New CCNS exam raises the bar for nurse specialists
More states are requiring certification for licensure
The bar has been raised a few notches for advanced practice nurses who are being urged to take a new certification exam introduced in January by the American Association of Critical Care Nurses Certification Corp.
States are beginning to require the advanced practice certification for clinical nurse specialists in acute and critical care as a basis for licensure. Nurses in those states who neglect to take and pass the new certification exam may face difficulty renewing their practice license or obtaining a new one in the case of recently promoted clinical nurse specialists.
Since its launch two months ago, the new Certification for Clinical Nurse Specialist (CCNS) exam has generated enormous interest from both nurse managers and clinical nurse specialists, says Jo-Ann Eastwood, RN, MN, CCRN, certification director at Aliso Viejo, CA-based AACN Certification Corp., also known as AACN CertCorp.
Test sponsors say they aren’t surprised by inquiries they’ve received from managers, who are encouraged in most cases to take the exam.
"It would be appropriate for many to take the test," Eastwood reports.
Although nurse managers are professionally the equivalent of nurse specialists, they are both essentially on different career tracks, and their daily functions in the unit are quite different.
States are demanding proof of competency
The CCNS exam is specifically designed for the nurse who holds a master’s degree or its equivalent. Nevertheless, it offers nurse managers who meet the minimum eligibility requirement the opportunity to broaden their scope professionally and provides them the opportunity to change career paths if they wish, Eastwood says.
To be eligible for the exam, a nurse has to have:
• An unrestricted registered nurse’s license.
• A master’s degree in nursing.
• 500 hours of direct clinical practice either within the master’s program or as a clinical nurse specialist.
• Evidence of expertise in clinical knowledge, skills, and judgment. Part of that expertise can be demonstrated by an entry-level, basic, or advanced certification in nursing, according to AACN CertCorp.
A growing number of states, including Minnesota, Texas, and Louisiana, are requiring proof of advanced practice capabilities before recognizing nurses under CNS status. More are expected to follow suit. The Critical Care Registered Nurse certification (CCRN), while still valid for bedside registered nurses, is no longer acceptable as a certification status by many states for advanced practice.
However, states requiring the higher certification have left the task of designing and administering the exam to AACN, which was an appropriate decision, according to Eastwood. A professional organization or society is in a much better position to develop and design the test content, she adds.
Applicants who take the CCNS will be surprised by a number of differences from the CCRN exam. Unlike the CCRN test, which has become a standard among veteran CCU nurses, the CCNS represents a departure in both content and focus, says Martha A.Q. Curley, RN, PhD, critical care clinical nurse specialist at Children’s Hospital Boston. Here are four main differences:
• Patient-centered focus.
The biggest difference lies in the test’s patient-centered focus. While the CCRN and other nursing exams concentrate on testing clinical tasks and procedures, the task-oriented focus has been replaced in the CCNS with questions that emphasize a nurse’s clinical competency in meeting a patient’s medical needs. (For sample CCNS test questions, see chart, left.)
• Master’s degree complexity.
Another difference lies in the way the test is skewed. "While the test meets the National Council of State Boards of Nurses’ [located in Washington, DC] standards, in design it is geared to the knowledge level of a newly graduated master’s degree nurse," Eastwood says. The questions also are more complex than those for a bedside RN, but a seasoned advanced practice nurse should have no trouble with the questions, Eastwood adds.
• Emphasis on concepts not mechanics.
Nurses who have not had abundant acute care or cardiac unit experience will be able to pass the exam. The questions do not demand a specialized knowledge of equipment use or procedures.
The exam will require the test-taker to understand concepts and cause and effect. For example, questions regarding the cardiac intraaortic balloon pump will concentrate more on the medical purpose for the device rather than specific timing or inflation-deflation factors in its use.
The CCNS exam application contains a list of study topics, labeled as a blueprint that covers the test content. It is divided into three general problem areas: neonatal, pediatric, and adult patient care. There is also a helpful bibliography. The materials should be sufficient to help applicants prepare for the test, says Curley.
• Computer-based testing format.
Unlike most nurse certification exams, the CCNS will be computer-based. The test will be given in a workstation setting at several designated testing sites.
The format allows applicants to schedule their exams when it’s convenient and they can obtain their scores and results more quickly than with conventional pen-and-paper tests.
The four-hour test consists of 175 multiple-choice items. Of those, 150 concern non age-related patient questions. The remaining 25 address either adult, neonatal, or pediatric patients. Each question attempts to assess one or more nurse characteristics identified by test designers as part of the synergy model, the term for the exam’s patient-care focus.
The principles of the synergy model are based on the assumption that synergistic interaction between nurse competencies and patients’ needs will result in "optimal patient outcomes," according to test designers.
AACN CertCorp has identified eight patients’-needs characteristics and eight nurse competency characteristics that will be incorporated into the exam. (For a list of these characteristics, see chart, above.)
"The test is by no means a given for passing. We expect a pass rate of about 75%," says Eastwood. "Nurses will find it challenging, but any prepared and experienced master’s-level advanced practice nurse will be able to do well."
Sample Test Questions
1. The critical care department is considering purchasing new ET tube holders. An appropriate program of evaluation would include testing the new device:
a. Using a specified protocol for care compared with care routinely provided.
b. In the post-cardiac surgery unit, and compare with current care being provided in the medical-surgical ICU.
c. On a randomly assigned group of patients using a standard care protocol for patients in both the routine care and test groups.
d. For a six-month test period followed by a comparison period of six months.
Reference
Gift AG. Cost Effectiveness: Designing research for product evaluation, Clin Nurse Spec 1995; 9:204-206.
2. The CNS would guide the staff nurse in making which of the following recommendations to the inter-disciplinary team to provide ongoing pain relief for this neonate post operatively:
a. Monitor for episodes of tachycardia.
b. Increase the Fentanyl infusion to 3 mcg/kg/hr.
c. Initiate a paralytic agent such as Pavulon.
d. Provide music therapy as a non-pharmacologic intervention.
Reference
Gomella TL. Neonatology: Management, procedures, on-call problems, diseases, and drugs. Stamford, CT: Appleton & Lange; 1994.
Patients’ Needs Characteristics
• Resiliency: Capacity to return to a restorative level of functioning.
• Vulnerability: Susceptibility to actual or potential stressors.
• Stability: Ability to maintain steady-state equilibrium.
• Complexity: Entanglement of two or more systems, (body, family, therapies).
• Resource availability: Extent of medical/social resources.
• Participation in care: Level of patient/family involvement.
• Participation in decision making: Level of patient/family decision making.
• Predictability: Expectation of course of events or illness.
Nurse Competency Characteristics
• Clinical judgment
• Clinical inquiry (innovator/evaluator)
• Facilitator of learning
• Collaboration potential
• System thinking skills
• Advocacy/moral agency (working with patient/family/nursing staff)
• Caring practices
• Response to diversity
Source: AACN Certification Corp., Aliso Viejo, CA.
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