Certification is one of the ways of empowering nurses since it validates their competency and increases their chances of experiencing professional growth. However, certification comes at a cost and one has to spend time pursuing the certification process. Certified nurses are often regarded as specialty leaders in their practice.

For a nurse to get certification, many hours have to be spent in a program that facilitates the certification process. Therefore, the initials that are found in names of some nurses indicate more than professional excellence; they also indicate the efforts that the nurse made in pursuing a program that would facilitate the recognition of her individual nursing excellence in a particular specialty.

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While certification plays a very important role in the nursing profession, it also has a share of problems. The implication created by certification by specialty is that nurses practice as autonomous groups. These groups are established in the process through which different nurses are required to meet different qualifications in order to be certified. Practice, education and experience requirements differ from one specialty to another.

Specialty organizations have in the past been trying to propose the creation of a nursing specialty board at the national level whereby certification criteria and standards would be established uniformly. The presupposition of this proposal was that this would increase the value of credentials in a scenario where there is wide variation in nursing certification programs, thereby improving professionalism in nursing.

Certification is a means of empowering nurses. Specialty certification benefits the individual nurse, the area of specialty where the nurse practices, (and generally, the nursing profession), the institution and the entire community. Gibson (1989), (cited in Tenney etal, 1992) revealed in a research study on nurses’ perceptions of specialty certification that nurses anticipated an automatic validation of professional achievement as well as an improvement in their self-image upon becoming certified. The study also revealed that 84% of all the 493 respondents who were surveyed said that certification would enable them make improvements in patient care skills.

Nurses with specialty certification tend to get respect and great admiration from their peers because of their expertise and advanced knowledge. Certification stimulates many nurses to stay up-to-date with knowledge and practice since they are often exposed to continuing education. Additionally, certification makes it easy for nurses to find opportunities for private practice, where they can take up career roles as expert witnesses or consultants (Tenney et al, 1992)

This research explores the perceptions that influence nurses into seeking specialty certification. The research delves into benefits of getting nursing certification with a view to find different perceived benefits and inherent, self-evident benefits. The main aim of this research, therefore, is to clarify the validity of different benefits of getting certified.

Tenney etal, (1992) lists five main different areas where benefits are achieved through specialty nursing certification: (a) to the individual nurse, (b)areas of specialty practice, (c) the nursing profession, (d) the nursing institution, and (e) the community. This research will explain the benefits of nursing in all these different areas, although the main emphasis will be on the benefits that accrue to the individual nurse, the main aim being to try and disentangle inherent benefits from mere perceptions.

To the specialty practice, certification makes it easy for different levels of competence in the practice to be clearly drawn out and defined. Through certification, the legitimacy a certain specialization is guaranteed. To the nursing profession, certification is a form of self-regulation. A nurse is recognized through the validity of his proficiency. A nurse who is certified in a certain areas is considered to have mastered a certain body of highly specialized knowledge, has adhered to certain established standards and has become competent in terms of practice and experience.

The nursing institution, too, derives many benefits through certification, one of them being creation of a basis for hiring, promotions, wage increases, and provision of practice privileges. Certification is a good basis for third-party payment (Edari and Staff, 1979 cited in Tenney etal, 1992). The community benefits through certification through improvement in quality in the care given to patients.

For a nurse to become certified, he has to commit some time, money and energy into the certification process. There are exams to be taken, and this means drawing up study plans for several months that precede the exam. Demauro (2008) says that today, certifications are available for almost every nursing specialty such as the American Nursing Credentialing Center (ANCC) or Board of Certification for American Nurses). The ANCC certifies nurses in more than 20 different specialties. Certification, adds Demauro, is a good basis of getting a pay increase, whereby certified nurses according to national salary statistics, earn more compared to their uncertified colleagues with the same level of academic qualifications.

According to Demauro (2008), many nurses are motivated to seek certification since it carries the same connotation regardless of where one works – in the military, NGOs, private practice and so on. National salary surveys indicate that it becomes easy for certified nurses to get better-paying jobs that fall squarely along their chosen career paths.

Statement of the Problem

Nurses associate certification with pay increase, better-paying jobs, respect and improved self-image. However, not all benefits of certification are real. Some people may question the rationale of a nurse having to incur additional expenses in terms of time, money and energy merely to put additional initials in front of his name. This, though, is not where the main problem lies; the main problem is with the perceptions associated with certification.

The state of affairs in nursing profession is far from settled and the certification designs to be adopted in future certifications remain uncertain Tenney etal, (1992). Woods (2009) notes that in the year 2001, 341,000 certifications were made, spanning in 134 specialties. The certifications were made by 67 different certifying organizations. The main reason for this high number of certifications was the marketing potential that nurses believed, and continue to believe certification has. However, these figures are an indication of a reduction in the number of nurses who have been seeking certification since the early 1990s.

According to recent research, specialty nurse training and education can improve the quality of care given to patients. Specialty nurse certification can also improve the job satisfaction of nurses, leading to a sense of empowerment. Additionally, it may result in positive effect collaboration among team members in the healthcare system. Despite the potential for these rewards to accrue to nurses, there is lack of extrinsic value to people who are in the nursing profession, making it unlikely that a higher number of nurses will be attracted into certification programs unless opportunities for recognition and greater compensation are put in place by administrators.

Certification brings about intrinsic value to nurses. Intrinsic values are non-tangible benefits such as indication of professional growth, validation of knowledge, personal satisfaction, indication of attainment of a practice standard and a feeling of personal accomplishment. It fails to bring about extrinsic benefits. Although intrinsic rewards by far outnumber intrinsic rewards, extrinsic rewards appear to be the main driving force that motivates nurses into deciding whether to become certified or not.

Some of the most referred to extrinsic rewards include increased knowledge, enhanced collaboration between member of the medical profession and improved skills. This research sets out to find out whether nurses are motivated by extrinsic or intrinsic rewards with the basis of investigation being the perceptions that dominate the nurses’ understanding of extrinsic and intrinsic rewards.

This research will be beneficial to all stakeholders of health care, especially those involved in setting up of policy frameworks in the nursing profession. For nurses, this research will shed light on the real benefits of getting specialty certification. For employers, the findings of this research will be useful in setting up frameworks that ensure that the needs of nurses are met, the most important of which is recognition of those nurses who have dedicated their time, money and energy into efforts to get specialty certification.

Significance of the Problem

Certification, in most cases, is a matter of a nurse’s individual efforts. Even in cases where reimbursements and additional payments are made for nurses who pursue certification, this scenario is more of an exception rather than a rule. When nurses register for certification, this results in shortage of nurses, increased call duty on nurses’ days off and limited time spent on oneself and family.

There is need for an assessment to be made on the true cost of certification and whether the accruing benefits are worth the efforts made. Against this backdrop, this research may be a good reference point for policymakers in the healthcare sector. Through proper policies, some fundamental stressors that nurses encounter can be eliminated and nurses may get better rewards for their efforts at certification.

Wade (2009) notes that a better understanding of the enticements and interventions that would make more nurses seek certification certified can prove beneficial to the health care industry, patients and the nursing profession.

For the nursing profession, the findings of this research have very far-reaching implications. Wade (2009) reports fears that there are too many nurses leaving the profession and at the same time, there are too few nurses entering the profession. However, he expresses the hope implied by recent researches, which indicate that nurses who feel empowered in their work environments, and who are recognized for their contributions are likely to stick to their profession.

Certification is one of the ways through which the experience, competence, knowledge and contribution of nurses to the healthcare sector is recognized. Therefore, argues Wade (2009), it has the potential to bring about retention of nurses in the profession. By addressing the issue of perception towards intrinsic and extrinsic rewards of certification, this research highlights the true meaning of this process, what it takes to become certified, the policy implications and most importantly, the potential of certification to bring about satisfaction and retention of nurses.

