The past 2 decades have seen a vibrant discussion about patient safety and quality in healthcare. The National Academy of Medicine's (formerly the Institute of Medicine) Crossing the Quality Chasm: A New Health System for the 21st Century, a damning report on systemwide fatal deficiencies in patient safety, led to another report emphasizing a core set of competencies in health professions education.1 The nursing profession's response to the ongoing challenges in patient safety resulted in a clamor to increase the number of baccalaureate-prepared nurses who possess competencies in patient-centered care, interdisciplinary teamwork, evidence-based practice (EBP), quality improvement, and informatics.2 There is significant evidence correlating positive patient outcomes with care provided by baccalaureate-prepared nurses. These include lower postsurgery mortality; lower rates of pressure injuries, failure to rescue, and postoperative venous thromboembolism; shorter length of stay; and overall reduction in adverse outcomes.3 By extrapolation, obtaining specialty certification might confer similar benefits based on the notion that nurse specialty certification hinges on baccalaureate education.4 Certification is associated with better patient outcomes, but only when care is provided by baccalaureate-prepared nurses.4
The focus on patient safety competencies matches the aims of specialty certifications such as the CCRN®. The CCRN is not an acronym for “critical care registered nurse.” It is a registered service mark that denotes certification in acute/critical care nursing as granted by the American Association of Critical-Care Nurses (AACN) Certification Corporation.5 The high-stakes demands of the critical care environment provide an impetus to protect healthcare consumers by validating the knowledge of nurses through the CCRN certification exam.
Who benefits from the CCRN?
It has been shown that all nurses benefit from specialty certification.6 Nurses who are specialty-certified report an increased confidence in their knowledge, competency, job satisfaction, and self-perceived status, along with respect from other professions.7 In a healthcare field that is expanding in complexity, the importance of quality nursing care is increasingly being associated with improvement in patient outcomes. Education is a key element of improving nursing care. Specialty certification, or post-entry-level credentialing, is one method to demonstrate ongoing competency.8 Of all the specialty certifications, the CCRN is one of the most-conferred certifications; this is important for several reasons. Critical care nurses are at high risk for burnout because of the higher acuity of the patients they care for and the stress of caring for complex patient populations. Burnout is a contributing factor to the high turnover rate among ICU nurses. Lower job satisfaction among critical care nurses is associated with intent to leave their position.7,8 Further, critical care nurse competency is crucial in delivering the level of care required to maintain patient safety. The CCRN has been linked with positive patient safety outcomes.9 The certification credential is a proxy validation of the clinician's competency.
The value of CCRN
The greatest value provided by specialty certification may be to the patient. In ICUs with a higher proportion of certified registered nurses, the rate of patient falls is lower.10 In acute care settings, increases in specialty certification rates among nurses have been correlated with improvements in total fall rates over time and an overall reduction in total patient fall rates.11
Studies have illustrated the correlation between specialty certification and decreased rates of central-line-associated bloodstream infections (CLABSIs) in surgical ICUs.14 It has been shown that bedside surgical nurses who are specialty-certified are able to decrease CLABSI rates in the postsurgical patient population.14 Overall, specialty certification is associated with decreased incidence of failure to rescue, which can ultimately reduce patient mortality.16-18 Although the evidence between CCRN and patient outcomes needs further research, it is reasonable to assume that a notable increase in skill and knowledge as demonstrated by specialty-certified nurses should ultimately result in overall improved patient outcomes.7,9,11,19
Benefits of certification to the nurse
Along with other specialty certifications, the CCRN contributes to bedside nurse empowerment and decision-making confidence. Certified nurses have demonstrated their competency within their specialty beyond those with entry-level competency and are considered experts.20 Numerous studies have correlated specialty certification with enhanced knowledge and skills demonstrated by certified nurses.11-18 Their effort in preparing and sitting for the certification exam also highlights their commitment to continuing education. Studies have also shown that certified nurses have a higher level of empowerment compared with those who are not certified.8,19 Specialty-certified nurses report an intrinsic sense of accomplishment that contributes to their overall job satisfaction.6,8 Typically, certified nurses receive a certification differential or bonus, thus increasing their earnings and bargaining control when negotiating salaries. Surveys have also indicated that specialty certification correlates with higher salary for nurses, which can be a major incentive for achieving certification.6,20 Magnet®-designated institutions value specialty certification, giving a possible higher chance of employment prospects and upward mobility.
Added value to the institution
Specialty-certified nurses are valuable to the healthcare institution through their commitment to EBP. Healthcare organizations rely on quality nursing care to provide optimal patient care. Attaining and maintaining a workforce of specialty-certified nurses displays the organization's commitment to provide support for knowledgeable nursing staff. Moreover, specialty-certified nurses' increased job satisfaction is correlated with decreased attrition,ensuring an institution's retention of a committed and qualified nursing workforce.6-8,19
With increased patient complexity, certification that demonstrates increased nursing knowledge and skill allows for improved patient care. Many adverse patient-care incidents are attributed to lack of knowledge. Therefore, specialty certification such as the CCRN displays to the patient and their family the high level of care they can expect to receive. It has been shown that patients and their family members are often aware of specialty certifications as an entity.6-10 Therefore, being cared for by certified nurses allows them to feel confident in the quality of care provided, leading to increased patient experience satisfaction. In the current healthcare landscape where patients have options of choosing healthcare institutions to provide care, data have shown that patients are more likely to choose organizations with a high percentage of specialty-certified nurses.6,7,9 Moreover, the associated decrease in patient care errors from specialty-certified nurses may be a factor in increasing patient safety.6-8 Institutions seeking Magnet designation have an added impetus to support their staff in obtaining certification as required by Magnet standards.21
CCRN for professional development
Specialty certification provides bedside nurses with professional recognition for their knowledge and skills. This recognition, in combination with their displayed commitment to clinical excellence, allows certified nurses to participate in professional development initiatives such as the Clinical Ladder Program. Structured systems for career advancement are designed to promote retention, job satisfaction, empowerment, and clinical excellence.20
The ABCs of CCRN
The CCRN exam is open to nurses who provide direct care to critically ill adult, pediatric, or neonatal patients. These nurses may be working in such units as the ICU, critical care transport/flight, trauma, ED, nurse anesthesia, and other CCUs. The AACN Certification Corporation governs the CCRN certifications among 15 different certifications. Of these, there are seven CCRN certifications. (See CCRN certifications.)
