Strength in Numbers: Certification Is a Culture in Duke System
By Mary E. Holtschneider, RN, BSN, BC, MPA, NREMT-P
Secretary, AACN Board of Directors
Creating a “culture of certification” in a large health system, where nurses, administrators, and other key stakeholders respect, reward and encourage certification, can be a daunting task. It is particularly difficult if, historically, the value of certification has not been uniformly recognized throughout the system. However, by starting with a small but dedicated group of nurses who are passionate about certification, we have been able to spread enthusiasm and gain support for nurses to become certified in our three-hospital Duke University Health System.
Nearly two years ago, some of us discussed establishing a “CCRN Group.” Having recently sponsored a CCRN review course at our hospital, we thought that starting a CCRN Group would be a good way not only for CCRNs to stay connected, but also to encourage other nurses to pursue becoming CCRN certified. Approximately 20 nurses from different critical care units attended a meeting we scheduled to determine the interest level.
At this initial meeting, we also discussed the fact that some units heavily supported certification efforts by paying for study materials, review sessions and certification exam fees, while other units offered no support. Of course, we wanted to address this inconsistency among units and strive for a more uniform approach to supporting certification efforts.
What we had not anticipated was the excitement and passion that existed for certification in general, not just the CCRN. The group was so excited about promoting certification efforts that they encouraged including other specialty certifications. There was also strong sentiment that the effort should be systemwide, not just at one hospital.
Harnessing the Passion
We developed goals for our group, which we now called the “Certification Group.” These goals are to educate nurses and other staff about certification and what it means to be certified, to gain uniform monetary support for nurses to take certification exams appropriate for their specialty areas, and to creatively recognize and reward certified nurses and those who are on their journey toward certification.
Ignited by the passion of our initial meeting, we met with our chief nursing officer, who highly supported all efforts to promote certification. She charged us with presenting our goals to the hospital nursing governance council, made up of staff RNs, and creating a list of appropriate certifications for each of the areas, such as CCRN for ICUs, PCCN for progressive care areas and OCN for oncology areas.
In addition to the hospital nursing governance council, we have presented our goals to the nurse managers and clinical practice councils at each of the hospitals and ambulatory clinics. We have used the AACN Certification White Paper titled “Safeguarding the Patient and the Profession: the Value of Critical Care Nurse Certification,” to help explain how certification benefits the RN by promoting professional development, the community by protecting the public and the health system by showcasing how many nurses achieve certification. We are also educating staff that certifications should be accredited from entities such as the National Commission for Certifying Agencies or the American Board of Nursing Specialties.
During our initial educational efforts, we found that there was confusion concerning what a certification actually is. For example, many staff and managers were under the impression that ACLS (advanced cardiac life support) was a certification like CCRN. Our efforts gave us the opportunity to clarify the differences. We realized that, if people are not clear about what a certification is, they are less likely to want to attain it or place a high value on it. Our ongoing educational efforts about the importance and relevance of certification have been essential.
Signing Up Ambassadors
We also realized that, if our small initial group was to have significant impact, we needed input and active participation from a variety of staff in different areas of practice. Adapting AACN’s Ambassador model, we developed a plan for volunteer “certification ambassadors” to be in all areas of the health system as well as the ambulatory clinics. All the ambassadors are staff RNs who maintain certification bulletin boards in their respective areas to provide information about which certifications are appropriate for their practices, educate staff about the procedures for becoming certified, and are enthusiastic promoters of certification. These ambassadors do not need to be certified; they only need to have a passion for certification and a desire to promote it.
In addition to the bulletin boards, some ambassadors have developed binders for their areas that have reference and study material.
“Since each unit has its own specialty area,” explains certification ambassador Pat Ostergaard, RN, MSN, “the ambassadors are the perfect people to help others learn the details of how they can use certification to improve patient care and as part of their own professional development.”