This research has far-reaching theoretical implications on Benner’s theoretical model, which ranks proficiency from the level of a novice to that of an expert (Benner, 1984 cited in Wade, 2009). According to this model, nurses gain knowledge and develop skills of nursing practice by passing through five levels: novice, advanced beginner, competent nurse, proficient nurse, and expert nursing professional. When nurses opt out of the nursing career on account of lack of satisfaction, Benner’s model may be seen to be an ineffective tool for explaining this scenario. When there is a proper assessment of the certification factor in a research such as this one, Benner’s theoretical framework becomes a credible tool of explaining career progression in the nursing profession.

Purpose of the Study

The aim of this study is to find out whether nurses are motivated to seek certification by intrinsic benefits or extrinsic rewards. The case study method of inquiry will be used will be used to gather qualitative data for purposes of identifying the reasons that motivate nurses into seeking certification. The analysis of these findings will be done in such a way that perceptions about the rewards of certification will be highlighted.

Perceptions that nurses have concerning certification determine how motivated the feel to undertake a certification education and exam. For this reason, any study of intrinsic and extrinsic benefits of nursing, whether perceived or real, has to focus on what nurses’ perceptions about certification really are.

The main units of analysis will include

The nature of perceptions of empowerment among nationally certified nurses
Relationship between professional characteristics and clinical nursing expertise: focus on the role of certification.
Perceptions on the value of specialty nursing certification

In each unit of analysis, focus will be on the motives that drive nurses into seeking specialty certification and these professions perceive the relationship between empowerment through certification and career progression as described in Benner’s theoretical model. An assessment will be made on the likelihood of a perceived intrinsic or extrinsic reward driving a nurse into seeking specialty certification. Different relevant case studies will be analyzed based on the gaps in knowledge indicated in the literature review section.

Research Question

Does specialty certification give intrinsic and extrinsic rewards that are necessary for build-up of proficiency from the level of novice to expert among nurses?

Definition of Terms

Extrinsic benefits————-these are the benefits that accrue as extra rewards upon compliance by professionals. They include increased pay, free food at the hospital’s cafeteria, free long-distance calls over the hospital’s cyber café, transport, remuneration packages for overtime-hour schedules and so on.
Intrinsic benefits———— Intrinsic values are non-tangible benefits such as indication of professional growth, validation of knowledge, personal satisfaction, indication of attainment of a practice standard and a feeling of personal accomplishment. Intrinsic benefits are very integral sources of job satisfaction.
Specialty certification——this is the mechanism through which the nurses are recognized for their professional qualifications, practice and experience, mainly for purposes of validating clinical competency and bringing about professional growth.

Theoretical Framework

Benner’s theoretical model that involves ranking proficiency from the level of a novice to that of an expert will guide this study. According to this model, as nurses continue to develop skills as well as to gain knowledge through nursing practice, they pass through five levels of proficiency. This theory is based on the proposition that each level is always built heavily upon the experiences that have been generated at lower levels (Benner, 1984).

The different levels of nursing described by Benner include novice, advanced beginner, competent nurse, proficient nurse and expert level. These levels are a reflection of a nurse’s movement from the reliance on abstract principles to repeated use of past education and experience (Benner, 1984)

Without a proper understanding of the complexities of acute situations that tend to be very perplexing, a novice nurse is very limited to routine task performance that requires little analysis. A step up from the level of a novice, advanced beginners may have the ability to perform simple emergency tasks within a department such as triaging very simple, straightforward cases as well as recognizing and identifying normal variability in vital signs that are common in clinical scenarios.

However, practitioners at the level of an advanced beginner may still be mislead by atypical scenarios, so competent nurses apply critical thinking and analytical skills while assessing multiple relevant elements present in patient’s condition in order to devise treatment plans encompassing both short-term and long-term goals (Benner, 1984). In Benner’s theory, emphasis is on education and experience as key factors of helping a nurse move from the level of a novice to that of an expert nurse.

In the first unit of analysis entitled “The nature of perceptions of empowerment among nationally certified nurses”, all the levels of professional development that Benner outlines will be the main reference point. Instances where notions of empowerment do not coincide with the needs of professional growth as outlined by Benner, then such notions will be considered to be perceptions. From this point, it will be easy to refer to these perceptions as the basis of determining their influence on nurses’ decision to seek specialty certification.

Benner’s theoretical framework will also be used to research the second unit of analysis entitled, “Relationship between professional characteristics and clinical nursing expertise: focus on the role of certification”. The role of certification in each of Benner’s stages of professional growth will be succinctly defined. A qualitative analysis of different case studies will make it easy for various points at which nurses start to perceive the need for specialty certification to be identified.

In the third unit of analysis, “Perceptions on the value of specialty nursing certification”, focus will be on the effect of certification towards nurses’ attitude towards challenges in the process of becoming experts. Although the relationship between specialty certification and competence is yet to be examined by researchers in the medical field (Kendall-Gallagher 2009), there are many case studies from which analysis can be made on these relationships. This research will make use of such secondary data in order to derive analyses and arrive at findings. Moreover, the relationship between competence and safety of patients in the hands of caregivers, which in recent years has attracted a large body of research information, will also be explored.

Assumptions and Limitations

The most fundamental assumption in this research is that the research findings of all the research studies where secondary data will be gathered will be accurate. It is impossible for abstract notions used by novice nurses to be quantified, which is why the qualitative method suits this research best. Moreover, at the level of a novice, a nurse may lack exposure to the understanding of the notions of empowerment as they apply to more experienced nurses who are seeking specialty certification. They may also follow the crowd when registering for specialty certification exams. The accuracy of analyses derived from this group’s information may be contested.

In the first unit of analysis, perceptions will be derived from lack of congruency between notions of empowerment and the need for professional growth. In this case, the respective nurses will be considered to be making moves towards certification using the wrong arguments. However, there could be other underlying motivating factors that may which lie outside the scope of this research.

Summary Paragraph

The need to create a work environment that is conducive to nurses is an important issue in healthcare. Nurses, like all other professionals, love opportunities and if they believe that certification brings them closer to where professional opportunities are, they should be encouraged to seek certification. This goes a long way in analyzing researches that have been done before relating to the nursing professional environment, with and without certification. Within this environment, an analysis of nurses’ perceptions towards specialty certification is made. Although it is a nurse’s sole discretionto decide why to get certification and why not to do so, this professional decision is of national significance, something that this research seeks to exemplify.

Chapter 2: Review of the Literature

One of the reasons given by nurses who seek certification is that it doing so is a way of ensuring self-empowerment. They seek validation of their clinical competency through certification. Research on the current state of certification is ongoing. Researchers of today are interested on the both intrinsic and extrinsic benefits of certification. They are also interested on its potential benefits.

Healthcare today continued to become more complex as more and more people are covered by these services. This has brought about many challenges to nursing professionals. Nurses find themselves in a situation whereby they have to keep updating their specialized skills as well as technological skills in order to be able to offer their services to the public more efficiently. For these professionals to get recognition for their qualifications, certification seems like a necessity. In a world of competitiveness such as the modern one, nurses continue to perceive many benefits of registering for a specialty nursing certification examination.

Tenney (1992) says that certification is the mechanism through which specialization in the nursing profession is recognized. The number of nurses who continue to seek certification continues to increase. According to Tenney (1992), this increase is as a result of the conviction among nurses that it will lead to recognition and professional growth.

Kendall-Gallagher (2009) sought to find out the relationship that exists between the proportion of nurses who are certified within a unit and the risk of harm to the patients within the specified unit. The result of the investigation were that unit proportion of the certified staff nurses who were registered had an inverse relationship with rate of falls; whereas the total number of hours spent in nursing care was very positively related to errors in medical administration. From these findings, a conclusion was made that specialty certification and registered nurses’ competence are related to safety of patients. There is need for further research to be done in this area (Kendall-Gallagher, 2009).

