Certification is a process by which a nongovernmental agency validates, on the basis of predetermined standards, an individual nurse's qualification for and knowledge of practice in a defined functional or clinical area of nursing.1 Only 500 000 nurses worldwide are certified in their specialty areas.2 Certification for nursing practice is designed to protect the public, recognize and encourage professional achievement, and enhance professionalism.2 Licensure and registration are based on minimum requirements, whereas certification denotes a recognized higher standard of knowledge and practice.3 Requirements vary for nursing specialty certification, but all include a practice component, an identified body of required knowledge, and a testing blueprint.
Benefits of Certification
Why do nurses become certified? In 2006, the American Board of Nursing Specialties (ABNS) white paper on nursing certification stated that certification is perceived by nurses and the public as influencing accountability, professional accomplishment and growth, and specialized knowledge in a particular specialty.4 The ABNS cited enhanced feelings of personal accomplishment, enhanced personal satisfaction, professional challenge, enhanced professional credibility, and evidence of professional commitment as nurses' top perceived values of certification.4 Similarly, perioperative and emergency department nurses who obtained certification in 1989 reported achieving a personal goal and aspiration to confirm personal achievement.5
In 2001, Cary6 surveyed 19 452 nurses from registries of 23 certifying organizations. She found that participants cited recognition and personal growth as their impetus for seeking specialty nursing certification. Nurses in this study also identified their desire to advance their knowledge and education; demonstrate mastery of skills, knowledge, and abilities; and distinguish themselves through commitment to lifelong learning and career growth as reasons they pursued certification. A sense of accomplishment and satisfaction and enhanced professional credibility were also cited as reasons nurses choose to become certified.6
What motivates nurses to seek certification? The personal value of certification may be the strongest motivator to achieve and maintain these credentials, especially in work environments that do not offer financial incentives or professional recognition to nurses who achieve certification.3 Results from studies have indicated that nurses become certified for the personal value of certification, personal achievement, recognition by others, professional credibility, job satisfaction, career development, validation of knowledge, greater earning potential, and increased access to job opportunities.3,6,7 Certification recognizes nurses' competencies.8 Nurses in a survey at an academic medical center stated that an increased sense of pride, increased self-esteem, professional growth, and peer recognition were the most commonly cited reasons for seeking certification.2
Certification has been associated with high levels of professionalism characterized by attitudes of self-regulation, self-determination, and independence. Nurses who pursue and obtain national specialty certification perceive themselves as having a high level of commitment to the profession.9 Voluntarily testing against a national standard, certified nurses are role models of professional accountability. Certified nurses distinguish themselves through a commitment to lifelong learning and career advancement. Earning specialty certification is a personal achievement that is positively associated with greater nurse job satisfaction, a higher degree of accountability, and increased confidence in decision making.9
In a survey conducted by ABNS, 86% of participating nurse managers preferred to hire certified nurses over noncertified nurses when everything else was equal.2,9 Nurse managers expressed a preference for hiring certified nurses because certified nurses have a proven knowledge base, have documented experience in a given specialty, and demonstrate lifelong learning.9 Many respondents also viewed certified nurses as both informal and formal leaders, better preceptors and mentors, and more likely to serve on unit or hospital-wide committees.2
Researchers have reported that nurses who are certified have higher perceptions of empowerment.8,10,11 Certification provides recognition of the nurses' knowledge and expertise in the specialty area, which in turn is empowering. Empowered nurses who are adequately recognized for their expertise by their employers may choose to remain in that health care organization.12 Therefore, organizations that support and recognize this achievement may experience improved turnover and retention rates.10
Barriers to Nursing Specialty Certification
Why are all nurses not certified? Despite strong evidence to support the value of certification, there are also barriers. The ABNS cites the top-3 barriers to certification for nurses who had never been certified: cost of the examination, lack of institutional reward, and lack of institutional support.4 Many nurses report that they are unable to pay for both a review course and the certification examination.2 Lack of institutional reward such as a pay increase following certification is another barrier cited.2 Aside from leaving the specialty, nurses who let their certification lapse cited inadequate compensation, inadequate recognition, renewal fees, and costs associated with attaining the required continuing education for certification renewal as top barriers.4 Nurses do not necessarily agree that certification increases salary.1,12 Low levels of agreement with this value statement were expected, as it reflects findings from previous studies.
