Linkages between Certification and Outcomes for Patients, Systems or Nurses

2016 Articles

• This article describes a Canadian graduate project, implementing an ICU educational program aimed to reduce stress by supporting and creating an empowering environment for nurses undergoing certification preparation, using the Humanist Model and problem based learning. Needs assessments; communication strategies; co-development of the program by participants and educator; development and discussion of scenarios; paid preparation days; and study groups were some strategies used. Although not designed as a research study, a retrospective questionnaire found unanimous agreement amongst participants regarding the relevance of the approach and the method used during the educational program. (Supporting and empowering nurses undergoing critical care certification. Clinical Nurse Specialist. July 2016).

2015 Articles

• The findings of this study offer preliminary support for a relationship between job satisfaction and patient outcomes, in that as perception of task requirements and organizational policies increased, the incidence of VAP and CLABSI at the unit level decreased. Unexpected findings include a positive relationship between favorable perceptions of pay and CLABSI, and between professional interaction and VAP. In order to better explain these relationships, this study should be replicated with a larger number of ICUs. Nursing job satisfaction, certification and healthcare-associated infections in critical care. Intensive and Critical Care Nursing. 2015 Oct;31(5):276-284.

• The purpose of this article is to share the process and outcomes of one medical center’s multimodal plan designed to prepare and support nurses seeking specialty certification in pediatric nursing practice. They conducted needs assessments at the nurse and unit level about challenges and barriers. They addressed challenges including adding a fee for the review course, scheduling it over 5 sessions, and providing for partial reimbursement upon completion. They also implemented creative interactive teaching strategies such as participants creating electronic flashcards for assigned topics, games, use of audience response technology and inclusion of test taking strategies and exam registration processes. They were able to increase not only the attendance at each session of the course, but the percent of course participants registering for the certification exam from 50% to 60% by the end course (with ultimately 93% of participants registering for the exam). (Increasing Nurse Certification Rates Using a Multimodal Approach. JONA. April 2015).
   
• In this study, nurses’ perceived value of certification was found not to be related to their employment in a Magnet® vs. non-Magnet® recognized facility. There was little difference between the intrinsic and extrinsic values of nurses from Magnet® vs. non-Magnet® facilities. However, the perceived value held by certified nurses differed from that held by noncertified and formerly certified nurses. The summary of the study suggests strategies to improve certification rates should focus on improving agreement with the extrinsic values of certification including recognition from all sources (employers, professional and peer acknowledgement). (The Perceived Value of Certification by Magnet® and non-Magnet® Nurses. JONA. April 2015).
   
• This study examines time trend (2004–2010) associations between unit level RN national nursing specialty certification rates and total patient fall rates. Findings included a small statistically significant relationship that may suggest that increases in RN national nursing specialty certification rates are associated with improvements in total fall rates in acute care settings. (Longitudinal Association of Registered Nurse National Nursing Specialty Certification and Patient Falls in Acute Care Hospitals. Nursing Research.June 2015.) 
   
• Institute for Credentialing Excellence (ICE) published a White Paper on the Value of Certification (VoC) which discusses the importance of understanding certification stakeholders, VoC research process, and process of disseminating VoC results. (ICE. Value of Certification: An Exploration of Concept and Research Process. http://www.credentialingexcellence.org/p/pr/vi/prodid=191&source=5. Accessed June 23, 2015.)

2014 Articles

• The purpose of this research was to explore the relationship between certifications commonly held by perioperative nurses in the hospital setting: certified ambulatory perianesthesia nurse (CAPA), certified postanesthesia nurse (CPAN), certified nurse operating room (CNOR) and certified RN first assistant (CRNFA) and nursing-sensitive patient outcomes in SICUs and surgical units. The research showed higher rates of CPAN and CNOR/CRNFA certification in perioperative units were significantly associated with lower rates of central-line associated bloodstream infections in SICUs. (Boyle DK, Cramer E, Potter C, et al. The relationship between direct-care RN specialty certification and surgical patient outcomes. AORN Journal. 2014 Nov; 100(5):511-28.

2013 Articles

• The April 2013 Survey of Registered Nurses was the fourth annual survey conducted by AMN Healthcare, to which 3,413 nurses responded (3.36% response rate). Related to certification, 34% of those responding were certified; 36% are considering certification in the near future; and 30% do not plan on obtaining certification in the future. The survey sample found that more highly educated RNs are more likely to hold specialty certification. (AMN Healthcare. 2013 Survey of Registered Nurses. http://www.amnhealthcare.com/industry-research/2147484433/1033/. Accessed November 22, 2013.) 