Not many researchers have dedicated much to investigate the effects that specialty nursing certification has on the quality of care that is given to patients, especially those who are in the Intensive Care Unit (ICU). Additionally, not much as been done in order to clarify the relationship that exists between competence and certification. In this case, the implication is that research on situations where incompetent nurses are granted challenging tasks on account of being certified rather than being competent is worth exploring in greater detail (Kendall-Gallagher, 2009).

Meanwhile, certification remains one of the most recognized methods of assessing nurses in terms of knowledge, competency and skills. Kendall-Gallagher (2009) notes that specialty certification has been observed to be strongly linked to nurse staffing, patient satisfaction and retention rates. Registered nurse specialty certification is a good approach of exploring the level of knowledge of nurses in a manner that impacts on the quality of professionalism at the point of care. There is a need for an understanding of this relationship in order to find out what motivates nurses into seeking specialty certifications and whether these aspirations are compatible with the need for better outcomes.

Woods (2009) thinks of professional certification as a marketing tool for professionally ambitious nurses as well as the nursing organizations and institutions for which they work. On the part of nursing administrators, the reality of competitiveness calls for efforts that not only lead to the best outcomes for patients, but also uniqueness of the services offered.

Specialty nursing has been suggested as ways of enabling a medical organization maintain a competitive advantage in a turbulent industry. Certification is a way of professional development. It is viewed by Woods (2009) as a catalyst in a healthcare system whose administrators are interested in instilling professionalism, experience and a sense of commitment. These things, notes Woods (2009) are the ones that make nursing more of a profession than a job. For this reason, certification must not be viewed in isolation, as a task of passing a specialty certification examination; it must be viewed as a continuum of learning processes and professionalism.

Certification should be viewed from multiple perspectives if its importance in the profession is to be realized. Among the many reasons why it was put in place, two have stood the test of time: (a) to meet the needs of various stakeholders, and (b) to offer assistance and protection to the public (Woods, 2009). Although this is true, it is not a true reflection of the people at the core of the whole certification idea: the nurses themselves. It is disappointing that Woods (2009) failed to appreciate the motivation that drives nurses to seek certification. It should be borne in mind that certification is not a mandatory requirement for one to join the nursing profession. Therefore the underlying motivation for the efforts must be viewed from the point of view of intrinsic and extrinsic benefits that accrue to individual nurses. Any impact that this generates should be an issue of secondary importance to the nurse as far as his professional advancement is concerned.

Some researchers have dedicated much time to addressing the nature, dynamics and motivation of employers who offer their employees incentives to pursue certification courses. In order for nurses to manage to juggle between work and certification classes, their employers have to come into the picture, either as providers of incentives or professional opinion/advice in this matter (Woods, 2009).

The support that employers provide takes the form of reimbursement, scheduling flexibility to create room for class attendance, provision of continuing education and recognition of the nurse’s efforts as well as to reward them. Not much has been done to find out the real extent of employer support in certification. If such research information exists, it would be a great source of insight into the motivations of nurses towards becoming certified in a specialty.

Woods (2009) reports Cary’s international study whereby 77% of respondents said that certification gave them an opportunity to experience personal growth while 67% said they had a sense of satisfaction while working as a certified professional nurse. Additionally, 65% of the certified nurses said that through certification, they always felt more competent while making using their professional skills; 54% said they felt more accountable; and 53% experienced higher levels of confidence while in their practice.

According to the ABNS, the public makes use of certification as the main criterion of determining the credibility of the nurses who are practicing in various medical facilities. In a study done by AACN (American Association of Critical-Care Nurses), three out of every four people who were surveyed said that they would be much more likely to select a hospital that has employed a rather high percentage of nurses with specialty certification (Briggs et al cited in Woods, 2009). This has a very far-reaching effect on the professional paths that nurses take. Yet no research information exists that can be used to determine the nature of effects this has on professional preferences.

However, there is an abundance of case studies that assess the impact of certification on nursing. One such study was carried out by the International Study of the Certified Nurse Workforce. In a random sample comprising 19,452 nurses whose names were in registries of 23 different certifying organizations, in Canada and the United States, it was found that the main benefits of certification included financial gain, recognition, job security and promotion. The most commonly given responses to the statement “Certification enabled to …” were: “feel more satisfied as a member of the nursing profession”, “experience personal growth”, “experience more confidence in the workplace”, and “feel more competent as a nurse”.

During a nursing conference in 2002, a survey was conducted by the ABSN in which 139 respondents were approached for views;the outcome was clearly inclined towards nursing managers’ preference for hiring certified nurses over their uncertified counterparts if all the other factors remained equal (National Board for Certification of Hospice and Palliative Nurses. (2009). Majority of the respondents in contacted during this survey did not have a nursing certification.

These nurse managers argued that certified nurses possessed a certain foundational knowledge in their specific areas of specialty. Additionally, 58% of all the managers surveyed said that they could easily appreciate the level of performance attained by certified nurses.

Perceptions of empowerment by nurses

In a study done in 2006 to determine the nationally certified nurses’ perceptions of empowerment, 259 staff nurses and 174-bed community hospital nurses were targeted, whereby the outcome showed that a high perception of formal and informal power. In this study, 39% of these participants possessed a national certification. Certification was found to be a very strong building block for the respondents’ self esteem (National Board for Certification of Hospice and Palliative Nurses, 2009).

In nursing, like in every other profession, self esteem determines an individual’s professional performance. As Reigle (2004) points out, nurses take so much time displaying their certifications in various organizations and publications that it becomes obvious that they are doing so for personal reasons as opposed to professional reasons. Certifications are often manifested through littering initials such as CHPN, CCRN, CNAA and MSN, all of which are specialty certification organizations. These nurses seem to be more inclined towards showing the world what they are worth rather than proving it through use of the skills and competencies that are definitive of their professions.

Overzealous display of credentials is a good indication of what motivates nurses to pursue various certification badges. Reigle (2004) opines that this overzealousness in displaying credentials and initials divides “our” profession more than it unites it. No wonder many people consider the nursing profession to be heavily complex, complete with numerous layers of competence, certification and credibility (Reigle, 2004). There are multiple educational entry routes that one may follow in order to emerge out of the other end of the curriculum, a nurse of one kind or the other. there are many certifying organizations in the United States and Canada, meaning that when each nurse seems to convey a unique set of initials as a way of showing certification, it appears to patients, colleagues and families as if every nurse is different.

Reigle (2004) traces the origin of nursing to non-academic roots, noting that the first nurses took care of patients through skills that were acquired by doing. Today, legitimacy is a bit harder to attain. Many decades have passed since the struggle for the introduction of an entry route that would produce nursing professionals started. According to Reigle (2004) failure in matters of professional licensure nursing has led to a situation where every nurse chooses the kind of certification to pursue and where members of the professions are not valued for the skills they have toiled for many years trying to achieve.

The secret to creating standards in the profession, says Reigle (2004), is to standard licensure and to respect a uniform certification procedure. Nurses, in most cases, appear to be motivated by a perception of incompetence when in the actual sense they are even overqualified for the tasks at hand.

Concern about health care quality in the United States seems to be growing since the release of a report by a report by the Institute of Medicine entitled: To Err is Human1 and Crossing the Quality Chasm. The reports, as well as numerous studies done on the issue of healthcare quality in the country, all have documented the pervasive problem of health care quality and the role that nursing practitioners should play.

According to recent evidence, education has been suggested to be a major factor in terms of increasing the efficiency of nursing care. The Pew Health Professions Commission, the American Nurses Association and AORN continue to support specialty area certification as well as credentialing as an effective means of enhancing the quality of care given to patients by nurses. Certification, according to these organizations, enables nurses to improve their level of education as well as expertise in the areas of the profession where they specialize.

