Nursing Specialty Certification and Patient Outcomes: What We Know in Acute Care Hospitals and Future Directions

The associations among nurse work engagement, job satisfaction, quality of care, and intent to leave: A national survey in the United States

Objectives

Employee work engagement, job satisfaction, quality of care, and intent to leave are critical indicators for healthcare organizational performance. This study aimed to analyze the current state of nurses' work engagement and its factors to examine the associations among nurses' work engagement, job satisfaction, quality of care, and intent to leave in the United States (US).

Methods

This is a quantitative descriptive cross-section design. Data were collected online from the US registered nurses from March to September 2022. Measures comprised the Utrecht Work Engagement Scale, the demographics, and questions regarding job satisfaction, perceived quality of care, and intent to leave.

Results

Nine hundred nurses participated in the online survey. Among the participants, 79.2% reported holding a specialty certification, 59.4% scored high/very high on job satisfaction, 82.2% expressed high/very high on the perceived quality of nursing care, and 28.4% conveyed likely/very likely to leave in the following year. Nurses' work engagement was positively associated with nurses' job satisfaction and their perceived quality of care but negatively associated with intent to leave. More certified nurses reported high or very high job satisfaction than non-certified nurses. As for demographics, the linear regression analysis showed that nurses who were older, identified as White, and held doctorate degrees reported higher levels of work engagement in comparison to their counterparts.

Conclusions

This study shows that nurses' work engagement is associated with their job satisfaction, perceived quality of care, and intent to leave. Nurses' work engagement in this study is lower than in other studies, especially before the COVID-19 pandemic, which may indicate a possible association with the COVID-19 impact. Because nurses' work engagement is significantly associated with job satisfaction, nurse leaders need to find ways to promote nurses' job satisfaction and retention.

Differences in Perioperative Nurse Job Satisfaction by Specialty Certification Status

PURPOSE

To describe differences in perioperative RN job satisfaction by specialty certification status.

DESIGN

A retrospective, exploratory, cross-sectional design.

METHODS

We conducted a secondary analysis of annual data from the National Database of Nursing Quality Indicators (NDNQI) RN Survey with 12 Job Satisfaction Scales. The sample consisted of 776 perioperative units in 206 hospitals with 13,061 study participants. We used multilevel mixed modeling to examine differences in job satisfaction for nurses holding CAPA (Certified Ambulatory Perianesthesia Nurse), CPAN (Certified Post Anesthesia Nurse), CNOR (certification for perioperative registered nurses), CRNFA (Certified RN First Assistant), other specialty certification, and not specialty certified.

FINDINGS

Twelve percent of RN participants held a perioperative nursing certification (CAPA, CPAN, CNOR, CRNFA), 15% held other nursing specialty certifications, and 73% were not certified. Regardless of certification status, nurses were the most satisfied with nurse-nurse interactions and task. They were the least satisfied with nursing administration, decision-making, and pay. CNOR certified nurses reported the lowest levels of job satisfaction in the study. CAPA and CPAN certified nurses reported higher job satisfaction than their noncertified colleagues on multiple job satisfaction scales (ie, CAPA 10 of 12; CPAN 5 of 12). CNOR certified nurses did not report meaningful differences in job satisfaction from non-certified nurses.

CONCLUSIONS

As job satisfaction impacts retention, productivity, and patient care quality, our findings have important implications for hospital leaders, nurses, and health care consumers. Based on our findings, we identified nursing professional development as a potential gap in job satisfaction that leaders can target for improvement. Our findings suggest that higher specialty nursing certification rates in perianesthesia nurses may potentially improve job satisfaction and retention of nurses.

Organizational culture and roles in promoting nurse specialty certifications: A qualitative study in the United States

Objectives

Nursing specialty certification validates nurses' mastery of specialty knowledge in disease management, education, or leadership above entry-level education and licensing. Research suggests direct relationships between nursing certifications and patient care quality. However, nurses' specialty certification rates are still low. This study aims to better understand nurses' perceptions of the facilitators and barriers in promoting nurses' desires and ability to obtain specialty certifications, which exclude advanced nursing practice roles, such as nurse practitioner or nurse midwife.

Methods

This qualitative descriptive study took place virtually across the United States from May 2022 to September 2022. The study sample was a nested sample of a large national survey study. Among the nurses agreeing to be interviewed, a purposive sampling method was used to achieve maximum variation in diversity, such as years as a nurse, race, ethnicity, and certification status. Information saturation was used to gauge the sample size. Data were collected via in-depth virtual face-to-face interviews. The coding process was based on Colaizzi's method of data analysis.

