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  1. Satusky, Mary Jo

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The American healthcare system continues to undergo profound and turbulent changes. Models of care are placing increased emphasis on quality, with resulting financial implications to facilities. "This evolution in healthcare provides an opportunity for all nurses to more fully realize their commitment to quality and safety in patient care" (Stobinski, 2015, p. 377).


Licensure examinations verify the readiness of entry-level nurses; certification examinations confirm the ability of expert nurses to provide evidence-based care at all levels of acuity in a specialized area of care (Elwell, 2017; Martin, Arenas-Montoya, & Barnett, 2015). Certification may be viewed as a commitment to professional development and lifelong learning. A certified nurse is a more meaningful contributor to safe and quality patient care and improved patient outcomes (Stobinski, 2015).


"Certifications are time-limited and the maintenance of certification requires ongoing acquisition of both knowledge and experience in practice" (Institute of Medicine, 2010, p. 197). The requirements to maintain certification are a key component in developing a personal plan for ongoing professional development.


Registered nurses (RNs) who hold a specialty nursing certification reported a higher frequency of evidence-based practice behaviors, as well as a higher ability and desire for evidence-based practice behaviors. Characteristics of Magnet standards for designation require organizations to set and meet higher goals for formal education and nursing certification (Wilson, 2015). Percentages of RNs certified by a nationally recognized organization are included in the Characteristics of Magnet (American Nurses Credentialing Center, 2018).


Musculoskeletal diseases are the most frequent chronic health problem in the United States, causing pain and disability (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2017). Because so many Americans are affected in some way by diseases of bones, joints, muscles, and skin, it is critical that nurses caring for patients of all ages with musculoskeletal conditions be qualified to provide quality specialty care.



The National Association of Orthopaedic Nurses supports certification because certification adds value to key stakeholders in healthcare today. The National Association of Orthopaedic Nurses supports orthopaedic nursing certification as provided by the Orthopaedic Nurses Certification Board (ONCB).


Patients and their families benefit from advances in safety and quality and improved processes of care delivered by certified nurses. Consumers have more confidence in certified nurses (Fitzpatrick, 2017).


Certified nurses enjoy enhanced professional credibility, increased job satisfaction and marketability, higher levels of transformational leadership, and higher perception of both formal power and informal power (Fitzpatrick, 2017; Martin et al., 2015).


Organizations realize benefits in reducing turnover and costs, advancing safety and quality, improving recruitment and retention, and improving culture (Martin et al., 2015).



Certification, as defined by the American Board of Nursing Specialties (2016), is the formal recognition of the specialized knowledge, skills, and experience demonstrated by the achievement of standards identified by a nursing specialty to promote optimal health outcomes. The Institute of Medicine (2010) report, The Future of Nursing: Leading Change, Advancing Health, stated, "Nurses who receive certification, including those serving in all advanced practice roles, provide added assurance to the public that they have acquired the specialized professional development, training, and competencies required to provide safe, quality care for specific patient populations" (p. 197).


The requirements to maintain certification contribute to ongoing professional development and continuing competence. Ongoing professional development may be the key to patient safety and, ultimately, better patient outcomes. Those nurse-sensitive outcomes may include a reduction in total patient falls, selected hospital-acquired infections, restraint use, and unit-acquired pressure ulcers and decreased odds of mortality and failure to rescue (Boyle, 2017; Fitzpatrick, 2017; Martin et al., 2015).


The ONCB was founded by the National Association of Orthopaedic Nurses in 1986 in response to a request from the membership of NAON for a certification program to further establish orthopaedic nursing as a specialty and to recognize expertise in the field. The ONC credential indicates that an RN has attained basic orthopaedic certification. Advanced credentials (OCNS-C and ONP-C) indicate a nurse has attained orthopaedic certification as a clinical nurse specialist or nurse practitioner. The ONC-A advanced portfolio certification program is offered to other nurses who have completed graduate education in nursing or an allied discipline (e.g., MPH, MNA).


The ONCB certification programs are rigorous, and the certifications are sound, legally defensible measures of orthopaedic nursing knowledge. Orthopaedic nursing certification validates nurses' attainment of stringent requirements for knowledge and recognizes expertise in musculoskeletal health. Orthopaedic nursing certification benefits patients and their families, nurses, and employers across all settings where nursing care is provided for musculoskeletal conditions. All nurses who provide care to or support for patients with musculoskeletal conditions should seek to become certified by ONCB. NAON encourages employers to hire orthopaedic certified nurses, support employed nurses in attaining and maintaining certification, reward nurses who become certified, and inform patients and the public about the certification status of their RNs.




American Board of Nursing Specialties. (2016). About us. Retrieved from http://www.nursingcertification.org/about[Context Link]


American Nurses Credentialing Center. (2018). Characteristics of Magnet(R). Retrieved from https://www.nursingworld.org/organizational-programs/magnet/why-become-magnet/ch[Context Link]


Boyle D. (2017). Nursing specialty certification and patient outcomes: What we know in acute care hospitals and future directions. Journal of the Association for Vascular Access, 22(3), 137-142. [Context Link]


Elwell S. (2017). Certification matters. Journal of Trauma Nursing, 24(6), 342-344. [Context Link]


Fitzpatrick J. (2017). The value of nursing certification: Revisited and reinforced. Journal of the Association for Vascular Access, 22(3), 131-134. [Context Link]


Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from https://www.nap.edu/read/12956/chapter/1[Context Link]


Martin L., Arenas-Montoya N., Barnett T. (2015). Impact of nurse certification rates on patient satisfaction and outcomes: A literature review. The Journal of Continuing Education in Nursing, 46(12), 549-554. [Context Link]


National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2017). Mission. Retrieved from https://www.niams.nih.gov/about[Context Link]


Stobinski J. (2015). Certification and patient safety. AORN Journal, 101(3), 374-378. [Context Link]


Wilson M. (2015). Empowering nurses with evidence-based practice environments: Surveying Magnet, Pathway to Excellence, and non-Magnet facilities in one healthcare system. Worldviews on Evidence-Based Nursing, 121, 12-21. [Context Link]