Many fields that are health-related continue to provide specialty area certification for nurses who are pursuing post-entry level credentialing. In nursing, professional credentialing has existed for about 35 years Wade (2009). In fact, according to International Council of Nurses, it is defined as “a process that is used to designate that an individual has met all the established standards that have been set by an agent (in this case governmental or non-governmental) who is recognized in the work of carrying out this task.

In the case of AACN and CCRN, 40,000 certificates have been conferred while 30,000 certificates have been conferred by CNOR. The ONS has already conferred 22,835 certificates. Additionally, the ANCC had conferred 20,752 certificates to candidates by the end of 2008 (T. Peterson, ANCC senior communication specialist, telephone conversation, August 2008 cited in Wade, 2009).

People who advocate for certification argue that this is an important way of not only improving the quality of healthcare, but it is also an efficient way of increasing the level of nurses’ job satisfaction and a sense of empowerment. In a review of literature, Wade (2009) notes that recent evidence suggests the need for specialty certification and nurse education for purposes of improving the quality of services given to patients. Despite this evidence (of the existence of many intrinsic values that are achieved through specialty certification), it has been noted that nurses still feel the need for more extrinsic benefits and this underpins their pursuit of specialty nursing certification (Wade, 2009). From this finding, a conclusion is made to the effect that few nurses are going to be attracted into the profession if healthcare administrators do not increase opportunities for nurses to be recognized and compensated more.

The perceptions that nurses generate are as a result of the interactions that exist among these professionals in the workplace. They are influenced by, among other things, claims made by the people who advocate for specialty certification. The way in which nurses perceive their jobs always takes a different turn whenever they encounter differences in respect, recognition and recognition on account existence of titles that have been gained after a successful completion of a specialty nursing certification examination.

Wade (2009) reports that there is a positive association between specialty nursing certification and a sense of empowerment among nurses. Moreover, nurses are noted to perceive six different benefits, which ultimately influence them to seek certification or to justification their pursuit of it. These perceptions include empowerment, intrinsic value, patient satisfaction, clinical nursing outcomes, enhanced collaboration and patient outcomes. There were more nurses who perceived intrinsic value compared to compensation as a result of certification.

Collaboration in the nursing profession takes many forms, all of which relate to communication and coordination. When nurses perceive that there is higher quality of communication and coordination, collaboration is said to be the outcome. In this case, specialty certification appears to be an important determining factor on the level to which nurses collaborate with each other. In Wade’s (2009) literature reviews, six studies showed that both certified and non-certified nurses believed that certification enabled nurses to improve their collaboration skills.

Patient satisfaction is a very important factor in the way nurses perceive the value of certification. It is interesting that nurses’ self reports do not strongly indicate a strong relationship between certification and patient satisfaction. It is unclear whether this is indicates that nurses’ pursue certification for personal reasons only, but it appears as if this is the case. In a qualitative study of self-reports, Woods (2009) found no relationship between certification of nurses and perceptions in improvement of patient satisfaction.

Piazza (2006) carried out a study on perceptions of empowerment among nurses and found out that certified nurses have much higher perceptions of empowerment. For this reason, certification improves work effectiveness through creation of positive perceptions among nurses. Additionally, the background to Piazza’s study shed light on the nature of forces that drive nurses into seeking specialty certification. In most cases, nurses tend to be encouraged to seek specialty certification within their work environment both overtly and covertly. In terms of empowerment, research indicates that achievement and success are easily obtained through access to empowerment structures (Piazza, 2006).

The issue of empowerment of nurses keeps emerging in many research studies relating to certification. Power, in the view of Kanter’s theory of empowerment, refers to “the ability to get things done with ease”. It is often derived mainly from the structural conditions that exist in every organization. Various structural conditions that are necessary for the emergence of a sense of opportunity among all members in teamwork include availability of and access to resources, support and information. Access to opportunity takes the form of job mobility, growth and professional accomplishment. Access to support from peers and superiors is as important as access to information as far as a feeling of empowerment is concerned.

Chapter 3: methodology

This research was molded on Benner’s theoretical framework. Information was gathered on various publications, documents, reviews, analyses and factsheets. In total, 16 publications were accessed. The keywords that guided the selection of these publications include nurse certification, patient, workforce, intrinsic values, extrinsic values, quality outcomes and empowerment. Due to difficulties in accessing and analyzing the data from many sources, mixed qualitative approaches were used. Secondary sources of information were used.

A thorough assessment of the views contained in these publications was done regarding the perceptions of nurses as far as the issue of certification is concerned. The case study method was used to give a succinct description of all variables. In cases where quantitative data was provided, a narrative method was used to give its implication on the findings of the research.

The independent variable in this research is specialty certification while the dependent variable is perceptions of intrinsic and extrinsic benefits among nurses. The variables were assessed within the framework of main units of analysis namely: (a) The nature of perceptions of empowerment among nationally certified nurses (b) Relationship between professional characteristics and clinical nursing expertise: focus on the role of certification, and (c) Perceptions on the value of specialty nursing certification.

Various intervening variables were identified as professional characteristics, empowerment within the nursing profession, the evolution of the nursing profession and influences on nurses to seek specialty certification. Professional characteristics were considered for analysis of data only as far as its influence on nurses to pursue certification is concerned. The various professional characteristics surveyed, analyzed, described and used for generation of findings include entry paths into the nursing profession, influences of peers, nature empowerment in the workplace and its impact on perceptions about the value of specialty certification.

The difficult in analysis of complex data on findings of numerous researches was highlighted through a presentation of background information on the evolution of the profession and the certification changes that have been taking place in the course of this evolution. A succinct exploratory search was directed towards a comparative analysis of the inherent benefits of certification and the extent to which nurses understood these benefits. From this analysis, findings are generated on whether nurses acted more on perceptions and workplace pressure or on these inherent intrinsic and extrinsic benefits.

Areas of analysis

Empowerment within the nursing profession

In this unit, the professional characteristics were described and its relationship with levels of clinical nursing expertise surveyed^[1]. The characteristics that were emphasized on are those that are influential for purposes of generation of clinical nursing expertise. This expertise impacts very significantly on the evolution of professional practice models. Therefore, an analysis of the effect of the evolving clinical expertise was necessary for determination of the basis for nurses’ perceptions about specialty nursing certification.

An investigative work by Tenney, Demoucell & Wians (1992) that contains different case studies will be referred to in order for a narrative on what nurses thoughts are regarding empowerment through specialty certification^[2].

The evolution of the nursing profession

Through a close assessment of the various ways in which the nursing profession has evolved, it is easy to come to find out whether the profession is headed towards a trend of compulsory certification or this is just a transient practice that will die away with passage of time. Against this background, nurses’ perceptions are assessed. The various ways in which they have influenced the evolution of work practices since the 1970s when the certification wave took off are also identified^[3].

influences on nurses to seek specialty certification

In this case, outcomes of interviews by two nurses on what they value most about specialty certification were narrated^[4]. Attention was put onaspects of valuation of certification namely promotion, research agenda, nurses’ perceptions, barriers to certification, values and behaviors that relate to certification, and impact of certification on retention of nurses.

In terms of research, priority areas were focused on and the findings generated were highlighted. Additionally, focus was put on those barriers to certification that shape nurses’ perceptions from both professional and personal perspectives. The aim was to determine the extent of influence exerted by perceptions on the value of certification and vice versa. The way in which nurse managers perceive certification, their account of barriers and challenges of certification as well as its rewards and benefits also counted towards quantification of the value of the professional practice. A comparison was made on thoughts of nurses, both certified and non-certified and nurse managers.

In a research done by Niebuhr & Biel (2007), a close analysis of the Value of Certification Survey by American Board of Nursing Specialties (ABNS) is made. This close analysis will be referred to for generation of insights into the nature of perceptions and driving forces that nurses act upon while at work and while away from work^[5].