• This study of pediatric cardiac surgery patients, across 38 children’s hospitals that contribute to the Pediatric Health Information System data set, found that odds of death increased as the institutional percentage of pediatric critical care unit nurses with 2 years clinical experience or less increased. The article states that this is the first study to link clinical nursing experience with pediatric patient outcomes. They also made mentioned in the article’s discussion that the CCRN credential was aligned with decreased odds of death, which is clinically important for the profession. They speculated that many organizations have embraced the need for nursing certification because of patient’s and families’ expectations of certification and the education knowledge and experience required to achieve and maintain professional certification. (The Effect of Critical Care Nursing and Organizational Characteristics on Pediatric Cardiac Surgery Mortality in the United States. JONA. December 2013). 

• Over half of nurse managers/leaders responding to the survey (59.2%) indicated that they aren't certified in their clinical specialty. For those who are certified, some of the most common certifications include CCRN, CEN, CMSRN, CNOR, NEA-BC, and ONC. Original research: Salary survey 2013 - A staff report. Nursing Management. October 2013.

• Eight-five percent (85%) of 2052 adults (over age 18) responding to the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) and Citizen Advocacy Center (CAC) by Harris Interactive survey believe it is important that health care professionals who are going to treat them have an independent body of health professionals evaluate their skills/knowledge to certify them as competent. (Harris Interactive Poll. June 2013. http://www.nbcrna.com/about-us/news_archive/Pages/Press-Release-Public-Survey-on-Healthcare-Providers.aspx)

• Magnet® hospitals had significantly better work environments and higher proportions of nurses with bachelor's degrees and specialty certification. These nursing factors explained much of the Magnet® hospital effect on patient outcomes. However, patients treated in Magnet® hospitals had 14% lower odds of mortality (odds ratio 0.86; 95% confidence interval, 0.76-0.98; P=0.02) and 12% lower odds of failure-to-rescue (odds ratio 0.88; 95% confidence interval, 0.77-1.01; P=0.07) while controlling for nursing factors as well as hospital and patient differences. (Lower Mortality in Magnet® Hospitals. Medical Care. May 2013. http://www.ncbi.nlm.nih.gov/pubmed/23047129.)

2012 Articles

• This study reported a significant correlation between maladaptive thinking patterns and nurses's burnout thoughts and behaviors. One highlight of this quantitative replication study found that nurses with specialty certification are less likely to have thoughts focused on failure and feelings of inadequacy, which may help protect them from burnout. (Professional nursing burnout and irrational thinking: A replication study. J Nurses Staff Dev. 2012;28(1):2-8.)
• Certification rates might be increased by modeling Magnet® hospital efforts, particularly the early adopters, and focusing on unit types that lag behind in certification rates. Across all unit types, those in Magnet® hospitals had higher certification rates. Regardless of Magnet® status, pediatric units of all kinds, adult critical care and adult rehabilitation had the highest certification rates. (Boyle DK, Gajewski BJ, Miller PA. A longitudinal analysis of nursing specialty certification by Magnet® status and patient unit type. J Nurs Adm.2012 Dec; 42 (12) 567-73). 

• Results showed that hospitals with a larger percentage of nurses who had baccalaureate degrees and certification had lower 30-day mortality and failure to rescue rates for surgical patients. Every 10% increase in the percentage of baccalaureate nurses in hospitals was associated with a 6% decrease in the odds of patients dying (both 30-day mortality and failure to rescue). Every 10% increase in baccalaureate nurses with certification was associated with a 2% decrease in these odds. Years of experience in the hospital did not have a significant effect on patient outcomes. (Does Certification of Staff Nurses Improve Patient Outcomes? Evid Based Nurs. 2012;15(2):54-55.) 

• California hospitals appear to have significantly lower rates of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection if their infection control directors are board-certified. Although most California hospitals are involved in activities to decrease multidrug-resistant organisms (MDRO), there is variation in specific activities utilized with the most focus placed on MRSA. This study highlights the importance of certification and its significant impact on infection rates. Additional research is needed to confirm these findings. (Pogorzelska M, Stone PW, Larson EL. Certification in infection control matters: Impact of infection control department characteristics and policies on rates of multidrug-resistant infections. Am J Infect Control. 2012;40(2):96-101.

2011 Articles

• Total empowerment scores and intent to leave either the position or the profession did not differ between staff nurses who were certified and those who were not. However, perceptions of informal power, opportunity and support did differ between the two groups. (Fitzpatrick JJ, Campo TM, Lavandero R. Critical care staff nurses: empowerment, certification, and intent to leave. Crit Care Nurse. 2011;31(6):e12-7.)   