In a recent national survey, results noted that support for specialty certification declined somewhat in all areas. The percentage of respondents reporting no support for specialty certification increased noticeably from 15.9% to 23.7%.13 However, Mee14 found in her annual salary survey of registered nurses that certified nurses annually earn on average $9200 more than noncertified nurses. It is unknown whether this finding is related to other variables such as tenure, promotion on the clinical ladder, or higher annual raises secondary to the identified characteristics of certified nurses.
Nurses have reported a lack of time, a lack of experience, and not considering certification renewal as a necessity as 3 of the primary reasons for not obtaining certification.12 Lack of time can include issues such as time needed for preparation for the certification examination or time to maintain continuing education for certification renewal.2,7,12
Some nurses report that they lack the experience and/or qualifications to become certified and question the relevance of certification to their practice.12 They may also question whether certification is actually associated with increased competency.12 In addition, some nurses find the idea of taking an examination to demonstrate their knowledge frightening, and they fear failure.2,12 Other barriers are more concrete and include lack of access to written resource materials, books, and computer tests.2,6,7 Finally, perceived lack of institutional support and recognition may contribute to unwillingness of nurses to get certified.2,6,7 In many ways, nurse leaders can assist staff in overcoming these barriers to becoming certified.
The Nurse Leader's Role
Nurse leaders are an important force in driving a culture of certification.15 It has been suggested that the likelihood of nurses becoming certified increases when they are encouraged by nurse leaders.16 In a study conducted by the American Association of Critical-Care Nurses (AACN) and the AACN Certification Corporation, 92% of nurse managers who participated were AACN members and reported that they provided encouragement to nurses to become certified. Nonmembers of AACN reportedly did the same.17
Nurse leaders can implement many strategies to promote certification. To begin, nurse leaders can promote certification by gathering information. Determining what staff members know and understand about national specialty nursing certifications is essential. Perhaps some staff members are already certified. The nurse leader should discern what prompted them to become certified. Staff can be invited to share their stories and experiences about becoming certified. Nurse leaders should become role models by becoming certified themselves, and share with staff what led them to become certified. Nurse managers may choose to become certified in their clinical specialty. Or, they may choose to pursue the certified nurse manager and leader (CNML) credential. AACN and the American Organization of Nurse Executives have collaborated to develop a certification examination exclusively for nurse managers.
It has been suggested that aligning certification with the mission, vision, and values of the organization may help to make a compelling argument to staff. The Virginia Commonwealth University Health System (VCUHS) and other organizations require that all nursing leaders become certified when they are eligible to sit for the specialty certification examination. Some organizations have also set certification goals for each nursing unit on the basis of staff who are eligible to sit for the certification examination. These goals can be tied to unit scorecards and evaluated quarterly.
Consideration should be given early as to which specialty nursing examination(s) is(are) most appropriate for your area. Nurse leaders can obtain information about the examination(s) and distribute this information to staff. Many certification organizations have fact sheets or posters that discuss the benefits of certification and outline steps to becoming certified.
After selecting the nursing specialty examination(s) most appropriate for an area, the next step is to set a goal (percentage) of eligible staff to become certified along with a target date for meeting your goal. Tracking progress toward the goal, and discussing the progress at staff meetings should be done on an ongoing basis. Celebrations should be held when a goal is met in your unit or within your organization. Setting goals to achieve certification in a unit promotes team cohesion, collaboration, and meaningful opportunities to advance together and celebrate success as a team.
It is never too early to begin promoting certification. Nurse leaders can discuss the expectation to become specialty certified when eligible with all hires, both experienced nurses and new graduates. They may review with all staff members when they will be eligible to sit for specialty certification and what examinations are relevant to the unit. A description of how the unit will support them on their certification journey should be provided. Support for certification has been shown to be an effective workforce development program. Certification has the potential to recruit and retain staff because it validates and recognizes nurses' skills and knowledge.18
In a survey conducted by AACN and the AACN Certification Corporation, nurses felt that encouragement to become certified should include reimbursement for examination fees and preparation, an increase in salary, meaningful recognition, and certification as a requirement on the career ladder.17 Giving a “congratulations” letter to staff members once they become eligible to sit for the examination may provide additional incentive. The letter can include a definition of certification, a description of its benefits, and the information needed to sit for the examination. A description of what support the unit leadership and your unit offer during the certification journey should also be included. Holding one-on-one discussions with staff regarding your support of certification may be of benefit. Staff may fear failure, think that they are not smart enough to be successful in testing, or feel that they will not receive support for their endeavors. A discussion about specialty nurse certification during annual personnel evaluations, and setting becoming certified as an individual goal for the upcoming year, may be an additional incentive that nurse leaders can provide. As more nurses become certified in your unit, other nurses will be motivated to become certified.
