Certification—the gold standard

AORN Journal, Sept, 2004 by Sharon E. Hohler

Certification for perioperative nurses (ie, CNOR) denotes excellence in practice and commitment to quality patient care. The CNOR credential provides

   the documented validation of the professional
   achievement of identified
   standards of practice by an individual
   registered nurse providing care
   for patients before, during, and after
   surgery. (1 (p1))

Nurses who have attained the CNOR credential are expected to be aware of the latest research and best information and incorporate this knowledge into patient care. Certification must be renewed every five years, which demonstrates a commitment to continuing education. The first certification examination was held on 1979, and a total of 166 nurses have maintained the credential for fine full 25 years. (2)

The Certification Board Perioperative Nursing (CBPN) is the independent organization that offers CNOR certification. The organization's mission is to "be the leader in competency credentialing and education that promotes safe, quality patient care" (3) in the perioperative arena. The CBPN is accredited by the American Board of Nursing Specialties, which "advocates consumer protection by establishing grad maintaining standards for professional specialty nursing certification," (4) and by the National Commission for Certifying Agencies. (4)

WHY CERTIFY?

Many facilities support nurses' educational efforts financially. At St Francis Medical Center, Cape Girardeau, Mo, a career ladder rewards nurses who obtain certification. Nurses can stay directly involved in patient care and benefit financially through the career ladder, which incorporates certification and baccalaureate degrees into its levels. Facilities that do not have career ladders may have programs that will pay a portion or all of a nurse's expenses for obtaining certification.

Some facilities have no such programs in place. Nurses who work in such facilities may say, "I won't get paid for certification. Why should I pay my hard-earned dollars to take the examination?" The answer is that each nurse should do it for himself or herself. Certification encourages professional growth through continued learning and recognizes individual perioperative nurses for proficiency and achievement. (5) Certified nurses have increased self-confidence and job satisfaction because they know their patients are receiving the highest-quality care.

A recent study found that 90% of nurses value certification. (6) Study participants included certified nurses, nurses who were not certified, and administrators. According to the study, motivations for seeking certification included intrinsic rewards (ie, internal motivators) such as accountability; professional confidence; knowledge and competence; and personal achievement, satisfaction, and growth. Extrinsic rewards (ie, external motivators) included consumer confidence, marketability, salary, and recognition from peers and other health care professionals. (6)

ELIGIBILITY AND PREPARATION

Obtaining certification requires taking and passing the certification examination. Candidates for CNOR certification must be currently licensed and employed in perioperative nursing. In addition, they must have a minimum of two years and 2,400 hours in perioperative practice. (7)

Resources are available to help nurses study for the examination. The CBPN publishes the CNOR Study Guide and Practice Resource (8) and a companion CD-ROM, which are available from the CBPN or AORN's Perioperative Book store. The guide includes 200 "retired" questions and answers from actual CNOR examinations. (9) The CBPN also offers online practice tests (10) and provides a sample curriculum for study groups on its web site." Other resources recommended by the CBPN are listed in Table 1.

AORN frequently offers two-day programs in preparing for the CNOR examination. A two-week online version of this program also is offered (see "Educational Opportunities" in this Journal).

HOW THE EXAMINATION IS DEVELOPED

The CBPN contracts with a professional testing agency to develop and score the CNOR examination and a computer-based testing organization to administer the examination throughout the United States. (12) Certification examination questions are written, reviewed, and validated before they are included in the examination.

ITEM WRITING. Every year, CNOR nurses volunteer to serve on the Item Writing Committee (IWC) by completing a willingness-to-serve form. After they are chosen by the CBPN to serve on the committee, these nurses sign a confidentiality statement and receive information on how to write test questions. Writing a good multiple-choice question requires effort and thought. Good questions are worded in a positive way, avoiding ambiguities that might cause confusion for the test taker. Each question requires rationale from an up-to-date source (ie, published within the past five years), such as Alexander's Care of the Patient in Surgery. (13)

Each IWC member writes five questions and sends them to the professional testing agency to be critiqued. The critiqued questions are returned to the IWC member with suggestions for improvement. The IWC member then writes 15 more questions and sends all 20 to the testing agency by a deadline in November. In January, the IWC members meet in Denver for two days. The committee members review the questions based on