AACN News—November 2002—Certification

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Vol. 19, No. 11, NOVEMBER 2002

Study of Practice Explores Changing Environment

By Roberta Kaplow, RN, PhD, CCNS, CCRN
AACN Certification Corporation Board of Directors

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.

Historical Perspective
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 patients.

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.

What�s Ahead?
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 settings.

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 considered.

The final Study of Practice report is expected to be issued in Fall 2003.

Award to Recognize Advancement of Certification

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 certified nurses
� 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 http://www.certcorp.org.

Research Grants Relate to Certified Practice

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 http://www.aacn.org. 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, Liz.Miller@aacn.org.

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