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Journal of Nursing Administration:
Departments: In My Opinion

The Case for Mandatory Certification

Brady, Christine BS, RN; Becker, Kathleen BS, RN; Brigham, Lynette Eckes BS, RN; Goldman, Julie MS, RN; Wilson, Barbara Beilman BS, RN; George, Eda PhD, RN

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Author Information

Author affiliations: Students (Ms Brady, Ms Becker, Ms Brigham, Ms Goldman, Ms Wilson) and Associate Professor (Dr George), Division of Nursing, Regis College, Weston, Mass.

Corresponding author: Eda George, PhD, RN, Division of Nursing, Regis College, 235 Wellesley St, Weston, MA 02493-1571 (Edageorge@aol.com).

As graduate students in a combined nursing administration and business management program, we believe that mandatory certification by specialty after initial licensure is one logical response to the American Nurses Association’s (ANA) position statement that “Professional self-regulation through practice and ethical standards, certification, and other activities retains a place of central importance in ensuring safe, high-quality services.”1 Changes in the profession brought about by issues such as the movement of nursing practice into less supervised settings, the knowledge explosion and demands of the educated consumer, multistate licensure, and the complexity of the healthcare system provide compelling justification to support mandatory certification.

The nursing profession has demonstrated its commitment to excellence by establishing high standards. The concept of certification originated in the United States 50 years ago to recognize the value of expert nurses. Until that time, no mechanism existed to distinguish a practitioner with advanced skills and knowledge from those at the entry level. In 1973, the ANA formed its own certification program to give formal recognition for professional achievement and excellence in specialty areas. Today, 410,000 nurses hold certifications; however, this number indicates that fewer than 15% of the 2.1 million nurses who currently practice have sought voluntary certification.

We do not expect this recommendation to be embraced by all members of our profession without discussion and evaluation. Concerns regarding the impact on the individual, such as cost and implementation must be addressed. Redd and Alexander note that the number of regulating boards and inconsistent standards among the current certification agencies raise questions of overall lack of uniformity, validity, and quality. 2 Little research has been done to confirm that a certified nurse work force contributes to productivity, retention, and positive patient outcomes. 3

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Preventing Errors

Conversely, findings from the largest survey of U.S. and Canadian nurses who hold professional certifications revealed that certification is a “key tool” in reducing healthcare errors. 4 A recent study reported that 95% of certified nurses believed that obtaining certification in their specialty affected their practice in a positive way. Other findings from the same study suggest that certification also may contribute to improved patient outcomes. Carey states, “Since not all adverse events are preventable or attributable to errors, the ability of the nurse to recognize and intervene at sentinel signs/symptoms during the trajectory of the patient’s condition is critical to the outcomes of these adverse events.”5(p50) Further, the Nursing Credentialing Research Coalition has reported that certified nurses experience fewer adverse events and errors in patient care. It suggests that certified nurses experience greater confidence in their ability to detect early signs and symptoms of complications and to initiate prompt and appropriate interventions.

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Educated Consumers

Our societal knowledge explosion has produced educated consumers who not only desire to participate in their healthcare decisions but who also want to be assured of the competence of their care providers. Our present healthcare system supports patient participation with public policy measures, such as the Patient’s Bill of Rights and healthcare proxies. These measures change the landscape of the nurse-client relationship by strengthening our historical and essential role of patient advocate and by stressing the need for nurses to remain proficient in their specialties. Although current state licensing ensures that nurses meet minimal standards of practice, certification will demonstrate to the consumer our commitment to ongoing excellence and state-of-the-art care.

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Retaining Nurses

The issues of the aging nurse population and the inability to attract new recruits are frequently addressed in the nursing literature. Nursing cannot afford to lose its most accomplished practitioners due to the physical demands of the job; it also cannot afford to alienate its newest members due to a lack of mentoring and support. The “Generation Y-ers” thrive in an atmosphere of change and diversity. Certification facilitates the integration of the combined strengths of these two groups and will enhance nursing practice. The resultant sense of value, autonomy, and empowerment experienced by both will have a beneficial effect on the entire nursing community.

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Multistate Licensure Compact

Another trend with implications for mandatory certification is the multistate licensure compact. The movement resulted from nurses’ demand for a simplified licensing process, the burgeoning telecommunication industry, and an increasingly mobile society. If nationwide licensure is instituted, it underscores the need for all nurses to have evidence of their competencies. Mandatory certification eases the implementation of a national licensure movement because certified nurses have already demonstrated their commitment to higher standards and have assumed greater control over their practice. In addition, the process can guide nurse administrators in selecting qualified staff, determining hiring criteria, designing educational programs, and restructuring compensation systems, thereby fostering retention and enhancing practice.

The treatment of patients in the 21 st century will be completely different from what we know as traditional medical care. 6 The information age compels us to develop lifelong learning skills to remain proficient and accountable. Nursing is poised as a frontrunner in the healthcare revolution. It is our contention that mandatory certification by specialty will assist in the process of establishing nursing as a pivotal force in the healthcare arena.

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References

1. ANA Response to the Pew Commission Report. Available at:http://nursingworld.org/readroom/pew.htm. Accessed January 28, 2001.

2. Redd ML, Alexander JW. Does certification mean better performance? Nurs Manage. 1997; 28 (2): 45–49.

3. Flarey DL. Is certification the current gold standard? JONA’s Healthcare Law, Ethics, and Regulation. 2000; 2 (2): 43–45.

4. American Nurses Credentialing Center. Certified nurses report fewer adverse events survey links certification with improved healthcare. Available at:http://www.NursingWorld.org Accessed February 10, 2001.

5. Carey AH. Certified registered nurses: results of the study of the certified workforce. Am J Nurs. 2001; 101 (1): 44–52.

6. Porter-O’Grady T. Beyond the walls: nursing in the entrepreneurial world. Nurs Adm Q. 2001; 25 (2): 61–68.

© 2001 Lippincott Williams & Wilkins, Inc.

 

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