To prepare students for 21st century practice, nurse educators need to be clinically and pedagogically proficient (American Association of Colleges of Nursing [AACN], 2019; National League for Nursing [NLN], 2017). Graduate education is expected to support developing competency in a specialized area of advanced nursing practice (AACN, 2019; NLN, 2017) with certification, a common approach to confirm advanced knowledge and skills (NLN, 2019). Although certification is often equated with expertise in a specialized area of nursing practice, there is limited evidence to support a relationship between certification and specific outcomes.
The NLN has offered academic nurse educator certification (CNE) since 2005. A few studies associated with CNE have reported examination pass rates, candidate characteristics, perceived values, and barriers to seeking certification (Barbe & Kimble, 2018a, 2018b; Lundeen, 2018; Ortelli, 2008). Barbe and Kimble (2018a), who first adapted the Perceived Value of Certification Tool (PVCT) for use with nurse educators, reported that certified nurse educators valued certification more than noncertified nurse educators and rated intrinsic values higher than extrinsic values. Poindexter et al. (2019) adapted the PVCT differently (the PVCT-Academic Nurse Educator) and studied a large, national sample of CNE-certified and non-CNE-certified nursing education administrators and nurse educators. Participants in all four categories valued satisfaction with professional accomplishments (intrinsic) over professional recognition and marketing (extrinsic). In addition, CNE-certified administrators demonstrated higher mean value scores on both the intrinsic and extrinsic subscales in comparison to administrators who were not certified nurse educators or nonadministrator educators.
Findings on reported values between certified and noncertified nurse educators were consistent with those by Barbe and Kimble (2018a). The most frequently reported barriers to seeking academic educator certification included the cost of certification and a lack of time, support, and employer recognition.
Credentialing organizations have identified a priority for rigorous research on the link between clinical certification and patient outcomes (McCoy & Weisfeld, 2015). A synthesis of the literature on certification and outcomes recommended conducting qualitative research as the initial step to examine the nonlinear relationships among factors influencing certification and outcomes of certification (Biel et al., 2014). These recommendations can also guide research on the outcomes of the CNE. The NLN (2017) describes the linkage between nurse educators' specialized expertise in teaching and practice and preparation of the future nursing workforce with skills to provide safe, quality patient care. Establishing a relationship between CNE and patient or student outcomes will require a nonlinear approach, beginning with examination of variables that may influence the intent to seek certification. The purpose of this article is to report the motivators and outcomes of CNE as expressed by certified and noncertified academic nurse educators and administrators.
CONCEPTUAL UNDERPINNINGS AND FRAMEWORK
The ANCC published a sensitizing, research-focused definition of certification in nursing: "Certification in nursing acts as a mechanism for validation or formal recognition by documenting individual nurses' knowledge, skills, and abilities specific to their specialty. The intended outcome of certification in nursing is to validate competency with the overall goal of improving safety, quality of care, and health outcomes for people who use healthcare services" (Chappell et al., 2019, p. 1). Nurse educators have the potential to impact safety, quality, and health outcomes through their guidance of students preparing for nursing practice at the prelicensure and postlicensure levels.
The study design was informed by the Expanded Conceptual Model (ECM) for credentialing research in nursing (McCoy & Weisfeld, 2015). The model depicts dimensions of credentialing in nursing to include a set of influencing factors and outcomes via the pathways of invisible architecture, work organization, and nurse performance. All elements of the pathways are depicted as influencing each other and ultimately influencing the business model (McCoy & Weisfeld, 2015). We applied the ECM in this study by exploring factors influencing CNE and by operationalizing "organization" as the nursing education unit, "nurse" as the nurse educator, and "patient/population" as students/cohorts of students.
METHOD
This qualitative study was conducted using an Internet-based survey with nine open-ended questions. The results reported here were part of a mixed-method study of academic nurse educators' and administrators' perspectives of CNE. Inclusion criteria were nurse administrators and nurse educators employed by their academic organization. There were no exclusion criteria.
Instrument and Procedure
The open-ended questions (see Table 1) aimed to amplify participants' quantitative responses about the value and motivations for CNE and to gain an early understanding of the outcomes of CNE. Twelve nurse educator content experts from three academic institutions provided feedback on question content, ease of response, readability, and flow that led to minor question modifications. Each expert had five or more years of experience in nursing education and a minimum of a master's degree.
