General Information Bulletin 

 Facts About the NCC 2001 Telephone Nursing Practice Certification Examination 


Valerie Grossman, RN, BSN, CEN  
Director of Nursing for Medical/Surgical Services
ViaHealth of Wayne
Newark, NY

Julie Briggs, RN, BSN, MHA  
Administrative Director, Emergency Services
Good Samaritan Community Health Care  
Puyallup, Washington

Deborah Gresham, RNC, MSN
Clinical Nurse Specialist
Miami Valley Hospital
Dayton, Ohio  

Elizabeth Jerebeck, BSN
Senior Nurse Consultant

ViaHealth Link
Rochester, NY

Sherry Smith, RN, MS, MBA,  
Vice President of Operations

Boston, Massachusetts / Portland, Maine  

Carol Stock, JD, MN, RN,
Attorney at Law

Carol M. Stock & Associates

Seattle, Washington  

Suzanne Choiniere, RN, C, MSN
Perinatal Liaison
NCC Immediate Past President  
Miami Valley Hospital  
Dayton, Ohio


This bulletin will provide an overview of the Telephone Nursing certification examination and information on how to obtain registration materials when available. 

  General Information

 Who is NCC?

NCC is a not for profit organization representing over 55,000 nurses certified primarily in women's health, primary care and neonatal specialty areas.  Established in 1975, NCC sponsors certification examinations for nurses and nurse practitioners, and subspecialty examinations for competency validation for nurses, nurse practitioners, and other health care professionals. NCC also sponsors a self assessment program offering home study modules for nurses to earn CE to maintain their certification.  

 Why Certification in Telephone Nursing?  

Many of NCC's certified nurses identified that telephone nursing (triage) is becoming a bigger and bigger part of their practice. Through a series of task forces with leaders in the telephone nursing arena, it became apparent that a need for certification in this area was important, not only to women's health and neonatal nurses but those in primary care and other types of specialty care. 

It also identified that Telephone Nursing Practice was becoming a specialty unto itself.  NCC's mission has recently been revised to incorporate meeting the needs of those working in primary care and to address certification needs for other types of health professionals and those in other but related overlapping specialties.  Based on the fact that telephone nursing is carried out primarily by nurses, NCC felt its expertise in certification and its identified broadened mission, offering certification in Telephone Nursing Practice would meet the needs of a wide variety of nurses in addition to the women's health care/neonatal specialties. 

 Who's eligible?  

Licensed registered nurses who have two years of experience in telephone nursing which is comprised of a minimum of 2000 hours are eligible to apply.

  When and where will  the tests be given?

The examination is anticipated to be offered in 2001.  A specific date will be announced in the fall of 2000. Typically, NCC examinations are given in approximately 50 sites across the U.S. and Canada.  

 How much will the exam cost? 

The fee for taking the examination is $250, of which $50 is a nonrefundable application fee. Mastercard and Visa are accepted. 


 Frequently Asked Questions

 What is the purpose of certification?

Certification is an evaluative process that provides nurses in the telephone nursing practice specialty the opportunity to publicly demonstrate what they know and to be recognized for the knowledge they possess.  As a voluntary certification process, the NCC certification examination is designed to test for special knowledge of the specialty nurse.

 What does the test look like?

NCC core certification examinations are multiple choice and consist of 160 questions.  Of the 160 items, 150 questions are counted for scoring and 10 are pretest items embedded at random.  Pretest items are not counted toward the examinee's final score.  Each question has three answer options from which the examinee selects the best response.  Three hours are allotted for the examination. 

 What credential will I receive once I pass the subspecialty examination?

Successful candidates are awarded the designation RNC (Registered Nurse Certified). 

 How long does it take to get test results?

Test results are mailed within 6 weeks of the test administration.  For example, if you take the test on February 25, your results will be mailed by April 14. 

 How are the examinations scored?

NCC Examinations are criterion referenced. This means the passing score is based on predetermined criteria.  The Rasch psychometric measurement model is used for examination development and analysis. The passing score is established by the NCC Board of Directors and is a standard score of 500. 

The difficulty of the examination determines the actual number of questions that must be answered correctly in order to achieve the standard score of 500.  Because more than one form of the examination is given, a process called equating is used.  This procedure converts all scores to a common scale.  Someone who takes a slightly more difficult form of the examination will need to answer fewer questions correctly than someone who takes a slightly easier form of the examination.  This ensures that the standard score has the same meaning for all examinations given. 

 How long is the certification in effect?

Certification is awarded for a period of three years.  You will be assigned a quarterly expiration date of either March 31, June 30, September 30, or December 31, whichever date most closely corresponds to your initial certification date.

