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