CCNS Exam: An Overview

The American Association of Critical-Care Nurses (AACN) Certification Corporation administers the Certificate for Adult, Neonatal, and Pediatric Acute and Critical Care Clinical Nurse Specialists (CCNS) exam at testing locations across the country on dates throughout the year to clinical nurse specialists interested in strengthening their credibility in the medical community. By taking and successfully passing this exam, clinical nurse specialists will demonstrate their abilities to treat patients across the age spectrum. Because of the many physiological differences between infants and adults, or teenagers and the elderly, it is necessary for clinical nurse specialists to be capable of drawing on very specific knowledge and experience at a moment’s notice. The CCNS exam not only provides standards up against which to determine their level of knowledge, but it also pushes them to learn more.

There are more than 150 testing locations for the CCNS exam across the country. Each of these locations offers testing six days per week, except on holidays. If you think becoming certified may be the right career choice for you, you’ll first determine whether or not you are eligible to take the exam. Then you will need to fill out an application, which you can find at the website for the AACN, and then mail it in to the offices of the AACN along with your college transcripts, a copy of your nursing license, an eligibility verification form, which can also be found and printed off from the AACN’s website, and all appropriate fees. The test can be taken in one of two formats, paper and pencil, or by computer, though most people will be required to take the computer version. If you are an AACN member, your fees will be $245 and fees will be $345 if you are not a member.

The pencil and paper version of the exam is only offered if you do not live within a 3 hour range of a Computer-Based Testing (CBT) location. Fees for the paper and pencil version will be similar to the computer version, but will vary depending on whether you are an AACN member or not, whether you are taking the test at a U.S. or military location, and whether or not you have four, five, or six or more people in your group taking the exam. Special arrangements can also be made for test takers with disabilities.

If you meet all eligibility requirements and are approved for a spot in the exam, you will schedule an exam location and time at the website for the Applied Measurement Professionals, Inc. (AMP). On the day of your test, you will need to show up with your confirmation postcard, which you will receive by mail shortly after being approved, two forms of government-issued identification, such as a driver’s license or passport, and pencils if you are taking the paper and pencil exam.

The exam will consist of 175 multiple-choice questions, 155 of which will count toward your final score. The other 20 questions will be used for statistical purposes. You will be given a 3 ½ hour time limit, and content will cover clinical practice and ethical practice as related to adults, children, or infants according to the age bracket you wish to work with. In one portion of the exam, questions will not be particular to any age group; questions will be drawn at random from all age brackets. Before you begin the computer-based test, you will be allowed to take a practice test to get yourself accustomed to the format. The time you spend on the practice exam will not detract from the time you will have to complete the actual exam. It is not mandatory that you practice at all, but it is wise, as this time will give you a chance to see what the test will be like and work through any nerves arising from uncertainty of the computer format.

CCNS Exam Content: Adult Test and General Core Portion

The first two versions of the Certificate for Adult, Neonatal, and Pediatric Acute and Critical Care Clinical Nurse Specialists (CCNS) exam cover pediatric and neonatal healthcare and the ethics pertaining to the treatment of patients in these age brackets. The third version of the CCNS exam covers healthcare for adults in critical conditions. General healthcare for patients in critical conditions that span the age spectrum will be presented on each version of the test. The adult test is very similar to the pediatric and neonatal tests. Some of the same conditions that appear in these other tests may appear under the adult heading with the only difference being the necessity of a different age-appropriate treatment. There may be some illnesses covered that will only pertain to adults because they are not present in younger patients.

As with pediatric and neonatal patients, there are two major categories the adult portion of the exam will test on: clinical judgment and ethical practice. Clinical judgment will take up 22% of the material on this portion of the test, and it will deal with the various systems of the body and the conditions associated with each of them. Test takers will be expected to know how to identify these conditions, their implications, and how to treat them in a normal adult population. Some of the systems covered include the cardiovascular system, pulmonary system, and endocrine system. Conditions associated with hematology, neurology, the gastrointestinal system, and multisystems will also be covered.

Within the cardiovascular system, questions might arise on coronary syndromes, myocardial infarction, peripheral vascular insufficiency, dysrhythmias, or heart failure. Questions relating to the pulmonary system may test your knowledge of acute lung injury, respiratory infections, hypoxemia, emphysema, bronchitis, chronic lung disease, or lung contusions. Possible questions on the endocrine system may touch on acute hypoglycemia, hyperosmolar hyperglycemic state, or diabetes insipidus. Hematology topics could center on organ transplants, HIV, coagulopathies, and blood products. Some examples of neurology topics are strokes, seizures, skull fractures, aneurysm, or meningitis. Pancreatitis, gastrointestinal surgeries, and gastro-esophageal reflux are examples of topics related to the gastrointestinal system. A few possible renal system topics are hypoxia, dialysis, renal trauma, or potassium imbalances. Multisystem problems and conditions will also be represented in the clinical judgment part of the adult healthcare section.

