AACN News—February 2003—Opinions

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Vol. 19, No. 2, FEBRUARY 2002

President's Note: Bold Voices

Certification-Good for Whom?

By Connie Barden, RN, MSN, CCNS, CCRN
President, AACN

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 practice

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 profession.

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 certification.
� Identify yourself as certified on your name badge and when talking with patients, families, nurse colleagues and other health professionals.
� 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 nurses.
� 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 healthcare decisions.
� 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 nursing practice.

My Turn

Multiple Factors Compound Problems

Dana E. Cross, RN, CCRN
Springfield, Mo.

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 world-patient care.

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