The value of certification—a research journey

AORN Journal,  April, 2004  by Michelle Byrne,  Wendy Valentine,  Shannon Carter

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Patient safety and satisfaction depend on recruitment and retention of outstanding perioperative nurses who exemplify nursing excellence. One measure of nursing excellence is achieving specialty certification. (1) The term certification is defined as a voluntary process, the purpose of which is to provide professional recognition of knowledge, skills, and clinical practice. (2) Many nursing certification programs have been developed to support a standard of care that is recognized outside of the practice field and with the intent to protect the public. Although licensure and registration are granted for meeting minimal professional requirements, certification denotes a more advanced level of knowledge and practice. (2, 3) There currently are more than 50 different nursing certification credentials. (4)

The Certification Board Perioperative Nursing (CBPN) provides specialty certification for perioperative nurses. The organization's mission is to be the leader in competency credentialing and education that promotes safe, quality patient care in the perioperative arena. Its values are to

* develop and maintain collaborative endeavors and relationships with those who support the mission,

* enhance and promote the value of the credentials,

* engage in evidence-based quality improvement for all products and services,

* solicit broad-based and diverse constituent input, and

* use innovative and dynamic approaches in the decision-making process.

In a recent survey of certified nurses, 72% of respondents reported one or more benefits of certification, including decreased errors or adverse events. (5) There is a lack of research, however, documenting the benefits received by nurses certified in perioperative nursing and their perceptions related to certification. Congruent with its mission, CBPN's board of directors initiated a research agenda in 1998 to conduct studies about the needs of and implications for the credentialing environment. This article describes the historical background of the CBPN's research activities. Current and future research plans also are presented.

HISTORICAL BACKGROUND

The CBPN is an independent organization that was initiated when the House of Delegates of the Association of Operating Room Nurses, now called AORN, voted to provide a voluntary certification program for OR nurses. In 1978, a certification council, which consisted of five AORN members and four members from associated professional nursing organizations, was appointed to develop these programs. In 1979, the council was incorporated as an independent entity to separate certification activities from educational initiatives, and thus, minimize conflicts of interest. Currently, a 10-member board of directors representing education, clinical practice, administration, research, and consumer perspectives governs the CBPN. A variety of volunteer committees (eg, item review, test specifications, item writers) ensure that the certification examinations reflect current perioperative practice. As of Jan 28, 2004, 28,656 nurses were CNOR certified, and 1,651 RN first assistants were certified (ie, CRNFA).

The CBPN has been a member of the American Board of Nursing Specialties (ABNS), which is a coalition of nursing specialty certification organizations, since 1998. Members of the ABNS participated in the Nursing Credentialing Research Coalition, which conducted a survey of the certified nursing workforce in 1999. Although the CBPN was represented and supported this endeavor financially, the final survey tool did not contain any items specific to perioperative nursing. The CBPN, however, is interested in finding evidence to describe the value of the CNOR and CRNFA credentials. The board of directors believes strongly that providing a research-based answer to the value of certification will provide meaningful and relevant information to its constituents.

In 1999, as an outcome of board discussions, the CBPN appointed its first research committee. In the summer of 1999, the group met and decided that the first order of business was to operationally define the perceived value of CNOR and CRNFA certification. A review of the literature suggested that the benefits of certification include

* a broader range of job opportunities,

* challenge,

* commitment to professionalism,

* greater earning potential and eligibility for third-party reimbursement,

* increased job satisfaction,

* personal achievement and satisfaction,

* professional obligation,

* professional prestige or status, and

* validation of knowledge. (6-11)

The research committee provided direction in developing focus group questions that would provide qualitative data for the CBPN's research.

The CBPN board members and test development committee members for the CNOR and CRNFA examinations agreed to participate in focus groups conducted by one individual. Focus group participants signed consent forms for the proceedings to be audio-taped and used for the CBPN's research purposes, including publication. All participants were asked an opening question related to their years of perioperative nursing experience. They then were asked how they personally perceived the value of the CNOR and CRNFA credentials. Next, the participants were asked about the value of the credentials to others. Finally, participants were asked about their beliefs related to the value of the credentials.