CCNS Exam Content: Adult Test and General Core Portion

The other 78% of the adult section will be spent on ethical practices. This is divided into several subtopics: advocacy, caring practices, collaboration, systems thinking, response to diversity, clinical inquiry, and facilitation of learning. It is critical that you be able to recognize serious medical injury and illness and know how to treat it, but as a clinical nurse specialist you will also be dealing with many types of people. Professionalism entails your being sensitive to the needs of others and treating them with dignity. The ethics practice portion of the exam (in all three sections, adult, pediatric, and neonatal) tests your ability to work with different types of people and to alter your approach as necessary.

The final portion of the CCNS exam is a general core section. These questions are the same kinds you might expect in the age-specific parts of the test, but they will not fall under the heading of a certain age category. You might receive one question that pertains to an elderly patient, and the next question might pertain to an infant. You might also get questions that can apply to all three age brackets: adults, children, and infants. This section will constitute the majority of the CCNS exam. While passing the CCNS exam may certify you to work as a clinical nurse specialist with a specific age population, it is important that you know how to approach other age groups as well. Some of the information you will be tested on may apply to any level of development.

CCNS Exam Content: Pediatric and Neonatal Tests

The Certificate for Adult, Neonatal, and Pediatric Acute and Critical Care Clinical Nurse Specialists (CCNS) exam will feature content pertinent to adult, pediatric, or neonatal patients depending on which age population you wish to be certified to work with. In addition to these three areas (which depend on your particular test), there will be a general core portion on each of the tests which will present questions that span across all age brackets.
For the pediatric portion of the exam, you will need to know about conditions relating to the cardiovascular system, such as acute heart failure, cardiac surgery, cardiogenic shock, cardiovascular pharmacology, congenital heart disease, hemodynamic monitoring, and pulmonary hypertension. Relating to the respiratory system, you will need to know about acute lung injury, acute respiratory failure, air-leak syndromes, respiratory infections, chronic lung disease, aspirations, pulmonary pharmacology, and congenital anomalies. You will need to know about various conditions associated with the endocrine system, such as acute hypoglycemia, inborn errors of metabolism, diabetic ketoacidosis, diabetic insipidus, and syndrome of inappropriate secretion of antidiuretic hormone (SIADH). In terms of immunology, you should know about sickle cell crisis, organ transplantation, immunosuppression, hyperbilirubinemia, and serious coagulopathies.

Neurological conditions will also come up on the test. These may include spinal cord injury, congenital neurological abnormalities, seizure disorders, head trauma, neurologic infectious diseases, neuromuscular disorders, and neurosurgery. Gastrointestinal conditions that may be covered include gastrointestinal abnormalities at birth, gastrointestinal surgeries, bowel obstruction, abdominal trauma, or gastrointestinal hemorrhage. Conditions relating to the kidneys that may appear on the CCNS exam are renal failure, renal trauma, and electrolyte imbalances. You also should expect to be tested on multisystem conditions (such as burns, toxic ingestion, and septic shock) and standards and ethics. Remember, these are only examples and other related conditions may appear on the exam. Also keep in mind that all of the material applies to pediatric patients.
The neonatal portion of the exam will cover material very similar to that found in the pediatric portion. The principal difference is that you will have to know the different ways you would approach these problems and treat them with infants instead of children. Cardiovascular questions may cover hemodynamic concepts, heart failure, inflammatory disease, cardiac surgery, shock states, and pulmonary hypertension. Conditions related to the respiratory system may include respiratory pharmacology, respiratory distress syndrome, apnea of prematurity, transient tachypnea of the newborn, and thoracic surgery. Conditions of the endocrine system may include inborn errors of metabolism, hypoglycemia, and diabetes in the mother of the infant. Immunology conditions may include anemia of prematurity, hyperbilirubinemia, and immunosuppression. Neurological conditions may include congenital neurological abnormalities, seizures, neurologic infectious diseases, and encephalopathy. Gastrointestinal questions may cover gastrointestinal abnormalities at birth, gastro-esophageal reflux, and hepatic failure. Conditions relating to the kidneys may also be on the test. These include renal failure and congenital renal-genitourinary abnormalities. You should also expect to see questions relating to multisystem conditions. Some examples of these include prematurity or low birth weight, serious maternal-fetal complications, or toxic exposures. Some of the neonatal questions will also deal with standards and ethics. Topics related to ethics you might expect include considerations of multiculturalism and diversity, advocacy, working as a team member, and the education of patients in areas relating to their conditions.

