JONA Volume 44, Number 6, pp 368-371 Copyright B 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

THE JOURNAL OF NURSING ADMINISTRATION

Supporting Nurse Manager Certification Susan Rees, DNP, RN, CPHQ, CENP Michele Glynn, MSN, RN, RN-BC Rebecca Moore, MBA

Rebecca Rankin, MS, RN, CPHQ, PMP Linda Stevens, DNP, RN-BC, CPHQ, CSPHP

Professional certification is desirable for nursing staff and leaders to demonstrate high levels of knowledge and expertise. Nurse managers can be role models for staff by attaining certification. The organization highlighted in this article developed a process that included an in-house nurse manager certification review course resulting in increased certification rates from 33% to 50% for nurse managers in a 14-month period.

there is a 2% decrease in patient deaths.2 Patient falls are reported to be lower on units where the percentage of certified nurses is higher.3 Certified oncology nurses follow evidence-based guidelines at higher rates than do noncertified nurses for chemotherapyinduced nausea and vomiting.4 Educating nurses on the concepts related to nurse certification was associated with an increase in knowledge, an increase in adverse event reporting, and a decrease in the nursing vacancy rate.5 A majority of certified nurses (77%) perceive that certification has an impact on patient and family satisfaction.6 One study did report no relationship between the percentage of certified nurses and nurse-sensitive outcomes including ventilatorassociated pneumonia, catheter-associated bloodstream infection, and hospital-acquired pressure ulcers.7 National studies indicate that the perception of nurse certification is favorable by both nurses who are and are not certified.8,9 In addition, NMs positively perceive the value of certification.1,8,9 A significant relationship was found between the perception of workplace empowerment and percentage of certified nurses.7 While the value of certification is apparent, creating a culture that promotes and supports certification should be in place to increase the number of certified nurses. Nurse managers should become role models in achieving certification.10 Additional reasons for seeking certification include an increased personal sense of achievement (94%), professional recognition (63%), validation of clinical competency (57%), and supervisor encouragement (31%).6 Unitbased strategies to increase certification are role modeling, identifying eligible staff for certification, selecting a specific certification program, dedicating fiscal resources, developing preparation strategies for the examination such as review courses or materials, supporting staff on the day of the examination, and recognition for certification.11

The importance of and challenges of the role of a nurse manager (NM) are well documented. Because of the increasing complexity in the healthcare environment, the ongoing training and development of NMs are essential. To address these issues and ensure competence, some organizations require that all NMs become certified when they meet the eligibility requirements for certification.1 Supporting NMs in achieving certification is 1 way to demonstrate highlevel performance and an understanding of standards of excellence. The impact to patients when higher percentages of nurses are certified has been well documented.2-6 Patient outcomes related to the percentage of nurses certified report that for every 10% increase in the number of BSN-prepared nurses who are certified, Author Affiliations: Vice President, Development, Nursing & Patient Care Services (Dr Rees); Director, Education and Development for Nursing & Patient Care Services (Ms Glynn); Director, Nursing Finance and Staffing Effectiveness (Ms Moore); Director, Nursing Informatics (Ms Rankin); and Director, Nursing Quality and Safety (Dr Stevens), University of Wisconsin Hospital and Clinics, Madison. The authors declare no conflicts of interest. Correspondence: Dr Rees, University of Wisconsin Hospital and Clinics, 600 Highland Ave, H4/822, Madison, WI 53792 ([email protected]). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jonajournal.com). DOI: 10.1097/NNA.0000000000000083

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Background As a Magnet organization, the importance of professional certification is recognized. In 2012, the NM certification rate was 33% (21 of 64), with just 1 NM certified in nursing management/administration, and the remainder certified in a clinical specialty. Nurse managers identified a desire for information and support regarding nurse leader certification in an annual learning needs assessment. Upon further informal exploration by executive nursing leadership, it was determined that the NMs did value certification for themselves. Finding the time to prepare for the examination was identified as a barrier preventing managers from pursuing certification. In addition, NMs expressed a desire for additional professional development in leadership concepts. Nursing leaders felt that combining professional development opportunities with certification preparation could serve a dual purpose and maximize time commitments. Nursing leaders recognized that NMs could serve as role models for nursing staff to advance levels of certification. A process was envisioned by organizational nursing leaders to include the following: A

 creation of an NM certification preparation



 



course utilizing content experts from the organization as instructors for the course development of easy-to-access resources regarding how to study, how to register, and how to form study groups provision of 1-on-1 coaching as well as proctored practice sessions from content experts utilization of multimodal methods of communication to keep the enthusiasm and momentum going and stimulate learning when achieved, publicly recognizing those who achieved certification

The purpose of this article was to describe the process that this 566-bed academic medical center implemented to increase the percentage of certified NMs.