 What are the benefits of certification?

Certification serves as an added credential to attest to attainment of special knowledge beyond the basic nursing degree. Certification serves to maintain and to promote quality nursing care by offering nurses a way to demonstrate their special knowledge in a specific nursing area.  Successful candidates will be able to use the designation RNC (Registered Nurse Certified) to indicate their certification status. 

Promotion of quality care through certification benefits not only the individual nurse and the profession of nursing but the public as well. Certification documents to employers, professional colleagues and health team members that special knowledge has been gained. It provides for expanded career opportunities and advancement within the specialty of telephone nursing, and elevates the standards of practice. 

Certification also provides each certified nurse a source of personal satisfaction by enhancing individual nursing practice, validating individual special knowledge and demonstrating commitment to professionalism in nursing. 


  How can I get registration information?

Registration catalogs will be available beginning at the end of 2000.  If you have already submitted your name and address to NCC for more information, you will be sent a registration catalog at that time.  

  What happens if I fail the test?

NCC puts no limit on the number of times a candidate can take the examination.  A new application for determination of eligibility must be filed and all applicable fees must be submitted.

 How can I prepare for the test?

NCC does not provide specific study materials as it is a conflict of interest for NCC to do so.  Eligibility criteria have been established to identify minimum levels of preparation for the examinations.  Each candidate will receive a detailed test outline and suggested resources upon receipt of their application.  Sample questions are provided to familiarize candidates with exam format.

 Examination Information

  Competency Statements

Telephone Nursing Practice is defined as a telephone encounter between a caller and a nurse in which the nurse makes decisions and recommendations utilizing the nursing process to give advice based on critical judgment and guided by protocols.  Such advice involves prioritization of patient needs/problems, crisis intervention, health education/and counseling and identification of information resources or referral. 

The registered nurse who is certified in Telephone Nursing Practice should be able to 

1. Use decision support tools such as protocols, algorithms, or guidelines to systematically assess and address caller needs. 

2. Use assessment skills to identify actual or potential health, safety and educational needs.  

3. Prioritize the urgency of caller needs utilizing critical thinking skills.

4. Develop a collaborative plan of care with caller, their support systems and their providers. 

5. Evaluate outcomes of care and modify care plan accordingly.  

6. Recognize and apply the essential elements of documentation as a communication tool and legal record.  

7. Incorporate knowledge of ethical/legal issues and professional nursing standards necessary for providing patient care and information. 

8. Demonstrate goal directed communication including effective listening, counseling, and negotiation skills. 

9. Apply clinical knowledge of primary health in prevention and wellness, health risk assessment, disease management, and self care. 

10. Identify and utilize appropriate internal and external resources. 

11. Utilize research findings, legal trends, and clinical outcomes to improve practice.  

Telephone Nursing Practice Certification Examination Test Outline 


10.01  Components of Telephone Nursing  
            a.    Establishing Contact  
                   1.    Initial Greeting  
                          a.    Nurse ID
                          b.    Organization ID
                   2.    Demographics
                       a.    Name
                       b.    Telephone Number
                          c.    Date of Birth
            b.    Assessment
                   1.    Chief complaint
                   2.    Patient History
                          a.    Data Relevant Current 
                                 1.    Baseline Data
                                        a.    Weight
                                        b.    Pregnancy Status
                                        c.    Medications
                                        d.   Allergies
                                 2.   Pre-existing Conditions
                                 3.   Symptom Analysis
                                 4.   Situation Analysis
                                 5.   Forming a Diagnosis
            c.    Prioritization
               1.    Identifying Emergencies
                  2.    High Risk Patient Populations
                  3.    Cultural Differences
                  4.    Type of Calls
                          a.    Multiple
                          b.    Emergent, urgent and non-urgent
            d.   Planning
                  1.    Acuity/Disposition
                  2.    Interventions
                         a.    Advice
                         b.    Education
                  3.   Assessing caller 
               4.   Patient Access to Care (availability or barriers)
                        a.    Nearest health care facility
                        b.    Weather
                        c     Time of Day
                     d.    Availability of Transportation
                        e.    Insurance coverage
             e.  Evaluation
                  1.  Caller understanding/comprehension
                        a.   Care advice
                        b.   When to call back
                  2.  Nurse Follow ups and Call backs

