step-by-step and have you up and running in about 20 minutes. Again, the best thing is that it is entirely free to set up a Weebly site. There are other free sites available that can be easily found by googling the term "free websites." 

If you have the time (and will continue to put the time in), consider setting up a blog. This can be done for free on your Weebly site as well - or it can be added (for free) at any time. It is perfectly fine if you don't feel comfortable having your own blog. The next best thing you can do is comment on other sites that are relevant to your areas of interest. Your comments don't have to be long, but they should be relevant and well written. Do not write anything negative or too controversial. Do make sure there are no spelling errors and use your real name. It can be as simple as, "I found this article to be immensely helpful. I agree with you wrote about XYZ and always consider XYZ when providing care to my patients. Thank you for posting this." Or, you can comment on another poster's comment, "I agree with what ABC said about XYZ, I think it is very important to do blah, blah, blah when working with patients." (Blah, blah, blah is simply a re-statement of what ABC wrote - how easy is that!) This is a good starting point. As you get more comfortable (or more knowledgeable), you can begin writing more relevant and substantial comments, such as "I agree with XYZ, but feel it's also important to consider 123 when providing care." 

After you've written about a half dozen or comments, check your name again and see what appears. Chances are, your comments will show up on the first page or two of your results. The first page that appears in a Google search is what you really want to improve, however the first three pages are considered important. Try it and see for yourself. And once you see results, keep up the good work. You will see how easy it is to build a positive online identity and may even make a few connections while you're at it. The biggest mistake you can make is to ignore what your online identity reveals to others. Future employers will be looking at you and it's up to you to decide what they will see. 

Also consider setting up an account on Linked In to get your name out there. This is another free site  that is considered a very important tool for job seekers. Not only can you use LinkedIn to show your brand to others, but you can learn (and connect with) potential employers as well. (More about LinkedIn to follow in an article I will be posting soon). Good Luck!


This is a lengthy list that I initially prepared for my BSN students on what they need to know when seeking their first RN job.  The first half is tailored to them, but still may be helpful for the New Grad NP. The last half of the list is specific to NPs. These may seem like minor points but I can assure you, each one is important. Ironically, I had issues that involved nearly every single point on this list during the past year. (I apologize for the funky-formatting. This site has a mind of its own!)Questions to ask yourself…
  • What do I want to do? It’s ok to not know yet. 
  • Do I like/not like working with certain populations?  men vs. women, younger vs. older, do you speak another language (Spanish)
  • What do I NOT want to do? Pediatrics, Oncology, medical, surgicial.
        ◦       Medical floor- pts tend to be sicker, more chronic, more debilitated, liver failure (ETOH, DTs, confused, psychosocial issues), renal disease (diaylsis, AV shunts, lab values, renal diet, renal precautions with meds, fluid restrictions)
        ◦       Surgical- pts tend to be healthier, shorter LOS, predictable course of disease, (i.e. day #1, get OOB, foley comes out, PCA D/C’d; Day #2 tolerating full diet, Physical Therapy, etc à very specific treatments/goals), ALSO- have incisions, wounds, drains, foleys, PAIN (giving narcotics, pts can be demanding/cranky/lethargic).

Type of hospital or practice?
        ◦       Large, inner city- lots of staff, pay for parking, expensive cafeteria, tend to be higher crime areas, etc.
        ◦       Small, community hospital- smaller staff, get to know people more, free parking, less expensive (but may pay better)
       ◦       Magnet hospital- better reputation, more prestigious
        ◦       Teaching hospital- residents, interns, students
  • How far from home? Transportation- traveling requires reliable car, more time for commute, longer work hours, etc.
  • Nights vs days? Nights- pay more, able to learn at a slower pace. Days- pays less, see more people, in-sync with “the rest of the world”, busier/heavier
  • 12 hours shfts vs 8 hour shifts? Days are shorter with 8 hour shifts, but you work 5 days/ week if fulltime vs Longer days with 12 hour shifts but work 3 days a week or so

**ALWAYS do some RESEARCH before you interview/apply: google yourself, google hospital, google MDs, names of HR, nurse managers, look at overall reputation of hospital. Consider- Is there lots of turnover? Are they always hiring? For example. Yale is considered “woman friendly” and one of top hospitals.