Piazza (2006) assessed the different ways in which nurses perceive empowerment. The research compared the perceptions of nationally certified with those of non-certified nurses. This constituted a good source of secondary data for this research. Focus was put on the objectives, background information and the methods used. The research was in the form of a descriptive comparative study whereby in the demographic section of the questionnaire, the nurses’ certification status of the nurse was recorded.

The research was a good source of information on the notions of empowerment, one of the intrinsic benefits that drive nurses into seeking specialty nursing certification (Piazza, 2006). In this case, insight was borrowed largely from Kanter’s Structural Theory of organizational power. In the research, 246 nurse administrators, staff nurses and nurse managers were provided and questionnaires.

The main areas probed within this research included job satisfaction, perceptions of burnout and empowerment. The instruments were more or less similar to the ones used in this research. Additionally, 2-item Global Empowerment Subscales were used to determine the reliability of the ordinary questionnaires.

In the tabulation process, a balance was maintained between the results of 265 questionnaires and the information contained in the demographic data. Using this approach, the general trend was surveyed. Additionally, the shortcomings of this approach were checked through crosschecking the outcomes with those generated by the Statistical Package for the Social Sciences (SPSS, 2003) software program.

Outcomes were derived from the way the research questions were answered. The first research question was aimed at determining the level of empowerment that registered nurses get at the hospital under study. Scores were used as demarcated in the research, with the terms ‘moderate level of empowerment’ and ‘high level of empowerment’ being used to describe the two equal ranges of data within the continuum.

Chapter 4: Data Analysis

Empowerment within the nursing profession

Tenney, Demoucell & Wians (1992) indicate that according to reports of the American Nurses Credentialing Center (ANCC), the number of people who are seeking nursing certification continues to increase every year. Additionally, numerous organizations are offering certification programs. The ANCC alone offers 21 different areas of certifications.

In the work done by, Tenney, Demoucell & Wians (1992) an outline of a typical Certification Review Course is given. Some of the areas covered include theoretical background, Integration into the community, Test-taking strategies, pulmonary rehabilitation, sexuality and disability, care of the person after stroke, post-amputation rehabilitation, skin integrity issues and activities of daily living. These are areas that are of interest to SRH nurses as far as their professional skills are concerned. However, they do not seem to be the main influencing factor as far as the task of nurses seeking certification is concerned.

According to Tenney, Demoucell & Wians (1992) 24 nurses took CRRN examination in December 1990, 16 of whom had already attended a review course. Six had not been able to attend the review course, citing work schedules and personal commitments. When the exams were finally released, Spaulding Rehabilitation Hospital (SRH) congratulated 15 new CRRNs. Out of the 16 nurses who had attended more than half of all the classes, 69% (11 of them) were successful.

Course attendance may have affected study’s result and the researchers made no attempts to analyze different variables that are known to affect outcomes in a research of this nature. Meanwhile, it was found out that all the nurses who passed the exam had a sense of pride and increased self-esteem. Recognition by management and peers was steadfast and enthusiastic. For the nurses who failed the exam, the reaction was positive. They considered the experience as a very enlightening one.

Accordingly, the first SRH nursing reception was held by CRRN in February 1991 in honor and recognition of certified nurses. Each nurse was presented with a name pin that bore the credentials acquired. Co-workers of the nurses attended the event in order to congratulate their peers. The certification task force considered this to be a successful event that was a culmination of the previous year’s efforts as well as a beginning of a recruitment campaign for a new year.

The experience of the SRH task force demonstrated that nurses get the motivation to advance professionally by way of certification. When provided with supports and resources, staff members in the nursing profession consider certification as a perfect move in the pursuit of professional challenges and opportunities.

The SRH task force’s experience has far-reaching implications as far as Benner’s theoretical framework of professional growth of a nurse from a novice to an expert is concerned. First, it was noted that certifications seems like a rite of passage that marks the transition from one professional level to the other. Secondly, the review course taken prior to certification prepares nurses to more challenges in their professional, meaning that certified nurses are more competent and skilled compared to their non-certified counterparts.

As the SRH was preparing to take its certification campaign into the second year in 1991 with high prospects for success, the American Board of Nursing Specialties (ABNS) was being formed. Its main role was to bring about uniformity in areas of nursing certification as well as to increase public awareness on the value of specialty certification. Since then, ABNS has been playing a crucial role in identifying priority research areas. One of such areas is perceptions of managers on what the value of certification is and the impact that certification has on retention of nurses. Other areas put on focus include impact on lost workdays and the benefits and rewards for certified nurses.

In study that was conducted in 2004, a survey was prepared and then disseminated to various certified and non-certified nurses as well as their managers. The value of certification was measured using the Perceived Value of Certification Tool (PVCT), a highly reliable tool that contains 18 value statements that are certification-related. Additional questions focusing on various identified research demographic items and priorities were also included. The survey was hosted on the internet and was approved by the Institutional Review Board (IRB).

All the twenty (83%) participating organizations participating in the survey were ABNS members. They were requested to invite all their certified nurses as well as an equal number of uncertified nurses in various areas of specialty to complete the survey. The organizations could draw non-certified members from various lists of affiliated organizations, unsuccessful candidates, and potential applicants. All ABNS members’ organizations with a large number of certified nurses used a sample of less than 100% when it came to selecting certified nurse samples.

The findings of this study were classified into five areas (a) certified and non-certified nurses’ perceptions as well as those of their managers on the matter of certification (b) barriers and challenges to certification (c) rewards and benefits of being certified (d) effect of certification on lost workdays (e) effect of certification on retention of nurses.

Certified and non-certified nurses’ perceptions as well as those of their managers on the matter of certification

Majority of certified and non-certified nurses were in agreement with the survey’s value statements. Nurse Managers also agreed with the value statements. “Certification increases salary” was the only value statement that failed to receive an overall agreement among all respondents. This value statement was expected to generate low levels of agreement because it is a reflection of findings of previous findings.

Barriers and Challenges to certification

Nurses without certification perceived the highest barriers to be lack of institutional rewards, lack of institutional support and high cost of exams. Respondents who had let their certification lapse said that this happened since they were no longer practicing in that specialty, there was inadequate recognition or there was inadequate reimbursement for certification purposes.

Rewards and Benefits for being certified

Nurse respondents listed many incentives offered by their organizations in order to recognize and promote certification. Top in the list of these incentives include display of credentials on nametag and business card, reimbursement of exam fees, reimbursement for continuing education. A few nurse respondents (18.6 %) said that their facilities provide salary increase after certification while a higher percentage (21.4%) noted that their facilities provide them with no incentives whatsoever after certification.

Effect of certification on lost workdays

All respondents surveyed said that they were absent for a range of 0 to 35 days for a whole year. On average, for both certified and non-certified nurses, two days of absence were recorded. In other words, there was no difference between absenteeism in certified and in non-certified nurses.

Effect of certification on nurse retention

For purposes of assessing retention rates, the participants were requested to indicate whether they were anticipating finding a new employer, to retire or to change jobs. The responses were similar for both categories of professionals. The researcher appreciated the complexity of the retention and turnover issue, saying that many variables have a profound influence on an employee’s decision to switch or quit jobs. In conclusion to the survey findings, a clear picture failed to come out in order to reveal whether certification status, the inherent rewards and benefits that organizations provide to certified nurses or the existing barriers and challenges presented by organizations pose any impact on retention rates among nurses.

Conclusions

From the perspective of about 11,000 nurse respondents who were sourced from 20 specialty nursing organizations that offer 36 different certificate credentials, this research was significant for purposes of creating an understanding of nursing certification the perceptions that members of the profession have towards this issue.

It was found that nurses greatly value certification. This value of certification is also supported by nurse managers as a way of retaining the workforce as well as bringing about motivation. In cases whereby nurses are not given any recognition, the value of certification is lost. The indications are that were it not for many barriers and challenges faced by nursing professionals in the process of getting certification, many more nurses would get specialty certification.

