AACN News—December 1998—Certification

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Vol. 15, No. 12, DECEMBER 1998

Item Writers Gather

Members of the AACN Certification Corporation Item Writers volunteer group recently met in La Jolla, Calif., to compose questions for the adult, pediatric, neonatal CCRN� certification exams. Beginning July 1, 1999, questions on the computer-based exams will be based on the Synergy Model, which matches nurse competencies to patient needs. Pictured are (from left, front row) Lorraine Victor, Barbara Malebranche, Michelle McNulty-Scannell, Cathy Haut, Deborah Hagler, Mary Beth Martin, Kim Clipp, Jeanne Braby, Elliot Stetson, Maria Chico, Kathy Rodgers, and Michael Relf and (from left, back row) Teresa Goodell, Karen Thomason, Lori Jackson, Mike Day, Heidi Hess, and Pat Jones (PES). See Certification Connection, page 9, for more information about the Synergy Model.

Creating Safe Passage: Certification Exams Based on Synergy Model

The AACN Certification Corporation has adopted the Synergy Model as the basis for developing its certification exams.

The new CCNS� exam for clinical nurse specialist in critical care, which is available starting in January 1999, uses this model. The CCRN� exams in adult, pediatric, and neonatal specialities will be based on the Synergy Model after July 1, 1999.

All these exams are computer based and available at Sylvan Prometric locations throughout the United States and Canada and in U.S. territories. For a list of testing sites, visit the AACN Certification Corporation home page at http://www.aacn.org. To obtain application materials, call (800) 899-2226.

The Synergy Model emphasizes that the needs of patients and their families drive nurse competencies. In doing so, it focuses on the professional nurse’s role in creating safe passage for patients and contributing to quality of care, cost containment, and optimal patient outcomes.

Patient Characteristics
Instead of the “body system” orientation, nurses take a multidimensional view of the patient, each of whom brings a set of unique characteristics to the care situation. The following patient characteristics are considered:
• Resiliency—the capacity to return to a restorative level of functioning using compensatory coping mechanisms; the ability to bounce back quickly after an insult
• Vulnerability—susceptibility to actual or potential stressors that may adversely affect patient outcomes
• Stability—the ability to maintain a steady-state equilibrium
• Complexity—the intricate entanglement of 2 or more systems (e.g., body, family, therapies)
• Resource availability—the extent of resources (e.g., technical, fiscal, personal, psychological, social) that the patient, family, and community bring to the situation.
• Participation in care—the extent to which the patient and family engage in aspects of care
• Participation in decision making—extent to which the patient and family engage in decision making

• Predictability—that which allows one to expect a certain trajectory of illness

For example, a healthy, uninsured, 40-year-old woman undergoing a pre-employment physical could be described as an individual who is (a) stable (b) not complex (c) very predictable (d) resilient (e) not vulnerable, and (f) able to participate in decision making and care, but (g) has inadequate resource availability.

On the other hand, a critically ill infant with multisystem organ failure can be described as an individual who is (a) unstable (b) highly complex (c) unpredictable (d) highly resilient (e) vulnerable, and (f) unable to become involved in decision making and care, but (g) has adequate resource availability

Nurse Characteristics
To meet the needs of patients and their families, nurses integrate knowledge, skills, experience, and attitudes. Following are continuums of nurse characteristics that are derived from patient needs:
• Clinical judgment—clinical reasoning, which includes clinical decision making, critical thinking, and a global grasp of the situation as well as nursing skills acquired through a process of integrating formal and experiential knowledge
• Advocacy and moral agency—work on another’s behalf and representation of the concerns of the patient, family, and community; serving as a moral agent in identifying and helping to resolve ethical and clinical concerns within the clinical setting
• Caring practices—the constellation of nursing activities including vigilance, engagement, and responsiveness that
respond to the uniqueness of the patient and family and that create a compassionate and therapeutic environment, with the aim of promoting comfort and preventing suffering
• Collaboration—work with others (e.g., patients, families, healthcare providers) in a way that promotes and encourages each person’s contributions toward achieving optimal and realistic patient goals

• Systems thinking—the body of knowledge and tools that allow the nurse to appreciate the care environment from a perspective in which the holistic interrelationship existing within and across healthcare systems is recognized
• Response to diversity—the sensitivity to recognize, appreciate, and incorporate differences (e.g., individuality, cultural differences, spiritual beliefs, gender, race, ethnicity, disability, family configuration, lifestyle, socioeconomic status, age values, and alternative medicine preferences) into the provision of care
• Clinical inquiry or innovator/evaluator—the ongoing process of questioning and evaluating practice, providing informed practice, and innovating through research and experiential learning
• Facilitator of learning or patient/family educator—the ability to facilitate patient and family learning

Nurses become competent within each continuum at a level that best meets the fluctuating needs of their population of patients. More compromised patients have more severe or complex needs, requiring nurses to have advanced knowledge and skill in an associated continuum.