During your visit:
*        Look at the condition of facilities: run down? not enough supplies? vs. brand new, state-of-the-art
*        Look at the staff:  Do they seem stressed out? Frazzled? Running around? vs Are they calm? Friendly? Able to take time to speak with you?
*        Sources of jobs: www.advancefornurses.com, nursing spectrum, allnurses.com, SimplyHired, Indeed.com, go to job fairs, open houses, word of mouth
BEFORE you accept the job: Questions
*        Length of Orientation: hours, days, location, preceptor
*        Evaluations/ Performance Reviews: 3, 6, 9 months and by whom?
*        Pay: hourly rate, bonuses, shift differentials, weekend differential, incentive pay, how do pay periods run – weekly, biweekly? Education days? Paid for  attending meetings, conferences on days off?
*        Job requirements: day/night rotations, float to other units, mandatory overtime, nurspt ratio, ancillary staff (no unit secretary on night shift, less PCAs), IV team or do nurses do them? Will you be you trained? Who does Phlebotomy- nurses or PCAs?
*        Benefits: holidays observed, vacation time, sick time, conferences, malpractice insurance, tuition reimbursement, PTO carried over year to year? Insurance- decent insurance? Start immediately or after 30 or 90 days? Dental? Vision? Short term disability? Long term disability? Pension plans?  Sunshine clubs?

Employment contract: Terms of Employment for NPs:
*        Orientation: length of orientation, location, preceptor, policy & procedure manuals, number of visits/day, time allotted for visits, time for learning EMR/ charting
*        Duration: “Evergreen Clause” (automatic renewal)
*        Compensation: hourly, salary, raises, bonuses, incentive pay
*        Benefits: medical insurance, malpractice insurance, holidays observed, PTO (sick, vacation, carry-over yearly), Conference days, CE reimbursement, Professional association dues, Licenses/renewals, Communication devices
*        Promotion of Company/NP visibility:  NP introductory letter, business cards, NP brochures, Advertising, signs
*        Performance Evaluation: Specific Examples i.e., review of 5% of charts for completeness, accuracy, accountability, compliance w/ laws. Input from co-workers, staff re: interoffice communication, flexibility, overall personality
*        Termination: 60- 90 days notice, In contract, state specific reasons for dissolution of contract (violation of law, breach by either party, performance of NP, Personal reasons)
*        Non-compete clause: 1-2 years, 10-50 miles
*        Job Description: responsibilities, evening and weekend coverage, refills, support staff, Staff expectations from NP (VS, triage, room stocking/maintenance)

*        Practice history, philosophy, and reputation in the community
*        Past litigation, experience with previous NPs
*        Five-year plan for practice
*        NP Introduction: Introductory letter to patients, business cards, pamphlets
*        NP visibility, signs, brochures, advertising
*        NP access to profit/loss statements
*        Routine access to financial information, NP revenues generated

Patient Population:
*        Established client base, population targeted, assessment of population needs
*        Age parameters
*        ALWAYS ask: Most common diagnosis and treatment guidelines followed
*        Insurances: % T18, % T19, % MCO (which MCOs are practice contracted with, capitation/fee-for-service, NP billing)
*        Services offered: women’s health, emergencies, procedures performed
*        Expected patient volume, time allotted for visits

Office location:
*        Proximity to banks, retail shops, restaurants
*        Traffic, parking, access to building, free access to the office space, or is occupancy restricted to particular hours?
*        Safety issues, security personnel, outside lighting, crime issues
*        Condition of building, age of facilities, heat/plumbing issues, elevator issues
*        Office maintenance, cleaning crews
*        Availability of phones (# of lines), messaging, copy machines, fax machines, computers
*        Number/ size of exam rooms, staffing ratio for rooms, sinks available, condition of exam tables, stocking/re-stocking of rooms between patients
*        Equipment on-site- ECG machine, Pulse ox, O2 tanks, tympanogram, spirometry, vision/hearing testing
*        Condition/ age of current equipment, routine maintenance, cleaning/disinfection policy, cleaning of office, etc
*        Emergency equipment available
*        Availability of disposable equipment/ misc supplies (gloves, tape, gauze, office supplies, pt instruction sheets)

Office Schedule:
*        Hours of operation, weekend hours, after-hours coverage
*        Scheduling/ cut-off time for appointments, last appointment of the day, room in schedule for urgent visits/ walk-ins?
*        Room in schedule to return phone calls, reply to messages/emails, handling of refills, etc.
*        Policy for late/ no-show appointments
*        Office meal times, break times