An analysis of how the nursing profession has evolved: emphasis on certification

Certification is one of the various professional nursing advancement programs that have been in place for many decades. Since the early 1970’s the main aim of advancement programs has been to give recognition to nurses and to promote clinical excellence. Brenner (2008) traces the evolution of Rochester General Hospital’s (RGH) Clinical Advancement System (CNAS), which was started in 1982. When it was introduced, the system was portfolio-based. When it was redesigned in 1991, it was became a performance behavior system.

The CNAS Committee developed completely new job descriptions that were based on the nursing process; clinical expertise; and education, teaching, leadership, quality and research management. Previously, the system used to be underpinned on professional preparation, clinical experience, nursing process, and teaching, leadership, research and research abilities.

In 2005, an activity-based system was put in place. It was based on clinical expertise; teaching and leadership; quality improvement, research and evidence-based practice. Within this new system, which is in place even today, the nursing process is often reviewed separately through performance appraisals.

The changes made in 2005 were a reflection of growing inapplicability of some of the provisions that were in place, especially those that deal with the performance of nurses and their professional roles. The changes were considered to be a priority need when nurses started stating that without the interest and involvement of unit managers, CNAS programs would not be a success (Brenner, 2008).

The changes made in 2004 were also geared towards removal of a barrier that existed in the form of absence of follow-through soon after advancement as a way of ensuring that nurses who had been promoted continued to work and live up to advanced-level standards. When the redesign was being started, the CNAS committee membership had been expanded in order to include representatives who had to be selected from every nursing unit instead of every division, as a way of supporting the existing shared-governance model. The CNAS advancement continuum consisted of six levels namely Clinician I, Clinician II, Clinician III, and so on, up to Clinician VI.

The factors used to determine movement from one level to another included years of experience in terms of hours practiced for a specified number of years, activity points, advanced preparation and certification and approval by various authorities. Prior to that, completely new nurses had to possess qualifications as entry-level nurses in different areas of specialization.

In an effort to increase retention as well as expand recruitment, some additional categories were made eligible for nurses who wanted to pursue CNAS certification. Nurses who work less than 20 hours were allowed to enter into the first level of the CNAS ranking. Other nurses who were incorporated into the continuum include corporate float nurses, in-house agency nurses, and bed coordinators. In other words, all nursed were taken through advancement using a similar criterion.

The activity points system is geared towards rewarding expertise by nurses. These activity points are modeled on Benner’s model of transition from a novice to an expert nurse. Expert practice nurses earn more points compared to all the lower levels. Additionally, as one goes through the continuum, the points one can during a specific time keep on increasing.

Nurses are required to maintain the same standards in every CNAS level each year. The hospital pays, upon verification, a bonus for the achievements made in the form of certification and recertification. Nurse advanced by the CNAS get financial incentives upon reaching the advanced level in addition to certification recognition of 50 cents per hour.

For the validity of the CNAS program to be attained, there has to be an ongoing appraisal system. Feedback from nurses who had advanced through the system unanimously gave positive responses regarding the system. When the system was evaluated, it was found out that in 2001, prior to the introduction of the system, 76 nurses had applied for the advancement program, 51% of whom successfully completed the advancement process. In 2006, two years after the point-based system had been put in place, 215 nurses applied for the advancement process and the completion rate was recorded as 55%. Before the new system had been put in place, there were 344 RNs and LPNs, all of whom had earned genuine promotions through CNAS. Today, more than 600 nurses have earned advancement. In 2001, only 1% of nurses had certification; by 2007, the proportion had risen to 34%.

The findings of this research were that the CNAS system works out well for purposes of retaining nurses through provision of various intrinsic and extrinsic benefits in the form of recognition, salary increase and professional development. As a result, the vacancy rate in the nursing department decreased to 1.6% in 2006 from 22% in 2002, yet the hospital incurred only moderate costs of putting the CNAS certification program in place. The most significant impact o f the CNAS program was that nurses who always maintained CNAS advancement requirements were good at clinical professionalism. Additionally, some of the nurses who have received promotion through this system are working with various local, state, national and global health initiatives.

influences on nurses to seek specialty certification

Trossman (2005) posed the question ‘What do credentials mean to you?’ to different nurses in order to stimulate them into talking about the value, if any, that they attach to ANCC certification. Noreen Brennan was one of the people who were approached. She is a believer in lifelong learning and has been certified as a medical-surgical nurse. She already has two years’ experience, a basic requirement for almost all the 37 certification examinations offered by the American Nurses Credentialing Center (ANCC) each year. Brennan is among 150,000 nurses who strongly believe in ANCC certification.

At ANCC, professionals like Noreen can become certified at two different levels. At one level they may get certification as advanced practice registered nurses (APRNS) they are “board-certified”, earning the various credentials, including RN, BC and even Diploma as well as associate degree. At the other level they may be certified as baccalaureate-prepared nurses.

Trossman (2005) reports that both types of certification are awarded on the basis of the education, skills, passing grades as well as proven experience in a certain specialty area. In order for a nurse to be recertified he needs to demonstrate ongoing practice in addition to meeting ongoing education requirements. The other Alternative is retaking the examination after five years.

Brennan, like many other nurses who have gone through this certification process that focuses on a wide range of study areas, is convinced that certification means much more than merely possessing additional credentials on one’s name. She believes that it is all about commitment, to the profession and maintaining quality health care standards.

Trossman (2005) reports that Smolenski Mary, EdD, the ANCC director of Certification alluded to a 1999 study aimed at determining the value that nurses perceive in certification. The study had been conducted through the sponsorship of the Nursing Credentialing Research Coalition, a body comprising 20 certifying bodies.

The study’s finding was that that nurses went through fewer errors and adverse events in patient care upon becoming certified. They also said that they had become more confident about their ability to carry out assessments of early signs of complications as well as to intervene much more quickly. Additionally, certified nurses indicated that they were satisfied with their jobs and collaborated in a better manner with their peers and seniors.

Smolenski offered an additional anecdote: a report from a risk manager who worked for several self-insured hospitals in Chicago. The risk manager reported that her firm found out that fewer malpractice claims were encountered by hospitals that had more certified nurses compared to those whereby the majority of nurses were non-certified.

In another interview, Trossman (2005) approached Daddario, a nurse who likes explaining what the additional initials on her badge mean. Daddario said that when people find out the meaning of having proved ones knowledge in a specialty, they naturally feel more at ease. “At such times, adds Daddario, “the nurse feels more satisfied with his work and the outcomes tend to be positive.

Brennan (Trossman, 2005) also noted that certification is a very good source of pride and a sense of accomplishment among nurses. “It is because of it that other health care professions approach me for opinions on various issues such as documentation”. She added that at Mount Sinai, where she practices, nurses are encouraged to pursue certification and they are even given annual bonuses when the heed their managers’ advice by becoming certified.

The conclusion of this narration that specialty certification is beneficial to the nurse, nurse managers, the organizations that certified nurses work for, and the public. Nurses get intrinsic and extrinsic benefits such as recognition and a sense of pride, bonuses, professional accomplishment and better outcomes.

Chapter 5: Conclusion, Implications and Recommendations

Conclusion

The research generated ample evidence to show that nurses perceive a need for certification. Certification is something that brings about meaning to their careers by giving them recognition and asserting their position in the society and the workplace. Specialty certification gives nurses intrinsic and extrinsic benefits that are necessary for build up of proficiency from the level of novice to expert.

However, in some cases, there are some intervening variables the extents to which nurses succeed in going through various steps of professional growth. If not well planned,certification efforts may be counterproductive, as nurses may record a reduction in workdays. Enough research has not been done in this area, though, since the findings do not show an acute loss of work-days by people who attend certification courses.