For example, if the gestalt of a patient is stable but unpredictable, minimally resilient, and vulnerable, primary competencies of the nurse would center on clinical judgment and caring practices, which include vigilance. If the gestalt of a patient is vulnerable, unable to participate in decision making and care, and inadequate resource availability, the primary competencies of the nurse would focus on advocacy and moral agency, collaboration, and systems thinking.

Although all competencies are essential for contemporary nursing practice, the importance of each depends on a patient’s characteristics. Synergy results when a patient’s needs and characteristics are matched with a nurse’s competencies.

The Synergy Model is guided by the following assumptions regarding nurses, patients, and families:
• Patients are biological, psychological, social, and spiritual entities who present at a particular developmental stage.
• The patient, family, and community all contribute to providing a context for the nurse-patient relationship.
• Patients can be described by a number of characteristics, all of which are connected and contribute to each other.
• Nurses can be described on a number of interrelated dimensions.
• A goal of nursing is to restore a patient to an optimal level of wellness as defined by the patient.
• Death can be an acceptable outcome, where the goal of nursing care is to move a patient toward a peaceful death.

Synergy Model Reference List
1. Niebuhr B. Credentialing
of critical care nurses.
AACN Clinical Issues. 1993;4:611-616.
2. AACN. Scope of Practice for Nursing Care of the Critically Ill Patient and Family. Working draft. 1995.
3. AACN Certification Corporation. Certification Think Tank final document. Unpublished report. September 1994.
4. AACN Certification Corporation. Redefining nursing according to patients’ and families’ needs: an evolving concept. AACN Clinical Issues. 1995;6:153-156.
5. Villaire M. The Synergy Model of certified practice: creating safe passage for patients. Critical Care Nurse. 1996;16:95-99.
6. Curley MAQ. Patient-nurse synergy: optimizing patient outcomes. American Association of Critical-Care Nurses (unpublished). 1996:12.

CCRNs get 10% off Liability Insurance

Maginnis & Associates, AACN’s recommended provider of professional liability insurance, is now offering all CCRN-certified nurses a 10% risk-management credit off liability insurance premiums.

“We realized the value of certification in raising the levels of competency for the nursing profession and believe CCRN-certified nurses deserve a discount off their liability insurance premium for their efforts,” said Joan O’Sullivan, senior vice president of Maginnis.

Maginnis is the only liability insurance program that recognizes CCRN certification as a qualifier for the risk-management premium credit.

Maginnis & Associates offers liability insurance for nurses practicing at any level, from staff nurse to advanced practice nursing specialties. Although some companies require professionals to attend an insurer-designed program to be eligible for a risk-management credit, the 10% credit through Maginnis is available to nurses who attend any risk-management seminar.

AACN recommends that all nurses carry their own professional liability insurance to protect them in a malpractice case. Even if you are included in your employer’s insurance, the coverage is limited to professional acts performed on behalf of your employer.

Because a nurse is a nurse 24 hours a day, 365 days a year, advice or care that you give outside of your employment can lead to a malpractice claim. The Maginnis program provides you with professional protection regardless of whether the professional act in question is performed in or outside of your employment activities.

Benefits offered under the Maginnis Professional Liability Plan include an occurrence form, which means that you are covered even after your insurance lapses if the professional act involved in the claim occurred during the policy period.

Another unique feature of the Maginnis program requires the company to seek your consent in writing before settling a claim. This provision is especially valuable when the National Practitioner Data Bank is considered.

If you are interested in applying for Maginnis’s liability insurance protection and in receiving the 10% risk management premium credit, or if you are already insured under this plan and are now eligible for the premium discount, call Maginnis at (800) 621-3008, ext. 105.


How Many CCRNs Practice in Your Hospital?

What percentage of the nurses in your hospital is CCRN� certified? What does CCRN certification mean to you and your hospital?

The 3 hospitals with the highest percentage of CCRN-certified nurses are eligible for prizes. They will also be highlighted in AACN News.

Send information on the percentage of CCRN-certified nurses in your hospital, along with a brief explanation of what CCRN certification means to you and your hospital, to AACN Certification Corporation, Attn: Laura Sorenson, 101 Columbia, Aliso Viejo, CA 92656; fax, (949) 362-2020; e-mail, laura.sorenson@aacn.org.

The deadline for submissions is January 31, 1999.

Certification Special!

Preparing to take the CCRN� exam?

Combine your exam fee
with AACN membership and SAVE.

Just $248!

Includes 1-year AACN membership
certification exam fee

Offer is limited.
Sign up by March 1, 1999.

Call (800) 899-2226.

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