Office atmosphere:
*        Professionalism of staff: Is there a handbook for personnel? Is the office understaffed /administrative deficiency? Do employees have clear job descriptions? Clear designations/duties?
*        Office dress code (hair, nails, jewelry), behavior code (smoking, personal calls, texting, music)
*        Areas for lunch, breaks, safekeeping of belongings and personal items
*        Noise level/space in waiting room, reception area, and exam rooms
*        Privacy/ ability to hear phone conversations, exams
*        Policy/attitude re: drug reps, sales people

Office staff:
*        Chain of command, senior staff, turnover rate, family members working together
*        Qualifications of bookkeeper, billing staff, % collections
*        Education level and credentials of support staff
*        Attitude toward NPs, experience with NPs
*        Delegation of tasks, triage, VS, Urine dipsticks, glucose, etc
*        Procedures for ordering tests/-getting results, informing patients, tracking
*        Staff meetings, input/suggestions
*        Handling of complaints, resolution of conflicts

*        Telephone system/communication: individual voice mails? Policy on email exchanges with PHR and patients? How are incoming telephone calls handled?
*        Marketing/Practice Promotion: How are new patients recruited? Expected to do seminars/lectures? Healthcare fairs/screenings? Expected to recruit patients? Ask for referrals?
*        Patient satisfaction: Does office ask for patient feedback? Follow-up phone calls or mail questionnaires? Patient retention programs/incentives
*        Time Off: How to request time off, sick day policy – Who covers patients? When are you expected to cover other providers who are sick/ on vacation?
*        Hospitalized patients: Can you get admitting privileges? Process for getting patient admitted to hospital? Who follows patients in hospital and/or rehab?
*        Referrals/consultations: When and how to refer/consult? Does office refer to specific MDs? (Cardiologist, orthopedic MD, etc)
*        Abnormal test results: For example, 12 lead EKGs – if results are unclear, is there cardiologist who will review results?

I have not posted much on this site lately and I sincerely apologize for that! I landed my first job and spent 10 very busy months there. The time has come for me to move on. I decided to begin posting here again to share what I have learned as a new FNP. The first year out was like a roller coaster ride, lots of ups and downs, moments of excitement interspersed with moments of sheer terror and fear! Many more good days than bad days. I absolutely LOVE being a Nurse Practitioner and wouldn't trade it for the world. It is the best job in the world! If you are still in school, don't get discouraged! You are entering into a fantastic profession at a very interesting/ transitional time in healthcare. I promise you that you will LOVE it too!
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Step 1-05/15/10 Graduation from MSN/FNP program 

Step 2- 05/17/10 Request for final transcript submitted to university, paid via echeck per suggestion of registrar (BIG mistake-takes 10-14 days to clear) 

Step 3- 06/04/10 Transcript received, 2 sealed copies, 1 copy opened to check for accuracy.

Step 4 - 06/07/10 AANP application complete now that final transcript received, mailed to AANP

Step 4- 06/17/10 Received letter from AANP "pleased to notify you …application to sit for exam approved" Now need to wait for letter from testing site with "window"

Step 5- 06/25/10 Letter from Prometric with number required and info on date selection, date for exam tentatively scheduled 6 weeks ahead for August 7, 2010 (really losing it now…looked at moon schedule, horoscope and biorhythm prediction before choosing date:)

Step 6- 07/27/10- panic mode, realize that every 1 out of 3 questions will be Pedi, decided to postpone date, to Sunday 8/22/10 (Feast of the Immaculate Heart of Mary, moon entering capricorn, at some kind of astrological crossroad…really losing my mind)

Step 7- 08/22/10- Take exam and pass! On-screen notification "you have successfully PASSED…." after 3 minutes of staring at screen, pure joy sets in!

Step 8- 09/10/10- Receive certificate from AANP in mail

Step 9- 09/30/10- Application for State of Connecticut APRN license mailed (needed to raise $200 for state license fee). Required passport photo; notarized application; proof of graduate level 40 hour pharmacology course, signed by school administrator

Step 10- 11/01/10- Received State of CT APRN license, effective dat 10/25/10 (expires month of my B-day Jan 2011, will need to pay another $200)

Step 11- 11/4/10 Application for State of CT "Controlled Substance…" submitted. One page form, $40 fee. 

Step 12- 12/6/10 Received state DEA license, mailed Federal DEA application with $591 fee

Step 13- 12/15/10 Received Federal DEA license- Now officially ready to work- a full SEVEN MONTHS after graduation

Step 14- 01/05/10 Negotiate employment, construct "Collaborative Agreement" with new MD employer. Apply on-line for free NPI number (federal requirement to bill as practitioner). Receive official NPI number via email same day.

