President's Note: Bold Voices
Certification-Good for Whom?
By Connie Barden, RN, MSN, CCNS, CCRN
To me, there are only two kinds of critical care
nurses-those who are certified and those who aren't yet certified. Yes, I'm
passionate about this. As a nurse with both CCRN and CCNS certification, I now
have a powerful tool to help me speak up boldly about this passion for certified
Last December, a landmark report from AACN and AACN
Certification Corporation was released to the national media and the public.
"Safeguarding the Patient and the Profession: The Value of Critical Care
Certification" documents known data about certification and why it's good for
patients, employers and nurses. Intuitively, we've known this all along. Now, we
can communicate it to a wider audience of healthcare colleagues, administrators,
the media and the public.
Never before have a major nursing organization and a
credentialing board compiled such an extensive report outlining the benefits of
certification and a bold call that nurses who care for critically ill patients
need to become certified. AACN and AACN Certification Corporation not only have
detailed the benefits of certified practice, but also have revealed how
certification is a critical link to patient safety and improved outcomes. In
unveiling certified practice as the standard to be achieved, we have declared
that certification is an essential component in protecting the patient and the
Above all, certification is good for patients and
their families. And, many of them know it. In November, a nationwide Harris poll
queried a representative sample of the American public. Nearly eight of 10
respondents were aware that nurses could be certified. That was higher than
their awareness that teachers and physicians could be certified. In fact, three
of four said they were much more likely to select a hospital that employs a high
percentage of nurses with specialty certification.
Certification is good for employers. It is an
important indicator that a nurse is qualified and competent in a specialty and
has met rigorous requirements to achieve this expert credential. As a voluntary
process it points to nurses' commitment to career development and dedication to
patient care in this constantly changing environment. Employers who embrace and
support nurse certification are better positioned to thrive in the highly
competitive healthcare market.
Certainly, certification is good for nurses. A study
of 19,000 certified nurses in the U.S. and Canada reported that nurses whose
clinical judgment had been validated through certification believe they make
decisions with greater confidence. The study also found that certified nurses
overwhelmingly reported that certification enabled them to experience personal
growth and feel more satisfied in their work. Ongoing education and experience
reduces our exposure to risk and better prepares us to make informed decisions
that encompass a larger scope. Marsh Affinity Services, a leading insurance
program management company and the world's largest insurance broker, offers a
10% discount on liability insurance premiums to certified critical care nurses.
Certified practice then becomes an important factor
in creating a work environment that supports nurses delivering the very best
care. Every nurse wants competence, quality and an environment that supports
nursing excellence. So does every employer. Every patient and family certainly
needs it. And, we all have a role to play.
� Protect critically ill patients by acquiring
specialized knowledge and skills and demonstrate your competence through
� Identify yourself as certified on your name badge
and when talking with patients, families, nurse colleagues and other health
� Recognize and support those who advocate for
certification, continually widening the circle of advocates.
� Expand a commitment to safety and quality through
robust support of continuing education, certification and recertification of
� Demonstrate the value of this commitment through a
dynamic internal and external communications program.
� Conduct studies to validate that certification
contributes to better outcomes for your institution, including nurse retention,
increased job satisfaction and reduced turnover.
Patients and Families:
� Become familiar with local hospital practices
concerning nurse staffing, including nurse vacancies, employment of certified
nurses and support for continuing education. Use this knowledge when you make
� Verify that health plans are aware of nurse
certification and consider it as a key factor in evaluating the quality of the
care facilities with which they contract.
� Communicate to health providers the importance of
consumers knowing the credentials of their caregivers.
The report is another way that AACN continue to lead
and speak boldly about issues of consequence for nurses, patients and
healthcare. The report is a vital tool for critical care nurses thinking about
their own certification and for all of us who are committed to elevating nursing
standards and knowledge.
The opportunity is ours, and the time is now to
embrace the CCRN credential as the gold standard for critical care nursing. When
we embrace the value of certification and insist on this level of competence,
others will follow. As we boldly advance this step toward excellence, nurses
will clamor for it, administrators will seek and reward it, physicians will
support it, and the public will expect and even demand it.
