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Nursing certification provides recognition for nurses, employers

Publish Date: 2/27/2013

According to the American Board of Nursing Specialties (ABNS), certification is “the formal recognition of the specialized body of knowledge, skills, and experience demonstrated by the achievement of standards identified by a nursing specialty to promote optimal health outcomes.”1 In recent years, greater focus has been placed on the value of specialty nursing certification and much work has been done to validate the intrinsic and extrinsic benefits for nurses and the relationship between certification and patient outcomes. The ABNS, which was incorporated in 1991 to create uniformity in nursing certification and increase public awareness of the value of certification,2 has partnered with many proponents of certification to promote certification and undertake efforts to determine its effects on the nursing industry.

As the promotion and perceived value of certification continues to increase, there is evident growth and competition in the specialty nursing certification market. Many certification programs have obtained accreditation through the Accreditation Board for Specialty Nursing Certification, the only accrediting body specifically for nursing certification, that provides a peer-review mechanism for applying for accreditation.3 In addition, more employers are requiring certification to help achieve industry benchmarks and some state boards of nursing are allowing certification to count towards relicensure. Overall, certification trends and research efforts show an overall increased interest in certification across all nursing specialties.

Driving factors

The strong growth in nursing certification can be largely attributed to the American Nurses Credentialing Center (ANCC) Magnet Recognition Program®, a quality indicator for nursing excellence that accredits health care institutions with work environments that reward quality nursing services. “Probably the single biggest driver for certification that we see is the Magnet® status of the facility,” said Jim Stobinski, PhD, RN, CNOR, director of credentialing and education at the Competency and Credentialing Institute (CCI), Denver. “The most recent statistics we drew on new certificant demographics show a very high percentage work in a facility with either Magnet designation or on the Magnet journey.”

Of the 5,724 hospitals in the United States,4 391 are Magnet-recognized hospitals,5 which translates to 6.8 percent of all U.S. hospitals holding the Magnet designation. The model for the Magnet recognition features “14 Forces of Magnetism” organized into five model components:

  • Transformational Leadership;
  • Structural Empowerment;
  • Exemplary Professional Practice;
  • New Knowledge, Innovations, and Improvements; and
  • Empirical Quality Results.6 

The Structural Empowerment component involves executive leaders providing an innovative environment where strong professional practice flourishes and developing and empowering staff members to find the best way to accomplish organizational goals and achieve desired outcomes.6 The promotion of certification falls under the Structural Empowerment component, as it includes Force 14: Professional Development, which lists two outcome indicators specific to specialty certification as examples of empirical quality: the percentage of direct-care registered nurses with certification and the percentage of nurse leaders with certification.7 Magnet hospitals, which have been nationally recognized for nursing excellence and high-quality patient care, support certification as it not only meets requirements within the Structural Empowerment component but it has also shown to have a positive effect on patient outcomes. Research shows that Magnet hospitals have lower odds of mortality and failure-to-rescue than non-Magnet hospitals, and the positive patient outcomes are associated with better work environments and higher proportions of nurses with bachelor’s degrees and specialty certifications within Magnet hospitals.8 

In addition to the employer benefits of achieving Magnet status, there are other motivations driving nurses to obtain certification. Financial incentives are a significant factor in nurses pursuing certification. According to the Nursing 2011 Salary Survey, the average salary for nurses certified in a specialty was $9,400 more than the average salary for nurses who were not certified.9 If nurses do not receive a direct pay increase, certification often does count for a significant number of points towards clinical ladder programs. Certification is also pursued for career advancement for nurses who wish to move into management roles or migrate into other OR-related areas such as informatics, process improvement, and quality control. Personal and professional feelings of accomplishment also come from attaining advanced knowledge and skills in a specialty area.10 

Research initiatives

An extensive amount of research activities have been conducted to quantify the value of certification. In partnership with 20 ABNS member organizations, the ABNS undertook a national study to validate nurses’ perception, values, and behaviors related to certification. The ABNS Value of Specialty Nursing Certification study surveyed 94,768 nurses using CCI’s Perceived Value of Certification Tool, which incorporates 18 certification-related value statements using a five-point Likert scale response that are grouped according to intrinsic (i.e., enhanced feelings of personal accomplishment) and extrinsic (i.e., promotes recognition from peers, other health professionals, and employers) rewards for certification.2 