Results

Twenty nurses participated in the study. Five major themes emerged related to organizational culture and strategies to foster nurse specialty certifications. The five organizational strategies included 1) sharing resources, 2) a culture of ownership and a sense of belonging, 3) mentorship and role modeling, 4) recognizing nurses' efforts and accomplishments, and 5) cultivating a sense of meaning, purpose, and support.

Conclusions

The findings indicate that organizational culture and leadership significantly promote continuing learning environments. Organizations need to develop an organizational culture that promotes nurses' specialty certifications. This study identified significant areas that are important to support nurses seeking certifications. Additional research is needed to evaluate which interventions significantly impact initial and continued certification levels, especially in the post-COVID-19 era.

Health education competence: An investigation of the health education knowledge, skills and attitudes of nurses in Kazakhstan

AIMS

This study assessed the nurses' knowledge of, skills on and attitudes toward health education among nurses working at the University Medical Center Corporate Fund (UMC) in Kazakhstan. The personal and professional factors influencing the nurses' knowledge of, skills on and attitudes toward health education were also investigated.

BACKGROUND

Health education is one of the nurses' fundamental responsibilities. Nurses' role in health education is critical in empowering patients and their families to live healthier lives, thus ensuring optimum health, well-being and quality of life. However, in Kazakhstan, where the nursing profession is still establishing its professional autonomy, data concerning the competence of Kazakh nurses in health education is unknown.

DESIGN

A quantitative study, specifically the cross-sectional, descriptive and correlational designs.

METHODS

The survey was performed at UMC in Astana, Kazakhstan. Using a convenience sampling technique, 312 nurses participated in the survey from March to August 2022. The "Nurse Health Education Competence Instrument" was used to collect data. The personal and professional characteristics of the nurses were also collected. Standard multiple regression analysis examined the personal and professional variables influencing the nurses' health education competence.

RESULTS

The respondents' average score in the "Cognitive domain," "Psychomotor domain," and "Affective-attitudinal domain" was 3.80 (SD = 0.66), 3.99 (SD = 0.58) and 4.04 (SD = 0.62), respectively. The nurses' category as a nurse, medical center, attendance to health education training/seminars in the last 12 months, provision of health education to a patient in the last week and perception of health education's significance in nursing practice were significant predictors of the nurses' health education competence contributing an approximately 24.4 %, 29.3 % and 27.1 % of the variance of the health education knowledge (R² = 0.273, Adjusted R² = 0.244), skills R² = 0.320, Adjusted R² = 0.293) and attitudes (R² = 0.299, Adjusted R² = 0.271).

CONCLUSIONS

The nurses reported high levels of health education competence (knowledge, attitudes and skills). The personal and professional factors influencing the nurses' competence in health education are essential to consider when developing interventions and healthcare policies to ensure nurses' competent provision of health education to patients.

Sources of nurse-sensitive inpatient safety improvement

OBJECTIVE

To examine the association of hospital expenditure with continuing nurse education and staffing on improvements in nurse-sensitive, patient-safety outcomes.

DATA SOURCES

Data obtained from 12-year (2007-2018) panel of Florida acute-care general hospitals.

STUDY DESIGN

We assess the relationship of hospital expenditure on continuing nurse education and staffing on nurse-sensitive, patient-safety outcomes from the Agency for Healthcare Research and Quality: advanced-stage (stage 3 or 4) pressure injuries/ulcers, central venous catheter-related blood stream infection, and deep vein thrombosis. We attempt to mitigate expected omitted-variable bias by (1) exploiting the panel structure of our data, controlling for time and time-invariant hospital fixed effects and (2) incorporating measurable variables representing four unobserved hospital characteristics underlying hospital safety culture (organizational type, organizational structure, leadership, and market conditions) that are likely associated with both inpatient safety and our key determinants. We include two policy initiatives that took effect during the period under study.

DATA EXTRACTION METHODS

From our initial sample of 177 acute-care hospitals we exclude hospitals with missing variables or years of data. Our samples are a balanced panel of 150 acute-care hospitals (N = 1800) for pressure ulcer and catheter-related blood stream infection, and 143 hospitals (N = 1716) for deep vein thrombosis.

PRINCIPAL FINDINGS

A one standard deviation increase in nursing education-policy interaction is associated with a 16.6% (p < 0.01) reduction in the rate of catheter-related blood stream infection and associated with an almost 5% (p < 0.05) reduction in the rate of deep vein thrombosis; a one standard deviation increase in staffing per 1000 inpatient days is associated with a 68.5% reduction in pressure-ulcer rates: 31.4% from direct staffing (p < 0.01) and 37.1% from policy-staffing interaction (p < 0.01).