Step 15- 01/13/10 Apply for Malpractice Insurance- $1000 for one year policy (includes new-grad discount, "tail", $1,000,000/$3,000,000 coverage)

Now, work for six weeks learning the ropes. Had to teach myself about CPT codes, documentation requirements for reimbursement, new EHR system, order prescription pads. Still not officially recognized by medicare, medicaid or insurance companies. 03/11/11- Submit application to "CAQH." Very long and painful application process. Required names, dates, description of all clinical rotations, date of initial RN licensure (9/8/91), references, background check, etc. CAQH will submit application on my behalf to multiple insurance companies for approval as provider. Saves time and effort of applying to each individual company. 10 months after graduation, still not done with the red tape. To be continued…

This is the time of year when soon-to-be-graduating nursing students start to panic. Their college years are almost over. In two short months, they will be graduating and preparing for the NCLEX exam - It’s time to get a job. As if there isn’t enough going on, they are faced with the critically important task of writing a resume. I am posting some suggestions I offer to them below: 

Some ways to describe student nurse /PCA duties:
Instead of  "I gave baths and assisted with ADLs"
Say I assisted patients in meeting their personal care needs and provided individualized attention/interventions while encouraging patient involvement in self-care, promoting independence,  and maintaining dignity

Instead of:  "I was a float"
Try:  I have experience adapting to any hospital unit / a variety of clinical areas /changing situations/environments.  I have the ability to quickly establish rapport and a positive working relationship with nurses and ancillary staff. I can quickly orient myself to unit, independently take initiatives/ require minimal assistance/ encouragement/ instruction…

I can function as an integrated member of the staff/team in any situation and deliver the safe, effective/efficient care to complex pts. I can readily/easily adapt methods/ interventions to a wide range of situations.

Instead of  "I was a sitter"
Try: I have experience providing focused, one-to-one care and ensuring a safe, nurturing/caring/positive environment for patient’s who are at a significant risk for injury or complications.

Other descriptions of duties
-Acted as pt advocate, expressing pt concerns/needs/desires to nurses and other staff who were unable to devote/ spend as much time with patient

-Utilized the time spent providing personal care/bathing to: perform thorough skin assessments, assess nutrition and hydration, look for signs of neglect and abuse, spot early signs of skin breakdown and/or identify pts who were at risk, promote measures to prevent skin breakdown, initiate toileting schedule,  etc

- Ensure adequate nutrition and hydration, assess for problems with chewing and/or swallowing /eating difficulties that may increase risk of aspiration/ poor nutrition.  Assisted pt/family with increasing safety awareness/promting a safe environment;  set-up meal, encourage independence/feed self,  ensure proper positioning to promote adequate food absorption and digestion, prevent aspiration, etc.

-Accurately monitored/assessed and reported/recorded intake and output, nutrition/hydration status.

-Educated pts/families on fall prevention, safety risks, use of call bell, importance of calling for assistance, etc.

-Ensured adequate lighting, clear pathways, safe transfers, promoted/reinforced proper positioning, transfer techniques, use of assistive devices.

-Ensured that all items were within reach and pt was comfortable, adjusting temperature, lighting, clothing, bedding/ linen was clean, dry and wrinkle free.

- Assisted with communication with families, making pt/family needs known, answered questions, directed to appropriate sources to answer questions, etc. 

- Promote socialization, conversation, allow patient to express concerns in a non-judgemental, non hurried environment.

- Assessed level of orientation, ability to read and understand written material (menu, paper) and comprehend what was read, ability to make decisions (meal choices), etc.

This is such a fantastic time to be a Nurse Practitioner! If you are an NP student or considering NP school, you may be feeling discouraged or overwhelmed by some of the negative things you hear from new grads or NPs. There is a lot of talk about difficulty finding jobs, low pay, poor treatment and excessive workloads. While some of it is true, you must take what you read with a grain of salt. Remember that people with negative experiences tend to be more vocal than others. This is not a criticism, by any means, just an observation.

An example from my own experiences: After I graduated in May and began studying for boards, I joined a popular forum that discussed the NP certification exam. The majority of posters had failed the exam, some more than once, and were writing about their experiences. Other posters (like myself) were preparing to take the exam, and writing about their anxieties and fears. I made some wonderful friends on that site who offered important advice that helped me pass. As time went by, I began to notice that once a friend successfully passed the exam, they rarely posted on the site. I began to realize that once they passed, these posters had little more to say on the subject and were moving on to the next phase of their career. So while it seemed like “everyone who took the exam was failing” I was not actually getting an accurate picture of the typical test taker. The fact of the matter is that somewhere between 80-90% of test takers pass the exam. Whether it is on the first try or not, who knows. But if it takes more than one attempt to pass, it is not the end of the world. It is not something you have to disclose on your resume or during an interview.

