Public Health Nursing Vol. 32 No. 5, pp. 565–576 0737-1209/© 2015 Wiley Periodicals, Inc. doi: 10.1111/phn.12206
SPECIAL FEATURES: HEALTH POLICY
Credentialing Public Health Nurses: Current Issues and Next Steps Forward Christine L. Vandenhouten, PhD, RN, APHN-BC,1 Crystal L. DeVance-Wilson, MS, MBA, PHCNS-BC,2 and Barbara Battin Little, DNP, MPH, RN, APHN-BC, CNE3 1 University of WI-Green Bay Professional Program in Nursing, Green Bay, Wisconsin; 2University of Maryland School of Nursing, Baltimore, Maryland; and 3College of Nursing, Florida State University, Sarasota, Florida
Correspondence to: Christine L. Vandenhouten, University of WI-Green Bay Professional Program in Nursing, 2420 Nicolet Drive, Green Bay, WI 54311-7001. E-mail: [email protected]
ABSTRACT Objectives: The purpose of this descriptive, cross-sectional study was to identify Public Health Nurses (PHN) perceived motivators and barriers to seeking PHN board certification. Design and Sample: In collaboration with the Quad Council of Public Health Nursing Organizations, PHNs from across the United States were invited to complete the PHN Certification Survey, a 14-item online questionnaire. Measures: A total of 912 surveys were completed. Results: PHNs were motivated to seek PHN board certification by three overarching categories: professional competence, personal satisfaction, and financial incentives. Frequently cited barriers to certification were lack of knowledge of certification opportunities, being unaware of eligibility criteria, cost, perceived lack of value/reward by employer, and preparation time. Conclusions: Demonstrating a highly educated, competent, and reliable PHN workforce can only be achieved through ongoing professional development and credentialing. PH stakeholders (i.e., PHN organizations, employers, PHNs, etc.) need a strategic approach to address the main barriers to certification identified in this study (a) awareness of certification and eligibility criteria, and (b) recognition of the credential by employers. In addition, research on the relationship between PHN credentialing and population health outcomes is essential. Key words: certification, credential, public health, public health nurse, workforce development.
A well-prepared public health nurse (PHN) workforce is needed to ensure the health of the public. Healthy People 2020, the nation’s health plan, identified the need for a capable and qualified workforce as one of the three key components of an effective PH infrastructure (U.S. Department of Health and Human Services, 2015). Further, the Institute of Medicine’s (IOM) landmark report, The Future of Nursing: Leading Change, Advancing Health, recommended accrediting bodies, schools of nursing and health care organizations collaborate to ensure that nurses engage in lifelong learning to gain the competencies needed to provide for diverse populations. An effective method to demonstrate these competencies is through credentialing (Institute of Medicine [IOM], 2011).
Despite the benefits of credentialing for patients, health care institutions, and nurses, the numbers of board-certified public health nurses remain low. A national PHN enumeration study conducted by the University of Michigan (2013) surveyed 48,832 registered nurses employed by local (LHD) and state (SHD) health departments. When asked about certification, 16% of PHNs reported holding certification in nursing or PH. Of those certified (n = 7,864/48,674), only 12% (n = 924/7,864) hold Advanced Public Health Nurse-Board Certified (APHN-BC) certification with an additional 10% (n = 762) holding the credential Public/Community Health Clinical Nurse Specialist-Board Certified (PHCNS-BC) and 6% (n = 479) hold the Certified in Public Health
565
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(CPH) credential (University of Michigan, 2013, p. 50). Level of education provides one explanation for the low numbers of PHN board-certified nurses. Advanced practice public health nursing certification requires a minimum educational attainment of a master’s degree. The enumeration study identified 39% of registered nurses (RNs) in LHDs and SHDs held associate’s degrees or diplomas, 49% held bachelor’s degrees, and 12% held master’s or doctoral degrees in nursing (University of Michigan, 2013). Before the retirement of the baccalaureate PHN board certification, a substantial portion of the PHN workforce studied (61%) would have met the educational criteria needed to apply for PHN certification. However at this time, only 12% of the sample meets the master’s educational requirement for the new certification portfolio process. Nursing education programs currently prepare nurses at the associate and baccalaureate degree levels for RN licensure; however, associate’s degree programs provide very little population-focused, public health nursing content. While licensure of RNs ensures a minimal level of safety, PHN board certification, also referred to as credentialing, recognizes advanced PHN specialty knowledge as well as a commitment to providing excellent care (American Nurses Credentialing Center [ANCC], 2014). Credentialing recognizes the professional expertise required for public health decision making that can only be verified through a process outside of the educational experience (Gebbie et al., 2007). Both educational and credentialing requirements to practice PH nursing lack consistency across the United States. For example, baccalaureate education is a minimum requirement for PHN positions in only a few states (e.g., CA, MD, MN, NC, NJ and WI), while in other states an associate’s degree is the minimum level of education required to practice PH nursing. Some states (e.g., California, Minnesota) require nurses to have at minimum a bachelor’s degree in nursing (BSN) and hold a state-specific PHN certification (CA) or registration (MN) to hold the title PHN. The requirements to obtain the state-specific PHN recognition involves documentation of PHN content and field experiences obtained from an accredited nursing school (Minnesota Board of Nursing, 2012; State of California Department of Consumer Affairs, Board of
September/October 2015
Registered Nursing, 2013) and training in child abuse recognition and reporting (State of California Department of Consumer Affairs, Board of Registered Nursing, 2013). While documentation of PHN content in the baccalaureate curriculum ensures the PHN workforce has basic knowledge, this process does not ensure the level of specialty knowledge documented through traditional examination or portfolio credentialing process currently required by ANCC.
Background PHN credentialing options. The ANCC is the main source of nursing specialty credentialing designed to document specialized knowledge and competency. In past years, both bachelor’s- and master’s-prepared PHNs were able to demonstrate specialty PH knowledge and expertise via the basic Community/PHN Board Certified (C/PHN-BC) credential (bachelor’s-prepared nurses), APHN-BC, and PHCNS-BC credentials (master’s-prepared nurses). In 2005, the ANCC retired the basic C/ PHN-BC exam, thereby eliminating a PHN credentialing option for bachelor’s-prepared nurses, which comprise the majority of the PHN workforce. Then in 2014, ANCC retired the advanced-level exam citing poor exam psychometrics resulting from insufficient numbers of nurses sitting for the exam (ANCC, 2014; Bekemeier, 2007; Little, Vandenhouten, & DeVance-Wilson, 2013). The advanced-level exam was replaced with a portfolio-based assessment for nurses with graduate degrees in public/ community health nursing or a related field (ANCC, 2014). Alternatively, PHNs with graduate degrees in PH from a program accredited by the Council on Education for Public Health (CEPH), may seek the non-nursing CPH credential offered by the National Board of Public Health Examiners (NBPHE, n.d.). Perspectives on nurse credentialing. Professional credentialing/certification in nursing has existed for approximately 35 years. There are currently over 200 specialty nursing certifications offered by national nursing organizations with over 100,000 nurses holding a nursing credential (Wade, 2009). As evidenced by the numbers of specialty nurse certifications, certification is widely viewed as an effective means for demonstrating competency and quality in nursing practice. Although nurses value certification, utilization of
Vandenhouten et al.: Credentialing Public Health Nurses
567
nursing certification varies across specialties, institutions, and geographic regions. While credentialing provides a means to document specialty knowledge and expertise, many PHNs encounter challenges to seeking board certification. Williams and Counts (2013) summarized the results of 39 articles on the value, challenges, and outcomes of nursing specialty certification. They found the issues related to certification centered on motivators and barriers to becoming certified, including effective strategies to promote certification, documenting the impact of certification on patient care quality and outcomes, and demonstrating varying levels of competence between certified and noncertified nurses. Bekemeier (2007) explored the perceived value of credentialing in a sample of PHNs belonging to a national PHN organization. She found both intrinsic and extrinsic factors motivated PHNs to seek credentialing. Intrinsic factors were those with personal implications such as personal satisfaction, a feeling of accomplishment, professional challenge, validation of specialized knowledge, and enhanced professional credibility. Extrinsic factors were those that were more “outwardly focused and market related” and included increased salary, employer recognition, and consumer confidence (Bekemeier, 2007). Outside of personal motivation, there were few incentives for PHNs to seek certification. Bekemeier found four categories of barriers to PHN credentialing. These included external recognition barriers (e.g., lack of financial remuneration or promotion incentives), credentialing requirement barriers (e.g., lack of knowledge, cost of certification, maintenance requirements), personal barriers (e.g., lack of professional benefit, leadership opportunities, or academic benefit), and confidence barriers (e.g., not identifying self as expert C/PHN, lack of test taking skills, and lack of confidence in one’s knowledge). Similarly, Hilliard and Boulton (2012) in a review of PH workforce research cite “the lack of external recognition for the credential and related financial or other benefit” as a strong barrier to utilization.