Certification Review Courses
Nurse leaders play a pivotal role in supporting specialty certification. Consistent support from nurse leaders was deemed an important strategy to enhance candidates' success with the certification process.19 In a 2008 national survey, Ulrich et al13 found that 23.9% of the respondents rated support for certification as excellent, 32% as good, 24.6% as fair, and 19.6% as poor. One method of support is to provide preparation courses. An expert speaker may be hired to provide a course for your organization. If this is not financially feasible, sending a few staff to a national review course and having them lead courses for other staff can be an option. McCarthy20 recently described how to carry out a certification review on a shoestring budget. Suggestions of available resources for critical care specialty examinations offered by AACN that were identified include the certification examination handbook, practice examination questions, DVD sets, and books. Those interested in borrowing a book reference available for loan provide a check deposit. The check is returned if the book is returned in the same condition it was in when borrowed. A bulk discount may be available when groups of candidates apply for the certification examination at the same time.
At the VCUHS, the unit-based clinical nurse specialists (CNSs) have taught review course material in their respective specialties. In addition to content being presented by in-house experts, test-taking strategies are discussed. Staff members who attend the review course are asked to register for the examination before attending the course. This decreases the number of staff who attend the course but never take the examination. Another strategy is to audiotape or videotape review classes. The tapes can be made available to staff who were unable to attend or those who learn through repetition of information.21
Study Groups and Resources
Formation of study groups can be a way to provide support and promote learning. Members of the study group can each focus on a chapter or a topic covered on the examination and can educate each other on their content. These groups may be facilitated by an expert nurse, such as a CNS, a certified nurse, or certification champion. Study groups may meet at work, a restaurant, or a member's house. Some meet weekly, whereas others meet monthly. Certification packets that contain registration information, frequently asked questions regarding certification, and study materials for interested staff may be created to give to interested staff.
Nurses in a neonatal ICU in Oklahoma applied for a grant to support a certification program and creation of a certification library. Examination candidates at this facility were allowed to borrow study materials, including the core curriculum, practice examinations, and a video of a certification review course.22
Many of the strategies implemented at the VCUHS are consistent with those reported in the literature.16 Games are a fun way to learn. For example, a “Jeopardy!” game can be created as a poster session for staff to review. The game lists sample questions that test their knowledge and build their confidence during examination preparation. Currently, the VCUHS progressive care units are creating the “Are You Smarter Than A PCCN?” exercise (see Figures 1 and 2). The progressive care CNS group is creating poster sessions with study questions, which will be posted to aid staff in studying for their PCCN. Each member is focusing on questions in their area of expertise and sharing them with the other progressive care units. A study question of the week can be e-mailed or posted on a bulletin board. Formation of an organization on Facebook and posting a study question of the day is an innovative strategy.
One-on-one support is also important. Some staff need individualized coaching.23 Others will benefit from handwritten notes encouraging them during their certification journey. A buddy or mentor system may be created to support and encourage potential candidates. Discussion with staff regarding their approach to the examination, and self-care strategies to encourage success, may be helpful. For example, ensure that their schedule supports their test date, provide test-taking tips, and express your belief that they will be successful.23
A plan also needs to be created for those staff members who are not successful in their certification testing. Reviewing their certification results with them and one-on-one coaching in areas of weakness may be beneficial. Allowing them to spend clinical time caring for patients in specialty areas of their testing deficiencies will augment learning. They should also be made aware of certification resources on their unit or offered within the organization.23
Provide Financial Support
Money is a barrier for some staff to become certified.2 Study materials can be obtained with creation of a unit certification lending library as described earlier. Registration fees for review courses or examination fees may be paid, or educational time may be provided for staff to attend a review course. The registration fee, examination fee at a membership level, or both may be paid. This has a dual benefit, as it may encourage staff to become members of their professional organization. Some organizations commit continuing education monies to their departments to pay for certification fees. Other organizations have a hospital or volunteer foundation or auxiliary that funds grants; these grants could be obtained for sponsorship of certification activities such as funding for speakers or books. Examination fees may be requested.21