Finding a job may be more challenging than you would like it to be. BUT...that is true for ANY job seeker in this economy. There ARE jobs out there, but you will have to put some time and effort into getting one. During the time I spent studying for the exam, I also made sure I spent some time every day on the job hunt. I will go into this more in future post, but just know that there IS a market for new grad NPs.

In terms of low pay and/or excessive workloads, I think it is partially true, Again, you have to consider the source. Any new grad, RN or NP, has to start at the bottom. And there is always a period of time when a new grad feels overwhelmed and overworked. It is part of the transition to a new role. As time passes and experience grows, the work gets easier and each patient takes less time. As you become more efficient, the work takes less timeIt’s the whole “Novice to Expert” concept that Patricia Benner writes about in her books and articles. And for experienced RNs who become NPs, it’s actually novice RN to expert RN, back to novice as an new grad NP. It’s a challenging time, but not impossible and it’s something that every new grad goes through. Just keep plugging along and take it one day a time. It may seem overwhelming and impossible right now, but you will get through it!

Some random thoughts on school. You give up a lot when you decide to go on for a Nurse Practitioner degree (or any degree, for that matter) - even if you are a relatively young nurse when you start the program. (Although most NP students are older. Statistics show that the average age of a Nurse Practitioner is 47 and she (96% female) has been practicing for 10 years).

1) It is already a given that you will lose income. Even those students who work full time are only able to do so for a portion of the program. Once you are at the point of starting your clinical rotations, you will lose one full day or more. Most primary care, OB-GYN, and peed offices are Mon-Fri daytime hours. Some students will work weekends or nights, but this takes it's toll after awhile. It will be reflected in your health, in your relationships at home and work, and in your school performance.

2) You will spend more money than planned for tuition, books, computers, printers, paper, ink, and "other" expenses. Even if you are very fiscally responsible, and have a savings account or money somewhere else that you've earmarked for school, the unexpected always pops up. The furnace will break, a deer will run out in front of your car, a tornado will throw a tree limb through your roof, your hard drive will crash... You WILL spend money on the unexpected, usually at the most inconvenient times.

3) You will do damage to your body. Stress and worry takes it's toll. You will lose sleep, miss meals, eat junk, develop carpal tunnel, a stiff neck or some other ailment related to studying.

4) You will lose a portion of your life AND the lives of those around you. This is by far the most difficult of all losses. After graduation, I wanted to get back to my life. Unfortunately, while I was spending all of my free time studying, life went on without me. The friends I used see for lunch or drinks every few weeks moved on. There've been divorces, new babies and, in some cases, new friends that have filled the spots left when I went off to study.

The hardest thing is what is lost in terms of those closest to you. Exactly one year ago, I was spent Christmas break frantically working on my Capstone project. Even though I was "off" for a month, I was consumed trying to meet deadlines for the required final project. Last year, we didn't even put up a Christmas tree. I didn't have time to really shop, so it was gift cards for nearly everyone. Last year, I went to some of the usual celebrations, but my mind was on school. I was there and involved, but I really wasn't "there." Now I find the tree is dirty, very dusty, and spider-filled from 2 years of sitting. Lights don't work, ornaments are missing, probably from hurriedly putting the tree away two years, in a panic, with a new semester looming.

Most painful (yet wonderful) of all, my nieces and nephews have grown up. Now officially teenagers, they don't want to sit and talk to me while there are friends to text and music to listen to. They now know that there is no Santa. They don't play with toys anymore. That is the thing, oddly enough, that really hit me hard. With more time and more money than previous years, I began my Christmas shopping early. As I looked at the colorful ads in the Toys-R-Us circular, I was completely overcome by sadness. Suddenly it hit me like a ton of bricks and I realized that those days are over. No more toys for the kids…ever. I missed it…It all happened without me…I totally and completely missed those last few magical Christmas' when the kids were still "kids." While I was studying and focusing on school, they were growing up. How incredibly sad I felt. I was finally "ready and able" to jump right in and be the "Auntie Jessie" they always knew and loved BEFORE school. For them, however, those days are in the past. The last few Christmases are nothing but old memories for them. Memories that do NOT include me.