Exam eligibility requirements and fees
The CCRN Exam Handbook (www.aacn.org/certification/preparation-tools-and-handbooks/~/media/aacn-website/certification/get-certified/handbooks/ccrnexamhandbook.pdf) provides detailed and definitive information on the eligibility requirements to take the certification exam. The major requirements are licensure, clinical practice hours, and practice verification. Requirements vary depending on the population focus of the certification. (See Uniform initial eligibility requirements.)
The test plan
The CCRN exams are 3-hour computerized tests consisting of 150 multiple-choice items.22 The CCRN test plan is divided into two major categories: Clinical Judgment, and Professional Caring and Ethical Practices. (See Breakdown of CCRN test topics.)
Essential to passing the CCRN exam is a clear grasp of the Synergy Model, which is tested under the Professional Caring and Ethical Practices category. The model's premise is patient-centered care based on a holistic view. The handbook provides an overview of the key patient and nurse characteristics vital to understanding this model.5
General guide for CCRN test prep
Any nurse who has taken the National Council Licensure Examination (NCLEX) is familiar with common sense test-taking tips such as “read the question thoroughly.” It is beyond the scope of this article to elaborate on specific CCRN test-taking skills. The applicant is encouraged to use any of the leading CCRN review books for specific hints for success.
Obtaining and maintaining certification reaffirms the public's trust in nurses as guardians of patient safety. CCRN credentials mark the nurse for distinction in clinical excellence and validation of the nurse's commitment to lifelong learning. The certification seeks to ensure that a nurse maintains ongoing competence in a given specialty.2
- CCRN Adult: For RNs and advance practice registered nurses (APRNs) providing direct care to acutely/critically ill adult patients.
- CCRN Pediatric: For RNs and APRNs providing direct care to acutely/critically ill pediatric patients.
- CCRN Neonatal: For RNs and APRNs providing direct care to acutely/critically ill neonatal patients.
- CCRN-K (Adult, Pediatric, Neonatal): For RNs and APRNs influencing care of acutely/critically ill adult, pediatric or neonatal patients, but not providing direct care.
- CCRN-E (Adult): For RNs or APRNs working with acutely/critically ill patients behind a camera from a remote tele-ICU location.
Detailed information on initial certification and renewal can be found online at www.aacn.org/certification/get-certified.
Uniform initial eligibility requirements
A current, unencumbered US RN or APRN license is required. An unencumbered license is not currently being subjected to formal discipline by any state board of nursing and has no provisions or conditions that limit the nurse's practice in any way. This applies to all RN and APRN licenses currently held.
Clinical practice hours
- 2-year option: Practice as an RN or APRN for 1,750 hours in direct care of acutely/critically ill patients during the previous 2 years, with 875 of those hours accrued in the most recent year preceding application.
- 5-year option: Practice as an RN or APRN for at least 5 years with a minimum of 2,000 hours in direct care of acutely/critically ill patients, with 144 of those hours accrued in the most recent year preceding application.
Eligible clinical practice hours
- Must be completed in a US-based or Canada-based facility or in a facility determined to be comparable to the US standard of acute/critical care nursing practice.
- Are spent actively providing direct care to acutely/critically ill patients or spent supervising nurses or nursing students at the bedside of acutely/critically ill patients, if working as a manager, educator, preceptor, or APRN. The majority of practice hours for exam eligibility must be focused on critically ill patients.
- The name and contact information of a professional associate must be given for verification of eligibility related to clinical practice hours. If you are selected for audit, this associate will need to verify in writing that you have met the clinical hour requirements.
- A professional associate is defined as your clinical supervisor or a colleague (RN or physician) with whom you work.
For AACN members $239; for nonmembers $344.
Source: American Association of Critical-Care Nurses. CCRN (Adult). www.aacn.org/certification/get-certified/ccrn-adult.
Breakdown of CCRN test topics
Clinical Judgment: 80%
- cardiovascular (17%)
- pulmonary (15%)
- endocrine/hematology/gastrointestinal/renal/integumentary (20%)
- musculoskeletal/neurological/psychosocial (14%)
- multisystem (14%)
Professional Caring and Ethical Practices: 20%
- advocacy/moral agency
- caring practices
- response to diversity
- facilitation of learning
- systems thinking
- clinical inquiry
For details on key information on the day of the exam can be found in Certification Exam Policy Handbook, www.aacn.org/~/media/aacn-website/certification/get-certified/handbooks/certpolicyhndbk.pdf.
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