In their quest toward certification, many ambassadors and other staff members have requested that we sponsor more certification review courses. We have been able to organize review courses at a greatly reduced rate for health system employees, which has been another benefit of developing and spreading our “culture of certification.” For example, we recently sponsored a PCCN review course, attended by more than 100 people.
No discussion about promoting certification is complete without discussing payment of certification test fees. Our group has been working closely with Friends of Nursing, an endowed health system program that was started by a patient as thanks for the excellent nursing care that he received. We are in the process of working with a donor who will dedicate funds to Friends of Nursing for certification support, including test fees, recognition and rewards. Once this is finalized, many of the financial barriers to taking an exam will be removed.
The financial barrier is often seen as the main barrier to becoming certified. However, our group has identified other obstacles, such as fear of failure and apathy. The certification ambassadors are key resources in their respective areas to address these concerns.
As interest in certification has grown in the health system, we have seen an ongoing increase in the number of nurses becoming certified, preparing to sit for exams and wanting to become certification ambassadors.
We have learned many lessons while creating our “culture of certification.” Most important, creating this culture where certification is valued takes time, energy and, above all, passion. Securing funds to pay for certification tests, though often seen as the main barrier, is only one small aspect of creating this culture. Everyone in the workplace must value and understand the relevance and importance of certification and what it means to the individual nurse, the public and the institution. Through the dedication, perseverance and passion of all of the certification ambassadors, we have been able to gradually transform thinking and grow into an organization that recognizes and supports certified nurses and those on their journey toward certification.
Mary E. Holtschneider is a clinical nurse educator with the Duke University Health System, Durham, N.C.
Ambassador Ben Hocutt created a bulletin board to help
educate nurses on various nursing certifications. Photo
originally published in Inside, the employee newsletter
of the Duke University Medical Center and Health System.
Exam Item Writers Help Expand Pool
New certification exam items are rolling in from a group of volunteers who participated in the Item Writing Workshop at AACN’s National Teaching Institute and Critical Care Exposition in New Orleans, La., in May.
The item writers were selected from the AACN Volunteer Profile Database (www.aacn.org > Volunteer Opportunities) following a call for volunteers to serve in this capacity.
The volunteers, following confidentiality and security protocols, were assigned to write items on specific exam blueprint topics, validate their answers with current nursing textbook citations and submit the items within a specified time frame. These items will now be reviewed and approved by the appropriate Exam Development Committee before being moved to an unscored test slot on a certification exam to gather statistics on performance.
Thanks to the following item writers for their contributions to expand our item pools for the CCRN, CCNS, PCCN, CMC and CSC exams:
Susan Allison, RN, MSN, CCNS
Michele Avila-Emerson, RN, BSN, BA, CCRN
Beth Baker, RN, MNS, CCRN, CCNS
Sheri Carey, RN, MS, CCRN
Louise Cook, RN, CNS, MSN, CCRN
Elizabeth “Tina” Covington, RN, MN, CCRN, CS
Elsie Croom, RN, MS, CCRN
Janet Davies, RN, MSN, CCRN
Laurie Finger, RN, MN, APRN, CCRN, CCNS
Vicki Good, RN, MSN, CCRN, CCNS
Rosemary Lee, RN, MSN, CCRN, CCNS
Jeannette Meyer, RN, MSN, CCRN, CCNS, PCCN
Janet Mulroy, RN, MSN, ACNP, CCNS, CCRN
Mary Frances Pate, RN, DSN
Jacqueline Rhoads, PhD, ACNP-BC, ANP-C, CCRN
Hildy Schell, RN, MS, CCRN, CCNS
Elizabeth Smith, RN, BSN, CCRN
CCNS Deadline Reminder
Nine months remain until the July 1, 2006, deadline to have transcripted clinical hours for CNS program deficiencies and be eligible to sit for the CCNS exam. If you plan to sit for the exam, please evaluate your eligibility now. Once the window closes, if your program was deficient, you will not be able to make up the hours and consequently will not be able to sit for the CCNS exam.