After university institutional review board approval, email invitations were sent to 1,206 administrators in a database of nursing education programs in the United States developed from the NLN and AACN websites. The survey was housed on a secure server (Qualtrix(R)). Nurse administrators were invited to participate and to forward the survey link to their nurse educators. Two email reminders were sent a week apart. Additional institutional review board approval was required by and received for three academic programs. Participation in the study was completely voluntary. No information that could identify a participant was gathered, and all responses were anonymous.
Data Analysis
The content analysis approach adapted from Elo and Kyngas (2008)(see Supplementary Table 1, Inductive Content Analysis Process, available at http://links.lww.com/NEP/A209) was used to analyze responses to the open-ended questions. Two certified nurse educators, experienced in qualitative research, conducted the analysis using inductive reasoning and three stages: 1) preparation, in which the researcher becomes immersed in the data; 2) organizing, where words are distilled into fewer content-related categories; and 3) reporting, in which the analyzing process and the results are reported. Strategies for the analysis included: 1) independent open coding followed by discussion of code descriptions to achieve consensus; 2) independent aggregation of codes into categories followed by discussion to reach consensus, development of category descriptions, and identification of exemplars; 3) independent analysis followed by discussion to identify and describe overall themes, with categories across open-ended items examined for overlap, and to maintain objectivity; and 4) debriefing during biweekly phone conferences throughout the data analysis with all three researchers. Analytical memos were used to explore and record notable results.
A checklist of strategies to promote trustworthiness of the content analysis was adapted from Elo et al. (2014). In addition, member checks were provided by attendees at a national nursing education conference. Eight attendees overwhelmingly concurred with the findings, and two identified an additional barrier to pursuing CNE, which we incorporated in our results.
Characteristics of Participants
We received 721 surveys from academic nurse educators in 48 states. The total sample for each item varied, as individual participants chose whether to respond and some open-ended items were directed to specific subgroups (see Table 1). A total of 217 of 706 participants (30.7 percent) reported being currently certified as a CNE. Of those not currently certified as CNE, 18 of 488 (3.7 percent) reported being a certified nurse educator in the past. Of 434 participants who reported being certified in any nursing specialty, 76.03 percent held a non-CNE certification and 23.96 percent held the CNE (CNE only, 13.8 percent; CNE plus another certification, 10.1 percent).
Participants (n = 694) were from research-intensive universities (28.5 percent), liberal arts colleges (44.5 percent), community colleges (23.3 percent), technical vocational programs (2.31 percent), and diploma programs (1.3 percent). More than half of the 718 respondents were administrators (n = 396, 55.2 percent). Almost half of 696 participants (44.55 percent) held doctoral degrees. Others reported their highest educational level as master's degree (50.1 percent), bachelor's degree (1.87 percent), and associate and other degrees (3.45 percent).
REPORTING OF RESULTS
Analysis of the responses elicited three constructs: 1) Motivation to Pursue the CNE Credential, 2) Nurse Educator Outcomes, and 3) Student Outcomes. Incidental findings follow reporting of the constructs (see Table 2). The code in parentheses following each quote indicates the item number (see Table 1) and the number of the response.
Construct 1. Motivation to Pursue CNE
Personal factors pertaining to the respondent's private life and emotions, rather than public life or career, were the most common reasons current certified nurse educators had pursued the credential. Many used the word "personal" linked to a noun such as "motivation" (6-65), "achievement" (6-48), "satisfaction" (6-62), and "accomplishment" (6-97). Participants desired to gain credibility or recognition for competence as a nurse educator. This was expressed as "demonstrates competence and expertise" (6-144), "wanted to provide credible evidence of my knowledge base to self and employer" (6-221), and "desire for recognition among my peers" (6-15).
The importance of recognizing nursing as a specialty was emphasized. Some participants were proud to have been early certified nurse educators. Participant 6-159 noted: "I was thrilled to see certification that recognized the field of nursing education." Participant 6-18, who did not qualify for any of the ANCC certifications, said, "I was so proud when NLN decided to provide this opportunity. I was one of the first[horizontal ellipsis]to seek the CNE."
The CNE was seen as an avenue to demonstrate enthusiasm and commitment to excellence in nursing education. Participant 6-102 wrote: "Certification represents dedication to a chosen area[horizontal ellipsis]my passion for nursing education." The expressed pledges to nursing education included long-term commitments, as expressed by Participant 6-06: "I had been teaching nursing[horizontal ellipsis]for over 20 years."