                  3.  Assessment of caller's comfort with 
                       treatment plan   
10.02   Interview Skills  
             a.  Communication Skills
                  1.  Counseling skills  
                  2.  Listening skills
                  3.  Questioning skills  
                  4.  Negotiating skills
                  5.  Customer Relations  
             b.  Barters
                  1. Language  
                  2. Disability
                  3. Educational level  
             c.  Special Callers/Situations
                  1. Frequent callers 
               2. Irate callers 
3. Obscene calls 
4. Suicide calls  
                  5. Threatening callers  
                  6. Interrupted calls  
             d.  Other type of Media Contact
                  1. E-mail/fax,
                  2. Conference calls  

10.03   Telephone Nursing Protocols  
             a.  Essential components 
          b.  Selection
             c.   Interpretation
          d.  Symptoms Not Covered by Protocols
             e.  Deviations from Protocols  


11.01   Body Systems Review and 
             a.  Musculoskeletal e.g.  
                  1.  Backache
                  2.  Trauma
                  3.  Joint pain
             b.  Dermatology e.g.  
                  1. Rash
                  2. Bums  
             c.  Reproductive/Urology e.g
                  1. Vaginal discharge/bleeding
                  2. UTI  
             d.  Gastrointestinal e.g.  
                  1. Abdominal pain
                  2. Nausea and vomiting  
                  3. Diarrhea  
                  4. Constipation               


            e.  Cardiopulmonary e.g.  
                  1. Chest Pain
                  2. Shortness of breath
             f.   Endocrinology  
                  1. Diabetes related symptoms
                  2. Thyroid related symptoms  
             g.  Neurology  
                  1. Headaches  
                  2. Dizziness  
                  3. Seizures  
                  4. Stroke symptoms  
             h.  ENT
                  1. Earache  
                  2. Toothache  
                  3. Sore throat  
                  4. Eye symptoms  
              i. Immunology  
                  1. Fever  
                  2. Infectious diseases
                  3. Autoimmune diseases  
                  4. Allergic reactions  

11.02   Psychosocial
             a.  Psychological disturbances
          b.  Domestic abuse/family violence 
          c.  Suicidal/Homicidal ideation 
          d.  Substance abuse  

11.03   Special Populations  
             a.  Infants and children  
             b.  Pregnant Women  
             c.  Geriatric population  

11.04   General Health Prevention/Promotional

11.05   Resource Identification/Referral
             a.  Resource Identification
                  1.  Availability  

                  2.  Patient Access  
                  3.  Financial ability

             b.  Referral  
                  1.  Physician referral
                  2.  911 or emergency room  
                  3.  Crisis Centers or Hotlines  
                  4.  Support Groups  
                  5.  Other Community Referrals

12.00   PROFESSIONAL ISSUES (5-10%)  

12.01   Documentation
             a.  Components 
b.  Source Reference 

12.02   Ethical Aspects of care
          a.  Autonomy 
          b.  Beneficence 
          c.  Maleficience 
          d. Justice  

12.03   Legal Aspects of Care
             a.  Malpractice/Negligence  
                  1.  Definition  
                  2.  Liability Risks
                  3.  Trends  
             b. Confidentiality 
               1.  Release of information|
                  2.  Transmission of data 
               3.  Leaving messages
               4.  Taping and monitoring calls  
             c.  Delay or Denial of care
             d. Calls from Minors

12.04   Research/Quality Assurance  
             a.  Definition of Terms
             b.  Standards of care  

 Item Writers Needed  

If you would like to participate in examination development we are seeking telephone nurses who would like to serve as an outside item writer.  You will be assigned 5 questions of your choice to write. You will receive specific instructions and an item writer manual.  Your participation as an item writer will not affect your ability to take the examination when offered.  If you would like to be an item writer please contact our office

 To receive registration materials 

 Contact NCC at: 

P.O. Box 11082  
Chicago IL 60611-0082
Telephone: 312-951-0207

 Other NCC examinations available

 Core Exams Leadinq to the RNC Credential

Women's Health Care Nurse Practitioner
lnpatient Obstetric Nursing  
Neonatal Intensive Care Nursing  
Neonatal Nurse Practitioner  
Low Risk Neonatal Nursing  
Maternal Newborn Nursing

 Subspecialty Exams Leading to a Certificate of Added Qualification

Electronic Fetal Monitoring  
Obstetrics and Gynecologic Reproductive Health for the Primary Care Nurse Practitioner  
Menopause Educator (coming in December 2000)  
Menopause Clinician (coming in December 2000)

To comment on the NCC Telephone Nursing Certification Exam, go to the E-Health & Telephone Nursing Bulletin Board

 Video / Audio Tape Library 

Carol M. Stock & Associates provides consulting, presents seminars and offers audio and video tapes on Telephone Nursing as well as other nursing practice areas.  To order audio and or video tapes on Avoiding Legal & Practice Obstacles In Telephone Nursing or  other nursing areas, click on the above link.

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