Certification and its Professional Application in Specialty Areas:

PeriOperative and PeriAnesthesia Nursing

PeriOperative and PeriAnesthesia nurses often will seek specialty certification at some time in their practice. The reasons behind this are variable – for many it is an opportunity to validate and justify their competency within their specific specialty practice – for others it is an adjunct or means to further their knowledge base and education – still more seek it to enhance opportunities for advancement within the specialty. Many more see it as a credential that will open doors for them to become more active within their own hospital organization or to seek office/board positions in a professional nursing organization.

The concept of certification in a specialty is described as a ‘gold standard’ in literature that defines professional practice issues. (Hohler, 2004). Synonyms for certification include affirmation, endorsement, sanction, and warranty. Purposes of establishing certification most cited were to protect the public good, provision of consumer choice in selection of providers of care, distinguish levels of care and enhance competition. (Cary, 2001). Cary further states that professional certification acts as a measure of distinctive nursing practice. The process of certification involves the establishment of examination criteria by a certifying body that is continually updated to represent the most current educational and practice standards for the given specialty. Certifying bodies that develop specialty practice examinations are distinct and separate from the associated specialty professional organization. Certification exam questions for specialty practice are developed by using role delineation studies (ABPANC, 2005).

Additionally, certified nurses write, review and validate test questions that are evidence/research based on current practice in the specialty in assigned committees within the certifying organizations.

The minimum eligibility requirements to sit for certification examinations require a specific number of practice hours described by each certifying organization. Certification is granted based upon the achievement of an established passing score. Re-certification is achieved either by re-examination after a defined time period or achieving continuing education activities. Continuing education activities include the accumulation of a specified number of contact hour accruals and/or other activities that support continuing education within that specialty. Some of these activities may include but are not limited to validated committee work within a professional organization or hospital organization, being a committee chairperson, holding an office or board position within a professional organization, writing policies and procedures, writing and publishing articles in newsletters or professional journals, speaking at professional meetings/seminars, serving as faculty or as a preceptor, program/presentation development related to practice, research projects and educational credits towards nursing practice undergraduate and graduate degrees.

In 2001, a survey conducted by the American Nurses Credentialing Center revealed that certified nurses represent 134 specialties, with 67 certifying organizations, and 95 specialty credentials. The mean age of the average certified nurse was over 40, most held either a diploma/associate or bachelor degree, and actively worked in nursing. Most worked in hospital settings in direct patient care areas.

The reasons that professional nurses seek board certification were personal growth/satisfaction as a professional nurse, (2001, OR Manager), peer and colleague recognition, and enhanced physician communication (Aiken, 2000).

Practice characteristics described by certified nurses included increased competence, confidence, credibility and control over own professional practice.

They cited improved confidence in detecting signs/symptoms of complications, and knowledge of prompt, appropriate interventions. Nurses described quality attributes such as increased collaborative skills, practice autonomy, fewer adverse outcomes and errors, and more career advancement opportunities and greater patient satisfaction.

The Certified Board for PeriOperative Nursing (CBPN) conducted a similar study on the perceived value of certification (Gaberson et al, 2003). This study showed professional commitment as a key reason for seeking the certification credential. Additional reasons cited were accountability, professional challenge and credibility, enhanced marketability, specialized knowledge, and employer/administrator value.

Newhouse et al. (2005) cited a study (Redd & Alexander, 1997) that supervisors rated certified nurses significantly higher than noncertified nurses in planning and evaluation, and indicated that more research is needed to determine whether certification is related to improved clinical practice.

Specialty Certification on the Operating Room

Schramm (2004) states that ‘certification assures the public that the nurse has completed all eligible criteria to earn a specific credential…that the nurse has developed specialty knowledge beyond the required minimum.’

Certification credentialing opportunities in the Operating Room are CNOR (certified nurse operating room), CRNFA (certified registered nurse first assistant), and CRNA (certified registered nurse anesthetist). A registered nurse must first achieve CNOR certification in order to be eligible to enroll in an RNFA formal education program.

RNFA programs require defined formal clinical and educational objectives. Eligibility to sit for the certification examination (CRNFA) is dependent upon further clinical experience and skill competencies.

Certified Registered Nurse Anesthetists (CRNA) are advance practice nurses who complete an undergraduate nursing program and master’s program making them eligible for CRNA examination and licensure. State Nursing Practice Boards define practice requirements for CRNAs as licensed independent practitioners directed by licensed physicicans. (State Practice Act, 24 Delaware Code, Section 1906(19) (24 Del.C. 1906(19))

Specialty Certifications in the PeriAnesthesia Areas

A variety of specialty certification opportunities exist within the perianesthesia areas. In the Day Surgery and PACU areas, perianesthesia certification as described in the American Board of PeriAnesthesia Nursing (ABPANC) Certification handbook (2005), are CPAN (Certified Post Anesthesia Nurse), CAPA (Certified Ambulatory PeriAnesthesia Nurse). Registered nurses practicing in endoscopy and cystoscopy suites seek CGRN (Certified Gastroenterology Registered Nurse) and CURN (Certified Urology Registered Nurse).

In conclusion, certification, available for over two decades in these specialty areas, validates that a nurse’s knowledge is current. With a strong public and regulatory focus on patient safety in the provision of care, ABPANC’s vision statement (2005) for certification is most appropriate for all areas in the perioperative and perianesthesia arena:

“Recognizing and respecting the unequaled excellence in the mark of the CPAN and CAPA credential, perianesthesia nurses will seek it, managers will require it, employers will support it, and the public will demand it.”

References

Aiken, L., et al. (2000). The magnet nursing services recognition program. American Journal of Nursing, 100 (3), 26-36.

American Board of PeriAnesthesia Certification, Inc. (2005). Certification Handbook and Application. New York. 1-26.

American Nurses Credentialing Center. (2000). The survey of certifying organizations for registered nurses in the United States.

Byrne, M., Valentine, W., and Carter, S., (2004). The value of certification: A research journey. American Operating Room Nurses Journal, 79 (4). 825--835.

Cary, A. (2001). Certified registered nurses: Results of a study of the certified workforce. American Journal of Nursing, 100 (1) 44-52.

Gaberson, K., Schroeter, K., Killen, A., and Valentine, W. (2003). The perceived value of certification by certified perioperative nurses. Nursing Outlook, 51 (Nov/Dec). 272-276.

Newhouse, R., Johantgen, M., Provost, P., and Johnson, E. (2005). Perioperative nurses and patient outcomes – Mortality, complications, and length of stay. American Operating Room Nurses Journal, 81 (3), 508-528.

Hohler, S., (2004). Certification-The gold standard. American Operating Room Nurses Journal, 80 (3), 544-552.

Redd, M., and Alexander, J. (1997). Does certification mean better performance? Nursing Management, 28, 45-49.

Schramm, C. (2004). Message from new president: Our credentials demonstrate commitment to patient safety. Certification Board PeriOpertaive Nursing Newsletter. Spring 2004, 1-2.

Statutory Authority: 24 Delaware Code, Section 1906 (19) (24 Del.C. 1906 (19)). Division of Professional Regulation: Board of Nursing.

Who is the certified nurse?. (2001). OR Manager, 17 (3). Workplace commentary, 32.