• This study has been an initial effort to capture the contextual factors that influence medication error in critical care. Moral distress and compassion fatigue emerge as contributing factors requiring further study in relation to the prevention of medication error. Findings from this study support building a transformed work culture in which error reporting is actually commended, instead of punished. The adoption of a nonpunitive, blame-free culture that promotes active reporting of medication errors could ultimately result in the elimination of errors. The direct involvement of CCRNs in the creation of such environments is essential. (Maiden J, Georges JM, Connelly CD. Moral distress, compassion fatigue, and perceptions about medication errors in certified critical care nurses. Dimens Crit Care Nurs. 2011;30(6):339-45.)   

• This study concluded that staffing models including daytime use of nonphysician providers (i.e, NPs and PAs appear to be a safe and effective alternative to the traditional house staff-based team in a high-acuity, adult ICU. (Gershengorn HB, Wunsch H, Wahab R, et al. Impact of nonphysician staffing on outcomes in a medical ICU. Chest. 2011;139(6):1347-53.) 

• This study found that pediatric nurses in a children’s hospital who were certified valued national certification to a greater degree than the nurses who were not certified. Although staff nurses valued certification, they indicated that professional recognition and monetary incentives would serve as motivators for those not certified. Based on comments from nurses surveyed they found a need for consumer awareness of certification and what it means to their children’s care while hospitalized. (Messmer PR, Hill-Rodriguez D, Williams AR, Ernst ME, Tahmooressi J. Perceived value of national certification for pediatric nurses. J Contin Educ Nurs. 2011;42(9):421-32. doi: 10.3928/00220124-20110516-01.)  

• This article reports on studies that have shown certified specialty nurses contributing to quality patient outcomes and satisfaction. In addition, nurses who have achieved their specialty certification have perceived intrinsic value, empowerment and heightened collaboration with the healthcare team. (Wilkerson BL. Specialty nurse certification effects patient outcomes. Plast Surg Nurs. 2011;31(2):57-9. )  

• Specialty certified nurses in critical care in the U.S. make on average of $18,000* more per year than their noncertified counterparts. If you take out the West region, which has as difference of $51,000 per year between certified and noncertified critical care nurses, the average in the other four regions is $9,750, in part due to the Southeast region averaging only a $6,300 difference. (ADVANCE for Nurses. 2011 ADVANCE for Nurses Salary Survey. http://www.nursing.advanceweb.com/Salary-Information/Salary-Survey/Nurse-Pay-Specialties-Certification.aspx. Accessed July 31, 2011.) 

• This systematic review of published literature indicates patient outcomes of care provided by nurse practitioners and certified nurse midwives in collaboration with physician are similar to and in some ways better than care provided by physicians alone for the populations and in the settings included. Clinical nurse specialists in acute care settings can reduce length of stay and cost of care for hospitalized patients. (Newhouse RP, Stanik-Hutt J, White KM, et al. Advanced practice nurse outcomes 1990-2008: a systematic review. Nurs Econ. 2011;29(5):230-50.)   

• In a study conducted by Nursing Management of more than 2800 nursing leaders, more than 24% of the nurses who are nationally certified earn more than $100,000 per year compared with 16% of noncertified nurses who earn more than $100,000 per year. (Hader R. Education matters: does higher learning yield higher income? Nurs Manage. 2011;42(7):22-7.)    

• Although 90% of ANPs and FNPs practice in settings consistent with their certification, a proportion of NPs practice in nontraditional settings and may benefit from additional education (formal, on-the-job and continuing education) and monitoring. 42% of ACNPs reported working in nontraditional primary practice settings, with most attributed to working in ambulatory outpatient setting. It is possible that an ACNP may have worked in a heart failure clinic, which would meet the definition of practicing in a setting as defined by the certification level, but according to the study definitions by the expert panel respondents would have been categorized as practicing in a nontraditional setting. The panel decided that this type of practice disagreement most likely would represent an outlier and not the standard of practice for most NPs practicing in a clinic setting. (Keough VA, Stevenson A, Martinovich Z, Young R, Tanabe P. Nurse practitioner certification and practice settings: implications for education and practice. J Nurs Scholarsh. 2011;43(2):195-202. doi: 10.1111/j.1547-5069.2011.01395.x.)   

• This study found a 10% increase in hospital proportion of BSN and certified BSN staff nurses respectively, decreased odds ratios of adjusted inpatient 30-day mortality by 4% and 11% and failure to rescue by 5% and 13%. Nurse specialty certification is associated with better patient outcomes; effect on mortality and failure to rescue in general surgery patients is contingent upon baccalaureate education. (Kendall-Gallagher D, Aiken LH, Sloane DM, Cimiotti JP. Nurse specialty certification, inpatient mortality, and failure to rescue. J Nurs Scholarsh. 2011;43(2):188-94. doi: 10.1111/j.1547-5069.2011.01391.x.)   

