[usPropHeader] Error loading user control: The file '/CMSWebParts/WK.HLRP/LNC/LNCProductHeader.ascx' does not exist.

Authors

  1. Kitto, Simon PhD
  2. Grant, Rachel MN, BScN, RN
  3. Chappell, Kathy PhD, RN, FNAP, FAAN
  4. Lundmark, Vicki PhD

Abstract

Specialty certification is an important method to demonstrate that RNs possess advanced training, knowledge, and competencies required to provide safe, high-quality care for specific populations.

 

Article Content

Specialty certification demonstrates to multiple stakeholders, including the public, healthcare employers, and 3rd-party payers, that RNs have externally validated qualification in a specialty or role. Nursing certification remains a strong benchmark for quality in Magnet(R)-recognized organizations. New and returning applicant organizations for Magnet recognition must provide evidence that they have met targeted goals for improvement in professional nursing certification.1 In addition, Magnet-recognized organizations submit annual demographic reports that identify the professional certifications held by their nurses.1,2

 

Evidence suggests that specialty certification in nursing may positively affect patient care quality. For example, 4 recently published studies found significant associations between higher unit-level rates of specialty certification and lower rates of hospital-acquired infections,3 lower rates of central line-associated bloodstream infections (CLABSIs) and ventilator-associated pneumonia,4 lower total fall rates,5 and better quality on a composite index of pressure ulcer and fall rates.6 However, findings from other research studies are mixed. One study focused on falls and restraint prevalence found that higher certification rates among RNs in medical-surgical units predicted lower restraint use but did not predict either falls or injury falls.7 Another study of direct care nurses in perioperative, surgical intensive care, and surgical units found specialty certification to be related to lower rates of CLABSI and, counterintuitively, to higher rates of hospital- and unit-acquired pressure ulcers, whereas no relationship was found between certification and catheter-associated urinary tract infections.8

 

Although certification is often hypothesized to lead to higher-quality patient care, some authors suggest that it is difficult to establish a causal relationship.5,9,10 One hindrance to research in this area has been the lack of consistency in clearly defining the credential or certification under study.11,12 As McHugh and colleagues12 suggest, not all credentials are equal. For example, within the United States, nurses can seek countless certifications that range from more basic and functional to highly specialized certifications.11-13 Advanced practice nursing certification is sometimes coalesced with data on postlicensure specialty certification of RNs, although they require different educational preparations for entry-to-practice (typically a masters degree and a baccalaureate degree, respectively).11 In addition, some certification programs may follow less stringent standards than others such as awarding a certification based on attendance rather than on a demonstration of competence.12 This variation can make it difficult for researchers to draw causal inferences between the certification of individual healthcare professionals and patient outcomes. Before certification can be defined, operationalized, and used more productively in research, we 1st need to understand the extent and nature of this variation.

 

Scoping reviews are a type of literature review that examines the breadth, depth, and nature of a body of research.14 Like a systematic review, scoping reviews use a rigorous, transparent methodology to systematically identify and analyze all of the literature in a given area.15 However, unlike systematic reviews, scoping reviews are exploratory and typically do not aim to assess the quality of the literature.16 Rather, a scoping review aims to provide a summative map of the literature in a given field. From the results of a scoping review, researchers can assess the feasibility of conducting a full systematic review, identify gaps in the literature, and propose new research questions and hypotheses for future investigation.14

 

The American Nurses Credentialing Center (ANCC) commissioned an independent scoping review to examine how certification is conceptualized and operationalized in nursing and medical literature and identify gaps in the literature. It has been guided by Arksey and O'Malley's16 methodological framework with some modification as recommended by more recent discussions of scoping review methodology.14,17-19 The Arksey and O'Malley16 scoping review framework involves 5 steps: (1) identifying the research question, (2) identifying relevant studies, (3) selecting the study, (4) charting the data, and (5) collating, summarizing, and reporting results.

