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Preparing for gerontological nurse certification.


According to the American Nurses Association Certification Catalog, gerontological nursing is "concerned with the health needs of older adults, planning and implementing health care to meet those needs, and evaluating the effectiveness of such care." For many years, though, the nurses who specialize in gerontology have felt like ugly stepsisters to the rest of the nursing community. This is in part due to the stereotyping of long-term care nursing as depressing, futile, and short on professional rewards and recognition.

Fortunately, however, nursing has developed a credentializing process that provides long-awaited recognition of achievement in this area of nursing practice. This autumn nurses will sit for the annual examination for certification in gerontological nursing. Though registration for this year's examination expired in April, the examination is given annually, and interested nurses can apply to the ANA for next year's. Pursuit of certification is, of course, one means of establishing gerontological nursing as an area for excellence and pride.

Requirements to sit for the gerontological certification exam include current licensure as a registered nurse and two years of practice working with an older population. The exam is usually given in the fall with a test application deadline of April 30.

The certification exam consists of one hundred and fifty questions divided among four domains of practice: nursing process, nursing practice and policy issues, management (administration), and education and advocacy. Greatest emphasis is placed on nursing process, which comprises 60% of the exam or approximately ninety questions. Of these, almost 30% focuses on assessment and nursing diagnosis, i.e., the differentiation of normal age-related changes from health problems.

Assessment focuses not only on physiology, but also on the patient's physical and psychosocial environment. Knowledge, for example, of such concepts as choosing contrasting colors for walls and floors or avoiding high gloss finishes is important to safety of nursing home residents. For community-dwelling elderly, nurses should be able to differentiate between formal and informal support systems, as well as identify indications of elder abuse.

For the past four years we have given a preparation course for the examination. In surveying our clientel, we have found that many of our course participants felt their knowledge base was deficient in the area of nursing process. The demographics of our certification review classes revealed that the majority had graduated from their basic nursing program before nursing process was integrated into the curriculum. We recommend, therefore, that those nurses working toward certification try to become comfortable with the framework of nursing process (see RESOURCES for recommended readings), and we offer a program along these lines.

The domain of nursing practice and policy issues comprise 20% of the exam, or approximately thirty questions. To do well in this area, nurses should familiarize themselves with standards of care, regulatory guidelines and reimbursement mechanisms, such as Medicare and Medicaid. Policy issues may include the history of nursing, current status of gerontological nursing, and political issues such as national health care reform. Nurses should be aware of legal and ethical responsibilities in care delivering, such as questions involving CPR and the patient's bill of rights. Understanding of research techniques and use of the literature is also helpful.

The management domain accounts for approximately fifteen questions, or 10% of the exam, and includes problems in health care delivery, basic principles of management and methods of evaluation, including quality assurance.

The last domain is advocacy and education, with approximately fifteen questions or 10% of the exam. This includes concepts of health promotion and patient education. Another potentially important area of examination would concern ageism and its impact on the provision of health care.

For many nurses, it is not the content but the format of the exam that is the source of difficulty. Essentially, the exam questions are multiple choice and often refer to a brief care study. Often, nurse candidates have been out of school for several years, are no longer accustomed to examinations, and feel nervous and pressured when considering this. Many nurses have found it helpful to take sample tests; these may be part of a review course or included in review textbooks. We also recommend practicing by using the answer sheet included in your ANA materials.

Once your certification application has been accepted, you will receive a handbook for registration and admission to the examination from ANA. Read this document carefully; it contains a detailed outline of test content and sample questions. A careful review of these topics will help you determine areas for further study.

Self-study programs, formal certification review courses or informal study sessions with peers or mentors are all viable options, depending on your preferred learning methods. Though the ANA Board on Certification indicates that, since the exam is practice-based, review courses are not necessary, our certification review participants indicate that a review course format affords them the opportunity to fully explore exam content and identify areas for additional study.


1. McCarty, P. ANA is the leader in certification for RN's. The American Nurse 1988; 14, Sept.

2. Am. Nurses' Association. The Career Credential Professional Certification. Certification Catalog 1987; 6.

3. Am. Nurses' Association. Handbook for Registration and Admission to the Examination 1990.

4. Am. Nurses' Association. The Career Credential Professional Certification. Certification Catalog 1990; 7.


A Challenge for Change: The Role of Gerontological Nursing. Pub #GE-9 (ANA).

American Nurses' Association, 2420 Pershing Road, Kansas City, MO 64108. 1-800-824-5834.

ANA Standards and Scope of Gerontological Nursing Practice. Pub #GE-12 (ANA).

Gerontological Nursing -- Concepts and Practice. Mary Ann Matteson and Eleanor S. McConnell, 1988, W.B. Saunders Co.

Gerontological Nursing Review: A Self-Instructional Text. Charlotte Eliopoulos, 1987, National Health Publishing.

Nursing Diagnosis: Application to Clinical Practice. Linda Carpenito, 1987, J.B. Lippincott Co.

Nursing Management for the Elderly. Doris C. Carnevali and Maxine Patrick, 1986, J.B. Lippencott Co.

The Nursing Process. Yura and Walsh, 1983, Appleton-Century-Crosfts.


1. The night before exam it is more important to rest than to study. Do something relaxing and get a good night's sleep.

2. Be sure to gather together all materials needed for the test the night before. In particular locate your admission slip and two pieces of ID.

3. Allow plenty of time to complete morning routine and travel to the test site.

4. Eat breakfast as usual -- avoid heavy meals and excessive amounts of caffeine.

5. Note the amount of time allotted for the exam (4 hours) and the number of questions (150). Know where you should be at the halfway point (i.e., two hours into the exam you should be at about question number 75).

6. Scores are based on the number of correct answers. There are no penalties for wrong answers, therefore it is better to guess than to leave a question blank.

7. If you do not know the answer to a question, begin by eliminating responses you know are incorrect. Narrow it down to two choices, if possible, and then guess.

8. Read questions and case studies carefully. For example, does the question refer to the nurse, the family, or the patient. Does it refer to the case study (it actually says so) or is it a general knowledge question.

9. Be careful about changing answers, your first choice is usually the correct response. Only change it if you are sure your initial choice was wrong.



I. Nursing Process (60%)

A. Collect data on health status (11.1%) B. Collect data on environments (8.7%) C. Nursing diagnosis (9.6%) D. Care plan (10.2%) E. Implementation (10.2%) F. Evaluation (10.2%)

II. Nursing Practice and Policy Issues (20%)

A. Specialty advancement (3.4%) B. Federal regulation compliance (3.6%) C. Ethical/legal issues (3.7%) D. Health care continuum (3.9%) E. Literature (3.2%) F. Research (2.2%)

III. Management (Administration) (10%)

A. Principles (5.1%) B. Evaluation (4.9%)

IV. Education and Advocacy (10%)

A. Education (5.4%) B. Advocacy (4.6%)

Marianne Matzo, MS, RNC, and Suzanne K. Goetschius, MS, RNC, are gerontological nurse practitioners at Saint Anselm College, Manchester, NH.
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Author:Goetschius, Suzanne K.
Publication:Nursing Homes
Date:Jun 1, 1993
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