CHEST to offer first-of-its-kind certification for APPs in critical care

If you’re a physician associate (PA) or nurse practitioner (NP) in critical care—or if you work with one—you’re well acquainted with the valuable, essential work that advanced practice providers (APPs) perform in this setting. APPs bring a wide range of skills, from stabilizing patients to providing hands-on care in the ICU, often spending more time interacting with patients than physicians can, said Robb Rabito, MEd, Senior Director, Strategy, at CHEST.

Yet, despite the importance of their role, there has been no certification available for an APP’s body of knowledge and experience in critical care—until now. Beginning in June, CHEST will open registration for a first-of-its-kind critical care certification for APPs.

It’s “one exam that can validate both professions,” said Allison Wynes, DNP, ACNP-BC, FCCP, at University of Iowa Health Care. And the certification also leads to benefits for the multidisciplinary teams working in critical care, as well as patients.

What’s covered?

CHEST’s Advanced Practice Provider Critical Care Exam is divided up into 11 domains:

1. Neurologic System 
2. Cardiovascular System and Shock 
3. Pulmonary System
4. Gastrointestinal System
5. Renal, Endocrine, and Metabolic Systems
6. Hematologic and Oncologic Disorders
7. Infectious Disease
8. Diagnostics and Procedures 
9. Special Considerations: Surgical, Trauma, and Obstetrics 
10. Pharmacology and Toxicology 
11. Patient-Centered Care, Health Equity, and Ethics 

VIEW DETAILED EXAM SPECIFICATIONS »

To determine these 11 topics—as well as each one’s percentage of the exam—CHEST used a rigorous and data-driven approach aligning with professional certification standards. It began with insight from the people who know the field best: APPs. A steering committee was assembled, made up of APPs with at least five years of experience across a variety of critical care environments, including surgical ICUs, pediatric ICUs, and others, said Leeah Sloan, MS, PA-C, Manager, Critical Care Advanced Practice Providers, at Henry Ford Health.

Committee members focused on foundational areas for practicing critical care that are meaningful across these different ICU environments. “The certification exam will be really applicable to the job you’re doing every day and the care you’re giving every day,” Dr. Wynes noted. CHEST also underwent a job task analysis to examine all the tasks an APP might perform in a critical care setting.

At each step, the team verified that the exam topic areas reflected what APPs encounter when providing critical care. For instance, a survey sent to hundreds of APPs allowed practitioners from around the country to weigh in on the specifications and specific elements APPs would need knowledge of in the exam. From there, the group developed a blueprint for the scope of work for APPs in critical care medicine, Rabito said.

One last step: With the topics set, CHEST confirmed that the exam mirrored the critical care physician board certification closely. “[The certification covers] what every provider needs to know when they’re working in critical care, whether you’re a physician or an APP—it’s what our patients need, [and] it’s the care that we’re providing day to day,” Dr. Wynes said.

Why it matters

If you’re not part of a team operating in the critical care environment, you might wonder: What makes this certification important and necessary?

One reason, Sloan noted, is the gap in education from when an APP graduates a program to when they practice in an ICU. “Our training programs, both acute care nurse practitioner and physician associate programs, really don’t adequately prepare you for the level of care that you’re expected to provide,” Sloan said. Training can be focused on what you’ll need to know as a generalist, which means that for APPs in critical care, a lot of education happens on the job, Sloan pointed out.

That can lead to an uneven playing field. Some APPs might wind up with a helpful physician mentor or find time to perform the research needed to gain a high level of performance; others might not. “We wanted to bridge that gap in education [with this certification],” Sloan said. As APPs prep for the exam, they can identify areas where they need more knowledge and study further, Dr. Wynes said.

Taking the extra step to earn the certification legitimizes an APP’s practice and ability to work in critical care. “It’s a signifier that says, ‘Yes, I know what I’m doing. Yes, I belong here. Yes, I can take good care of these patients,’” she said. “It’s not just a check-the-box certification.”

That legitimization is meaningful to APPs—not to mention fosters collaboration with physicians and trust from patients, Sloan said. Plus, the certification helps patients know that “qualified providers [are] caring for you at your sickest,” she added.

Certification might also provide APPs with an edge when job hunting, providing physician groups and hospital organizations with a quick view into a practitioner’s competence, Sloan said. 

Value from CHEST

There are some critical care fellowship programs for APPs scattered throughout the United States. But there’s no standard certification, and it’s meaningful that this certification is offered by CHEST. A physician may not be familiar with organizations geared toward NPs or PAs (and a PA may not know NP-focused accrediting agencies, and vice versa). But health care providers in the critical care space know CHEST well.

“It’s an organization that we can all interact with or be a part of and get education from all together,” Dr. Wynes said.

The certification may also push physicians to “see the value of partnering with us, mentoring us, and collaborating with us to really provide the best care for our patients,” Sloan said.

For APPs who have been in the critical care setting for a year or less, this exam will be a valuable way to validate their knowledge and competence in the ICU, Rabito said.

Rather than standards of knowledge and competence being set by health care institutions, which can lead to variability, Rabito said, this certification “will ensure that patients are getting the best care possible in the ICU, and that’s what is most important.”

This article was originally published in the Summer 2025 issue of CHEST Physician.