All I can do from this day forward is embrace the "here and now." Instead of toys for the girls, it's pretty nail polish and makeup. For my nephew, it's a Razor Sole Skate (some kind of one-footed skate board/ rolling skate thingie). All gifts easily returnable, as their taste changes day to day. Here's my advice: It's important to remember that life doesn't wait for you while your in school - it goes on without you. No matter how busy you are, you must make time for the people you love. If you don't, you will truly regret it. You can trust me on that one!

 Helpful hints for the last 6 months of the NP program:

) Buy a copy of an audio version of an NP review course. A new 15 CD set from FHEA (Margaret Fitzgerald) costs around $400. The 12 CD APEA version costs around $269. The 18 CD Barkley review costs around $400. An alternative is buying a used set of CDs. The Fitzgerald reviews can be easily found on Ebay for $150- 300. Also on Craigslist and occasionally Amazon. APEA is harder to find but cost less at $100-150. The “peak” season to find these is June-September and again in December-February. You can also find out if a recent graduate from your school is willing to sell their copy. For most grads, once the exam is done, they never want to listen to the CDs again. Try to get the most recent copy (new versions are released every year) and try to get the workbook that comes with the audio set. Listen to the CDs in your car, while running errands, while cleaning, vacuuming, folding laundry, doing dishes, etc. It will help you immensely in your classes as well as prepare you for the exam.

2) Buy a review book. While in school, commit to doing at least FIVE questions EVERY day. Keep the book next to your bed and do this EVERY night. My personal favorite is Fitzgerald’s latest review book (usually $35-55 on Amazon, Borders, etc). Two other excellent review books are by Maria Leik (Family Nurse Practitioner Certification: An Intensive Review) and JoAnn Zerwekh (Family Nurse Practitioner Certification Review). Both of these are older books and cost $30-50 but both are extremely helpful. Zerwekh comes with A CD of practice tests- absolutely the BEST way to prepare for the exam.

3) Request official transcripts from all of the previous schools you’ve attended. I would suggest having TWO official copies sent to your home- one for you to review and the other to keep in a safe place, completely sealed. Don’t wait until after graduation. The registrar gets very busy after graduation processing transcript requests and usually has limited summer hours. You will need to submit these for the ANCC exam.

4) In the last 4-6 weeks of the program, begin the ANCC or AANP application. Also find out what your state requires for licensure. There are forms that need to be filled out and/or signed by the school. Don’t wait too long. After graduation, professors and administrators are typically “off” for the summer and harder to reach.

5) Start saving for the costs associated with the certification process. Even putting away $5 per week will make a big difference. It can cost around $1500 or more by the time you’re done. For example,

Audio CDs = $300- 400
Review books = $100- 150
Transcripts = $30
Graduation fee = $125
ANCC/AANP exam fee = $240- 360
LIVE review course = $400
State license fee =$200
State controlled substance application = $50
DEA federal controlled substance application = $591



I have been an RN for nearly 20 years and in many ways, I still practice “old school” style. Back in the old days, there was a manual sphygmomanometer at every bedside. When I began teaching a few years ago, I was shocked to find that the new standard of practice was to use automated cuffs on all patients. It is difficult to even find a manual cuff on the unit. I was initially very strict and insisted that the students only use a manual cuff when assessing blood pressure. After awhile, it became impractical and for the sake of time management, I allowed the use of automated cuffs.

Last semester,  a senior nursing student was caring for a patient  who became very tachycardic in response to a medication. As the patient’s heart rate increased, the blood pressure plummeted. As we were waiting for the physician and doing the usual interventions for a hypotensive patient (i.e., wide open fluids, trendelenberg, etc), the automated cuff continued to cycle, but was unable to get a reading. I grabbed the manual cuff and instructed the student to get a blood pressure reading “the old fashioned way.” She was completely unable to perform this basic nursing task. As she was fumbling around, the physician came into the room, followed by a couple of residents and some other staff members. I pushed her out of the way and quickly got the reading myself. Afterwards, she was in tears. She felt horribly embarrassed and felt helpless that she could not help her patient when the patient really needed help. I agreed.

From that day forward, I went back to my old ways. Manual blood pressures on every patient. In a critical situation, the automated cuff won’t cut it. In a patient with Afib, the automated cuff won’t cut it. I was pleased to see an article out of the U.K. yesterday that confirmed what I already knew – manual cuffs are better and more accurate. I hope this leads to a shift away from reliance on automated cuffs. Technology is not perfect, and is not a replacement for good old fashioned hands-on skills. Sometimes, old school is better!