care, nursing excellence, and innovations in professional nursing practice” (ANCC, 2013). MAGNET recognition requires a minimum percentage of nurses be bachelor’s prepared and certified in their specialty practice. In many cases, nurses in acute care settings receive promotions, special recognitions, and financial remuneration for specialty certification, particularly those required by the employer. In 2011, the Public Health Accreditation Board (PHAB) began awarding accreditation to state and local public health departments based on a set of performance standards grouped into 12 domains. Domain 8 focuses on development of a competent PH workforce (including nurses) (PHAB, 2011). The PHAB does not specifically require PHN board certification for agency accreditation but does require documentation of workforce competency via professional development and training. Greater numbers of staff holding a PHN board certification provides evidence of workforce competency necessary for health departments seeking accreditation. The Quad Council of Public Health Nursing Organizations (n.d.) (Quad Council) comprised of representatives from the Public Health Nursing Section of the American Public Health Association (PHN-APHA), the Association of Community Health Nursing Educators (ACHNE), the Association of Public Health Nursing (APHN), and the American Nurses Association (ANA) conducted a webinar promoting PHN credentialing. In preparation for the webinar, a national survey was undertaken by the ACHNE Education Committee to assess the target audience. The purpose of this study was to explore motivators and barriers to PHN board certification and preferred preparation methods for the certification exam among PHNs.
Organizational accreditation and credentialing. Organizational accreditation processes for health systems and public health departments require documentation of workforce competence. For example, MAGNET recognition is awarded by the ANCC to hospitals providing “quality patient
2. Does membership in the PHN organizations, work setting, or role influence certification status?
Research questions The following research questions guided the study: 1. What is the current status and interest in PH board certification among PHNs?
3. To what degree do employers require and/or reward PHNs for the PH board certification/credential?
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4. What are perceived motivators for certification for board-certified PHNs? 5. What are perceived barriers to certification for PHNs not currently board-certified in PH?
Methods Design and sample This study used a descriptive, cross-sectional design. Following institutional review board approval, a convenience sample of PHNs belonging to the PHN-APHA section, ACHNE, and APHN were sent a link to the electronic PHN Certification Survey. The survey was distributed via e-mail using Qualtrics©, an online survey software application. An e-mail invitation was distributed to designated members of the PHN organizations who then distributed the survey via e-mail to their corresponding membership. Participants were instructed to forward the e-mail invitation to other PHN colleagues. This resulted in a “snowball” effect with the potential to increase representation of the broader PHN workforce. Measures A 14-item, online questionnaire was developed to explore PHNs current certification status, interest in becoming PH certified, awareness of the revised eligibility criteria for the APHN-BC exam, as well as perceived motivators and barriers to obtaining the PH credential. Participants were also asked whether their credential helped when applying for positions, and if their employer required or provided incentives (e.g., pay differential, promotion, etc.) for certification. An expert panel including PHN leaders representing the Quad council reviewed the instrument to enhance instrument validity. Analytic strategy Survey responses were analyzed using Statistical Package for the Social Sciences (SPSS) Version 21. Descriptive statistics were calculated for survey items including certification status by select demographic variables (education, work setting and
September/October 2015
role, and membership in professional organizations), awareness of certification option, interest in becoming PH certified, as well as, motivators and barriers to becoming certified.
Results A total of 912 PHNs completed the survey. When asked about their highest degree held, 16% of participants held an associate degree, 39% held a bachelor’s degree, 30% held a master’s degree, and 16% had an earned doctorate. The majority of participants (n = 647, 71%) reported they were not currently certified. Of the 29% who were certified, more PHNs (19%) held non-PHN certifications in specialties such as pediatrics. Of the 73 (8%) participants certified in PHN, equal numbers (4%) held the APHNBC and PHCNS-BC credential. An additional 22 (2%) held the nonnursing CPH credential.
