AACN News—May 1999—Certification

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Vol. 16, No. 5, MAY 1999


New Officers and Consumer Representatives Chosen for Certification Corporation Board

Patricia A. McGaffigan, RN, MS, has been selected as chair-elect of the AACN Certification Corporation Board for 1999-2000.

Also selected following the annual nominations process were Jan Foster, RN, MSN, CCRN, as secretary/treasurer, and the Rev. Philip Goff and Joan O’Sullivan as consumer representatives.

The new terms begin July 1, 1999, when Kimmith M. Jones, RN, MS, CCRN, succeeds Barbara A. Gill, RN, MN, as chair of the AACN Certification Corporation board. Leaving the board after two years of service is Holly Smith Jones, a consumer representative from Solana Beach, Calif.

Two directors of the AACN Board will also be appointed by incoming President Anne W. Wojner, RN, MSN, CCRN, in conjunction with Certification Corporation Chairperson Kimmith Jones. AACN board members Cathy J. Thompson, RN, MSN, CCRN, and Michael L. Williams, RN, MSN, CCRN, currently serve on the AACN Certification Corporation Board.

Following is information about the members selected during the annual nominating process:

Patricia McGaffigan
McGaffigan is director of new clinical markets for Aspect Medical Systems, Natick, Mass. She has served two years as secretary/treasurer of the board.

She previously worked for Nellcor Puritan Bennett/Mallinckrodt Inc., Pleasanton, Calif., as director of the Center for Outcomes Research and Education.

McGaffigan received her bachelor of science degree magna cum laude from Boston College, Chestnut Hill, Mass., and her master of science degree in the parent-child health, pediatric clinical specialist track from Boston University School of Nursing, Boston, Mass.

She has been a member of the Greater Boston Chapter of AACN since 1981.

Jan Foster
Foster is president of Nursing Inquiry & Intervention, Inc., Woodlands, Tex., and assistant professor in the College of Nursing at Houston Baptist University, Houston, Tex.

She is a member of AACN and a member and past president of the Houston Gulf Coast Chapter of AACN. She has served as an AACN national volunteer on both the Group of 100 and the NTI Program Task Force, and as a regional chapter consultant.

Foster graduated magna cum laude with a bachelor of science in nursing degree from the University of Michigan, Ann Arbor, and earned her master of science in nursing degree with honors from the University of Texas, Houston. She is a doctoral candidate at the University of Texas, Austin.

Philip Goff
Goff is pastor of the Federated Church, Ayer, Mass.. He is also administrator and a board member of Loaves and Fishes, a charitable organization serving five area communities.

He brings a lengthy list of community service and leadership roles to his position as consumer representative.

Goff received his bachelor of arts degree in secondary education from Ottawa University, Ottawa, Kan., and his master of divinity degree from Andover Newton Theological School, Newton, Mass.

Joan O’Sullivan
O’Sullivan is senior vice president of sales and marketing for the Maginnis and Associates Division of Albert H. Wohlers & Co. She is completing a one-year appointment to the board as consumer representative.

O’Sullivan brings to the board more than 24 years of business expertise including work with nursing associations. An employee of Maginnis and Associates since 1974, she directs its marketing operations including account executives and managers, advertising and production, product development, and sales.

As a resident of Bloomingdale, Ill, O’Sullivan is involved in community activities including the Girl Scouts; the Du Page County Council in Naperville, Ill; Joliet Catholic Diocese; and the Neighborhood Watch Program.

Kimmith Jones
Jones is an advanced practice nurse for critical care and the emergency center at Sinai Hospital of Baltimore, Baltimore, Md.

He joined the AACN Certification Corporation Board as a director in 1996.

Jones is a member and former president of the Chesapeake Bay Chapter of AACN, and was a 1992-93 AACN leadership fellow.

His bachelor’s degree in nursing is from the University of Vermont, Burlington, and his master’s degree in trauma and critical care nursing is from the University of Maryland at Baltimore.

The CCRN Exam —From Start to Finish

By Karen Thomason, RN, MSN, CCRN
Chairperson, Pediatric Exam Development
and Item Writer Service

Have you ever wondered how the questions for the adult, pediatric and neonatal CCRN� exam programs are developed or who puts the exams together? The work, which is carried out each year in phases, involves volunteer CCRNs as well as a professional testing company.

The process begins with the Study of Practice, which AACN conducts in collaboration with Professional Examination Services (PES). The most recent study in 1998 used 18 focus panels of up to 10 participants each as well as a survey disseminated to 1500 CCRNs. This was a comprehensive analysis of how critical care nursing practice looked on a national level. This information along with the Synergy Model, which matches nurse competencies with patient characteristics to produce optimal patient outcomes, forms the basis for the exam blueprint.

From this blueprint, exam questions are developed. AACN Certification Corporation works with PES throughout the exam development and implementation process. After PES determines the type of questions that are needed, the item writers proceed with writing, reviewing and approving each test item.

Each of the Item Writer Service committees is composed of up to eight nurses, who are clinical experts in their fields. In addition, the item writers are chosen to represent geographically diverse areas and facilities of different affiliations and sizes, from small community hospitals to large teaching institutions.

The item writers work independently to develop approximately 50 exam items each. Each exam item incorporates a component of the nursing process—assessment, planning, intervention/implementation or evaluation—and reflects varying levels of difficulty. Item writers use Bloom’s taxonomy of educational
objectives, which addresses knowledge, comprehension, application, analysis, synthesis and evaluation.