• According to the ADVANCE for Nurses 2011 Salary Survey results, nurses who had specialty certification earned an average of $36.36 per hour; noncertified nurses earned $29. (ADVANCE for Nurses. ADVANCE for NursesSalary Survey. http://nursing.advanceweb.com/Salary-Information/Salary-Survey/2011-Salary-Survey.aspx. Accessed January 31, 2011.)  

2010 Articles

• This article chronicles the phases of the VA’s “Let’s Get Certified Campaign” highlighting the success of one VA hospital’s campaign efforts. In addition, a number of studies are cited that detail organizational benefits for increasing the certification rates such as enhanced patient care and improved nursing recruitment and retention. (Seaman M, Bernstein A. Let's get certified: an innovative national campaign. Nurse Leader. 2010;8(6):31-36.)  

• This study reveals a positive and statistically significant correlation between workplace empowerment and certification, findings consistent with prior research that documented similar results. Though a statistically significant relationship between nursing certification and nurse-sensitive patient outcomes could not be documented, the study nevertheless highlights the strong association that exists between perceptions of overall workplace empowerment and certification. (Krapohl G, Manojlovich M, Redman R, Zhang L. Nursing specialty certification and nursing-sensitive patient outcomes in the intensive care unit. Am J Crit Care. 2010 Nov;19(6):490-8.)  

• This study describes a healthcare facility project to increase certification rates and measure the impact. Results included a positive association between an increase in certified nurses and quality of care (SHEP survey), knowledge and adverse event reporting by staff nurses and an inverse correlation of certification with RN vacancy rates. (Valente SM. Improving professional practice through certification. J Nurses Staff Dev. 2010;26(5):215-9.)  

• This national study of 1354 hospital based certified pediatric nurses found no significant relationship between the proportion of certified nurses on a unit and patients’ outcomes. However, the association between nurses’ perception of overall work-place empowerment and certification was positive and statistically significant. (Wyatt J, Harrison M. Certified pediatric nurses' perceptions of job satisfaction. Pediatr Nurs. 2010;36(4):205-8.)  

• This 2010 survey of readership (n=2000) showed that the new mean salary of a U.S. nurse leader is $80,170; three years ago, it was ($83,930), a 4.5% decline in three years. There’s been no increase in educational levels of professional nurse leaders in the past three years. National certification amongst nurse leaders has dropped from 44.6% in 2007 to 41.3% in 2010. The percentage of master’s-prepared nurse leaders decreased 2.8%, while the number of doctorally prepared leaders remained flat (2.6%). (Hader R. The compensation tumble. Nurs Manage. 2010;41(8):26-31.)  

• This is the first national study to examine all three variables of specialty certification, perceptions of empowerment and intent to stay in position and profession. Significant differences were found between perceptions of empowerment and intent to leave current position and profession between certified and noncertified nurses. A high percentage of critical care nurses (93%) indicated they did not intend to leave the profession. In all instances those nurses who did not intend to leave either their position or profession had higher empowerment scores. (Fitzpatrick JJ, Campo TM, Graham G, Lavandero R. Certification, empowerment, and intent to leave current position and the profession among critical care nurses. Am J Crit Care. 2010 May;19(3):218-26.)  

• This article discusses how certification and clinical ladder programs benefit the public, employers and nurses alike and makes a case for hospitals to pay attention to these programs to reduce nursing shortage and turnover, increase staff satisfaction, and to demonstrate commitment of the healthcare organization and nursing staff to provide high-quality care and professional nursing development. (Watts MD. Certification and clinical ladder as the impetus for professional development. Crit Care Nurs Q. 2010;33(1):52-9.)

2009 Articles

• This study measured knowledge and performance of novice and experienced critical care nurses in a simulated task environment. The nurses were also tested on their knowledge of the constructs present in the scenarios. Group differences in performance were demonstrated only when nurses who had achieved board certification in critical care nursing were compared with the remaining participants. The results demonstrate the lack of linkage between knowledge and clinical performance, which calls into question the supposition by many in nursing that knowledge and performance are inextricably linked. (Whyte J 4th, Ward P, Eccles DW. The relationship between knowledge and clinical performance in novice and experienced critical care nurses. Heart Lung. 2009;38(6):517-25.) 

