Certification Versus Licensing Versus Credentialing

If you are confused by these terms, you’re not alone. Certification, licensing and credentialing are important to understand as these are all requirements for doing our jobs as Nurse Practitioners. Today, we’re going to talk about:

• What each of these terms mean
• How they’re different
• How each is related to our job

Let’s start with what’s common between all three terms: well, all three terms – certification, licensing and credentialing – refer to processes that ensure and demonstrate that Nurse Practitioners, and other healthcare professionals, have the appropriate knowledge, education, training and experience to perform a specific job. 

Important things to know before we dive into certification, licensing and credentialing

APRN versus ARNP: Depending on the state you live in, you may hear and use the term Advanced Registered Nurse Practitioner (ARNP) or Advanced Practice Registered Nurse (APRN). For consistency throughout this post, and because it’s the most widely accepted term, I will be using APRN. 

Nurse Practitioners are not the only type of APRNs: One thing to keep in mind is the term APRN refers not only to Nurse Practitioners, but to three other types of nurses who have further graduate education. There are 4 Advanced Practice Nursing/APRN roles:

1. Nurse Practitioners (NP)
2. Clinical Nurse Specialists (CNS)
3. Certified Nurse-midwives (CNM)
4. Certified Nurse Anesthetists (CNA)

Nurse Practitioners and Clinical Nurse Specialists are then further classified by national certification based on population focus:

1. Family
2. Adult-Gerontology – Acute or Primary Care
3. Women’s Health 
4. Pediatrics – Acute or Primary Care
5. Neonatal
6. Psychiatric/Mental Health 

When you see all the letters and acronyms after a Nurse Practitioner’s name, what do they mean? Some of these are directly related to what we’re talking about today. 

Okay, now let’s dive into certification, licensing and credentialing. We’ll start by discussing certification, then we’ll move into licensing and finally, credentialing. 

Certification

In a nutshell: this refers to the fact that you have passed an exam that has tested your knowledge in a specific area. See this post for study tips and tricks for passing your certification exam.

Certification recognizes your education and knowledge through a national exam. Certification is available to any individual who has successfully met specific academic criteria or completed an accredited masters, post-graduate or doctoral nurse practitioner program within the population focus you studied in school. 

There are several different certification bodies depending on your NP track/population focus. 

Certification Board	Certifications Offered
American Academy of Nurse Practitioners (AANP)	Family Nurse Practitioner Adult-Gerontology Primary Care Nurse Practitioner  Emergency Nurse Practitioner
American Nurses Credentialing Center (ANCC)	Adult Nurse Practitioner Adult-Gerontology Acute Care Nurse Practitioner Adult-Gerontology Primary Care Nurse Practitioner Emergency Nurse Practitioner Family Nurse Practitioner Gerontological Nurse Practitioner Pediatric Primary Care Nurse Practitioner  Psychiatric-Mental Health Nurse Practitioner School Nurse Practitioner
American Association of Critical-Care Nurses (AACN)	Acute Care Nurse Practitioner – Adult-Gerontology Acute Care Nurse Practitioner
Pediatric Nursing Certification Board (PNCB)	Primary Care Certified Pediatric Nurse Practitioner  Acute Care Certified Pediatric Nurse Practitioner
National Certification Corporation (NCC)	Neonatal Nurse Practitioner  Women’s Health Care Nurse Practitioner

Once you are certified (aka met the certification board’s requirements and passed the exam), you are not yet eligible to start practicing. Certification is one of many steps in the process of getting licensed to practice and credentialed in your state. Check out this step by step guide to registering and passing the AANP FNP exam.

Once you are certified, you have to maintain your certification in order to keep your license. Depending on your certification board, there is usually the option to recertify based on a certain number of practice hours and continuing education hours. The second option is to recertify via taking the exam again. This second option is usually reserved for individuals who have been out of practice for several years for one reason or another. 

In the case of AANP and as an FNP, I have to complete at least 1,000 hours of clinical practice in the Nurse Practitioner role every 5 years through employment, volunteering or in a faculty clinical supervision role. In addition, I have to show proof of a minimum of 100 hours of continuing education with at least 25 of those hours in advanced practice pharmacology within the 5 year certification period. 

Licensing

In a nutshell: recognition that someone has met all of the state’s requirements to practice that profession 

Licensing is done on a state by state basis thus the requirements vary by state. Generally the minimum requirements are as follows for a new license:

• An active RN license in the state you want to practice
• Certification from a nationally recognized certification board (each state chooses which certifications it will accept) 
• Proof of graduation from an advanced nursing education program (DNP or MSN), often showing courses you’ve taken

You must have an active RN license before applying for your APRN or ARNP license. The State Board of Nursing will issue you a license, APRN or ARNP, often to practice in a specific role. This role is based on your certification, but depends on what your state recognizes. 

Most states require certification in order to be licensed and practicing; however, some states do not require this if you completed a program some number of years ago and have been regularly practicing as a Nurse Practitioner. 

The NP licensure and state designation has many different names depending on the state you live in, though APRN and ARNP are the most common and widely understood.

• Advanced registered nurse practitioner (ARNP)
• Advanced practice registered nurse (APRN)
• Certified registered nurse practitioner (CRNP)
• Certified nurse practitioner (CNP)
• Licensed nurse practitioner (LNP)
• Nurse practitioner certified (NPC)

This would definitely be better if it were streamlined across all states. For example, in the state I practice in, my licensure is listed as APRN-CNP with Family Across the Lifespan listed as my population focus. 

Credentialing

In a nutshell: this is the process your employer uses to make sure you are qualified to do the job you were hired to do and is necessary so you/your organization gets paid for the work you do 

This again is done on a state by state basis. Credentialing occurs during the hiring process and at least every three years (maybe more often) depending on the state you live in. The good news here is this process is more straightforward simply because the organization you work for often has a credentialing specialist who will walk you through the process and let you know what you need to do and when. 

So what is credentialing? It is a complicated and long process, but basically it is the process of your employer verifying your licensure, certification, education and references. Employers want to make sure you are appropriately qualified to do the job they hired you to do. The underlying goal of credentialing is to protect patients from unqualified healthcare providers. 

In the credentialing process, you can expect to fill out a lot of paperwork and share any documents you have proving your education, training, license, and certification. You may also be asked to provide references. 

Credentialing is also required if you and your healthcare organization want reimbursement for services you provide to patients with Medicare or Medicaid. Credentialing is often necessary for providers to bill other health insurance companies as well. 

Summary

So there you have it. We discussed certification, licensing and credentialing. As you can see, all the steps that happen between graduating and actually starting your first job are not very straightforward. It’s even more confusing because each state has different processes. In a future post, I hope to outline a step by step process that will help provide you with a checklist for navigating this process. 

One resource I found helpful is this tool on the AANP website. It allows you to learn about the regulatory structure, licensing requirements, and the nurse practice act specific to your state: https://www.aanp.org/practice/practice-information-by-state

For additional resources: https://npheadtotoe.com/resources/

Let me know if you have any questions by commenting below. 

Where are you at in this process – still in school? In the middle of board exam studying? Waiting for credentialing? What other questions do you have?