The written exam items are then submitted to a mentor from the Exam Development Committee, who provides feedback on form and content. Following revisions, the respective item writing groups meet for three days to review and approve each item for submission into the bank of test questions. PES selects test items from this bank to develop each exam.

Each of the Exam Development committees—for adult, pediatric and neonatal—is also composed of up to eight members.

As with the item writers, these members are CCRNs, are experts in their fields, and reflect demographics similar to the CCRN population. These committees meet once a year to review and approve each exam. Typically, four adult exams are developed each year, and two pediatric and neonatal exams are developed every other year.

During this review, each item is discussed to ensure that it is relevant to current best practice, that it reflects acceptable certification-level performance and that a lack of the knowledge measured could result in some level of harm, whether physiologic, psychological, or economic. In addition, the committee members evaluate how well the items are written: Are they easy to read? Are they free of language or descriptions that might be offensive to any segment of the candidate population including minority groups? Is there only one correct response for each item? Have "all of the above" and “none of the above” options been avoided? The committee also updates the references for each item to ensure that they are current to within three years.

When the Exam Development Committee completes the review and approval process, the test is ready to be administered.

Since 1997 the CCRN exam has been administered by computer, which has increased its accessibility for critical care nurses, because it can be taken six days a week at Sylvan Prometric testing sites around the country.

AACN Certification Corporation is always seeking volunteers to join the Item Writer services and Exam Development committees for both the CCRN and CCNS exams. Participation is a great way to meet fellow CCRNs and share your expertise.

For more information about the item writing and exam development processes, visit the AACN Certification Corporation Web site at http://www.certcorp.org.

To learn more about the Synergy Model that forms the basis of exam development, see the article titled “Patient-Nurse Synergy: Optimizing Patients’ Outcomes” by Martha A. Q. Curley, RN, PhD, CCRN, in the January 1998 issue of the American Journal of Critical Care.

Do Changes Diminish Meaning for CCRNs?

Following is a letter to the Board of Directors of AACN Certification Corporation from a CCRN who is concerned about recent changes in the certification exam process. The letter has been edited to meet style and space requirements. This letter is followed by a response from AACN Certification Corporation.

Changes Have Destroyed Value
I have been a CCRN for most of my 20-year-career in critical care and have always prized this credential above all others. In particular, I valued several unique qualities of the CCRN exam and its prerequisites: the toughness and broad scope of the test itself and the requirement that applicants work in critical care to obtain and maintain the credential.

I considered CCRN the credential of the working nurse, not something that could be possessed by the academics and managers who don’t do bedside nursing. Nor could it be obtained by the critical care “wanna-be’s” working in telemetry units and recovery rooms.

Through the years, you have progressively gutted the exam process of its key, unique elements, and reduced it to another academic exercise within reach of nurses who never touch patients and would not recognize a pulmonary artery catheter if they tripped over one.

By reworking the exam on some phony nursing process model and removing the technical skills requirements, you have finally removed all its value to me.

If your goal is to destroy the value of the CCRN credential and its meaning to those of us who do the dirty work in the trenches of critical care, you have succeeded.

I guess this just shows how low you will go to curry favor with the other dilettantes of critical care or to make a few more dollars off the test. Thanks for nothing.

Ted Proctor, RN
Brazil, Ind.

Technical Ability Still Necessary for Exam
The CCRN examination has always been and continues to be a certification for the bedside critical care clinician. Nurses whose positions move them away from direct patient care must relinquish their CCRN certification. Managers, educators and preceptors may apply only the hours they spend in hands-on supervision of students or other nurses in the care of critically ill patients. Many CCRNs work second jobs or negotiate bedside hours into their positions to be able maintain their certification.

As we are all aware, many patients who previously would have been cared for in the ICU now receive care in a variety of settings including the home. Eliminating the technical skills checklist allows critical care nurses working outside the “four walls” of the ICU to achieve and maintain CCRN certification.

Nursing is a profession, not strictly a technical occupation. While a variety of individuals can be taught to calibrate and obtain PA readings, it is the knowledge base and critical thinking behind these readings that separate the CCRN from the technician.

However, CCRN candidates must still be able to answer the technical questions on the exam, including those addressing various monitoring equipment and techniques. The clinical judgment portion of the CCRN examination was not altered to remove the clinical judgment aspect of the technical checklist.

The drastic changes in our healthcare delivery system require that nurses clearly articulate what they do. The technical aspect of critical care nursing can be described in terms of procedures. Outcomes based on the medical model, while disease-based in nature, continue to be an important part of measuring how our patients are doing clinically.

However, critical care nurses perform many other functions of care. In developing and adopting the Synergy Model, AACN Certification Corporation has begun the work of articulating the process of care.

We are certain that the characteristics expressed in your bedside care are primarily driven by your patients’ needs. We must identify these needs and characteristics before we can test for them.

CCRNs as a whole are a group with tremendous integrity. We know it is in this spirit that you have written. Again, thank you for your comments.
AACN Certification Corporation

Please Note

In the most recent printing of the CCRN Renewal Handbook, nomember renewal fees were listed incorrectly. Following are the correct fees:
CCRN renewal (by CERPs) $200
CCRN renewal (by exam) $250
Inactive status $175
Retired (CCRN-R) $ 95
Refunds will be sent to any CCRN who has overpaid any of these fees.