CONCLUSIONS

Our findings suggest that there are tradeoffs between funding continuing education and training of existing staff and expanding staff to achieve patient safety objectives.

Creating a culture of support for nursing surveillance

BACKGROUND

An estimated 98,000 deaths annually result from medical errors. Preventing these deaths must be a US healthcare goal. Surveillance decreases adverse events. Surveillance is essential for patient safety. Creating a unit culture that supports surveillance requires attention to its antecedents (nurse education, nurse expertise, nurse staffing, as well as organizational culture).

METHOD

The current literature on topics salient to creating a culture of nursing surveillance including its antecedents and its attributes were reviewed. The findings are summarized and presented.

DISCUSSION

Suggestions and tools enhancing a culture of safety allow the transition from one set of behaviors to another. An organizational culture that strives for excellence promotes surveillance which results in improved patient outcomes and better qualified nurses.

CONCLUSION

Unit change resulting in support for surveillance can minimize failure to rescue and promote interruption of adverse events. The patient outcomes include decreased morbidity and mortality.

Hospital-Acquired Conditions Reduction Program, Patient Safety, and Magnet Designation in the United States

OBJECTIVE

The aim of the study was to investigate the association between hospitals' nursing excellence accreditation and patient safety performance-measured by the Hospital-Acquired Conditions Reduction Program (HACRP).

METHODS

We linked data from the American Nursing Credentialing Center Magnet Recognition Program, Centers for Medicare and Medicaid Services HACRP, and the American Hospital Association annual survey from 2014 to 2016. We constrained the analysis to hospitals participating in Centers for Medicare and Medicaid Services' HACRP and deployed propensity score matching models to calculate the coefficients for our HACRP patient safety measures. These measures consisted of (a) patient safety indicator 90, (b) hospital-associated infection measures, and (c) total HAC scores. In addition, we used propensity score matching to assess HACRP scores between hospitals achieving Magnet recognition in the past 2 versus longer and within the past 5 years versus longer.

RESULTS

Our primary findings indicate that Magnet hospitals have an increased likelihood of experiencing lower patient safety indicator 90 scores, higher catheter-associated urinary tract infection and surgical site infection scores, and no different total HAC scores. Finally, when examining the impact of Magnet tenure, our analysis revealed that there were no differences in Magnet tenure.

CONCLUSIONS

Results indicate that the processes, procedures, and educational aspects associated with Magnet recognition seem to provide important improvements associated with care that is controlled by nursing practice. However, because these improvements do not differ when comparing total HAC scores nor Magnet hospitals with different tenure, there are likely opportunities for Magnet hospitals to continue process improvements focused on HACRP scores.

Nursing's Role in Successful Stroke Care Transitions Across the Continuum: From Acute Care Into the Community

Facilitating successful care transitions across settings is a key nursing competency. Although we have achieved improvements in acute stroke care, similar advances in stroke care transitions in the postacute and return to community phases have lagged far behind. In the current delivery system, care transitions are often ineffective and inefficient resulting in unmet needs and high rates of unnecessary complications and avoidable hospital readmissions. Nurses must use evidence-based approaches to prepare stroke survivors and their family caregivers for postdischarge self-management, rehabilitation, and recovery. The purpose of this article is to provide evidence on the important nursing roles in stroke care and transition management across the care continuum, discuss cross-setting issues in stroke care, and provide recommendations to leverage nursing's impact in optimizing outcomes for stroke survivors and their family unit across the continuum. To optimize nursing's influence in facilitating safe, effective, and efficient care transitions for stroke survivors and their family caregivers across the continuum we have the following recommendations (1) establish a system of coordinated and seamless comprehensive stroke care across the continuum and into the community; (2) implement a stroke nurse liaison role that provides consultant case management for the episode of care across all settings/services for improved consistency, communication and follow-up care; (3) implement a validated caregiver assessment tool to systematically assess gaps in caregiver preparedness and develop a tailored caregiver/family care plan that can be implemented to improve caregiver preparedness; (4) use evidence-based teaching and communication methods to optimize stroke survivor/caregiver learning; and (5) use technology to advance stroke nursing care. Nurses must leverage their substantial influence over the health care delivery system to achieve these improvements in stroke care delivery to improve the health and lives of stroke survivors and their families.

Credentialing and certification: Overview, science, and impact on policy, regulation, and practice

AIM

To engage the global nursing community in sharing knowledge, experiences, and lessons learned about credentialing of individual nurses to improve nursing practice, patient safety, and quality of care.