Nurses believe that specialty certification presents them with many additional benefits, opportunities and challenges. However, some findings showed that some nurses are reluctant to seek certification because it may set them up for higher professional responsibility. Some nurses are unwilling to be looked upon by peers for problems they may not be confident about solving.

Nurses need be motivated in order to register for certification exams. They need to be provided with the right resources and support from their workplace. Nurses are more readily likely to pursue certification if they will have the money spent to pay for the exam reimbursed by their current employers or future ones. In organizations where certification is an established yardstick for advancement, nurses consider certification to be the natural process of advancement in the career.

Certified nurses are considered to be more competent and skilled compared to their counterparts who are not certified. The perceptions that managers have towards certifications determine the benefits that they give to certified junior health workers. These managers have a significant influence on the debates that make rounds in the workplace on what needs to be done in order for an individual to make it into the next level in terms of professionalism.

Where the management of an organization is behind the certification initiative, it is more likely for retention rates to remain high since the nurses tend to have a high sense of professional attachment to the company. Additionally, in the survey that was distributed to ABSN members, majority of nurses, both certified and non-certified, agree with the values that are conventionally attached to certification. The only area that the findings were convincingly in support of the supposed perceptions is in the area of pay increase. Nurses think that it is not a guarantee for them to be rewarded with a pay increase because of being certified. Findings of previous researches have also given rise to similar findings.

An overwhelming majority of nursing in all the case studies and narrations made consider certification to be ridden with many barriers and challenges. Nurses’ perceptions on the value of certification keep changing depending on the organizational culture changes within an organization. A culture of non-recognition to certified nurses makes them to let their certification lapse. It may also make them switch from one job to the other.

Display of the credentials in the name tags of employees is considered a crucial benefit for nurses. Nurses believe that patients feel more at ease when they know about the professional experience of the nurses who attend to their medical needs. Not many organizations live up to the standards of certified nurses in terms of rewarding them. This could be because of negative perceptions mainly from non-certified nurses with no means of becoming certified. This finding was arrived at especially in cases where majority of the respondents were non-certified. In surveys where a high proportion of the nurses had specialty certification, perceptions of this certification were more positive and more benefits were cited.

There was lack of a clearly defined distinction between absenteeism of certified, non-certified nurses as well as nurses who were pursuing certification courses. The absenteeism trend was more or less similar. On the issue of retention, there was a complex set of variables that determine the retention rates, which were not investigated in this research. For this reason, it was difficult to tell whether nurses were influenced greatly by the certification-related problems in order to do away with one job and to embark in the search for another one.

Every organization that has put in place a certain form of advancement process such as RGH recorded increase in motivation of certified employees. Non-certified colleagues admired their peers who had passed the threshold into the next level of the nursing professional continuum. For this reason, certification was one of the ways through which professionally excellent nurses were held in high regard.

Since the early 1970s, when nursing certifications were introduced, many organizations have introduced nursing advancement programs for the professional benefits of both the nurses and the organizations that they work for. It is clear that as more nurses feel the need for certification, the nature of certification processes continue to change. It was beyond the scope of this research for a determination to be made on whether these changes are often tilted towards benefiting nurses or the organizations that have hired their services.

The evolution of certification over the years seems to have coincided with changes in perception by nurses. In some organizations, these advancement programs were welcomed with excitement continued to be an integral part of professional advancement as described Benner’s theory. In the organizations that remained unresponsive to the evolving needs of the profession, the excitement and enthusiasm on certification waned.

In the Case of the RGH, the transition from a portfolio-based system to a point-based system was proved to be an effective way of rewarding nurses for their positive behaviors. With time, the system has been seen to be effective in ensuring that nurses always live up to the professional standards of the advanced levels into which they have been promoted leading to unbiased professional excellence.

Certification ensures that nurses are rewarded based on their performance. In cases where certification programs are most efficient, nurses are forced to maintain the highest levels of professional integrity in order to prove that they are competent to qualify for the certification that they already. It is also through performance on the job that a nurse gets certification into the next level. In this type of arrangement, the nurse is always in a perpetual move towards the attainment of the professional standards that are befitting of an expert nurse.

In Benner’s model, it becomes injurious to a nurse’s career to switch from one employer to the other because of the hassles of proving competence and getting certification for it. Other factors that lead to satisfaction among nurses through certification include leadership, clinical expertise, quality and research management as well as education.

The level of a nurse’s activity on the workplace seems to be a major determining factor for purposes of certification. Although some nurses may possess higher qualifications than others, they may fail to meet certification requirements if they are in a workplace where there is no stimulation for professional advancement. This is one of the challenges that that were seen to influence negatively the perceptions of nurses on certification.

When the problem of absence of follow-through was solved in subsequent certification procedures, nurses were observed to have changed their perceptions about the reasons for seeking certification. The involvement of unit managers was felt to be naturally necessary, such that the process of certification became more of an organization-driven effort as opposed to an individual hassle.

In previous certification programs, unit managers were not involved, meaning there was a disconnection in terms of communication of values between the management and the health workers at a lower level. Today, certification is fast attracting the attention of managers, as the profession continues to move towards standardization. In the case of CNAS committee membership, the redesign took the form of an activity based standard that was based on the existing shared-governance model.

There is lack of enough evidence to show the differences that exist between the understanding of benefits between certified and non-certified nurses. However, previous studies hint at non-certified nurses being more enthusiastic about certification compared to their certified counterparts. This finding may be interpreted in two opposing ways. First, one may conclude that certified nurses find out, after certification, that their previous perceptions of benefits and rewards were too far-fetched or that certification did not live up to the perceived benefits and rewards. Secondly, one may conclude that non-certified nurses have overtly bloated perceptions about the benefits of certifications, most of which are shaped by ignorance.

Almost every nurse and nurse manager believes that certification provides personal satisfaction. The conclusion here is that certification is more about individual efforts and goals rather than an organizational and professional pathway. This could be the main reason why many organizations fail to reimburse nurses who pursue specialty certification. This is injurious to the professions. Organizational heads who realize this put in place in-house advancement programs whereby moderate costs are incurred for benefits to be achieved by both the organization and the nursing professionals. To further prove this point, nurse managers feel as strongly about the personal benefits of certification just as nurses do.

Another area where nurses strongly perceive benefits includes provision of various professional benefits such as commitment, growth, challenge and autonomy. It is not clear whether autonomy is the main factor that may de-motivate nurse managers from recommending reimbursements for certified nurses. As for professional growth, the organization can only win if these opportunities in the form of professional growth, autonomy and commitment are provided to nurses. The manner in which this issue is handled determines the retention rates of nurses.

Nurses do not feel strongly on the ability by certification to increase consumer confidence. However, this view is only valid when the outcomes are compared to those of other variables. Otherwise, the fact that 70% of all nurses, certified and non-certified believe that certification brings about consumer confidence speaks volumes about the values that these health practitioners attach to these advancement programs. Additionally, these views would be predictable since few people would ordinarily be expected to think more enthusiastically about the consumers’ needs compared to those relating to their personal-professional advancement.

Implications

There is need for nurses to be supported through certification for the benefit of both their organizations and their own careers. Advancement programs give meaning to work in addition to enabling nurses to get intrinsic and extrinsic rewards and benefits. Periodic changes within an advancement program such as certification should best be done through appraisal tasks, through which various perceptions of nurses are understood. Once they are understood, the positive ones are responded to positively while the negative ones are discouraged from affecting the workforce’s level of performance.

Certification will remain one of the best of instilling virtues of clinical professionalism in nursing. The perceptions are a necessary driving force of stimulating workplace debates on the career prospects of a nurse. The importance of certification is highlighted through the success stories of those nurses who have taken their careers to higher thresholds by working with state and global health initiatives.

