Everything You Need to Know to Become a Certified ENP | Rosh Review

Everything You Need to Know to Become a Certified Emergency Nurse Practitioner (ENP-C)

February 17, 2017
In January 2017, the American Academy of Nurse Practitioners Certification Board, also known as the AANPCB, in conjunction with the American Academy of Emergency Nurse Practitioners, also known as the AAENP, launched the first of its kind emergency nurse practitioner (ENP) certification exam. Successful completion of the ENP exam will earn you the ENP certification, or ENP-C.

Let’s start by reviewing the eligibility requirements to take the ENP examination.

Eligibility is based on the candidate meeting the following requirements:
  • Current, active registered nurse license in the U.S., U.S. territories, or a Canadian province or territory
  • Current national certification as a family nurse practitioner (FNP)
  • Emergency care specialty content that includes at least one of the following options:

Option 1

  • A minimum of 2,000 direct, emergency care practice hours in the past 5 years as an FNP and evidence of 100 hours of continuing emergency care education, with a minimum of 30 of those hours in emergency care procedural skills within those 5 years

Option 2

  • Completion of an academic emergency care graduate or post-graduate NP program

Option 3

  • Completion of an approved emergency medicine program

Let’s take a closer look at option 1.

What constitutes continuing emergency care education, and how do these CEs differ from those appropriate for maintaining your FNP certification?

For NPs who select Option 1 (CE & practice), to demonstrate ENP certification eligibility with 100 contact hours of emergency-related CEs, appropriate educational programs focus on emergency or urgent care medical screening, decision making, differential diagnosis, patient management, disposition, and professional, legal, or ethical issues related to ENP practice. All of the CEs used to qualify for the ENP examination may be used for FNP certification renewal for those certified by the AANPCB.

Next, let’s focus on the skill requirements for emergency care procedural skills.

Procedural skills and clinical experience include education course content for family nurse practitioners that includes, but is not limited to CE credits for the following:

  • Suturing
  • Lumbar puncture
  • Thoracentesis
  • Chest tube placement and management
  • Paracentesis
  • Advanced vascular access
  • Fracture and joint reduction
  • Nail removal and repair
  • Local and regional anesthesia techniques
  • Wound management and incision and drainage
  • Diagnostic and procedural ultrasound

According to the AANPCB, credits obtained from Advanced Trauma Life Support (ATLS) courses are acceptable, but ACLS, PALS, and BLS courses are not appropriate.

It is important to note that all continuing education credits and certification programs must be from an approved CE provider, such as the American Association of Nurse Practitioners, American College of Emergency Physicians, and American Medical Association. Education programs that do not have appropriate CE credits will not be accepted.

The AANPCB provides a list of ENP procedural skills.

Let’s take a closer look at Option 2.

You are eligible to take the ENP certification examination after you complete an academic emergency care graduate or post-graduate NP program. The AAENP maintains a list of ENP training programs and ENP fellowship programs.

The difference between ENP training programs and ENP fellowship programs is that training programs build in the ENP component from the start….meaning these entry-level programs academically prepare NPs for emergency care practices. Whereas fellowship programs are for NPs who already received an NP degree and now want to specialize in emergency care.

So NPs who go on to do an ENP fellowship meet Option 3 for eligibility for the ENP certification exam.

Once you determine your eligibility, you’ll want to start preparing for the ENP certification examination. For this, we recommend starting with the end in mind, meaning we should understand the exam content for the ENP test.

The AANPCB provides background information for the exam:
  • The exam questions are process-focused. They are based on the assessment, diagnosis, planning, and evaluation components of patient care. They are also associated with the NP role, specialty population, wellness-illness continuum, and associated problem areas.
  • The ENP examination tests clinical knowledge of emergency care in the role and population focus of the family/individual across the lifespan of prenatal, pediatric, adolescent, adult, elderly, and frail elderly primary care.
  • Content Outlines identify the proportion of questions from each domain that appear on the exam. Percentages are used to determine the number of test questions related to each domain and task that appear on the multiple-choice examinations.
  • Specific age parameters are not defined for any population. AANPCB uses growth and development as the basis of age-related changes for constructing the certification exams.

The AANPCB provides background information for domains, tasks, knowledge, and technical skills and procedures:

Knowledge Areas

Serve as the basis for the certification test blueprints. Knowledge refers to acquired information necessary to perform the job tasks and the ability to perform skills/procedures. This reflects characteristics of the individual worker performing the job.

Testing Domains

Contain the knowledge and skills required to competently perform tasks for the ENP examination. Domains are the major responsibility areas that make up a profession. Domains are mutually exclusive and encompass all of the tasks performed in practice.


Discrete work elements within domains. Tasks are distinct, identifiable, and specific practice-related activities.


Learned cognitive and psychomotor actions that must be performed correctly in order to successfully complete one or more job tasks.

According to the AANPCB, there are 150 questions on the ENP certification exam. However, 15 questions are considered pretest questions, meaning these are not scored. Only 135 questions are scored. According to the AANPCB website, these are questions developed during the process of item writing. Pretest questions are piloted on examinations to obtain statistical information for determining how well each question will perform prior to vetting them for use on the scored portion of an examination. The test taker’s performance on pretest questions does not affect the final score. Pretest questions cannot be distinguished from those that are scored.

The AANPCB provides the following information on how to apply for the ENP certification exam:
  • Applicants must establish an online account at www.aanpcert.org. Online applications and electronic submissions are preferred. An additional fee is assessed for processing paper applications.
  • To avoid loss of information submitted, an application must be completed within 30 days once started.
  • Normal processing time for initial applications may take up to six weeks, depending upon receipt of a completed application, required documents, and applicable fees.
  • Applicants are notified by email once weekly if additional information is needed to complete an application.
  • Applications are reviewed to determine qualification to take the examination and for completeness and undergo professional review by qualified NPs.