The findings revealed specific challenges and barriers identified by nurses that inhibit their pursuit of certification. For nurses who had never been certified, they identified the top three barriers to certification as having no desire/interest in certification, failing the exam, and lacking access to or availability of continuing education.10 For those whose certification had lapsed, the top three barriers to recertification were practice in the specialty had ceased, inadequate compensation, and inadequate recognition.8 On the benefits side, the nurses expressed agreement with certification enhancing feelings of personal accomplishment, providing personal satisfaction and a professional challenge, enhancing professional credibility, and providing evidence of professional commitment.10 

The ABNS has also leveraged the National Database of Nursing Quality Indicators® (NDNQI) to identify characteristics of specialty certified nurses and the differences between certified and noncertified nurses. After collecting data on 1,796 hospitals, the findings showed that certified nurses were older, had more tenure in nursing and their units, were less diverse, and were more likely to hold a BSN or higher degree than nurses who were not certified.10 In addition, certified nurses worked in critical care and specialty units in higher proportion and there was a higher ratio of certified nurses in perioperative units versus other types of nursing units.10 

Additional data analysis was undertaken to examine the association between trends in unit proportion of certified nurses and nursing processes, including risk assessment and prevention protocols and patient outcomes of pressure ulcers, injury falls, physical restraints, and nosocomial infections. The first glimpse of the findings will be shared by CCI at AORN Congress 2013 during the “Recent Developments in Nursing Certification: The Link to IOM Recommendations” session.

Research efforts focused on certification will also be strengthened by the formation of a new standing committee on Credentialing Research in Nursing, which held its first meeting in Washington, D.C., on Jan. 14, 2013. Backed by the Institute of Medicine (IOM), the committee kicked off its first meeting by examining gaps in credentialing research, methodological and measurement challenges, and priorities for advancing credentialing research. “The ANCC has provided resources to IOM to establish a standing committee with nurses and experts from across health care disciplines,” said Stobinski. “Their role is to make recommendations for reports, where we should go, what’s the state of the science, and they’re going to look at individual credentials and facility credentials.”

Conclusion

Nursing certification has assumed a greater role in the nursing industry, largely spurred by the success of the Magnet recognition program. In addition to employers achieving Magnet status, individual nurses have also reaped financial benefits, career advancement opportunities, professional recognition, and personal feelings of achievement from certification. Although research activities have helped to identify demographics of certified nurses, trends in certification, and perceived benefits of certification, the direct relationship between certification and patient outcomes is still inconclusive and future research efforts aim to link certification to improved patient outcomes to better quantify the true value of certification.

References

  1. A position statement on the value of specialty nursing certification. American Board of Nursing Specialties. http://www.nursingcertification.org/pdf/value_certification.pdf. Accessed February 12, 2013.
  2. Specialty nursing certification: nurses’ perceptions, values and behaviors. American Board of Nursing Specialties. http://www.nursingcertification.org/pdf/white_paper_final_12_12_06.pdf. Accessed February 12, 2013.
  3. American Board of Nursing Specialties: promoting excellence in nursing certification. American Board of Nursing Specialties. http://www.nursingcertification.org/. Accessed February 12, 2013.
  4. Fast facts on US hospitals. American Hospital Association. http://www.aha.org/research/rc/stat-studies/fast-facts.shtml. Accessed February 12, 2013.
  5. Find a Magnet hospital. American Nurses Credentialing Center. http://www.nursecredentialing.org/Magnet/FindaMagnetFacility. Accessed February 12, 2013.
  6. Magnet Recognition Program® Model. American Nurses Credentialing Center. http://www.nursecredentialing.org/Magnet/ProgramOverview/New-Magnet-Model. Accessed February 12, 2013.
  7. Byrne M, Schroeter K, Mower J. Perioperative specialty certification: the CNOR as evidence for Magnet excellence. AORN J. 2010;91(5):618-622.
  8. McHugh M, Kelly L, Smith H, Wu E, Vanak, J, Aiken, L. Lower mortality in Magnet hospitals. Med Care. 2012;0(0)000-000.
  9. Nursing2011 salary and benefits survey. Nursing2011. 2011;41(2):7.

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