The recent institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, recommended that nurses develop a commitment to life-long learning.1 For many nurses, this commitment to learning has been ingrained during our basic educational preparation. For others, practice in an ever-changing environment and a desire to provide high-quality care spur interest in learning beyond the entry level. Many nurses further learning and demonstrate their knowledge and skill by earning certification in their area of practice. This article describes the advantages of becoming certified and the practical steps to take to reach this milestone. But first, consider what certification means.

Certification is an official recognition of a nurse's knowledge and expertise within an area of specialty practice. The American Board of Nursing Specialties defines certification as "the formal recognition of specialized knowledge, skills, and experience demonstrated by achievement of standards identified by a nursing specialty to promote optimal health outcomes."2 Certification is associated with improved patient outcomes.2,3

Advantages of certification

Not only is certification beneficial for patients, but it can also have personal, professional, and economic benefits for you. You may experience personal growth, a sense of accomplishment, and recognition by successfully completing the certification process. Haskins, Hnatiuk, and Yoder noted this enhances nurses' feelings of empowerment within the clinical practice setting.3

Increased feelings of competence and self-confidence can influence the patient care you provide. Growing evidence shows that certified nurses provide improved quality of care, although most authors agree that additional research is needed in this area.4

Stromberg et al. reported that nurse managers prefer to hire certified nurses rather than nurses who aren't certified. Managers consider certified nurses to have a proven knowledge base in specialty practice and an enhanced ability to function in complex patient care situations.5

Employers may participate in the certification process by offering financial incentives. These may include reimbursement for exam fees or the cost of certification review materials or courses, or an increase in salary or status based on the certification acquired. According to the "Nursing 2011 Salary and Benefits Survey Report," nurses who are certified in a specialty earn an average of $9,400 more per year than those who aren't, and 31% of facilities pay nurses' fees for certification. The 2011 survey included 621 participants and 38% of respondents reported that employers recognized certification in the area of salary and benefits. The survey report didn't identify the types of certification held.6 In many settings, certification is a component of established clinical ladders or promotion criteria.

Preparing for the exam

Successfully completing an exam is the usual way to obtain certification. Specialty nursing organizations (such as the Academy of Medical-Surgical Nurses, American Association of Critical-Care Nurses, and Emergency Nurses Association) endorse certification exams through their associations.

The American Nurses Credentialing Center is another avenue for obtaining certification. Applicant eligibility varies based on the certification being sought and the nurse's educational preparation, clinical practice, and extent of practice experience. For instance, certification requirements may include an unrestricted RN license, a specified number of years or hours in specialty practice, and specific educational preparation (a bachelor's or higher degree). Carefully consider the eligibility requirements before applying for certification. (See "Your Guide to Certification" on page 43 of this issue.)

After you meet the eligibility requirements, you'll need to think about the application and fee for testing. You'll also need to consider the content on the exam, the exam testing dates and locations, and the timeline for studying and preparing.

Making a study plan

Review the content test listing while asking yourself these questions:

* In which areas do I have a strong knowledge base?

* In what areas am I most comfortable?

* In what areas do I need to learn more?

Review materials for all content areas after identifying topics that you need to study in more depth. For example, if you're interested in medical-surgical certification, you might feel confident about cardiac topics but think you need to learn more about renal topics. You can design your study plan to meet that need.

Create a long-range plan. Cramming isn't a good plan for studying or successful testing. Consider the material needed to prepare for the exam. While the texts you used in nursing school may be a starting point, they may be outdated. Supplement them with up-to-date articles from current nursing journals and reputable online resources.

Many specialty organizations offer a core curriculum, which often comprises the scope and standards of the specialty practice, practice guidelines, information related to disease processes, clinical application, and other review materials. Some offer test-testing strategies, study plans, tips for preparing for the certification exam, and review questions.

Broaden your knowledge

Another strategy is to seek more practice experience with patients in those areas where you need development. For instance, if you're a medical-surgical nurse with much experience caring for cardiac patients, ask to be assigned to surgical patients so you can learn more about another aspect of practice. Increasing care opportunities in the practice environment can help provide valuable learning opportunities and experiences.

You can also practice answering questions as you did when you prepared for the licensure examination. A NCLEX review book can provide practice questions, but remember that they're based on entry-level practice. In specialty certification, the focus shifts toward expert practice. Successfully completing the NCLEX questions won't necessarily provide the needed level of practice to prepare for a specialty certification exam. Many specialty organizations offer review questions in various formats.

Consider a course

A certification review course can provide another preparation opportunity. Online or computer-based courses continue to be expanded and offer flexibility. Certification courses may be taken in 1 or more days. Some employers may purchase certification courses and even offer them on-site for a large group.

Review courses let those seeking certification refresh their knowledge and identify areas where they need more education. The timing is a personal choice. Taking a review course in the beginning of your studies can help you identify areas where you need further study. Or you can use the review course as the final preparation just before testing.

Test-taking tips

When it's time for the certification exam, take a few steps to put yourself in the best frame of mind. Get a good night's sleep the night before the exam. Make sure to eat a healthy meal before going to the testing area. Arrive early to avoid additional stress on the testing day.

In the beginning of the exam, take a couple of deep breaths, relax, and think, "I can do this!" During the test, take your time. Read each question carefully and make sure you understand what the question is asking. Don't read into or beyond the question. After selecting your answer, read the question and your answer again. Make changes only if you're absolutely sure that your first response is incorrect.

When you've finished the exam, take a deep breath and relax. When the results will be available varies. In some cases, the results are available within minutes of the test's completion.

In other cases, the results will be sent to you via mail or e-mail.

Reaching your goal

Once you've obtained certification, provide this documentation to your employers-this may increase your salary or help you get a promotion. Also include the documentation in your professional portfolio.

Once you've obtained certification, you'll want to maintain your hard-earned credential. Your certification will be awarded for a specified time (often 5 years), depending on the organization. Your next step is to review the criteria for recertification. Most criteria include an opportunity for retesting or an opportunity to recertify based on documented continuing education and practice in the specialty area. Continuing nursing education credit in the practice area is one common component. The number of required credits generally ranges from 15 to 30 hours (or units) per year. Plan ahead for recertification activities as you continue to advance your skills and education.

Finally, celebrate your success in completing the exam and receiving the certification! Obtaining specialty certification represents life-long learning and demonstrates you have expert knowledge in an area of clinical nursing practice.

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