The AANPCB provides information about the score necessary to pass:
  • Exam results are reported as a “scaled score.”
  • The total number of correct responses is called the total raw score.
  • Total raw scores are converted to a scaled score ranging from 200 to 800 points using statistical procedures equivalent for all administrations of the examination.
  • A minimum passing scaled score of 500 must be obtained to pass the examination.
  • A candidate’s performance on the examination is not compared to the performance of others taking the examination. (The scaled score is neither a “number correct” nor a “percent correct” score.)
  • Candidates may obtain a preliminary Pass or Fail status at the testing center upon completion of the examination.
  • A preliminary report of Pass from the testing site is not an official notification, does not indicate active certification status, and may NOT be used for employment or licensure as an NP.

Let’s take a deeper dive into the content that can appear on your ENP certification exam.

ENP Examination Blueprint
Domain – I – Domains*% of ENP Exam# of Scored Items (135)
01 – Medical Screening20%27
02 – Medical Decision Making/Differential Diagnosis27%36
03 – Patient Management31%42
04 – Patient Disposition14%19
05 – Professional, Legal, and Ethical Practices8%11

*See below for domain detail

Patient Conditions or Type
Domain II – Patient Conditions% of ENP Exam# of Scored Items (out of 135)
06 – Thoracic-Respiratory disorders15%20
07 – Cardiovascular disorders12%16
08 – Dermatologic and Soft Tissue disorders8%11
09 – Abdominal and GI disorders14%19
10 – Musculoskeletal disorders (nontraumatic)11%15
11 – Renal and Genitourinary disorders8%11
12 – Nervous System disorders6%8
13 – HEENT disorders11%15
14 – Traumatic disorders8%11
15 – Psychobehavioral and Other disorders7%9
  • DOMAIN 01: Medical Screening
    -Perform an appropriately focused history and physical exam based on chief complaint
    -Establish patient acuity level
    -Stabilize critically ill patient
  • DOMAIN 02: Medical Decision Making / Differential Diagnosis
    -Develop a narrowed list of differential diagnoses based on the greatest likelihood of occurrence
    -Prioritize the list of differential diagnoses, considering the potential diagnoses with the greatest potential for morbidity or mortality
  • DOMAIN 03: Patient Management
    -Order and interpret diagnostic studies based on the pre-test probability of disease and the likelihood of test results altering management
    -Perform diagnostic and therapeutic procedures/skills as indicated
    -Select and prescribe appropriate pharmaceutical agents using current evidence-based practice
    -Select other integrative therapeutic interventions
    -Collaborate and consult with other health care providers to optimize patient management
    -Evaluate effectiveness of therapies and treatments provided during observation
    -Reassess to identify potential complications or worsening of condition
    -Consider additional diagnoses and therapies for a patient who is under observation, and change treatment plan accordingly
    -Simultaneously manage multiple patients using situational awareness and task switching
  • DOMAIN 04: Patient Disposition
    -Determine appropriate and timely patient disposition including admission, discharge (including follow-up plan), observation, or transfer as appropriate
    -Formulate a specific follow-up plan with appropriate resource utilization
    -Engage patient or surrogate to effectively implement a discharge plan
  • DOMAIN 05: Professional, Legal, and Ethical Practices
    -Record essential elements of the patient care encounter to facilitate correct coding and billing
    -Integrate cultural competence into patient care
    -Identify the needs of vulnerable populations, and intervene appropriately
    -Manage patient presentation demonstrating knowledge of EMTALA regulations
    -Adhere to professional ethical standards of emergency care

In the event you do not pass the ENP certification exam, the AANPCB provides information about what is necessary to retake the examination:

  • Candidates are required to complete a minimum of 15 hours of advanced practice continuing education from an accredited CE provider in the areas of weakness as indicated on their score report.
  • A general NP certification examination review course is recommended but not required.
  • CE must be completed after the examination date which the candidate did not pass.
  • The certification examination may only be taken TWICE in a calendar year (January 1st to December 31st).
  • Candidates apply online using the Retake Application option.
  • Candidates can also explore other areas within the medical field like learning how to become a PA in emergency medicine, or even looking into the SPEX exam.

Study Material and Question Bank

The Rosh Review Emergency Nurse Practitioner board review Qbank was created specifically to help users pass the ENP certification exam. In fact, we provide a 100% guarantee that if you do not pass you will receive your money back

The Qbank contains 1,500 questions with comprehensive, high-yield explanations of the correct and incorrect answer choices.

Embedded within each explanation is a high-yield teaching card for those who are visual learners. Here is an example:

As an added benefit and learning reinforcement, after each board-style questions is a One Step Further question, which is a factoid-based question and answer related to the topic of the main questions. This helps to solidify and reinforce what you just learned.

Understanding there are limited resources to prepare for the ENP certification exam, Rosh Review has made it easy. You can trust us, or sign up for a free trial. Whichever you decide, Rosh Review is here to help. Feel free to send us questions

This is an exciting time for NPs. It is a privilege for us at Rosh Review to be able to play a small role in supporting the education of future ENPs.

Keep working hard and always have a sense of mission for your work.

Adam Rosh, MD

Content modified from the AANPCB and AAENP websites.

Of note: Effective January 2017 the American Academy of Nurse Practitioners National Certification Board, Inc. changed its business name from AANP Certification Program (AANPCP) to the American Academy of Nurse Practitioners Certification Board (AANPCB).

By Adam Rosh

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