Among the Medicare population, heart failure is the fastest growing cardiovascular disorder in the US and the most common reason for hospitalization.1,2 With the passage of the Affordable Care Act and readmission penalties, clinicians and healthcare systems are continually striving to improve outcomes in patients with heart failure. Because nurses provide care in all healthcare settings, they have increased potential to recognize early signs of acute decompensation, prevent complications, optimize guideline-directed medical therapy, and facilitate communication and care coordination.3
Certification, as defined by the American Board of Nursing Specialties, is the “formal recognition of specialized knowledge, skills, and experience demonstrated by the achievement of standards identified by a nursing specialty to promote optimal health outcomes.”4 The American Association of Heart Failure Nurses (AAHFN) was established in 2004 as “a specialty organization dedicated to advancing nursing education, clinical practice, and research to improve outcomes for patients with heart failure.”5 The first Certified Heart Failure Nurse (CHFN) exam was offered in June 2011. Heart failure certification expanded in 2015 with the launch of the Certified Heart Failure Nurse-Knowledge based (CHFN-K) exam to include nurses who do not meet the clinical requirement for certification, for example, administrators, educators, researchers, and industry partners. To date, over 1,500 nurses have committed to advancing the field of heart failure nursing care by becoming heart failure certified.6 The chief goals of CHFN/CHFN-K certification are promotion of the highest standards of clinical practice, validation of core knowledge attainment, and promotion of continued professional growth. (See CHFN and CHFN-K credentials.)
In 2018, Albert and colleagues validated the importance of heart failure certification using vignettes to assess clinical decision-making. Nurses with the CHFN credential had higher overall scores and were more likely to have superior decision-making abilities in heart failure clinical care, especially related to acute care and chronic medical management.7 This article provides an in-depth look at the CHFN and CHFN-K certifications, covering eligibility criteria, exam considerations, recertification, and more.
Membership in AAHFN is not an eligibility requirement for heart failure certification. The CHFN and CHFN-K exams are identical, but the eligibility criteria differ. (See CHFN and CHFN-K exam eligibility criteria.)
About the exam
The AAHFN-Certification Board exam consists of 100 multiple-choice questions, plus 10 questions that are not scored but are pretested for future use. Candidates have 2 hours to take the exam. A pen-and-paper exam is offered yearly in conjunction with the AAHFN annual meeting. Computer-based testing centers across the US offer the exam during three windows of time per year. At the time of this article's publication, the paper exam cost was $275 for AAHFN members and $375 for nonmembers. The cost of the computer-based testing was $350 for AAHFN members and $450 for nonmembers. These fees are subject to change.
The exam is based on the 2013 American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) heart failure management guideline, as well as the 2016 focused update that incorporates newer pharmacologic agents.8,9 Many resources are available for exam preparation, including:
- exam content outline/blueprint (see CHFN/CHFN-K exam content outline)
- Heart Failure Nursing Certification: Core Curriculum Review book (available at AAHFN online store–www.aahfn.org)
- CHFN review course (available online at www.aahfn.org)
- webinars and other continuing-education (CE) activities (available at AAHFN Education Center–www.aahfn.org)
The Core Curriculum Review book is the official study guide and provides a comprehensive review of exam content. Each chapter includes practice questions for self-review and resources for further study.
Exam results for the annual pen-and-paper exam are mailed to the candidate within 4 to 6 weeks after the exam date. Computer-based test candidates receive their results immediately after exam completion. Successful candidates receive an official CHFN or CHFN-K certificate; certification pins are available for purchase from the AAHFN online store. Unsuccessful candidates may retake the exam for a reduced fee after a 2-month waiting period.
CHFN certification is valid for 3 years. Renewal is required before the expiration date identified on the original certificate. Failure to renew by the expiration date results in loss of certification and the inability to use the CHFN credential. Electronic renewal notices are sent at 6 months and again at 90 days prior to the certification expiration date. There are two options for CHFN recertification.5 Both require maintenance of an active RN license, current CHFN certification, and at least 600 clinical practice hours in the past 3 years. In addition, option 1 includes 40 hours of heart failure–specific CE in the past 3 years and completion of professional development activities, designated as A or B criteria. Either A or B must be completed to meet this requirement. Criterion A involves publishing an article in a cardiovascular, peer-reviewed journal as first author. Criterion B involves completing two of the following, or one of the following twice:11
- publication in a cardiovascular newsletter
- leadership role in a professional society
- presentation/lecture on a cardiovascular topic
- quality improvement project related to heart failure care
- academic credit (3 hours) related to nursing
- participation in heart failure research project
- poster presentation (local, regional, or national conference) related to heart failure
- 10 hours of additional CE credit focused on heart failure
- coauthoring a published cardiovascular manuscript
- development of a tool or program for heart failure management.
Option 2 requires 30 hours of heart failure–specific CE in the past 3 years and passing the certification exam again.
Renewal for CHFN-K has similar requirements and options. All applicants must maintain an active RN license and hold current CHFN or CHFN-K certification. Option 1 includes 50 hours of heart failure–specific CE in the past 3 years and similar requirements for completion of professional development activities as option 1 for CHFN renewal (excluding option of additional CE hours). Option 2 includes 30 hours of heart failure–specific CE and passing the certification exam again. CHFN-K renewal does not have a clinical practice hour requirement.
The credential, CHFN-Retired or CHFN-K/Retired, is intended for nurses who are retiring from practice or are no longer working in the heart failure specialty. Applicants must complete the designated application and pay a one-time fee. This credential may not be used on legal documents but allows previously certified nurses to identify themselves as those with unique and specific heart failure expertise.
Commitment to excellence
Certification is an official recognition of achievement, expertise, and clinical judgment. It is a mark of excellence that requires ongoing learning and skill to maintain. Certification holds many benefits for nurses, both personal and professional.
Benefits of certification include professional recognition and credibility, career advancement/professional opportunities, increased salary, and improved patient outcomes.3.12 The value of CHFN/CHFN-K-credentialed nurses reaches throughout the healthcare system. Increasingly complex patient acuity requires high-level heart failure nursing care. Certification promotes advancement of nursing expertise and clinical competence.
1. Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol
2. Fingar K, Washington R. Trends in Hospital Readmissions for Four High-Volume Conditions, 2009-2013: Statistical Brief #196. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. 2015.
3. Trupp RJ, Penny L, Prasun MA. American Association of Heart Failure Nurses position paper on the certified heart failure nurse - knowledge (CHFN-K) certification. Heart Lung
4. American Board of Nursing Specialties. A position paper on the value of specialty nursing certification. 2005. www.aaacn.org/sites/default/files/images/ABNS-cert-stat.pdf
5. American Association of Heart Failure Nurses. The mark of distinction. www.aahfn.org
6. American Association of Heart Failure Nurses. Annual Report. www.aahfn.org
7. Albert NM, Bena JF, Buxbaum D, et al. Nurses' decision making in heart failure management based on heart failure certification status. Heart Lung
8. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol
9. Yancy CW, Jessup M, Bozkurt B, et al. 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation
10. American Association of Heart Failure Nurses. Exam content. www.aahfn.org
11. American Association of Heart Failure Nurses Certification Board. Re-eligibility requirements. www.aahfn.org
12. American Board of Nursing Specialties (ABNS). Position Statement on the Value of Specialty Nursing Certification. 2004. www.nursingcertification.org