BACKGROUND

Although the United States has a long and robust history of credentialing individual nurses, the opportunity exists to expand the dialogue globally, and is supported by globally focused governing bodies who call for increased or expanded investment in nursing certification and credentialing. Foundational work to define and operationalize certification for research purposes and develop an administrative home for stakeholders interested in certification can be leveraged by countries and regions globally. Existing frameworks for credentialing research may be used to drive theory-based research in the future.

SOURCES OF EVIDENCE

PubMed, International Council of Nurses, National Academies of Sciences, Engineering, and Medicine, World Health Organization, American Nurses Association, American Nurses Credentialing Center, and the authors' own experiences.

DISCUSSION

Credentialing as a form of self-governance, as a method for public protection, and as a foundational element in the increasingly new forms of healthcare delivery is intensifying in importance. Credentials provide an opportunity to evaluate relationships between key elements such as nursing practice, environments where nursing care is delivered, and nursing programs with outcomes of interest for the profession such as safety, quality of care, and patient outcomes.

CONCLUSIONS

Establishing rigorous credentials for nurses demonstrates a commitment to excellence. Credentialing frameworks that are universally applied could enable nurses to move seamlessly across geographic boundaries, permit regulators and employers of nurses to have a common set of standards and expectations, and ensure a level of competency for nursing practice that can be interpreted and trusted by various stakeholders.

IMPLICATIONS FOR NURSING POLICY

Policymakers have a pivotal role in advancing credentialing in nursing worldwide. Countries developing credentialing programs in nursing need to study their results to help inform how practice might be required to change over time.

The Importance of Board Certification

The investment to support and obtain board certification demonstrates a nurse leader's commitment to their staff, the organization, and the communities they serve. It is important for nurse leaders to appreciate how organizational support of board certification can positively impact patient care and to be advocates for funding to support board certification for their staff. This month's Magnet® Perspectives column discusses the empirical evidence, as well as the professional value of certification.

Care of the Patient With Acute Ischemic Stroke (Posthyperacute and Prehospital Discharge): Update to 2009 Comprehensive Nursing Care Scientific Statement: A Scientific Statement From the American Heart Association

In 2009, the American Heart Association/American Stroke Association published a comprehensive scientific statement detailing the nursing care of the patient with an acute ischemic stroke through all phases of hospitalization. The purpose of this statement is to provide an update to the 2009 document by summarizing and incorporating current best practice evidence relevant to the provision of nursing and interprofessional care to patients with ischemic stroke and their families during the acute (posthyperacute phase) inpatient admission phase of recovery. Many of the nursing care elements are informed by nurse-led research to embed best practices in the provision and standard of care for patients with stroke. The writing group comprised members of the Stroke Nursing Committee of the Council on Cardiovascular and Stroke Nursing and the Stroke Council. A literature review was undertaken to examine the best practices in the care of the patient with acute ischemic stroke. The drafts were circulated and reviewed by all committee members. This statement provides a summary of best practices based on available evidence to guide nurses caring for adult patients with acute ischemic stroke in the hospital posthyperacute/intensive care unit. In many instances, however, knowledge gaps exist, demonstrating the need for continued nurse-led research on care of the patient with acute ischemic stroke.

Certified Surgical Services Manager (CSSM): The New Gold Standard for Perioperative Nurse Leaders

Specialty certification promotes improved surgical outcomes, enhances health care quality, and is an important external benchmark of overall clinician competence. Given the growing technological, financial, and administrative demands of the modern health care system, the roles of perianesthesia and perioperative nurse managers are increasingly complex. The Certified Surgical Services Manager (CSSM) certification establishes a standard of excellence for perioperative managers, demonstrating that they possess the capacity to adapt and lead in the continually evolving roles of perioperative leadership and surgical services management. In this article, we comprehensively review CSSM certification and offer insights into the importance of lifelong learning and continuous professional development. The topics discussed include the advantages of holding the CSSM credential, the importance of specialty certification, and a general examination overview. In addition, we emphasize the value of the CSSM credential and adopting it as the national standard for surgical service managers.

Progressing toward specialty certification as the National Standard for Nursing

Nursing specialty certification is an objective measure that assures the public that nurses demonstrate the highest level of professional knowledge in their field. Many nurses do not seek specialty certification, as evidenced by low certification rates. In this creative controversy article, we build a case that progressing toward nursing specialty certification as a national standard will increase overall nursing professionalism while better preparing nurses to meet the needs of their specialty patient populations and the changing health care system.