The Certification Initiative In late October 2012, 2 nursing leaders, in conjunction with the chief nursing officer, determined the organization should offer a course to prepare NMs to obtain either the certified nurse manager leader (CNML) certification offered by the American Organization of Nurse Executives12 or the nurse executive certification (NE-BC) offered by the American Nurses Credentialing Center .13 The content was reviewed for each certification by these 2 nursing leaders, and the content was categorized into 6 major sections. These categories were performance imA

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provement, financial management, strategic management, change management, technology, and human resources. It was determined that the organization had the in-house expertise to lead the course, which was projected to be 12 hours in length. The content areas were assigned to 5 content experts. Each expert completed a literature review to develop content for structured classroom teaching and to provide recommended resources for independent study by course participants. Presentations and written content were provided in a binder for each participant. The binders also included detailed information about the requirements for each certification examination, test-taking tips, study questions, practice examinations, and suggestions for independent and group study opportunities. Managers were expected to participate in the certification preparation in addition to their regular roles; however, many of the courses were offered during periods of projected lower census and on days of the week where the workload and meeting schedules were less. With this in mind, 5 weeks after the course was initially proposed, the 1st NM certification preparation course was provided to 19 managers in November 2012. It was clear from the onset that attendees were expected to sit for 1 of the 2 targeted NM certification examinations. Continuing Education One of the requirements for eligibility to take either certification examination is evidence of continuing education. To help participants meet this requirement, continuing education units were offered for the hours of training over the 2-day course. Incorporating adult learning principles, presentations were structured to be didactic as well as interactive with participants sharing multiple real-life scenarios to apply the content and learn for themselves and from their peers. An additional time period was offered at the conclusion of the course for participants to complete a written postcourse examination designed to test overall knowledge of content, gauge individual readiness for an examination, and identify areas for focused review. Content experts proctored the examination and were available to review any questions participants answered incorrectly and discuss the rationale for correct responses. Postcourse Activities Immediately after the course, participants requested and were offered additional time and materials to review financial management concepts and formulas. Access to review books used to prepare all the course content, flashcards, and other materials to continue their studies were provided. In early 2013, leaders

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adopted the course participants and followed up with each participant to inquire about the following: Have you had an opportunity to study? Do you need any further assistance? Would a practice test session be helpful? What are the barriers to you moving forward with the certification examination?  What can we do to support you?  When are you planning to sign up for the certification examination?    

It was discovered that several NMs were scheduled to take an examination or had target dates planned. One NM had organized a study group that several managers planned to join. The most common barrier to preparing for and taking the examination was competing priorities of work and personal stressors and obligations. Many participants expressed test anxiety and fear of failure. Participants requested an additional examination-based practice session to mimic the test-taking experience, which the course leaders offered approximately 2 months after the course. Leaders continued to connect with the NMs to monitor progress and encourage continued commitment to obtaining certification. A milestone was when the 1st NMs successfully passed the certification examination. After that, nursing leadership sent a congratulatory e-mail to each successful manager. Other managers from the cohort were copied on the congratulatory notes to recognize the accomplishment and encourage others to take the examination. The experience, feedback, and outcomes were so positive that course leaders decided to offer the course again in the spring of 2013. Based on feedback from the initial group, the course was expanded to 2 full days of content, with more time spent on financial management and more discussion time provided in the other content areas. Additional project management principles were added, and the course was reorganized to cover less familiar and more complex content on the 1st day.

examination but participated in the class as preparation for future test taking. An overall increase in the percentage of NMs who were certified increased from 33% (21 of 63) as of July 1, 2012, to 50% (31 of 62) as of November 1, 2013. It should be noted that 4 of the NMs who were certified in 2012 are no longer in NM positions (1 retirement, 1 resignation, 2 promotions). The most dramatic evidence in measuring success of the program is the increase from 1 nursing managementYcertified person as of July 1, 2012 (1 NE-BC and 0 CNML), to 17 (5 NE-BC and 12 CNML) as of November 1, 2013. The course evaluations have been positive. The 1st offering had a mean evaluation of 4.55 on a 5-point Likert scale for day 1 and a mean of 4.43 for day 2, with an overall evaluation of 4.49. The 2nd time the course was offered, there was an overall mean evaluation of 4.9 on a 5-point Likert scale.