• This article highlights an acute-care and academic partnership to educate and certify geriatric nurses and measure effects on patient fall rates and nurse’s work satisfaction. The outcome demonstrates that the partnership leading to geriatric certification may improve outcomes such as patient fall rates and nurse job satisfaction. (Lange J, Wallace M, Gerard S, Lovanio K, Fausty N, Rychlewicz S. Effect of an acute care geriatric educational program on fall rates and nurse work satisfaction. J Contin Educ Nurs. 2009;40(8):371-9. doi: 10.3928/00220124-20090723-03.) 

• This article cites a study published in 2002 by the American Board of Physical Therapy Specialties (ABPTS) of the American Physical Therapy Association (APTA) shows that board-certified PTs reported a higher average income than noncertified peers (Bryan J, Gill-Body K, Blake A. How employers view specialist certification. PT-Magazine of Physical Therapy. 2003;11(1):50-53.). This article reports that studies have also found that physicians and employers believe that certified specialists achieve more effective clinical outcomes and often manage patients with more complex conditions. The article also reports that specialty certification is a good time-management tool for recruiters and managers, offering greater assurances that a candidate has a certain skill level. (Mehallow C. Monster. Therapists Stand Out With Specialty Certification. http://career-advice.monster.com/career-development/education-training/physical-therapist-specialty-certifications/article.aspx. Accessed October 30, 2009.) 

• This position paper gives a good summary of many of the research studies that have positive outcomes related to certification. In addition they advocate for their specialty nurses (infusion nurses) to publicly display their credentials and introduce themselves as a certified infusion nurse. (INS/INCC. The value of certification in infusion nursing. J Infus Nurs. 2009;32(5):248-50.)

• The 2009 survey on earning power of healthcare environmental services/housekeeping and facilities professionals indicates that certification adds to a manager's salary (from 7-10% over peers without certification) and pays for itself over time. The article describes how certification can make the positive difference in hiring and layoff decisions. (Carpenter D, Hoppszallern S. 2009 salary survey. Earning power. Certification and other variables greatly influence department managers' compensation. Health Facil Manage. 2009 Jul;22(7):15-20.)

• This nationwide study showed that certified nurses scored higher than noncertified nurses on the "Nurses’ Knowledge and Attitudes Survey Regarding Pain" as well as the "Nausea Management: Nurses’ Knowledge and Attitudes Survey." Chart audits showed that certified nurses followed National Comprehensive Cancer network guidelines for chemotherapy-induced nausea and vomiting (CINV) management more often than noncertified nurses, though improvements are needed in this area. (Coleman EA, Coon SK, Lockhart K, et al. Effect of certification in oncology nursing on nursing-sensitive outcomes. Clin J Oncol Nurs. 2009;13(2):165-72.) 

• This salary survey indicates that holding a specialty certification garnered nurses an average of $12.81 more per hour, followed by working holidays ($8.03) or weekends ($3.79). (Fraleigh J. Nurse earnings survey. RN Magazine. 2009;28-31.http://digital.modernmedicine.com/nxtbooks/advanstar/rn_200907/#/30/OnePage. Accessed July 30, 2009.) 

• This 2008 follow-up survey (to the initial 2006 survey) includes the following key points: 
  • The majority of RNs in this survey of critical care nurses are very satisfied with nursing as a career.
  • Issues remain in the work environment that can impede quality of care, patient safety, and RN job satisfaction and retention.
  • Perceived organizational support for nursing certification is significantly related to the health of critical care nurses’ work environments, quality of care, RN career and job satisfaction, and RNs’ intent to leave their current positions.
  • Improved leadership could result in lower turnover.

(Critical Care Nurses’ Work Environments 2008: A Follow-Up Report.Critical Care Nurse. 2009;29:93-102.) 

• This research study found that the unit proportion of certified staff registered nurses was inversely related to the rate of patient falls. Specialty certification and the competence of registered nurses are related to patient safety. Small numbers indicated a need for caution in interpretation and the need for research. (Kendall-Gallagher D, Blegen MA. Competence and certification of registered nurses and safety of patients in intensive care units. Am J Crit Care. 2009;18(2):106-13.)

• Average nursing salaries in 2008 for nurses surveyed (4553 nurses) were up. In the $60,000–$64,999 salary range the numbers of certified and noncertified respondents were almost even. More than 60% of nurses within the salary range of $65,000–$120,000 reported they had a specialty certification. (Keefe S, O'Brien A. ADVANCE for Nurses. ADVANCE Salary Survey 2009. http://nursing.advanceweb.com/Article/ADVANCE-Salary-Survey-2009-4.aspx?prg=14. Accessed March 4, 2009.)

2008 Articles

• This article encourages nurse executives to support nursing specialty certification as an organizational workforce development strategy. A summary of the results of the ABNS 2006 white paper is contained; the article also mentions the Piazza study linking certification and perceptions of empowerment. (Ridge R. Nursing certification as a workforce strategy. Nurs Manage. 2008;39(8):50-2.) 

