Discussion: Specialty certification builds on nursing licensure

Discussion: Specialty certification builds on nursing licensure

Discussion: Specialty certification builds on nursing licensure

It acts as a mechanism for

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validation or formal recognition by documenting individual nurses’ knowledge, skills, and abilities spe- cific to their specialty. To become certified, nurses are required to meet predetermined eligibility crite- ria and achieve standards identified by a nursing specialty, including sufficient practical experience and passing a certification examination that provides external validation of knowledge and judgment. The intended outcome of certification in nursing is to validate compe- tence with the overall goal of improving safety, quality of care, and health outcomes for people who use healthcare services. (Chappell et al., 2019).

For the Certified Medical-Surgical Registered Nurse (CMSRN®) certifi- cation, initial eligibility criteria are registered nursing licensure, 2 years of practice in a medical-sur- gical setting (may include clinical, management, or education), and 2,000 hours of medical-surgical

practice in the past 3 years. Eligible candidates earn the cre- dential by passing an exam (Medical-Surgical Nursing Certifi – cation Board [MSNCB], n.d.). To recertify, CMSRNs must continue to practice in a medical-surgical setting and provide evidence of continuing competence in the specialty (MSNCB, 2019).

Continuing competence is “the ongoing commitment of a regis- tered nurse to integrate and apply the knowledge, skills, and judg- ment with the attitudes, values, and beliefs required to practice safely, effectively, and ethically in a desig- nated role and setting” (Di Leonardi & Biel, 2012, p. 350). The Con – tinuing Competence Task Force (Hospice and Palliative Creden –

tialing Center [HPCC], 2011) estab- lished this definition to guide estab- lishment of meaningful recertifica- tion requirements in nursing. MSNCB (2012), which administers the CMSRN credential, has en – dorsed the definition. MSNCB spec- ifies an accepted set of methods of evidence of continuing competence for CMSRN recertification. Exam – ples are continuing nursing educa- tion (CNE) activities, advanced car- diovascular life support, profession- al publications, and evidence-based practice projects (MSNCB, 2019). The Institute for Credentialing Excellence (ICE) provides a compre- hensive list of methods for demon- strating continuing competence. Examples listed by ICE, but not accepted currently by MSNCB,

Instructions for CNE Contact Hours

MSN J2012 Continuing nursing education (CNE)

contact hours can be earned for completing the evaluation associated Discussion: Specialty certification builds on nursing licensure

with this article. Instructions are available at amsn.org/journalCNE

Deadline for submission: August 31, 2022 1.4 contact hours

Specialty nursing certification is validation and formal recognition of nurses’ knowledge, skills, and abilities. The intrinsic and extrinsic reasons nurses value Certified Medical-Surgical Registered Nurse certification, as well as facilitators to and barriers of certification, are discussed. A combination of intrinsic and extrinsic facilitators is essential for certifying programs and healthcare organizations to use in achieving higher numbers of specialty-certified nurses.

July-August 2020 • Vol. 29/No. 4230

include obtaining a new certifica- tion in a related field, simulations, and oral, written, or performance competency assessments (Plaus et al., 2013).

To assure the continuing compe- tence of specialty certified nurses, Di Leonardi and Biel (2012) asserted certification and recertification pro- grams should employ periodic indi- vidual competency assessments and subsequent development of indi- vidualized learning plans to address learning needs noted in the evalua- tions. Consequently, some nursing specialty certification programs

responded by pioneering recertifica- tion requirements that include competency assessments and tai- lored learning strategies (HPCC, n.d.; Oncology Nursing Certifica – tion Corporation, 2020).

Purpose MSNCB is reviewing strategies

and requirements to demonstrate continuing competence for nurses who hold the CMSRN credential. However, no decisions have been made about specific changes in requirements (T. Hinkley, personal

communication, August 26, 2019). To inform these decisions and the general ongoing dialogue about continuing competence, MSNCB conducted a national online survey to determine CMSRNs’ methods of continuing competence, facilitators and barriers to continuing compe- tence and certification, and percep- tions of the value of certification.

Review of the Literature Literature was identified via

PubMed and CINAHL for three con- tent areas for 2015-January 2020. For continuing competence, search terms were continuing competence, continuing competency, continued competence, continued competency, continuing competence methods, and continuing competence requirements. For the value of certification, search terms were the value of certification, perceived value of certification, and nursing. For facilitators and barriers, search terms were certification facili- tators, certification barriers, certifica- tion benefits, and nursing.

Continuing Competence Di Leonardi and coauthors

(2020) reported a comprehensive literature review on continuing competence that included 50 arti- cles published since 2012. The review was preliminary work for purposes of revisiting the earlier definition of continuing compe- tence given in this article’s intro- duction (Di Leonardi & Biel, 2012). Literature findings were reported in four categories: identifying specific competencies, validating compe- tencies, international competency assessment, and competencies in disciplines other than nursing. Discussion: Specialty certification builds on nursing licensure

Review findings in the category of validating competencies were rel- evant to the current study. The cat- egory focused on how proficiencies required for specific credentials such as certification can be “validat- ed and revalidated periodically in a defensible yet financially and logis- tically feasible way” (Di Leonardi et al., 2020, p. 19). Attendance at for- mal or informal educational ses- sions was one of the most common methods for maintaining continu-


The Medical-Surgical Nursing Certification Board is reviewing strategies and requirements for demonstrating continuing competence for the Certified Medical-Surgical Registered Nurse (CMSRN®) credential.