Some respondents aimed to demonstrate mastery as a nurse educator. Participant 6-188 noted "continuous self-improvement," whereas Participant 6-185 noted "wanted to accomplish this goal." Participants acknowledged benefitting from the information and insight gained while preparing for the examination, for example, "Desire to learn more and become a more qualified faculty" (6-178). Other participants sought to be role models: "Wanted to set an example to encourage my faculty to also pursue certification" (6-15).
Many responses included more than one personal factor. By example, Participant 6-216 wrote: "I pursued CNE when it appeared it could be recognized as a significant achievement for nurse educators, inside and outside my organization. I saw it as a way to confirm my knowledge and skills as a nurse educator teaching in higher education and as a challenge to myself to continue learning and growing in my discipline." Participants were motivated by peers who held or were seeking the CNE, for example, "I followed the lead of my mentor who was one of the very first CNE" (6-226) and "encouragement from presenters at national nurse educator conferences and from associate dean" (6-69).
In some cases, the CNE was a condition of hiring, promotion, tenure, or continued employment. Participants wrote: "Our school requires it" (6-172) and "The director of our program wrote in our accreditation we would have 100 percent CNE. She was driven and felt it best for our program." Other participants noted their schools offered reimbursement for the examination cost (usually after passing) and access to exam preparation courses or materials. However, approximately two thirds of respondents reported there were no initiatives in their workplaces to support CNE: "Certification is highly encouraged by our administration; however, there are no program initiatives" (13-336).
Non-CNE participants indicated they might consider certification if their workplaces offered support, such as information about the CNE process, preparatory courses, financial assistance, and release time. These participants wrote: "cost. A qualified prep class that would ensure I would pass the exam" (11-18), "financial assistance from employer" (11-99), and "time to prepare for the exam. Workload limits time that is needed to adequately prepare for certification" (11-113). Many responses included more than one aspect that would "support the journey," for example, Participant 11-137 wrote: "time - I am an administrator in a small PN program and do many different jobs other than teaching right now; my school has no incentive to accomplish this - it would be my own expense and effort."
Participants reported the value of the CNE in their organizations ranged from no apparent value to possible value in providing support toward promotion and tenure. At some schools, the credential was recognized as evidence of expertise, as in this example: "CNE status is one factor in the promotion and tenure process" (13-627). However, many participants noted the CNE had limited value in their workplaces. Although recognitions such as congratulations from supervisors and peers, signs on office doors, and credentials on website were appreciated, participants noted that "A pat on the back is not enough." Comments included "if my employer provided some sort of meaningful benefit or recognition[horizontal ellipsis]higher salary or[horizontal ellipsis]recognized for promotion" (11-10) and "if my institution appeared to value it more" (11-22).
In some cases, participants noted no evidence at their institutions for the value of the CNE or reported that it was not valued, as in these statements: "I do not feel like my certification is overly valued at my institution. I am proud of the certification that I have as a personal achievement" (14-183) and "The older people I work with acted like it was no big deal to get it and almost discouraged me from getting a certification they did not have themselves" (14-476). Participant 14-195 noted: "none. Administration has been divinely indifferent as to whether one achieved certification or not."
Construct 2: Nurse Educator Outcomes
Participants used broad descriptors to comment about the role performance of certified nurse educators. Participant 17-399 indicated "proficient performance," Participant 17-403 noted "All are competent and good educators," and Participant 17-131 noted "increased performance in teaching and learning." A number of participants stated certified nurse educator colleagues are "more knowledgeable" (17-168).
Of the participants who were certified nurse educators, 39 percent reported changes in responsibilities, including teaching graduate courses in nursing education; increased opportunities for leadership outside the program; and administrative roles such as dean, associate dean, program director, or course coordinator. Participant 137 noted: "I have a commitment to leadership and mentoring other faculty, as well as encouraging achievement of certification. I have also served on the board of the state organization as a result of commitment to the organization." Participant 51 noted: "I am now a dean of a program which has undergraduate and graduate nursing programs on a comprehensive campus. The CNE highlighted my commitment to education when interviewing." Participant 187 wrote: "I was promoted to associate professor and tenured. I do believe that earning a CNE was part of being awarded promotion and tenure, but I think I would have been promoted and tenured without it as I had so many other accomplishments." Respondents who had certified nurse educators in their own organizations reported, "They are in more leadership roles and they assist the younger faculty who are just starting out. They share their knowledge" (17-119) and they are "more involved in assessment of program and curriculum development" (17-138).