These are the kinds of topics you can expect on the CCNS exam as related to pediatric and neonatal patients. Broadly, these fall into 2 categories: clinical judgment, which covers conditions associated with different systems in the body, and ethical practice, which deals directly with practice guidelines, ethics, and legal standards in the work place. The clinical judgment portion (both in the pediatric and neonatal tests) will count for 22% of the exam. The ethical practice portion (again, both in the pediatric and neonatal exams) will count for 78% of the test.

CCNS Exam: Eligibility and the Application Process

The Certificate for Adult, Neonatal, and Pediatric Acute and Critical Care Clinical Nurse Specialists (CCNS) exam is not available to everyone. There are certain eligibility requirements that any potential candidate must meet before applying. If you fill out and send in an application without having met these requirements, your application will be rejected and you won’t be granted a seat in the exam.

In order to qualify for the CCNS exam, you must have obtained a high school diploma or GED and gone on to complete a graduate advanced practice education program. Your degree must be taken at a college or university with a nursing program that goes to the master’s degree level or higher. Your concentration area will need to be as an acute and critical care nurse specialist (CNS). In the courses you take, you must get clinical experience under supervision. Altogether you must amass 500 hours of clinical practice under supervision. This experience must have relevance to the nursing profession. The appropriate educational program will require your taking classes such as pathophysiology, pharmacology, and physical assessment. You will get experience in the biological sciences, medical sciences, behavioral sciences, and nursing sciences. You should also take classes pertaining to standards and ethics as related to nursing in critical situations.

At the graduate level you must amass 500 more hours of clinical practice under supervision. This experience should be directly working with a single age range: adults, children, or infants. At this level you will also need to take at least 2 didactic classes. These classes should feature content pertinent to the care of critically ill or injured patients, and their content should meet the standards delineated in the CCNS exam handbook under the Clinical Judgment section heading.

Be prepared to submit proof of your completion of your degree and transcripts that verify both the courses you have completed and all of the clinical practice hours you have accumulated. Within the CCNS Exam Handbook you will find an Educational Eligibility Verification Form. Your program director must fill out this form, sign it, and send it in. If any of the courses you have completed have ambiguous titles that may or may not apply to the critical care of patients, the program director must include a description explaining the content of the course and how it related to the care of critically ill or injured patients. At the completion of your degree you should obtain a RN or APRN license. A copy of this license must be included with your application to clear you for eligibility.
If you meet all eligibility requirements, you can continue with the application process. To apply you will fill out the CCNS application and the CCNS honor statement. You’ll send these forms in to the AACN Certification Corporation along with a copy of your RN or APRN license, all necessary fees, your official graduate-level transcripts, the Educational Eligibility Verification Form, and the State Board Notification Request Form. The State Board Notification Request Form can be found in the CCNS Exam Handbook. By filling this form out and sending it in, you will verify your eligibility to take the CCNS exam, and you will be letting the Board know which states you plan to work in.

After you apply, it should take 2-4 weeks to find out if you have qualified for the exam. You will receive a postcard confirming your eligibility to test. After you have been approved, schedule an exam appointment on the website for the Applied Measurement Professionals, Inc. You will be able to choose from more than 150 locations across the country and appointment times running 6 days a week except on holidays. If you are in the military, an overseas testing location can be arranged. If approved, you will only be eligible to test for 90 days, so make an exam appointment as soon as possible.

CCNS Exam: Study Strategies

Your position as a clinical nurse specialist will require you to deal with medical situations of a serious nature. In critical situations, it may be necessary for you to make split-second decisions based on your knowledge of the medical problem at hand. Because the CCNS exam tests on such a broad range of information that can differ to lesser or greater degrees in the cases of adult, pediatric, or neonatal patients, you can expect it to be difficult. While the difficulty of the exam may result in some anxiety on the test taker’s part, you can rest assured that if you pass you will go back into the healthcare setting with knowledge that can make all the difference in personal and patient safety. If you properly prepare, you should be able to pass and go back to your job with full confidence of your qualifications.