Read this certification white paper and use it when
you talk about certification. It is a powerful tool. (The white paper and
accompanying reference documents are available online or by calling (800)
899-2226. Request Item #005062.) Use it to embolden your voice with colleagues,
employers, and patients and their families. AACN has spoken and the message is
clear. Certification is a valuable tool that promotes high-level, high-quality
Multiple Factors Compound Problems
Dana E. Cross, RN, CCRN
What problems prevent the recruitment and retention
of nurses in critical care? There are several problems that need attention.
Commitment-Employers must be committed to patients.
The budget, facility costs and outside regulators should not inhibit providing
the best care available to patients. Nurses get into nursing to care for
patients, and anything that gets in the way diminishes their desire to stay with
an employer. Having outdated equipment or too little equipment or too few
support systems to provide "best practice" would not be tolerated in any other
business. If the customer is not taken care of properly, the business dies.
Money has to be put where the rubber meets the road-and that's at the bedside.
Although patients have survived for centuries without JCAHO, OSHA or mountains
of paperwork, they won't last a day without their bedside nurses.
Training-Training for nurses must include more
clinical practice. In an effort to crank out nurses at a faster, more efficient
rate, we have deleted the "art" of nursing. The scope, type, extent and
frequency of patient assessment and nursing judgment is based on actual patient
care. No slide, book, mannequin or class is a substitute for spending time with
"real" patients. Many nursing schools have cut out the clinical rotation for
critical care. How can we expect nurses to pop out of training with a commitment
to work in a place that is totally foreign to them?
Pride-Nurses currently in critical care must take
pride in helping inexperienced nurses adjust and grow. Developing good judgment
requires a tremendous amount of time and experience. If new nurses don't
succeed, we also suffer. We are so short of help that we can't afford to let the
new ones become discouraged and leave.
Scheduling-Inflexible scheduling and refusing to
think outside the "normal" shift times are a deterrent. Is there a law that says
shifts have to start in the dark? Many nurses who would be great in critical
care choose physician's offices, where they can work reasonable hours that
accommodate family, church, school and community responsibilities. Even minor
scheduling changes, such as job sharing, flexible shifts and weekend option, can
be a relief to a nurse who is struggling to meet the demands.
Control-Although critical care nurses have huge
burdens of responsibility, they have little control of what goes on in their
institutions related to their own practice. Even if administrators ask for
input, they don't like to hear what is said. Complaining about anything is
perceived as a "bad attitude." Even patient advocate issues are shot down if
they mean more cost. Administrators ignore the cost of poor patient care or the
cost of losing a career nurse.
Regulations-Agencies like JCAHO, OSHA and insurance
companies create unrealistic regulations and paperwork that are a direct
obstacle to nursing. Many issues have been "fine-tuned" to the point of
"nit-picking," just so these outsiders can justify their own jobs. For example,
we have never had an incident where a restraint caused an injury. Yet, we are
punished by having to fill out three different forms per shift, with charting
every two hours, on about six columns of issues to justify keeping our patients
safe. Where has reason gone? Any caring nurse is concerned about safety,
security, best practice and privacy, but you can't legislate common sense.
Because every case is different, every nurse has to use judgment to manage each
case. No outside agency is a better advocate for my patient than I am! We must
be the ones dictating the issues that are high risk and high volume for us.
Incidents that happen in an extended care facility with one nurse for 35
patients may not apply to us at all. Why do we let outsiders waste our time and
spook our bean counters about issues that don't matter to our patients? We are
the patient experts.
Paperwork-Paperwork is a direct hindrance to the
"art" of nursing. It is an endless drain on our time, energy and attitude. Forms
usually are generated by someone far removed from the bedside. The extensive
duplication is infuriating. Regardless of how important something is, it doesn't
need to be charted in three or four places just to please chart auditors. My job
is to chart sufficiently to communicate with other nurses, physicians and
departments so we can deliver consistently excellent care. We need to determine
best practice and stick to it. We need to stop letting outside entities rule
what we chart. We need to let the lawyers have the "burden of proof" and stop
deleting time and energy from our very needy patients and their families.
I will continue to voice my concerns in my hospital
because these concerns diminish nursing and, therefore, the greatest job in the