A number of participants noted less formal role changes, such as serving as a mentor, coach, or resource person. Participant 115 wrote: "I am looked at as the education 'expert' among our faculty. Other faculty seek my opinion and advice about many matters pertaining to teaching." Others reflected on the presence of certified nurse educators in the organization, for example, "I have noticed that they possess an increased level of confidence and are often the 'go to' people within the organization for mentoring and precepting others" (17-358).
Many participants indicated certified nurse educator colleagues had notable teaching skills. Participant 17-449 noted: "They are more likely to seek out evidence of best practices and bring this concept into the classroom to introduce and use with students. They incorporate more research-based assignments into their curricula and encourage students to seek evidence beyond their textbooks and the classroom." Another participant (17-256) noted: "professional attitude, evidence-based techniques, correct test analysis, and high-quality evaluations." Participants 17-19 and 17-20 wrote: "more committed to the role of educator and are better able to more fully demonstrate the nurse educator competencies. They also seem to be more learner-centered" (17-19) and "quality instruction, understand education and not just clinical practice. Hold higher standards for students" (17-20).
Responses by certified nurse educators regarding changes after becoming certified included an expanded awareness of their roles. Participant 7-14 wrote: "increased awareness of teaching and learning activities with diverse approaches for adult learners, importance of a learning community and the coaching role of the educator," and Participant 7-64 noted, "I make a bigger contribution to curriculum design in my department. I place more value on scholarship and research."
Many certified nurse educator participants commented their context for teaching had improved (e.g., theory and evidence based). Comments included "I apply evidence-based principles in my teaching and interactions with students (7-64) and "I better understand the learning principles behind my teaching strategies and have added more active learning[horizontal ellipsis]More prepared to ensure test reliability and validity and have made improvements on exams overall" (7-134). Participant 7-65 reported "aggressive pursuit of high-quality exam analysis and improvement[horizontal ellipsis]focus upon the alignment of course objectives, learning activities, outcome measures."
A number of participants indicated their roles had expanded to include activities such as curriculum revision, program evaluation, teaching across levels, addressing student issues, legal aspects of education, collaboration across disciplines, scholarship, and service. Participants noted "expert in curriculum development and design, pedagogy, evaluation" (7-54) and "reflection upon the other types of scholarship beyond teaching (e.g., service opportunities)" (7-65).
Construct 3: Student Outcomes
When asked about outcomes of students taught by a certified nurse educator, over 65 percent of participants stated "none" or "do not know," "nothing that I can prove" (19-428), and "no difference, again the instructors who became CNE were very dedicated and doing a good job before they took the certification" (19-446). A few indicated they were in the process of evaluating such outcomes.
Participants who did identify student outcomes reported observations about changes in student perspective such as, "seem to be more satisfied" (19-70) and "higher with little to no confusion regarding outcome achievement or student grievances regarding performance" (19-13). Participant 19-397 wrote: "When teaching in MSN program for nurse educators graduates are much more aware of the value of the nurse educator role and are positively impacted that they can become certified in the role."
Comments regarding changes in student learning and practice included "learn more, are more easily able to apply critical thinking" (19-70) and "They are engaged" (19-102). Reported outcomes in clinical practice included "Students become skilled in health care teaching and develop competent clinical care" (19-83), "greater use of recognized evidence-based practice" (19-128), and "increased verbal spontaneity and engagement in the clinical setting. Increased concept comprehension and ability to apply concepts to new patient situations" (19-148).
A number of participants noted that identifying student outcomes is "difficult." Others noted challenges for differentiating CNE practice, for example, all of their faculty being certified nurse educators, only one faculty member is a certified nurse educator, or their faculty teach in teams, as in this response: "All of our nursing courses are team taught so this is hard to determine. I do not have a single course where all of the teaching team is a CNE" (19-404). Participants also noted that student outcomes are influenced by multiple factors, for example, "Outcomes are better, though I do not know if it is because of certification. I think outcomes are affected by full-time faculty as opposed to adjunct faculty. Our full-time faculty members are almost all certified" (19-375).
Incidental Findings
Some results did not fit directly with our study purpose but merit being reported.
CONCERNS ABOUT THE CNE Some participants noted reasons they would not pursue the CNE. These included age ("If I were younger maybe," 11-9), point in the career ("planning to retire in near future," 11-6), full schedules ("lack of time to prepare," 11-15), employment status ("If I were a full-time educator," 11-11), the stated high cost of certification and recertification, lack of accessible review courses, the requirements of maintaining one or more clinical certifications, and a desire to see data about outcomes. Other participants were not interested, for example, "I do not see a need for nurse educator certification" (11-12). Fear of failing the examination was a barrier suggested by participants during the member checks.
