Nursing Certification: A Decentralized Model
By Lynn Rew, EdD, RNC, HNC, FAAN
In the United States, nursing certification began some 50 years ago as a self-regulated process whereby nursing specialty organizations recognized the competence and expertise needed to practice nursing in expanded or unique roles.1
Certification in nursing is currently based on a decentralized model in which various professional nursing specialty organizations have developed and administered their own certification processes. As a result, there is a lack of uniformity in requirements for certification and recertification.1
Presently, at least 30 professional nursing organizations offer certification to nurses who have met entry-level licensure requirements and who have demonstrated a level of practice, knowledge, and competence beyond the entry-to-practice level.1 The certification process is generally related to a minimal amount of clinical practice and the measurement of a unique body of knowledge in the particular nursing specialty. Most certifying organizations have developed written multiple-choice tests with cutoff scores that represent the minimal body of knowledge needed by nurses to be certified as knowledgeable and competent in a specialized area of practice.
As states begin to recognize the expanded roles of advanced practice nurses (APNs), the variability of certification requirements for APNs will become apparent. In the future, certification of APNs may evolve into a standardized process with regulation requiring graduate education and certification in all states.2 Recent events, such as the U.S. Oncology Nursing Certification Corporation’s "State of the Knowledge" conference1 and the establishment of the American Nurses Credentialing Center Institute for Research, Education, and Consultation,3 focus the attention of the nation’s nurses on questions of who should have oversight of specialty certification, how competency should be measured, and what effects certification will have on health care delivery in the future.1
National certification in a specialized aspect of nursing, such as holistic nursing, documents that some nurses have completed additional educational requirements beyond those needed to obtain basic licensure as a professional nurse. State licensure laws document that nurses have completed basic educational requirements. However, the same license is granted to the nurse with an associate degree from a two-year community college and the nurse with a four-year baccalaureate degree. Certification standards are higher than basic, entry-level knowledge and skills. For example, the Core Curriculum in Holistic Nursing "is built on core requirements of the baccalaureate degree" to ensure that certified nurses meet certain standards in critical thinking, oral and written communication, and in general liberal arts knowledge.4
At present there is a great deal of controversy around issues such as the baccalaureate degree requirement for certification, accreditation of advanced nursing practice educational programs, and second licensure for advanced practice nursing.5,6 Such controversies enable critical analysis and dialogue to occur within the profession. There is mounting evidence that nurses and the public value certification. Much remains to be done to inform the public, particularly consumers and insurers, of the importance of nursing certification and its relationship to improved patient care out-comes.1
References
1. Report of a state-of the-knowledge conference on U.S. nursing certification. ONCC Research Committee and Executive Staff. Image J Nurs Sch 1999;31:51-55.
2. Hodnicki DR. Advanced practice nursing certification: Where do we go from here? Adv Pract Nurs Q 1998;4:34-43.
3. American Nurses Credentialing Center. 1999 Recertification Catalog. Washington, D.C.; 1999.
4. Dossey BM, et al. Inventory of professional activities and knowledge of a holistic nurse (IPAKHN). J Holist Nurs 1998;16:33-56.
5. Allan JD. Striving for quality in advanced practice nursing education. Adv Pract Nurs Q 1998;4:6-13.
6. Burns K, Welk D. American Board of Nursing Specialties: Past, present, and future. Nurs Outlook 1997;45:114-117.
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