 

The ANCC believes that initiating this scoping review on the certification of individual healthcare professionals will yield novel insights into the nature, extent, and range of certification literature in American and Canadian nursing and medicine. The trends and research gaps identified should be of interest to practitioners in healthcare organizations, as well as researchers, educators, and leaders in health professions education. Ultimately, it is hoped the results will inform the construction of an evidence-based taxonomy of certification in nursing across North America.

 

References

 

1. American Nurses Credentialing Center. 2014 Magnet(R) Application Manual. Silver Spring, MD: American Nurses Credentialing Center; 2013. [Context Link]

 

2. American Nurses Credentialing Center. Certification: National Certifications Currently Included in the DDCT. 2017. Available at http://www.nursecredentialing.org/Magnet/Magnet-CertificationForms. Accessed January 11, 2017. [Context Link]

 

3. Covell CL, Sidani S. Nursing intellectual capital theory: testing selected propositions. J Adv Nurs. 2013;69(11):2432-2445. [Context Link]

 

4. Boev C, Xue Y, Ingersoll GL. Nursing job satisfaction, certification and healthcare-associated infections in critical care. Intensive Crit Care Nurs. 2015;31(5):276-284. [Context Link]

 

5. Boyle DK, Cramer E, Potter C, Staggs VS. Longitudinal association of registered nurse national nursing specialty certification and patient falls in acute care hospitals. Nurs Res. 2015;64(4):291-299. [Context Link]

 

6. Boyle DK, Jayawardhana A, Burman ME, et al. A pressure ulcer and fall rate quality composite index for acute care units: a measure development study. Int J Nurs Stud. 2016;63:73-81. [Context Link]

 

7. Aydin C, Donaldson N, Aronow HU, Fridman M, Brown DS. Improving hospital patient falls: leveraging staffing characteristics and processes of care. J Nurs Adm. 2015;45(5):254-262. [Context Link]

 

8. Boyle DK, Cramer E, Potter C, Gatua MW, Stobinski JX. The relationship between direct-care RN specialty certification and surgical patient outcomes. AORN J. 2014;100(5):511-528. [Context Link]

 

9. Hickey JV, Unruh LY, Newhouse RP, et al. Credentialing: the need for a national research agenda. Nurs Outlook. 2014;62(2):119-127. [Context Link]

 

10. Lipner RS, Hess BJ, Phillips RL Jr. Specialty board certification in the United States: issues and evidence. J Contin Educ Health Prof. 2013;33(1 suppl):S20-S35. [Context Link]

 

11. Bell-Kotwall L, Frierson D, Kuiper R. Are certified nurses better professionals? Nurs Manage. 2012;43(6):30-35. [Context Link]

 

12. McHugh MD, Hawkins RE, Mazmanian PE, Romano PS, Smith HL, Spetz J. Challenges and Opportunities in Nurse Credentialing Research Design (Discussion paper). Washington, DC: Institute of Medicine; 2014 Available at https://nam.edu/wp-content/uploads/2015/06/CredentialingResearchDesign.pdf. Accessed January 11, 2017. [Context Link]

 

13. Miller PA, Boyle DK. Regulatory readiness nursing specialty certification: a measure of expertise. Nurs Manage. 2008. [Context Link]

 

14. Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69. [Context Link]

 

15. Pham MT, Rajic A, Greig JD, Sargeant JM, Papadopoulos A, McEwen SA. A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Res Synth Methods. 2014;5(4):371-385. [Context Link]

 

16. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. [Context Link]

 

17. Daudt HM, van Mossel C, Scott SJ. Enhancing the scoping study methodology: a large, inter-professional team's experience with Arksey and O'Malley's framework. BMC Med Res Methodol. 2013;13:48. [Context Link]

 

18. Grant RE, Sajdlowska J, Van Hoof TJ, Kitto S. Conceptualization and reporting of context in the North American continuing medical education literature: a scoping review protocol. J Contin Educ Health Prof. 2015;35(2 suppl):S70-S74. [Context Link]

 

19. Olding M, McMillan SE, Reeves S, Schmitt MH, Puntillo K, Kitto S. Patient and family involvement in adult critical and intensive care settings: a scoping review. Health Expect. 2016;19(6):1183-1202. [Context Link]