Not all participants viewed certified nurse educator colleagues in a more positive light. One third of participants (n = 147, 31 percent) noted no difference in role performance of certified nurse educators, and some indicated the performance of certified nurse educators was of lower quality than their non-CNE faculty. Participant 17-16 noted "They are not leaders. They do not initiate new programs or ideas. Certification seems more personal pride than making a difference in the department," and Participant 17-120 commented "Certification is completely unrelated to competence as a nurse educator."
Other participants noted that, although CNE faculty may have positive qualities and performance, faculty who are not certified nurse educators have similar characteristics. Participant 17-34 wrote: "I think they are already highly motivated people and their certification validates this." Participant 17-63 wrote: "They are varied - some excel, some are not impressive. All it means is that they studied for the test, passed it and now are low achievers."
POSITIVE ATTRIBUTES OF CERTIFIED NURSE EDUCATORS Many participants identified positive personal characteristics of their certified nurse educator peers, including confidence, pride, motivated, commitment, passion, leadership, professionalism, and higher standard. Participant 17-413 wrote that "the confidence that is expressed by these staff members is contagious." Participant 17-441 indicated "an increased level of commitment to the attainment of educational goals and excellence." Participant 17-8 wrote: "The certified nurse educators in our school are leaders among our faculty. They are often the individuals who help us remain thoughtful about pedagogy, objectives, and teaching strategies."
DISCUSSION
The number of responses and level of detail in the responses to the open-ended questions far exceeded our expectations. From recruitment at 1,206 schools of nursing, we received 721 surveys, which included responses from all US states except Idaho and Alaska. Moreover, our sample represented all types of nursing education programs, from vocational, technical, and community colleges through research-intensive universities.
The proportion of administrators in our sample was much higher (55.2 percent) than that reported by Barbe and Kimball (2018b); their sample included 3.4 percent administrators. However, we had robust numbers of both nursing education administrators (n = 396) and nurse educators who did not identify as administrators (n = 322). Participants reported their highest earned degrees as doctorate (44.55 percent), master's (50.1 percent), bachelor's (1.87 percent), and other (3.45 percent).
Motivating Factors to Pursue Academic Certification
Certified nurse educator participants had pursued the credential primarily for personal reasons, such as to challenge themselves, achieve a goal, demonstrate current knowledge and skills as academic nurse educator through a formal credential, be a role model, and gain new knowledge during the preparation process. Noncertified nurse educators spoke of external factors such as the point in their career; credibility among peers; time to prepare for the examination; provision of or reimbursement for a review course; the potential for teaching a higher level course, increased salary, or administrative positions; and meeting criteria for hiring, annual review, promotion, and tenure.
A thorough review of extant literature revealed no studies designed to identify factors influencing pursuit of the CNE or any other certification in nursing. There were, however, multiple studies of different nursing specialties, including the CNE, that examined barriers to certification (Barbe & Kimble, 2018b; Elwell, 2017; Fitzpatrick, 2017). Results were similar across specialties. Barbe and Kimble's (2018b) top 9 of 12 reported barriers to the CNE were congruent with many comments made by our participants: lack of time, cost, no desire/no interest, not prepared/do not meet requirements, enrolled in a doctoral program, certified in other nursing specialty, not valued by institution, education/credentials verify expertise, and nearing end of career.
Changes in Teaching/Role Performance by Certified Nurse Educators
Participants described changes in teaching and role performance by certified nurse educators through the construct, "Nurse Educator Outcomes." They noted generally positive effects of certification, changes in formal roles and informal role modeling, expansion of teaching skills and perspective, and connections to the broader aspects of nursing education. The changes in role perception are similar to aspects of empowerment identified in studies of clinical nurse certifications. Certified nurses in community hospitals, critical care units, perioperative services, and emergency departments have reported higher levels of informal and formal power than nurses in those areas who are not certified (Fitzpatrick et al., 2010, 2014; Piazza et al., 2006; Samedy et al., 2012). Certification as an academic nurse educator seems to have a similar and substantial effect on both the individual's sense of being an accomplished educator and colleagues' sense of the certified educator's expanded role. This changing perception by self and others often resulted in new leadership opportunities within the organization and a broader scope of influence for the certified educator.