PHN certification by select demographic characteristics Table 1 describes the certification status of study participants with regard to their highest degree held, employment setting/role, and membership status in one or more PHN organizations. Staff nurses and those in administrative positions were more likely to hold a non-PH board certification. Results indicated that master’s-prepared PHNs were more likely to hold a non-PH certification while those with a doctoral degree were more likely to hold a PH board certification. Board-certified faculty were almost equally likely to hold a PHN or other specialty board certification (27% and 24%, respectively). When exploring certification status in relation to type of employment setting, PHNs working in an official PH department were less likely to be PH board-certified than those employed in nonofficial, community-based settings (6% and 16%, respectively). Finally, between 50% and 62% of participants who identified themselves as a member of a PHN professional organization (e.g., ACHNE, PHN-APHA, APHN) were not certified in either PHN or other specialties. Members of ACHNE and APHN were more likely to be PHN certified, while PHN-APHA members were equally credentialed in PHN or other specialty certifications.
Vandenhouten et al.: Credentialing Public Health Nurses TABLE 1. Certification Status Select Sample Characteristics
569
with
Characteristics Education Degree Associate’s (ADN)b Baccalaureate (BSN/BS) Master’s (MSN, MPH, other) Doctoral (PhD, DNP, EdD) Role Staff Nurse Administrative Staff Educator Faculty Setting Official PH setting College/University Other Community settingc Membershipd ACHNE APHA-PHN APHN ANA Other (state affiliates) Not a Member of any organization
Other certification n (%)
Not certified n (%)
Total numbera
– 10 (3)
– 58 (17)
– 266 (79)
135 336
28 (11)
9 (3)
74 (28)
150 (82)
261
39 (29)
1 (.01)
25 (19)
70 (52)
135
PHN certified n (%) – 2 (0.01)
6 12 3 42
(2) (4) (17) (27)
16 (3) 39 (26) 18 (12)
47 50 13 35 18
(30) (19) (21) (16) (9)
7 (2)
CPH n (%)
7 11 1 1
(3) (4) (6) (
SPECIAL FEATURES: HEALTH POLICY
Credentialing Public Health Nurses: Current Issues and Next Steps Forward Christine L. Vandenhouten, PhD, RN, APHN-BC,1 Crystal L. DeVance-Wilson, MS, MBA, PHCNS-BC,2 and Barbara Battin Little, DNP, MPH, RN, APHN-BC, CNE3 1 University of WI-Green Bay Professional Program in Nursing, Green Bay, Wisconsin; 2University of Maryland School of Nursing, Baltimore, Maryland; and 3College of Nursing, Florida State University, Sarasota, Florida
Correspondence to: Christine L. Vandenhouten, University of WI-Green Bay Professional Program in Nursing, 2420 Nicolet Drive, Green Bay, WI 54311-7001. E-mail: [email protected]
ABSTRACT Objectives: The purpose of this descriptive, cross-sectional study was to identify Public Health Nurses (PHN) perceived motivators and barriers to seeking PHN board certification. Design and Sample: In collaboration with the Quad Council of Public Health Nursing Organizations, PHNs from across the United States were invited to complete the PHN Certification Survey, a 14-item online questionnaire. Measures: A total of 912 surveys were completed. Results: PHNs were motivated to seek PHN board certification by three overarching categories: professional competence, personal satisfaction, and financial incentives. Frequently cited barriers to certification were lack of knowledge of certification opportunities, being unaware of eligibility criteria, cost, perceived lack of value/reward by employer, and preparation time. Conclusions: Demonstrating a highly educated, competent, and reliable PHN workforce can only be achieved through ongoing professional development and credentialing. PH stakeholders (i.e., PHN organizations, employers, PHNs, etc.) need a strategic approach to address the main barriers to certification identified in this study (a) awareness of certification and eligibility criteria, and (b) recognition of the credential by employers. In addition, research on the relationship between PHN credentialing and population health outcomes is essential. Key words: certification, credential, public health, public health nurse, workforce development.