Many certifying agencies will host examinations on site if adequate space is available, and there are a sufficient number of potential certificants. Staff may be less anxious taking an examination with their peers, and in an environment that is familiar.23 Examination fees may also be less per participant. Financial incentives suggested in the literature include examination and renewal fee reimbursement, shift differential for those holding specialty certification, and reimbursement for continuing education activities to maintain certification.24
Recognize and Reward Certification
Nurse leaders play a key role in promoting specialty nursing certification and ensuring that those nurses who have become certified in their specialty are recognized and rewarded. The most meaningful recognition for nurses continues to come from patients and families themselves. However, becoming certified was also cited as the most meaningful recognition nurses had received.13 Although intrinsic rewards associated with becoming certified outnumber the extrinsic rewards, extrinsic rewards are the driving force behind nurses deciding to become certified or renew certification.25 Intrinsic rewards are defined as motivators internal to the individual and linked to values of personal development and self-concept. Extrinsic rewards were external to the individual or are defined by others. Extrinsic rewards include consumer confidence, employer recognition, marketability, nursing peer recognition, recognition from other health care professionals, and salary.7
Many institutions provide incentives to promote and/or recognize certification. Seventy-four percent of the respondent institutions gave 1 or more incentives, and 55% gave 2 or more incentives, whereas 25% offered no incentives for certification.9,12 In a national survey, nearly 75% of all units reporting indicated that some reward was available to recognize national certification; 42% gave public acknowledgment; 25% gave a bonus; and 27% gave a plaque, letter, or gift.15 The top-3 benefits and rewards given to nurses who become specialty certified included reimbursement of examination fees, displaying the certification credential on name tags, business cards or both, and reimbursement for continuing education.12,15,26
Public acknowledgment is the most common method of recognition. Banners congratulating successful certificates, bulletin boards identifying certified nurses, and acknowledgment of successful candidates during staff meetings are recognition strategies.23 Recognizing certified nurses at events such as Nurses Week has also been suggested.26
Nurse leaders may also send congratulatory cards or letters to each certificant, as they pass their examination. At the VCUHS, the chief nursing officer sends a note of recognition to each certified nurse's home annually. Congratulatory e-mails announcing staff passing a specialty certification examination is a cost-effective, yet meaningful idea. Staff can be recognized by the nurse leader in the unit or hospital newsletter. Submission of names of successful certificants to local journals such as ADVANCE for Nurses is another cost-effective, meaningful idea. Local papers may also print certification information in their business section. Recognition of staff on a unit may be accomplished through a “Wall of Fame.” This wall can hold a plaque listing each certified nurse's name (see Figure 3). The plaque may also be created through a PowerPoint presentation and posted on a bulletin board (see Figures 4 and 5).
Staff recognition with gifts such as a certification name tag, ribbon, or pin has been suggested in the literature.12,21 The AACN Heart of Piedmont Chapter held a “pinning ceremony” where newly certified nurses received their certification pin. Some organizations link certification achievement to clinical ladder programs. Shirey et al21 describe certified nurses receiving career ladder points for pay incentives to encourage nurses to advance along the path from novice to expert on the clinical ladder. This strategy also helps to retain clinical nurses at the bedside.
Certified staff may be recognized annually during a celebration event. Certified nurses may be acknowledged March 19, Certified Nurses Day, or on another special day. These celebrations may include a program, award ceremonies, receptions, meals, or any combination of these.21 Physicians, social workers, respiratory therapists, or other members of the multidisciplinary team should be invited to help in the acknowledgment.
Other Forms of Recognition
Less costly methods of recognition and reward are also available. Selection of certified nurses in hospital/nursing advertisements is one strategy. First preference to attend conferences may be given to certified nurses. Attaining certification may be incorporated into unit retention rewards or schedule perks. For example, certified nurses could be given one “no float pass” to be used at a time of their choosing annually. Allowing certified nurses to have a shift or schedule preference upon first becoming certified or upon renewal of specialty nursing certification is another strategy.
Certification is a mark of excellence, and it validates nurses' knowledge and skills. Voluntarily testing themselves against a national standard, certified nurses are role models of professional accountability. They distinguish themselves through a commitment to lifelong learning and career advancement. However, there are barriers to obtaining and maintaining specialty nursing certification that nurse leaders may assist staff in overcoming. Nurse leaders have the ability to promote, encourage, support, influence, reward, and recognize staff nurses on their unit. The value of nursing specialty certification has been demonstrated by its positive impact on staff, patients, and organizations. Support of specialty nursing certification will have a direct and positive impact on a unit, on the organization, and on the profession of nursing. Encouragement of certification by nurse leaders on a unit is essential.
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Certification; nurse certification; recognition; specialty nursing certification