• This study suggests that physician cognitive skills, as measured by a maintenance of certification (MOC) exam are linked with higher rates of performing processes of care in Medicare patients (e.g., care for diabetes and mammography screening). (Holmboe ES, Wang Y, Meehan TP, et al. Association between maintenance of certification examination scores and quality of care for medicare beneficiaries. Arch Intern Med. 2008;168(13):1396-403.)

• Nurses who hold professional certifications, work in emergency departments and are members of a professional organization are more favorable toward family presence during resuscitation than are other nurses and they invite family presence more often. (Twibell RS, Siela D, Riwitis C, et al. Nurses' perceptions of their self-confidence and the benefits and risks of family presence during resuscitation. Am J Crit Care. 2008;17(2):101-11.)  

• CCNS (Acute and Critical Care Clinical Nurse Specialist) highest average salary ($74,875 for CCNS, next highest category $71,053 for CNS). Nurses with specialty certification make more money than RNs only (approximately $3,000-$7,000 more per year reported in Pa., N.J., and Del. (O'Brien A.ADVANCE for Nurses. ADVANCE Salary Survey 2008.http://nursing.advanceweb.com/Article/ADVANCE-Salary-Survey-2008.aspx. Accessed July 15, 2008.)

2007 Articles

• An acute care medical unit in Virginia (from a 750-bed academic healthcare organization) increased their certified nurses 60% in one year and experienced a decreased turnover rate (from 16.7% to 8.1%); a decreased vacancy rate (from 11% to 4.73%); and an increased patient satisfaction rating (excellent nursing care ratings from 88.2% to 90.4%) within that same year. RN satisfaction in the areas of teamwork, participation in unit decision making and professional development also increased. (Craven H. Recognizing excellence: unit-based activities to support specialty nursing certification. Medsurg Nurs. 2007;16(6):367-71.)

• Other geographic concerns, including cost of living and professional factors like supply and demand, specialties, certifications, and years of experience, also can affect hourly rates. Highest demand - higher pay is often reserved for nurses, therapists and technologists who have expertise in a variety of specialty areas and who have shown dedication to their professions by becoming certified. While hourly rates vary by institution as well as by region, travelers in certain specialties or subspecialties can expect to earn a few dollars per hour more than their counterparts, as reflected in paychecks, bonuses, differentials, or overall benefit packages. (Ericksen AB. Dollars and sense: A closer look at healthcare travelers' earnings. Healthcare Traveler. 2007;14(9). http://healthcaretraveler.modernmedicine.com/healthcaretraveler/article/articleDetail.jsp?id=409167. Accessed March 1, 2007.) 

• Top perceived values of certification include enhanced feelings of personal accomplishment, personal satisfaction, and a professional challenge, enhanced professional credibility and evidence of professional commitment. Nurse managers' ratings indicate a high value placed on nursing certification. Top incentives offered by employers included reimbursement for examination fees, listing of certification credentials on name tag or business card, and reimbursement for continuing education. Top three barriers to certification for nurses who had never been certified included cost of the examination, lack of institutional reward, and lack of institutional support. Top three barriers to certification for nurses whose certification lapsed included no longer practicing in the specialty, inadequate or no compensation for certification, and inadequate recognition for certification. (Niebuhr B, Biel M. The value of specialty nursing certification. Nurs Outlook. 2007;55(4):176-81.)

• This study found an inverse relationship between use of certified rehabilitation nurses and length of stay (LOS). Specifically, a 1% increase in CRRNs on the unit was associated with an approximated 6% decrease in LOS. (Nelson A, Powell-Cope G, Palacios P, et al. Nurse staffing and patient outcomes in inpatient rehabilitation settings. Rehabil Nurs. 2007;32(5):179-202.) 

• Differences found between certified and noncertified nurses. Wound care certification makes a difference. A relationship between certification and increased topic knowledge has long been assumed. The present study showed little difference in knowledge scores by levels of nursing education, years in practice, or facility type. Differences were found between nurses certified as wound specialists by the Wound Ostomy Continence Nursing Certification Board (WOCNCB) and the American Academy of Wound Management (AAWM) and nurses not certified in wound care or any nursing specialty. Other certifications studied include med-surg, oncology, geriatrics, and nurse practitioner. There was a significant correlation (P < .05) among attending lectures or reading books or journal articles, using the Internet, and reading Agency for Healthcare Research and Quality guidelines. (Certification and Education: Do They Affect Pressure Ulcer Knowledge in Nursing? Adv Skin Wound Care. 2007;20(1):34-8.) 