Discussion The intervention of offering an in-house NM certification review course was very successful and can be replicated in any organization with access to in-house or external expertise. Establishing the course content for each of the major sections was relatively easy. Each content expert reviewed all relevant sections of sample examinations and practice questions that were available free of charge online along with completing a literature review to access current content and standards. Advantages of creating and offering a review course included the following:  Examination preparation time being sched-





Results A total of 27 NMs attended 1 of the 2 certification courses held in late 2012 and early 2013. Sixteen of the 27 course attendees (59%) have passed a certification examination (12 CNML, 4 NE-BC). Fourteen of the 16 (94%) who took the examination passed on the 1st attempt. Eleven NMs have not yet taken the certification examination. One of the 11 participants not taking the test did not meet the eligibility requirements for years of experience to sit for either

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uled into the NMs’ regular work day provided the motivation to start on the path toward certification. Time spent locating, sorting, and compiling examination review materials was performed by 5 content experts, saving valuable time for each individual NM in researching the content. Group discussion, question-answer sessions, and practice examinations following the review course provided each participant with valuable insight into areas needing further review. Review course participants bonded with each other, became study buddies, and provided motivation to take the certification examination. Content experts were identified upfront as resources available for follow-up questions.

Following completion of the 1st review course, the participant evaluations were summarized and reviewed by the content experts. Lessons learned include the following:

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 A 12-day course was not enough time to digest

and discuss all of the materials presented. The initial group of participants suggested increasing the time to 2 full days.  Managers wanted a mixture of what they considered easier and more difficult content on each of the 2 days.  These suggestions were implemented for the 2nd review course offering, and evaluations from group 2 showed an increase in the overall evaluation score. The presentation order and length of time allotted for each content section are available as Document, Supplemental Digital Content 1, http://links.lww.com/ JONA/A312. The concept of NM as role model leading to increased bedside nurse certification has been verified in our institution. As of February 2014, areas with a

certified NM have an overall nurse certification rate of 26.7%, whereas those where the NM is not certified have a rate of 21.3%. The overwhelming positive feedback from participants has led to the decision to continue to provide the NM certification review course at least annually. Every NM will be encouraged to attend the in-house review course when they have met the experience requirements needed for certification. Based on the outcomes realized thus far, it is believed that this example of the NM being a role model for staff, can be successful in promoting a culture of certification. The relationship between NM certification and staff certification should be explored as the numbers of certified NMs increase. Future plans also include a review of other nursing certifications to determine if the same approach can be utilized to increase certifications in other key areas with staff nurses.

References 1. Neibuhr B, Biel M. The value of specialty nursing certification. Nurs Outlook. 2007;55(4):176-181. 2. Kendall-Gallagher D, Aiken L, Sloane D, Cimiotti J. Nurse specialty certification, inpatient mortality, and failure to rescue. J Nurs Scholarsh. 2011;43(2):188-194. 3. Boltz M, Capezuti E, Wagner L, Rosenburg M, Secic M. Patient safety in medical-surgical units: can nurse certification make a difference? Medsurg Nurs. 2013;22(1):26-37. 4. Coleman E, Coon S, Lockhart K, et al. Effect of certification in oncology nursing on nursing-sensitive outcomes. Clin J Oncol Nurs. 2009;13(2):165-172. 5. Valente S. Improving professional practice through certification. J Nurses Staff Dev. 2010;26(5):215-219. 6. Wyatt J, Harrison M. Certified pediatric nurses’ perception of job satisfaction. Pediatr Nurs. 2010;36(4):205-208. 7. Krapohl G, Manojlovich M, Redman R, Zhang L. Nursing specialty certification and nursing-sensitive patient outcomes in the intensive care unit. Am J Crit Care. 2010;19(6):490-498.

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8. Brown C, Murphy C, Norton V, Baldwin P, Ponto J. The value of oncology nursing certification. Clin J Oncol Nurs. 2010;14(6):E63-E69. 9. Haskins M, Hnatiuk C, Yoder L. (2011). Medical-surgical nurses’ perceived value of certification study. Medsurg Nurs. 2011;20(2):71-77, 93. 10. Altman M. Let’s get certified: best practices for nurse leaders to create a culture of certification. AACN Adv Crit Care. 2011; 22(1):68-75. 11. Craven H. Recognizing excellence: unit-based activities to support specialty nursing certification. Medsurg Nurs. 2007; 16(6):367-371. 12. American Organization of Nurse Executives Web site. http:// www.aone.org/education/index.shtml. Accessed February 20, 2014. 13. American Nurses Credentialing Center Web site. http://www .nursecredentialing.org/NurseExecutive. Accessed February 20, 2014.

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Supporting nurse manager certification.

Professional certification is desirable for nursing staff and leaders to demonstrate high levels of knowledge and expertise. Nurse managers can be rol...
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