Determine current methods of continuing competence, facilitators and barriers of continuing competence, and perceptions of the value of certi- fication by CMSRNs.


A national online survey was disseminated to CMSRNs who were 3-5 years after initial certification or 3-5 years after recertification.


CMSRNs mainly used continuing education to demonstrate continuing competence. Certificants highly valued intrinsic aspects of certification, such as personal satisfaction and accomplishment. The extrinsic benefit of increased marketability was valued highly as well. Main facilitators of continuing competence and certification were reimbursement of costs and paid time off for continuing education and conferences. Main barri- ers were costs, lack of paid time off, and tracking education for various recertification requirements.

Limitations and Implications

A convenience sample and low response rate limit generalizability of results. A combination of intrinsic and extrinsic facilitators is important for certifying organizations and healthcare leaders to use to achieve high- er numbers of specialty-certified nurses. In addition, certifying organiza- tions may need to improve mechanisms to assist certificants as continu- ing competence requirements for recertification change.


Intrinsic and extrinsic values of certification, as well as the facilitators of and barriers to certification, have remained stable over time and across various types of specialty certifications. Future research should examine specific levels and types of certification needed to achieve optimum out- comes.

July-August 2020 • Vol. 29/No. 4 231

ing competence. Some evidence supported educational sessions as a method to increase knowledge and perceived competence. Alternately, the review reported professionals might attend educational courses that are convenient and affordable, but not of high quality or not in the area of greatest learning need. Atten dance at educational pro- grams does not ensure changes in practice. Authors suggested partici- pants may not “be able to under- stand, retain, or use the informa- tion that was provided” (p. 19).

Other continuing competence methods used for recertification included completion of a written examination, documentation of practice hours in the specialty, scholarship through publication and professional presentation, port- folios, and performance of a formal 360-degree assessment (Di Leonardi et al., 2020). Although simulation (patient and virtual) is accepted as a teaching tool, less evidence existed for using simulation as a method for evaluating continuing compe- tence in credentialing and certifica- tion.

The Value of Nursing Specialty Certification

Whitehead and colleagues (2019) reported a systematic review of the relationship between specialty nurs- ing certification and patient, nurse, and organizational outcomes. The review included 41 articles pub- lished 2000-2018. Nurse-related outcomes were reported in the cate- gories of personal and professional incentives, knowledge and skills, job satisfaction, organizational commitment, empowerment, and confidence. Discussion: Specialty certification builds on nursing licensure

Review findings in the nurse out- come categories of personal and pro- fessional incentives were relevant to the current study (Whitehead et al., 2019). In 13 studies representing a variety of specialty areas, respon- dents completed the Perceived Value of Certification Tool (PVCT), which measures the value of certifi- cation in two domains: intrinsic and extrinsic rewards, specified as per- sonal and professional incentives respectively by Whitehead and

coauthors. The three highest-rated intrinsic rewards for certified nurses were consistent across all 13 studies. These were enhances feeling of person- al accomplishment, provides personal satisfaction, and validates specialized knowledge. Based on seven of the 13 studies, the average agreement rate was 98.45%, 97.93%, and 97.13%, respectively.

Among the PVCT extrinsic values, Whitehead and colleagues (2019) reported the three highest-scoring statements were certification pro- motes recognition from peers, promotes recognition from other health profes- sionals, and promotes recognition from employers. The average levels of agreement were 85.96%, 78.68%, and 84.45%, respectively. Across studies in the review, extrinsic fac- tors scored lower than intrinsic fac- tors, but were still high, with one exception. Increases salary consistent- ly had the lowest average of 41.1%.

Since the review by Whitehead and coauthors (2019), two studies on the perceived value of certifica- tion have been published. Barbe and Kimble (2018) surveyed 92 nursing academic faculty members who were certified nurse educators. The three highest-rated intrinsic items were validates specialized knowledge (99%), enhances feelings of personal accomplishment (98.9%), and provides personal satisfaction (97.9%). For extrinsic items, the three highest scored items were pro- motes recognition from peers (91.3%), increases marketability (80.4%), and promotes recognition from employer (76.1%). Increases salary was the lowest scoring item (13.1%).

Garrison and associates (2018) surveyed 143 specialty-certified nurses at one midwestern commu- nity hospital. The two highest-scor- ing intrinsic items were enhances feeling of personal accomplishment (97.2%) and validates specialized knowledge (97.2%). Promotes personal satisfaction, enhances professional credibility, and provides professional challenge all received 96.5% agree- ment. The three highest-scoring extrinsic factors were increases mar- ketability (95.1%), promotes recogni- tion from employers (95.1%), and increases salary (88.1%). Discussion: Specialty certification builds on nursing licensure


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