• CCRNs at top of national survey of salary by credential. List of credentials includes CNOR, RN,C, OCN, and CCM. RNs averaged $59,650; CCRNs averaged $68,300. (ADVANCE for Nurses. ADVANCE Salary Survey 2007. http://nursing.advanceweb.com/Editorial/Content/Editorial.aspx?CC=84105. Accessed May 4, 2007.) 

2006 Articles

• Author Randy Claxton, RN, CCRN, NNP, MSN, cites a number of sources of quotes from certified nurses, to nursing administrators on the benefits of certification and calls for more research to link certification to outcomes. (Claxton R. Sky's the limit: certification: get it now. Men in Nursing.2006;1(6):52-53.)

• “Certificants, noncertificants and administrators agree, although to significantly different degrees, with intrinsic certification value statements as measured by responses to the PVCT. Nurses who are CNOR-certified perceive greater value in certification than do those who are not certified. Among certificants, administrators who are CNOR-certified perceive greater value in certification than do staff nurses who hold the credential. 
  
  “Respondents did not agree with the statement that certification increases salary. Although intrinsic values are important, barriers to certification most often listed were extrinsic (lack of reward and recognition). Nursing certification and healthcare organizations will need to find ways to provide extrinsic rewards if the goals of certification are to be achieved.” (Sechrist KR, Valentine W, Berlin LE. Perceived value of certification among certified, noncertified, and administrative perioperative nurses. J Prof Nurs. 2006;22(4):242-7.)

• Author Mary C. Smolenski, RN, EdD, APRN, BC, FAANP, CAE, of American Nurses Credentialing Center, provides a brief summary of eight reasons for nursing certification such as personal recognition, career progression, professional opportunities, networking, and reimbursement. (Smolenski MC.Nursing Spectrum. Eight Good Reasons to Certify. http://www.nursecredentialing.com/Documents/Certification/StaffDevelopmentResources/WhyANCCCertification.aspx. Accessed September 11, 2006.) 

• Among all nurses, those who reported being certified in a specialty made $9,200 more annually than nurses who weren't certified. (Mee CL. Nursing 2006 salary survey. Nursing. 2006;36(10):46-51.)

• Certified nurses in this study had increased access to job-related power and opportunity structures. Certification provides recognition of the nurses' knowledge and expertise in the specialty area, which in turn is empowering. Organizations that support and recognize this achievement may experience improved turnover and retention rates. (Piazza IM, Donahue M, Dykes PC, Griffin MQ, Fitzpatrick JJ. Differences in perceptions of empowerment among nationally certified and noncertified nurses. J Nurs Adm. 2006;36(5):277-83.)

• American Association of Occupational Health Nurses (AAOHN) has released new findings that reveal a steady annual increase in the salaries and benefits received by AAOHN members in the past five years. More than 3,000 members responded to the survey in 2005, providing information on salary and benefits by considering factors such as certification level, education, job, title, number of years in a position, work schedule, company size, and industry. Key findings include:
  • Average salary for AAOHN members is $63,472. Based on the results, AAOHN reports that the estimated average salary has grown 3.9% annually since 2001.
  • Members with any type of occupational and environmental health nursing certification earn significantly more than those without such certification.
  • (AAOHN profiles current salary, jobs. Professional Safety. 2006;51(4):17.) 

• Survey of Magnet® hospital leaders to find what incentives they were offering to promote nurse certification. 
  
  • 45/52 hospitals reimburse nurses for the cost of registration for the exam with proof of certification.
  • 14% of hospitals report that nurses receive a bonus for certification.
    • Nine hospitals report a pay differential to certified nurses.
    • 19 hospitals report certification is encouraged or required as part of their clinical advancement programs with financial compensation.
  • Nurses at 32 hospitals may display their certification letters on ID badges; in six of these hospitals, nurses may choose two credentials (RN and either another educational credential or certification credential).
  • Article also suggests the link between Magnet® status and NDNQI may be able to link levels of education, certification and patient outcomes.
  • (Weeks SK, Ross A, Roberts PL. Certification and Magnet® hospitals. Will certification advance your career and improve patient outcomes? Am J Nurs. 2006;106(7):74-6.)

