The rapidly changing landscape for healthcare professionals poses tremendous challenges for demonstrating value-based credentialing outcomes. A 2014 Institute of Medicine (IOM) workshop, "Future Directions of Credentialing Research in Nursing," addressed this theme. The workshop, sponsored by 20 nurse credentialing organizations, considered research priorities and strategies in light of the changing role of nursing with emerging specialties and innovative care delivery solutions.1,2 (The workshop was informed by previous public meetings of the IOM Standing Committee on Credentialing Research in Nursing.3) Workshop participants discussed needs for a shared research framework, better data availability and harmonization, and additional resources for research to quantifiably demonstrate how or if nurse certifications affect healthcare quality and patient health.1,2
The Literature Supporting Certification
Although more research is needed, existing literature demonstrates positive outcomes related to certification. According to the article, "Increasing Nurse Certification Rates Using a Multimodal Approach," the attainment of specialty certification can be beneficial for nurses, patients, and healthcare organizations.4 This study found that not only do certified nurses report a sense of empowerment and increased job satisfaction, but also certification is tied to increased patient safety and patient satisfaction.4
In a recent article titled, "The Value of Certification: What Do Pediatric Nurses Think?" investigators considered how individual nurses and groups of nurses at 1 organization value specialty certification and their motivation for obtaining certification.5 This study found both certified and noncertified nurses think certification enhances the feeling of personal accomplishment and satisfaction.5
A 2009 article, "Perceived Effects of Specialty Nurse Certification: A Review of the Literature," reviewed 12 studies published between 1980 and 2008 to assess evidence on the effect of certification on patient outcomes. The findings demonstrated that certification has intrinsic value for nurses and increases their sense of empowerment and collaboration with healthcare team members.6 The studies reviewed presented little evidence related to certification and patient outcomes, although 1 study found a positive correlation between the two.6
Anecdotal evidence from healthcare organizations and nursing executives validates the benefits of certification. Many healthcare organizations view certification as an effective approach to quality improvement for promoting patient outcomes. Nurse managers report the changes certification produces in nursing care and the impact on patients. Informally reported outcomes include nursing empowerment, self-reported enhancement in clinical confidence for specific patient populations, employee satisfaction and retention, and associated reduction in adverse events.
Organizational Leaders Promoting Certification
Organizations that prioritize certification promote this as part of the culture. Gina Ellerbee, MSN, RN, ACCNS-AG, CCRN, system director of nursing education at CoxHealth, said discussion around certification begins as soon as a nurse is hired. "We recognize that the literature supports nursing certification. Information regarding improved patient outcomes, reduced falls, hospital-acquired conditions, and pressure ulcers, among others, is shared with our staff to explain the importance of specialty certification. Our goal is to create a culture of nursing excellence such that certification becomes the expectation for our staff," Ellerbee explained. "The question becomes, 'When and how will I become certified?' not if. We offer programs to help nurses make the 'when' and 'how' questions much easier to answer" (G. Ellerbee, oral communication, June 18, 2015).
Lesa Cole, MSN, RN-BC, director of clinical education and professional development adult enterprise at Vanderbilt University Medical Center, said the biggest change she sees when nurses achieve certification is a sense of empowerment and confidence, which affects how nurses care for patients. "Our primary goal is to improve the quality of care by encouraging nurses to become certified. Certification empowers nurses and validates what they know. In turn, they are able to deliver patient care and collaborate with team members with more confidence," Cole said (L. Cole, oral communication, June 18, 2015).
Some nurse managers so strongly believe in the value in certification that they require it for all staff nurses.
"We want nurses to continue learning and keep up with ever-changing nursing practice, so Comfort Home Care made certification a requirement," said Jenna Johansen, BSN, RN-BC, director of nursing staff education at Comfort Home Care. "We're a more competitive company, we're a more productive company, and the bottom line for us is we're a safe company. When we're knowledgeable, our clients are safer, and if they are safer, they are healthier." (J. Johansen, oral communication, June 19, 2015).
Success Pays
Each of these organizations implemented successful certification and professional development strategies through the American Nurses Credentialing Center (ANCC) Success Pays program, which makes it easier and more affordable to encourage nurses to pursue certification. Organizations provide a minimum of 20 eligible nurses who receive 2 chances to pass in a 12-month period. ANCC discounts the application fees and bills the organization only for nurses who achieve certification. "Success Pays helps us eliminate the financial barrier for nurses. It's often difficult for RNs to spend money on the exam. Success Pays really helps increase certification opportunities for those nurses."
CoxHealth integrated Success Pays into its professional development plan in 2014 with a pay-it-forward program to improve access to nursing certification. In exchange for paying the certification fee, the organization requires newly certified nurses to participate in a professional development project for peers. "The ANCC Success Pays program is instrumental in helping us meet our goals. This is only our 2nd year, and we have a lengthy waiting list. Supporting nurses in this way makes a huge difference for our organization. Not only did we gain 117 newly certified nurses last year, we also added 117 projects that promote nursing excellence on a peer-to-peer learning level. Getting staff involved in improvements on their units is a great way to encourage engagement in future projects," Ellerbee said (oral communication, June 18, 2015). As the profession awaits further research and uniform databases to identify and measure certification outcomes, these firsthand experiences become the greatest validation of the importance of certification.
References