Student Outcomes
To our knowledge, our study is the first to specifically explore student outcomes of CNE educators. Previous research focused on the value for students while measuring only one statement: "increased consumer confidence." Perhaps it is too early in the history of academic CNE to expect to see student outcomes. Despite asking a very direct question about student outcomes, most participants were not able to articulate any student-level outcomes of being taught by certified nurse educators. Outcomes were directed primarily at roles within the larger educational program (i.e., mentor, committee chair, engagement at meetings). Currently, there are more than 7,500 certified nurse educators (L. Simmons, personal communication, September 25, 2019), yet many participants reported their school had none.
The need for a better understanding of student outcomes when taught by certified nurse educators reflects a state similar to that of certification research in clinical nursing. Fitzpatrick (2017) noted that, despite a growing body of research, "The evidence base in support of (clinical) nursing certification is not strong and convincing" (p. 133). Fitzpatrick's observations regarding patient outcomes of nurses with clinical certification included her argument that "If it can be shown that certification correlates to better patient outcomes, the rationale for supporting certification becomes more convincing from the financial standpoint" (Fitzpatrick, 2017, p. 133). Participants in our study recommended their institutions provide substantive support and rewards for educators pursing the CNE. However, pending clear outcomes for academic CNE, administrators appear to have been reluctant to commit scarce resources.
Theoretical Underpinnings
Although designed for clinical settings, the ECM (of credentialing research in nursing; McCoy & Weisfeld, 2015) proved a useful framework to understand both factors influencing nurse educators' decisions to pursue the CNE and outcomes for those holding the CNE credential. Although an array of personal factors was associated with pursuit of the CNE, nurse educators looked to the organization to value certification on par with clinical credentials and substantively recognize the CNE during annual reviews, promotion, and tenure.
The ECM may be useful for future research on three types of outcomes of CNE. Organizational (nursing education school, program, department) outcomes could be conceptualized as promoting retention of faculty and meeting regulatory and accreditation requirements; nurse (educator) outcomes could be viewed as effectiveness of teaching across roles and settings; and patient (student) outcomes could be conceptualized as responses of students at the course level and findings of student assessment and program evaluation, such as NCLEX-RN(R) and certification examination results.
Limitations
Regarding this study, there were limitations in the areas of recruitment and response format. The recruitment message was sent to deans or program directors of nursing programs listed as organizational members of either AACN or NLN, with a request for the message to be forwarded to the nursing faculty. If the program administrator did not forward the message, faculty members in that school had no opportunity to participate. Also, directing the initial recruitment messages to the program administrator may have resulted in the higher response rate from administrators than from faculty.
The anonymous online format allowed for access to many more participants and their perspectives than would otherwise have been available. However, the online format prevented follow-up to explore individual responses that might have provided additional meaning.
Content analysis, as an approach to qualitative research, has several limitations: The descriptive level cannot be used to link cause and effect, the process requires considerable time, and challenges can arise around trustworthiness (Maier, 2017). We implemented strategies to address the limitations and believe they are balanced by the strengths of the method: "content analysis is useful as a descriptive tool, has broad application, is relatively unobtrusive, and is a fairly 'safe' research method" (Maier, 2017, p. 6/6).
Implications
Research on academic CNE has important implications for educational policy and standards. These findings may be used to inform policy development for academic standards and serve as an accountability measure for program credentialing. CNE may also serve as a structural variable and be used as a predictor for improvement in organizational processes and outcomes. Policies may be expanded to strengthen qualifications for nurse educator preparation to teach. Outcomes associated with quality metrics can be used to increase accountability and benchmark organizational performance. Efforts to link CNE competencies and student learning outcomes may ultimately serve to improve graduate transitions to care and promote clinical excellence.
CONCLUSION
Certification is one method to demonstrate excellence in a specialty area of practice. Studies related to specialty certification in clinical practice have reported inconsistent results related to patient outcomes (Boyle, 2017). Use of ECM as a framework for credentialing research may provide a mechanism to examine variables that contribute to certification outcomes and enable comparison between studies in academic and clinical practice.
This study explored influencing factors and outcomes associated with academic CNE. Findings support a relationship between personal intrinsic factors such as validation and credibility as motivating factors to seek and attain certification. External factors such as higher salaries, professional recognition, and organizational support were motivators identified with greater frequency by those who had not sought CNE. Outcomes related to CNE were varied and difficult to measure due to intervening variables. Ongoing research examining the benefits and outcomes of certification using a rigorous methodological approach is needed to promote recognition of specialty CNE as a quality benchmark for educational practice.
REFERENCES