A well-prepared public health nurse (PHN) workforce is needed to ensure the health of the public. Healthy People 2020, the nation’s health plan, identified the need for a capable and qualified workforce as one of the three key components of an effective PH infrastructure (U.S. Department of Health and Human Services, 2015). Further, the Institute of Medicine’s (IOM) landmark report, The Future of Nursing: Leading Change, Advancing Health, recommended accrediting bodies, schools of nursing and health care organizations collaborate to ensure that nurses engage in lifelong learning to gain the competencies needed to provide for diverse populations. An effective method to demonstrate these competencies is through credentialing (Institute of Medicine [IOM], 2011).
Despite the benefits of credentialing for patients, health care institutions, and nurses, the numbers of board-certified public health nurses remain low. A national PHN enumeration study conducted by the University of Michigan (2013) surveyed 48,832 registered nurses employed by local (LHD) and state (SHD) health departments. When asked about certification, 16% of PHNs reported holding certification in nursing or PH. Of those certified (n = 7,864/48,674), only 12% (n = 924/7,864) hold Advanced Public Health Nurse-Board Certified (APHN-BC) certification with an additional 10% (n = 762) holding the credential Public/Community Health Clinical Nurse Specialist-Board Certified (PHCNS-BC) and 6% (n = 479) hold the Certified in Public Health
565
566
Public Health Nursing
Volume 32
Number 5
(CPH) credential (University of Michigan, 2013, p. 50). Level of education provides one explanation for the low numbers of PHN board-certified nurses. Advanced practice public health nursing certification requires a minimum educational attainment of a master’s degree. The enumeration study identified 39% of registered nurses (RNs) in LHDs and SHDs held associate’s degrees or diplomas, 49% held bachelor’s degrees, and 12% held master’s or doctoral degrees in nursing (University of Michigan, 2013). Before the retirement of the baccalaureate PHN board certification, a substantial portion of the PHN workforce studied (61%) would have met the educational criteria needed to apply for PHN certification. However at this time, only 12% of the sample meets the master’s educational requirement for the new certification portfolio process. Nursing education programs currently prepare nurses at the associate and baccalaureate degree levels for RN licensure; however, associate’s degree programs provide very little population-focused, public health nursing content. While licensure of RNs ensures a minimal level of safety, PHN board certification, also referred to as credentialing, recognizes advanced PHN specialty knowledge as well as a commitment to providing excellent care (American Nurses Credentialing Center [ANCC], 2014). Credentialing recognizes the professional expertise required for public health decision making that can only be verified through a process outside of the educational experience (Gebbie et al., 2007). Both educational and credentialing requirements to practice PH nursing lack consistency across the United States. For example, baccalaureate education is a minimum requirement for PHN positions in only a few states (e.g., CA, MD, MN, NC, NJ and WI), while in other states an associate’s degree is the minimum level of education required to practice PH nursing. Some states (e.g., California, Minnesota) require nurses to have at minimum a bachelor’s degree in nursing (BSN) and hold a state-specific PHN certification (CA) or registration (MN) to hold the title PHN. The requirements to obtain the state-specific PHN recognition involves documentation of PHN content and field experiences obtained from an accredited nursing school (Minnesota Board of Nursing, 2012; State of California Department of Consumer Affairs, Board of
September/October 2015
Registered Nursing, 2013) and training in child abuse recognition and reporting (State of California Department of Consumer Affairs, Board of Registered Nursing, 2013). While documentation of PHN content in the baccalaureate curriculum ensures the PHN workforce has basic knowledge, this process does not ensure the level of specialty knowledge documented through traditional examination or portfolio credentialing process currently required by ANCC.
