Some would say change has been the only constant in healthcare in recent years. A great deal of that change was prompted by the economics of the nursing shortage, and nursing certification has been affected profoundly, especially when the world entered the new millennium. Virtually every specialty board experienced a decline in the number of examinees and renewing certificants, in part because the focus on intense recruitment often failed to include the importance of professional development in retention efforts. Employer support for specialty nursing certification looked like it could become a thing of the past in some parts of the country.
A few positive changes in the healthcare environment have set certification back on a steadier path. First, more employers have realized the importance of retaining their skilled nurses. Recognizing that both nurses and employers benefit from a renewed focus on professional development, many hospitals have created initiatives to assist their staff in obtaining certification or pursuing advanced degrees.
Second, the Magnet Recognition Program has provided an important and invaluable impetus to employers wishing to promote a more professional nursing workforce. Among other measures, Magnet surveyors look for evidence that employers encourage and support nurses' attainment of specialty certification. ONCB leaders regularly hear from employers who want to sponsor examination sites for their nurses, and NAON has also provided support for these efforts by offering bundled pricing for purchase of examination-preparation products.
After an alarming slump in 1999, the number of ONC examination candidates experienced a modest increase in each year of this new century. These trends gave the ONCB directors new optimism for the future of the specialty, but the real "shot in the arm" came last year, when the number of candidates increased by approximately 30%.
Clearly, the tide has turned. Riding the crest of these positive events, ONCB has taken steps to ensure the continuing value of the ONC credential. First, the board has applied to register the ONC designation as a certification mark. If our application is granted, the ONC mark would be protected from any future group that wanted to use the same designation for a nursing credential.
Second, ONCB is pursuing ONC examination accreditation through the American Board of Nursing Specialties (ABNS). Accreditation is a rigorous voluntary process, and a consumer protection strategy developed to ensure that a certification examination is a psychometrically sound measure of a nurse's knowledge in a given specialty. The value of the examination will be recognized and assured through accreditation. ONCB will be tasked to demonstrate its compliance with 19 accreditation standards. These standards address everything from certification board governance to examination quality control. One especially important standard calls for public involvement on the board to ensure the consumer perspective is considered in all decisions. ONCB's newly appointed public member is Jacqueline Callahan (Bethesda, MD), whose experience with credentialing has already provided additional depth to the ONCB.
Finally, ONCB has begun an exciting new journey in developing certification examinations for clinical nurse specialists and nurse practitioners. The timeline for examination development began with a logical analysis at AAOS in February, when six APNs from various regions met to build role-delineation statements that will be used in a survey later this year. The vision for APN certification calls for a core examination of approximately 100 questions that reflect elements common to both the CNS and NP roles. An additional 50 questions will focus on role-specific responsibilities for each APN group. Item writers will be working through the summer and fall, and pilot examinations will be offered at the 2006 AAOS meeting and NAON Congress. The first examination will be administered in October 2006. ONCB is committed to providing an orthopaedic credential for the thousands of APNs who work in musculoskeletal health.
Recent experience in healthcare and nursing certification has confirmed that change is never easy. However, ONCB has chosen to define change rather than be defined by it. We face an exciting future, and we are confident that nurses will continue to value the unique practice of orthopaedics.