In order to reduce stress, make sure you are studying with the proper materials and not wasting any valuable time on subjects that will not appear on the test. Study the content areas that will be represented on the test and focus on these subjects. If you have any textbooks or notebooks you used in nursing school, find chapters that relate to these areas of content and go through them, reading carefully. Make flashcards and refer to them daily. Use flashcards only for information that is succinct and can be easily memorized with time. For example, any formulas/equations and terminology related to disease or illness would probably be absorbed and retained through the daily use of flashcards. At the end of every chapter you read, write out a brief summary of all the main points. Refer back to your book as little as possible when you do this. You’ll be able to ascertain how much you have learned while reading, and you’ll also find that you probably automatically filter out the information that is not as relevant. In addition to textbooks, reference the AACN website for a list of extra study materials that may prove valuable as you prepare for the exam.

Take the Self-Assessment Exam (SAE). The exam is taken over the Internet, and the content is similar to that you will encounter on the actual CCNS exam. Whereas the actual exam will have 150 questions, the SAE will only have 60 questions. This exam is still worth buying and taking, however, because it will give you an idea of what to expect on the actual test. Nervousness can have a negative impact on your scores, and having already taken a similar exam to the CCNS exam will go a long way in calming you. The SAE will also give you the chance to ascertain your problem areas so that you can focus more on those in the days leading up to the exam. On the website for the AACN you will find instructions on how to purchase this test. You will have to pay a $50 fee by credit card, but then you will have access to the practice exam for 90 days after you purchase it.

If you know several other people that are planning on taking the CCNS exam, plan regular study sessions. If another group member is strong in an area you struggle with, you can pair up for one-on-one instruction. If another member is weak in an area you are strong in, try teaching them. Doing this will make you more comfortable with the information you already know, and you might end up learning more. Try assigning different topics to each member of the group and then individually teaching your topic to the group. Another good study method is playing games that test you on the study material. Learning will not be as tedious, and the competition will encourage you to do better than you would studying on your own.

CCNS Recertification

CCNS RecertificationOnce you have passed the CCNS exam you must renew your certification every 4 years to remain accredited. This 4 year period begins on the first day of the month in which you pass your exam. You must recertify before this four years has elapsed. You will receive a notification of the pending expiration of your certification by mail 90 days before the deadline. There are two options for renewing your certification: continuing education and taking the CCNS exam again. Before you can do either of these, however, you must meet eligibility requirements.

Just as there were eligibility requirements for taking the CCNS exam the first time, there are requirements for qualifying to recertify. The first requirement is having a RN or APRN license. The second requirement is amassing the necessary number of work experience hours as a clinical nurse specialist. Throughout the 4 year period you must log 2000 hours as a clinical nurse specialist. In the final year leading up to your renewal deadline, you must log at least 400 hours. These hours must be spent working with the age bracket you originally became certified to work with. For example, if your certification was for a neonatal population and your hours were spent primarily with an adult population, you would not meet eligibility requirements.

The first route you can take to renewing your certification is through continuing education courses. In order to recertify in this way, you must accumulate at least 100 Continuing Education Recognition Points (CERP). You must accumulate at least 60 of these points in Area A (clinical judgment and clinical inquiry), 10 in Area B (caring practices, response to diversity, advocacy/moral agency, and the facilitating of learning), and 10 in Area C (collaboration and systems thinking). The other 20 points can come from any of these areas. These points can be gained by attending seminars, taking courses, attending conferences, or participating in workshops. They must be relevant to a particular area for you to get credit. For points falling into Area A, workshops, seminars, courses, or conferences could pertain to physiology, heart failure, anatomy, clinical research, or pathophysiology. Keep in mind that these are only examples. There are other things that would fall into Area A. Examples of continuing education topics that might relate to Area B are legal issues, public policy, or religious or spiritual considerations. Examples of continuing education topics that might relate to Area C are leadership, emergency planning, or communication skills. Instructions for calculating the points assigned to a particular activity can be found in the CCRN Renewal Handbook, available at the website for the AACN. Keep in mind that there are maximum numbers of points you can accumulate in any given area. In Area A you can get no more than 80 CERP, in Area B you can get no more than 30 CERP and in Area C you can get no more than 30 CERPs.

The other method of recertifying is by taking the CCRN exam again. If you meet the eligibility requirements and choose this method of renewing your certification, you will use the application found in the Certification Exam Handbook, which can be found at the website for the AACN. Fill out this application, submit all necessary fees and await approval for testing. If you are approved, you can schedule an exam appointment for the CCRN exam. This exam will be the same format and length as the one you originally took. The only difference will be the questions.
Renewing your certification by exam will cost you $170 in fees if you are an AACN member and $275 if you are not a member. Renewing your certification through continuing education will cost you $120 if you are an AACN member and $200 if you are not a member. Keep in mind that if you choose continuing education you may also have to pay for activities you participate in.

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