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Perioperative certification correlates with better care

Publish Date: 3/28/2012

In the session “The Value of Certification in Perioperative Nursing,” Melissa Biel, DPA, RN, and James Stobinski, PhD, RN, CNOR, presented the data that the Accreditation Board for Specialty Nursing Certification (ABSNC) has gathered about nursing certification and how that information applies to perioperative nursing certification. Biel noted that board certification of physicians is important to patients and hospitals and is a good indicator of quality care whereas nursing certification is less recognized by the public even though it does correlate with better care. Most physicians proudly post and publicize their board certifications, yet most nurses still identify themselves by first name only and rarely include their certification when introducing themselves to patients. The ABSNC would like to change that.

Biel noted that there is a difference between certification, formal recognition of a body of specialized knowledge by an accredited organization, and holding a certificate, which only indicates that you are competent in whatever class offered the certificate. Trends in certification indicate that there is increased interest and growth in certification across all specialties, more employers are requiring certification of nurses and 13 states now allow certification to count toward relicensure. The ABSNC survey included 94,768 nurses and garnered an 11% response rate. Across specialties, most certified nurses have BSN degrees or higher, 31% are staff nurses and more than 50% are in the 29 to 30 year age group. Barriers to certification include cost to maintain certification, taking and failing the exam, and no interest in certification.

Stobinski then described how these data affect perioperative nursing. Statistics on the number of perioperative nurses are hard to come by, he said, noting that AORN estimates that there are approximately 160,000 perioperative nurses, 40,000 of whom are AORN members. Perioperative certification has grown from 686 nurses in 1979 when the first test was administered to 33,950 nurses in 2011. There are more than 3.1 million nurses in the United States who hold licenses to practice and of those only 2.1 million actually practice. The National Database of Nursing Quality Indicators study surveyed 303,000 nurses; of these only 4,477 were CNOR® certified and 159 nurses held CRNFA® certification. The Competency & Credentialing Institute (CCI), which administers the CNOR/CRNFA examinations, show that certified perioperative nurses on average

  • are 48.8 years of age,
  • overwhelmingly white, non-Hispanic (77.9%),
  • hold BSN degrees or higher (57.7%), and
  • have more than 11 years of experience.

As he noted, people come to the OR to work and rarely leave to pursue another type of nursing. The OR, he said, “has a ‘Mafia effect.’ It’s easier to get into than it is to leave, perhaps because it takes a while to become good, and the specialization does not translate to many other areas of nursing.”

The Magnet™ process for hospitals tends to increase the number of certified nurses, who are paid more overall. He noted that perioperative nurses have the highest wage of any nursing specialty, but when questioned by an audience member, he admitted that AORN’s annual salary survey did not indicate whether this was because of overtime worked on a voluntary basis or because “there isn‘t anyone to relieve you at the end of your shift,” which made the audience laugh.

In conclusion, he said that nurses could have a much larger role in how they practice by creating one educational path to acquire licensure. It is important to evaluate sub-specialty education to determine how best to educate those who want to work in the OR, find a way to prove the clinical value of the certified perioperative nurse and create a common examination for entry into sub-specialties rather than every facility having its own way of orienting and educating new perioperative nurses. This is important for the perioperative specialty to be able to replace the average AORN member, who currently is more than 56 years of age, with well-educated competent new nurses. Stobinski predicted that CCI would need to be more involved with its certified nurses and be more directive of their continuing education for certification. Recertifying nurses “will no longer get to choose all orthopedic continuing education to recertify because that’s what you like. We hope to demand greater accountability of our CNORs and require life-long, CCI-directed learning to ensure competency.”

Editor’s note: ANCC Magnet Recognition is a registered trademark of the American Nurses Credentialing Center, Silver Spring, Md. CNOR/CRNFA are registered trademarks of the Competency & Credentialing Institute, Denver, Colo.  

Guidelines for Perioperative Practice


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