Background PHN credentialing options. The ANCC is the main source of nursing specialty credentialing designed to document specialized knowledge and competency. In past years, both bachelor’s- and master’s-prepared PHNs were able to demonstrate specialty PH knowledge and expertise via the basic Community/PHN Board Certified (C/PHN-BC) credential (bachelor’s-prepared nurses), APHN-BC, and PHCNS-BC credentials (master’s-prepared nurses). In 2005, the ANCC retired the basic C/ PHN-BC exam, thereby eliminating a PHN credentialing option for bachelor’s-prepared nurses, which comprise the majority of the PHN workforce. Then in 2014, ANCC retired the advanced-level exam citing poor exam psychometrics resulting from insufficient numbers of nurses sitting for the exam (ANCC, 2014; Bekemeier, 2007; Little, Vandenhouten, & DeVance-Wilson, 2013). The advanced-level exam was replaced with a portfolio-based assessment for nurses with graduate degrees in public/ community health nursing or a related field (ANCC, 2014). Alternatively, PHNs with graduate degrees in PH from a program accredited by the Council on Education for Public Health (CEPH), may seek the non-nursing CPH credential offered by the National Board of Public Health Examiners (NBPHE, n.d.). Perspectives on nurse credentialing. Professional credentialing/certification in nursing has existed for approximately 35 years. There are currently over 200 specialty nursing certifications offered by national nursing organizations with over 100,000 nurses holding a nursing credential (Wade, 2009). As evidenced by the numbers of specialty nurse certifications, certification is widely viewed as an effective means for demonstrating competency and quality in nursing practice. Although nurses value certification, utilization of
Vandenhouten et al.: Credentialing Public Health Nurses
567
nursing certification varies across specialties, institutions, and geographic regions. While credentialing provides a means to document specialty knowledge and expertise, many PHNs encounter challenges to seeking board certification. Williams and Counts (2013) summarized the results of 39 articles on the value, challenges, and outcomes of nursing specialty certification. They found the issues related to certification centered on motivators and barriers to becoming certified, including effective strategies to promote certification, documenting the impact of certification on patient care quality and outcomes, and demonstrating varying levels of competence between certified and noncertified nurses. Bekemeier (2007) explored the perceived value of credentialing in a sample of PHNs belonging to a national PHN organization. She found both intrinsic and extrinsic factors motivated PHNs to seek credentialing. Intrinsic factors were those with personal implications such as personal satisfaction, a feeling of accomplishment, professional challenge, validation of specialized knowledge, and enhanced professional credibility. Extrinsic factors were those that were more “outwardly focused and market related” and included increased salary, employer recognition, and consumer confidence (Bekemeier, 2007). Outside of personal motivation, there were few incentives for PHNs to seek certification. Bekemeier found four categories of barriers to PHN credentialing. These included external recognition barriers (e.g., lack of financial remuneration or promotion incentives), credentialing requirement barriers (e.g., lack of knowledge, cost of certification, maintenance requirements), personal barriers (e.g., lack of professional benefit, leadership opportunities, or academic benefit), and confidence barriers (e.g., not identifying self as expert C/PHN, lack of test taking skills, and lack of confidence in one’s knowledge). Similarly, Hilliard and Boulton (2012) in a review of PH workforce research cite “the lack of external recognition for the credential and related financial or other benefit” as a strong barrier to utilization.
care, nursing excellence, and innovations in professional nursing practice” (ANCC, 2013). MAGNET recognition requires a minimum percentage of nurses be bachelor’s prepared and certified in their specialty practice. In many cases, nurses in acute care settings receive promotions, special recognitions, and financial remuneration for specialty certification, particularly those required by the employer. In 2011, the Public Health Accreditation Board (PHAB) began awarding accreditation to state and local public health departments based on a set of performance standards grouped into 12 domains. Domain 8 focuses on development of a competent PH workforce (including nurses) (PHAB, 2011). The PHAB does not specifically require PHN board certification for agency accreditation but does require documentation of workforce competency via professional development and training. Greater numbers of staff holding a PHN board certification provides evidence of workforce competency necessary for health departments seeking accreditation. The Quad Council of Public Health Nursing Organizations (n.d.) (Quad Council) comprised of representatives from the Public Health Nursing Section of the American Public Health Association (PHN-APHA), the Association of Community Health Nursing Educators (ACHNE), the Association of Public Health Nursing (APHN), and the American Nurses Association (ANA) conducted a webinar promoting PHN credentialing. In preparation for the webinar, a national survey was undertaken by the ACHNE Education Committee to assess the target audience. The purpose of this study was to explore motivators and barriers to PHN board certification and preferred preparation methods for the certification exam among PHNs.
Organizational accreditation and credentialing. Organizational accreditation processes for health systems and public health departments require documentation of workforce competence. For example, MAGNET recognition is awarded by the ANCC to hospitals providing “quality patient
2. Does membership in the PHN organizations, work setting, or role influence certification status?
Research questions The following research questions guided the study: 1. What is the current status and interest in PH board certification among PHNs?