• Number of AACN Certification Corporation exam candidates has grown 44% over the last year. A recent survey was aimed at learning more about this increase. The survey was sent to 2,376 certificants who recently became CCRN and PCCN certified, with a response rate of 27%.
  • Both groups of CCRNs and PCCNs strongly agree with the statements that certification:
    • provides personal challenge.
    • demonstrates pride and commitment to specialty.
    • furthers knowledge and education.
  • Commitment to the specialty is the highest rated reason for becoming certified.
    • Professional development and ability to measure skills and knowledge against a national standard were also highly rated in both groups.
  • Half the newly certified CCRNs worked for facilities that have clinical ladder systems as part of their professional development and advancement programs.
    • 60% of the recently certified PCCNs work for hospitals with clinical ladders.
  • Recently certified PCCNs report twice as many of their hospitals recognize both specialty and subspecialty certifications than the newly certified CCRNs report.
  • 35% of nurses responding report obtaining a higher salary as a result of specialty certification.
  • (American Association of Critical-Care Nurses/AACN Certification Corporation. 2006 CCRN and PCCN Certification Survey.) 

• Nurse managers rate highly on agreement with certification value statements. Highest barriers to certification were cost, lack of institutional rewards and lack of institutional support. Top three incentives were reimbursing exam fees, displaying certification credential on nametag and/or business cards and reimbursing for continuing education. No difference in absences found between certified and noncertified nurses. Not clear results on nurse retention. N=11,000. (American Board of Nursing Specialties. American Board of Nursing Specialties Specialty Nursing Certification: Nurses’ Perceptions, Values and Behaviors Value of Specialty Nursing Certification Study. http://www.nursingcertification.org/wp-content/uploads/2014/11/white_paper_final_12_12_06.pdf Accessed December 22, 2006.) 

• American Association of Critical-Care Nurses’ National Survey of Facilities and Units Providing Critical Care found that out of 300 units responding in which nurses were recognized for activities:
  • About three quarters of facilities recognized nurses for certification, mostly through public acknowledgment (42% of facilities) or bonuses (25%). 
  • (Kirchhoff KT, Dahl N. American Association of Critical-Care Nurses' national survey of facilities and units providing critical care. Am J Crit Care. 2006;15(1):13-28.)

2005 Articles

• Purpose was to explore how certain factors in the environment and personal characteristics interact to affect hospital nursing practice behaviors. Surveys were sent to 500 nurses in Michigan, with a 73% response rate. The study suggested that both empowerment and self-efficacy (belief in one's abilities to mobilize the motivation, cognitive resources and courses of action needed to exercise control over one's work) relate to professional practice behaviors. Specialty certification was a control variable. Of the control variables (type of nursing education, specialty certification and years of work experience), only education and specialty certification were significantly related to professional practice behaviors. (Manojlovich M. Predictors of professional nursing practice behaviors in hospital settings. Nurs Res. 2005;54(1):41-7.)

• In a study by the American Board of Nursing Specialties (ABNS), 139 nurse managers shared their perceptions of nursing certification (Stromborg MF, Niebuhr B, Prevost S, et al. More than a title. Nurs Manage. 2005;36(5):36-46.)
  • 86% indicated they’d hire a certified nurse over a noncertified nurse if all else were equal because of:
    • proven knowledge base in a given specialty (85.8%).
    • professional commitment to lifelong learning (77.5%).
  • 30% assign more complex patients to certified nurses
  • 58% identified a difference in certified vs. noncertified staff performance (notably less than the 86% percent that prefer certified nurses).
  • 74% of institutions gave one or more incentives to promote and recognize certification. 

• RN magazine’s 2005 salary survey showed that 18% of nurses surveyed received an average of one dollar more per hour for having a specialty certification. 

• In a separate survey conducted by Nursing 2005, certified nurses earned 15% more than their noncertified peers.  

Prior Articles

• 93% of units surveyed in AACN’s 2004 National Critical Care Surveyreported that nurse managers encourage RNs to obtain specialty certification. 

• Class I Recommendation from ACC/AHA Guidelines states “nursing care should be provided by individuals certified in critical care, with staffing based on the specific needs of patients and provider competencies, as well as organizational priorities.” Level of Evidence: C. (Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction). J Am Coll Cardiol. 2004;44(3):E1-E211.) 

• A retrospective study of 15,427 admissions of northern Illinois residents who underwent segmental colon resection showed that American Board of Surgery (ABS) certification was associated with reduced mortality and morbidity, as was increasing years of experience since the ABS certification. Colorectal surgery subspecialty certification, however, and site of residency did not significantly affect outcomes. (Prystowsky JB, Bordage G, Feinglass JM. Patient outcomes for segmental colon resection according to surgeon's training, certification, and experience. Surgery. 2002;132(4):663-70.)

• Study results suggest that certified nurses perform better than noncertified nurses, particularly in the areas of teaching/collaboration and planning/evaluation. There were inconsistent responses between the staff and supervision evaluations of nurse performance, with the supervisor evaluation showing differences between certified and noncertified nurses. (Redd ML, Alexander JW. Does certification mean better performance? Nurs Manage. 1997 Feb;28(2):45-9.)