Study of Practice Explores Changing
By Roberta Kaplow, RN, PhD, CCNS, CCRN
AACN Certification Corporation Board of
AACN Certification Corporation has taken an
unprecedented step by launching a job analysis that is based on the entire
spectrum of critical care nursing practice instead of merely for the purpose of
updating a single certification exam.
This comprehensive study of practice will
explore the activities of nurses who care for acutely and critically ill
patients in a variety of settings, from entry level through advanced practice
roles. The unique approach will allow us not only to discover overlaps and
distinctions in different roles, but also to note the distinct transitions in
education, judgment and practice that must take place on progression of roles.
We believe that redefining nursing practice in
an ever-changing healthcare environment is essential for nurses to meet the
needs of patients and contribute to optimal outcomes.
For a certification examination to be valid and
legally defensible, it must be job-related and measure practice as it currently
exists, not as an ideal. To ensure that the questions for its CCRN and CCNS
certification exams are accurate reflections of current practice, AACN
Certification Corporation has traditionally conducted periodic job analyses or
studies of practices to determine what changes have taken place since the last
analysis. Based on the results, the test plan, or �blueprint,� guiding the
development of exam questions is updated.
In 1995, AACN Certification Corporation
conducted a comprehensive study of critical care nursing practice, based on the
Synergy Model concept. The subject experts who participated in the study
evaluated the continuums of patient characteristics and nurse competencies that
were originally developed and described the continuums for these aspects as low,
medium or high. Several pilot surveys of acute and critical care nurses were
conducted to test the continuums.
In 1997, a large-scale survey was conducted to
further validate the Synergy Model. In this study, patient profiles using the
patient characteristic continuums were mailed to participants nationwide.
Participants were asked to rate each patient profile using the characteristic
continuum and indicate their perceptions of the critical status of the patients.
The survey participants were also asked to rate the level of nurse competencies
required to meet the patients� needs. Findings from this survey served as a
basis for reframing AACN�s certification program, with the patient as the focal
point of nursing practice.
Where Are We Now?
In February, AACN Certification Corporation, in
collaboration with its test service, Professional Examination Service, convened
the Practice Analysis Task Force. Members of this group were charged with
several responsibilities. The primary goals included conducting a critical
analysis of the Synergy Model.
At the first meeting, a description of the
profession, including entry-level, certified nurses and advanced practice roles,
was drafted, and the Synergy Model was simplified and extended across the
continuum of all critical care nursing practitioners.
Subsequently, PES conducted 10 focus panels and
35 critical incident interviews with subject matter experts. Participants, who
were nominated by the task force, included nurses new to critical care, as well
as CCRNs and CCNSs.
Focus panel participants were asked to elaborate
on the descriptors for entry-level, competent and expert critical care nurses,
as well as descriptors for clinical nurse specialists and nurse practitioners.
The focus groups were conducted in diverse geographical regions, with
participants including nurses who care for neonatal, pediatric and adult
After PES conducted critical incident interviews
to enhance the initial delineation of domains, tasks, knowledge, skills,
procedures and interventions, a revised model of nurse competencies in the
Synergy Model was drafted.
The task force reviewed the results of the focus
panels and critical incidents interviews at its second meeting in July, where
the patient characteristics and nurse competencies of the Synergy Model were
further defined. The group is now preparing a prototype validation survey that
will include instructions, rating scales, a demographic and professional
questionnaire, and open-ended questions.
The goal of the task force�s next meeting is to
integrate the results of independent review into the revised delineation of
domains, tasks, knowledge, and skills, procedures and interventions and into the
enhanced model of nurse characteristics. In addition, the group will review and
approve all aspects of the validation survey and the draft of the sampling plan.
A pilot study of the survey with 35
representative critical care nurses will then be conducted to provide critical
review of the form and content. PES will conduct the data reduction and
statistical analyses. Based on these data, final test specifications for the
entry-level critical care, CCRN and CCNS programs will be developed.
PES plans to survey approximately 4,000 nurses�
including approximately 2,000 adult, pediatric and neonatal CCRNs and up to 500
noncertified nurses who have less than one year of experience caring for acutely
or critically ill patients. In addition, the survey will include all currently
certified CCNSs and 1,000 other advanced practice nurses in critical care
After all data are compiled and statistical
analyses conducted, the Practice Analysis Task Force will meet again in Spring
2003 to review the results of the validation survey and consider hypothetical
test specifications for each certification program. Warranted revisions will
then be made to the CCNS, advanced practice certification exam for clinical
nurse specialists in acute and critical care.
AACN Certification Corporation also expects to
identify a requisite core body of knowledge for the CCRN, acute critical care
nurse exam. If so, additional qualifications could be added in subspecialty
practice, such as acute burn, neurological or trauma care.
If, as a result of the research, the
competencies needed by novice or newly licensed acute and critical care nurses
can be compared, development of a critical care entry level examination may be
The final Study of Practice report is expected
to be issued in Fall 2003.
Award to Recognize Advancement of
A new award to recognize support for advancing
certified nursing practice in critical care will be added to AACN�s Circle of
Excellence recognition program for 2004.
Called the AACN Value of Certification Award,
the acknowledgment is part of a Certified Practice Recognition Program approved
by both the AACN Certification Corporation Board of Directors and the AACN Board
of Directors. As part of the initial phase of the program, a second award will
be developed in partnership with the American Organization of Nurse Executives.
Following are examples of the types of
accomplishments that successful applicants for the AACN Value of Certification
Award may have achieved:
� Increased the number of certified nurses
� Increased the renewal and retention of
� Influenced the preparation or ability of
nurses to qualify for certification
� Increased public awareness and promotion of
the value of certified nursing practice
� Contributed to research validating the impact
of certified nursing practice
AACN will begin receiving applications for the
AACN Value of Certification Award in spring 2003.
Save With the 3-Person CCRN Exam Discount
Dec. 31 is the deadline to take advantage of the
special 3-Person CCRN certification exam discount of $175 for AACN members and
$255 for others. Call (800) 899-2226 or visit the AACN Certification Corporation
Web site at
Research Grants Relate to Certified
AACN Certification Corporation supports four
grants of up to $10,000 each per year for studies related to certified practice.
The award is part of AACN�s Grants in Support of
Clinical Projects and Research program (see page 4), though applicants do not
need to be AACN members. Applications are due Feb. 1.
For more information, visit the AACN Web site at
The grants handbook is also available from AACN Fax-on-Demand at (800) 222-6329
Request Document #1013.
Is Your Practice Synergistic?
Do you apply the Synergy Model in your practice?
Do the unique characteristics of your patients dictate the nursing competencies
you use? If so, we would like to share your special stories in the �Synergy
Model in Practice� feature in Critical Care Nurse. Send your stories to AACN
Certification Corporation, Attn: Certification Specialist Liz Miller, RN, 101
Columbia, Aliso Viejo, CA 92656; e-mail,