3. To what degree do employers require and/or reward PHNs for the PH board certification/credential?
568
Public Health Nursing
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Number 5
4. What are perceived motivators for certification for board-certified PHNs? 5. What are perceived barriers to certification for PHNs not currently board-certified in PH?
Methods Design and sample This study used a descriptive, cross-sectional design. Following institutional review board approval, a convenience sample of PHNs belonging to the PHN-APHA section, ACHNE, and APHN were sent a link to the electronic PHN Certification Survey. The survey was distributed via e-mail using Qualtrics©, an online survey software application. An e-mail invitation was distributed to designated members of the PHN organizations who then distributed the survey via e-mail to their corresponding membership. Participants were instructed to forward the e-mail invitation to other PHN colleagues. This resulted in a “snowball” effect with the potential to increase representation of the broader PHN workforce. Measures A 14-item, online questionnaire was developed to explore PHNs current certification status, interest in becoming PH certified, awareness of the revised eligibility criteria for the APHN-BC exam, as well as perceived motivators and barriers to obtaining the PH credential. Participants were also asked whether their credential helped when applying for positions, and if their employer required or provided incentives (e.g., pay differential, promotion, etc.) for certification. An expert panel including PHN leaders representing the Quad council reviewed the instrument to enhance instrument validity. Analytic strategy Survey responses were analyzed using Statistical Package for the Social Sciences (SPSS) Version 21. Descriptive statistics were calculated for survey items including certification status by select demographic variables (education, work setting and
September/October 2015
role, and membership in professional organizations), awareness of certification option, interest in becoming PH certified, as well as, motivators and barriers to becoming certified.
Results A total of 912 PHNs completed the survey. When asked about their highest degree held, 16% of participants held an associate degree, 39% held a bachelor’s degree, 30% held a master’s degree, and 16% had an earned doctorate. The majority of participants (n = 647, 71%) reported they were not currently certified. Of the 29% who were certified, more PHNs (19%) held non-PHN certifications in specialties such as pediatrics. Of the 73 (8%) participants certified in PHN, equal numbers (4%) held the APHNBC and PHCNS-BC credential. An additional 22 (2%) held the nonnursing CPH credential.
PHN certification by select demographic characteristics Table 1 describes the certification status of study participants with regard to their highest degree held, employment setting/role, and membership status in one or more PHN organizations. Staff nurses and those in administrative positions were more likely to hold a non-PH board certification. Results indicated that master’s-prepared PHNs were more likely to hold a non-PH certification while those with a doctoral degree were more likely to hold a PH board certification. Board-certified faculty were almost equally likely to hold a PHN or other specialty board certification (27% and 24%, respectively). When exploring certification status in relation to type of employment setting, PHNs working in an official PH department were less likely to be PH board-certified than those employed in nonofficial, community-based settings (6% and 16%, respectively). Finally, between 50% and 62% of participants who identified themselves as a member of a PHN professional organization (e.g., ACHNE, PHN-APHA, APHN) were not certified in either PHN or other specialties. Members of ACHNE and APHN were more likely to be PHN certified, while PHN-APHA members were equally credentialed in PHN or other specialty certifications.
Vandenhouten et al.: Credentialing Public Health Nurses TABLE 1. Certification Status Select Sample Characteristics
569
with
Characteristics Education Degree Associate’s (ADN)b Baccalaureate (BSN/BS) Master’s (MSN, MPH, other) Doctoral (PhD, DNP, EdD) Role Staff Nurse Administrative Staff Educator Faculty Setting Official PH setting College/University Other Community settingc Membershipd ACHNE APHA-PHN APHN ANA Other (state affiliates) Not a Member of any organization
Other certification n (%)
Not certified n (%)
Total numbera
– 10 (3)
– 58 (17)
– 266 (79)
135 336
28 (11)
9 (3)
74 (28)
150 (82)
261
39 (29)
1 (.01)
25 (19)
70 (52)
135
PHN certified n (%) – 2 (0.01)
6 12 3 42
(2) (4) (17) (27)
16 (3) 39 (26) 18 (12)
47 50 13 35 18
(30) (19) (21) (16) (9)
7 (2)
CPH n (%)
7 11 1 1
(3) (4) (6) (