Specialty certification programs are ideal for nurses who believe in lifelong learning. In all certifying organization, there is a significant level of standardization whereby for nurses to be certified, they must have qualified into an entry-level nurse job and gotten two years of experience on a specialty area. Additionally, nurses did not seem to perceive failure in the certification negatively; rather they took it positively, as a crucial learning experience in their careers. However, this is more of an anecdote rather than a conclusive finding, since this research was not aimed at investigating attitudes towards failure of specialty certification exams.

In general terms, nurses seem to be more inclined towards perceptions of the benefits and rewards of certification as opposed to the inherent characteristics of the exams one has to take. That is, nurses are more inclined towards the meaning of these exams as it applies to intrinsic and extrinsic benefits.

As Trossman (2005) means, the viewpoints nurses often given always seem to leave the inter-disciplinary nature of certification untouched, meaning they pay not attention to the kind of examinations they will be given. This implies that personal career advancement ideals always take precedence over inherent competencies. Maybe this is because few nurses find the likelihood of entering into the world of academia, where criticisms on curricular are made, a good possibility (Trossman, 2005).

Specialty certification correlates with reduction in errors and adverse effects. However, the accuracy of the qualitative methods used, specifically individual nurses’ accounts, may be contested, meaning that there is need for quantitative researchers to carry out more investigations. Meanwhile, there are many indications to give credence to these views. For instance, nurses who are certified are better collaborators than their non-certified counterparts. Naturally, more collaboration means better communication channels and reduction in errors that may arise whenever there is a communication breakdown arises.

Additionally, the level of certified nurses is higher compared to that of their colleagues who are not certified. It is clear that the promises of intrinsic and extrinsic benefits that come with certification have everything to do with the increase in confidence and competency. Some of the extrinsic benefits that nurses get as a result of certification include recognition, increase in a sense of pride, better terms of employment. In a specific case, nurses find certification to be a good way of assuring patients that they have the requisite knowledge, skills, competencies and experience to take care of patients. When patients feel at ease, nurses feel more comfortable in their work as a result of being appreciated.

Non-certified nurses expressed resentment with the whole issue of display of credentials, saying it makes the nursing profession to appear like it is more about personality rather than professionalism. Although the findings were not highly conspicuous in this areas, nurses’ views implied their awareness with the fact that getting certification is not just about nursing excellence; it is also, to a very large extent, a manifestation of a nurse’s individual effort to secure money and time to be able to attend certification lessons and exams. The most far-reaching inference that is deducible from this finding is that non-certified nurses think that certification is dividing “our” profession rather than uniting it.

The perceptions of nurses on certification indicate their desire for professional advancement, something for which help is needed. The help in this case is expected to come from the organizations that nurses work for, in the form of support and resources. It is not clear whether or not nurses harbor strong perceptions, positive or negative, about the multifaceted nature of most certification programs. All they think is that it increases professional credibility and that it enabled nurses to be more confidential about their professional abilities. This is another area where further research needs to be directed in the future.

The opinion gathered in this research indicates that organizational help by way of follow-ups has been inconsistent and in most cases, invisible. The support of key people who spearhead education, administration and clinical practice is not as much as nurses want it to be. For this reason, nurses who succeed in getting certification seem to be getting recognition from their peers more because of overcoming the existing administrational bottlenecks and ending up with good-looking name tags that are presented in colorful ceremonies.

Recommendations

As long as certified and non-certified nurses continue to work as peers and receiving varying benefits, perceptions of non-certified nurses will always continue to differ with those of their certified counterparts. There is need for nurse managers and policymakers in the health sector to ensure that negative perceptions by one group are not pitied against the other, some that may jeopardize collaboration.

All the researches that have been done on perceptions of nurses have targeted the views of both certified and non-certified nurses. In some cases the number of one category is very much higher than that of the other group. This means that the findings end up not giving a clear picture on disparities in the views of both groups.

Additionally, it becomes difficult for data to be analyzed, compared and findings derived. For this reason, research on certified nurses perceptions needs to be done separately and conclusions drawn separately. This way, it becomes easy tailor value statements towards the points of view of every group.

Review courses are necessary for nurses who want to get certification. The certification process should be a continuum rather than a one-time event that comes to an abrupt end. When certified nurses allow the recertification duration to lapse, the image of certification becomes tainted. A review course may take the place of a full-fledged recertification task for many nurses, especially those who are on the lower side of Benner’s levels of professional growth.

The nature of certification exams is a thorny issue although nurses are too preoccupied with personal accomplishments to pay much attention to it. The outcome of certification is the greatest driver of existing perceptions. By making the exam reflect existing challenges in the profession, the image of certification gets a facelift.

Some researchers have attempted to analyze available data, whereby the come to the conclusion that the number of nurses seeking certification has been dropping in recent years. If future research proves this to be true, then it will be important for changes to be made by certifying organizations. The changes should be made in such a way that the specialty nature of each certification is left intact when changes are being made to the curriculum.

Healthcare systems operators should create their own study plans and course review classes in order to enable nurses familiarize themselves with the world of specialty certification. This is a good way of demystifying the process as well as bringing about convenience to users. For this to happen, there is need for cohesion to exist among nursing certification boards, healthcare organizations, and nurses.

On their part, health care organizations the main challenge is addressing why many barriers continue to be faced by nurses, yet there is a general consensus that certification, if well managed, can work out for the benefit of all stakeholders. The main challenge is on removing these barriers by supporting the efforts of nurses as they struggle to obtain specialty certification. A multi-faceted approach can work out very well in creating opportunities for healthcare organizations to offer support to nurses.

For specialty nursing certification boards, certification is a valuable way of enabling hardworking and professionally focused nurses to differentiate themselves from their peers. The certifying boards need to continue offering nurses the incentives that they need in order to influence the future of nursing in a positive way.

References

Brenner, Z. (2008). The evolution of clinical nurse advancement: Nursing management. Retrieved April 25,2010, from www.nursingmanagement.com

Demauro, N. (2008). Put Some Letters After Your Name: Why And How To Get Certified In A Specialty, Career Guide. New York: Macmillan.

Kendall-Gallagher, D. (2009). Competence and Certification of Registered Nurses and Safety of Patients in Intensive Care Units, American Journal of Critical Care, 18(2), 106-116.

Piazza, I. (2006). Differences in perceptions of empowerment among nationally certified and non-certified nurses, JONA 36(5), 277-283.

Reigle, J. (2004). Desperately seeking legitimacy. Are nurses with many titles better than those without? News updates October, 2009.

Tenney, J., Demoucell, P. & Wians, K. (1992). Rehabilitation Nursing, Empowerment of Nurses through Certification, 18(4), 231-236.

Trossman, S. (2005)What do credentials mean to you?nurses talk about value of ANCC certification, American Nursing Association, www.nursingcenter.com

Wade, C. 2009. Perceived Effects of Specialty Nurse Certification: A Review of the Literature, Aorn Journal 89(1), 254-322

Woods, D. 2002. Realizing Your Marketing Influence: Professional Certification as A Marketing Tool, JONA, 32(7/8) 379-386.

Appendices

ABNS———– American Board of Nursing Specialties

CHPN———– Certification of Hospice andPalliative Nurses

CCRN———– Certified in critical care nursing

CNAA ——— Certified in Nursing Administration, Advanced

MSN————- Master of Science in Nursing

AORN———– Association of Operating Room Nurses

CNOR———– Certified Nurse, Operating Room

SRH————- Spaulding Rehabilitation Hospital

[1] The relationship of nurses’ professional characteristics to levels of clinical nursing expertise

[2] Tenney, J. Demoucell, P. & Wians, K. 1992. Rehabilitation nursing, Empowerment of Nurses Through Certification, 18(4), 231-236.

[3] The evolution of clinical nurse advancement

[4] Trossman, S. (2005)What do credentials mean to you?nurses talk about value of ANCC certification, American Nursing Association, www.nursingcenter.com

[5] Niebuhr, B & Biel, M. (2007) The value of specialty nursing certification

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