A National, Qualitative Study of the Motivators and Outcomes of Nurse Educator Certification

AIM

This qualitative study sought to describe motivators and outcomes of academic nurse education certification.

BACKGROUND

Several studies have explored perceptions of the value of nurse educator certification (CNE). However, there is a gap in understanding motivators and outcomes of certification as a nurse educator.

METHOD

As part of a larger, web-based, mixed-method study, a national sample of certified and noncertified nursing educator administrators and faculty responded to nine open-ended questions. The inductive content analysis approach was used to identify constructs and themes.

RESULTS

From an overall sample of 721 participants, three constructs and associated themes emerged.

CONCLUSION

Motivators for pursing CNE align with previously reported intrinsic values. Participants seek extrinsic rewards as well. Educator outcomes include enhanced teaching and expanded roles. Student outcomes were less clear. Further study of outcomes of CNE is recommended to promote recognition of academic nursing education as an advanced nursing specialty.

Examining the Impact of Board-Certified Registered Nurses in Skilled Nursing Facilities Using National and State Quality and Clinical Indicators

A convenience sample of skilled nursing facilities was selected from a sample of graduates of an online training program for RNs who subsequently achieved board certification in gerontological nursing (RN-BC). Facilities that employed one or more RN-BC were pair-matched using 11 organizational characteristics with facilities that did not employ a RN-BC. Facility data were collected at two time points, and differences between time points and between facility type (RN-BC versus non-RN-BC) were analyzed. Findings showed that there were no statistically significant differences between RN-BC and non-RN-BC facilities with respect to quality ratings and nurse sensitive clinical indicators (e.g., restraint use, urinary tract infections, falls, antipsychotic medication use) between the two time periods; however, in the second time period, RN-BC facilities showed greater improvement versus non-RN-BC facilities in seven of nine outcomes, achieving significance in Overall (4.10 vs. 3.55, p < 0.01) and Survey (3.48 vs. 2.86, p < 0.01) 5-Star ratings. [Journal of Gerontological Nursing, 45(11), 39-45.].

Professional activity of stomatherapists graduated from the Federal University of Minas Gerais

Objectives: This study aimed to identify the area of professional activity, characterize the trajectory and clinical practice in the area of stomatherapy, and identify further training as a specialist. Method: A descriptive study with a quantitative approach was conducted by applying an online questionnaire to graduates of the specialization course in Stomatherapy of the Federal University of Minas Gerais, which began in 2007, totaling 97 by 2015. The convenience sample was composed of 84 specialists who agreed to answer the questionnaire considering the study variables. Results: Most of the graduates were female (86%), aged between 31 and 40 years (68%), residents (58%) and working (59.6%) in Belo Horizonte. They remain active in their specialty area (70%), with predominance of stoma and wound care (31%), in care activities (29.3%), in the hospital area (27.3%) and in the health public sector (38%). The pursuit of specialization was predominantly motivated by interest in technical-scientific development (48.5%) and (69%) of the graduates continues capacitating after specialization. Conclusion: Stomatherapy is expanding in the national market, requiring the continuation of national research for a broader view of the specialty.

Atuação profissional dos estomaterapeutas egressos da Universidade Federal de Minas Gerais

Objetivos: Este estudo teve como objetivos identificar a área de atuação profissional, caracterizar a trajetória e a prática clínica na área da estomaterapia e identificar posteriores capacitações como especialistas. Método: Estudo descritivo com abordagem quantitativa realizado por meio da aplicação de questionário online aos egressos do curso de especialização em Estomaterapia da Universidade Federal de Minas Gerais, iniciado no ano de 2007, totalizando 97 egressos até 2015. A amostra por conveniência foi composta pelos 84 especialistas que concordaram em responder o questionário contemplando as variáveis do estudo. Resultados: Os egressos eram em sua maioria do sexo feminino (86%), com idade entre 31 e 40 anos (68%), residentes (58%) e atuantes (59,6%) em Belo Horizonte. Mantêm-se atuantes em sua área de especialidade (70%), com predominância dos cuidados com estomias e feridas (31%), em atividades assistenciais (29,3%), na área hospitalar (27,3%) e no setor público de saúde (38%). A busca pela especialização foi motivada predominantemente pelo interesse no desenvolvimento técnico-científico (48,5%) e (69%) dos egressos continua se capacitando após a especialização. Conclusão: A estomaterapia encontra-se em expansão no mercado nacional, sendo necessária a continuidade de pesquisas de âmbito nacional para uma visão mais abrangente da especialidade.