1. Schroeter, Kathryn PhD, RN, CNE, CNOR

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To be certified or not to be certified-that is the question. What determines why a nurse decides to become certified in a specialty area of practice? The reasons will be as varied as the nurses who make the resultant decision. Some nurses are required to be certified by virtue of their specialty area of practice, such as certified registered nurse anesthetists while other nurses may choose to become certified for their own personal achievement.


Certification recognizes clinical knowledge, experience, and clinical judgment within a nursing specialty. Benefits of certification may include personal growth, career advancement, financial reward, professional recognition, and perceived empowerment. A specialty certification can also function as the means for nurses to achieve higher levels of professional and financial achievement.



I admit that I am biased-as is evidenced by the certifications after my name. I assert, though, that the reasons why individuals choose to pursue or reject personal/professional goals are affected by their values. If we choose to gain something-a new job, education, or certification-we are driven to do so by our values. If we choose to keep something that we have attained in life like our jobs or certification-again it is because we value these things. We might value many different things in our lifetimes and, as a result of life circumstances, we may find ourselves prioritizing our values differently. For example, when we have children, our values may evolve to focus on them. If your career focus is on certification, then you may decide to pursue it.


In a study utilizing the Perceived Value of Certification Tool,1 a sample of 2750 certified (CNOR and/or CRNFA) perioperative nurses was surveyed. Factor analysis extracted 3 factors, accounting for 61% of variance: personal value, recognition by others, and professional practice. More than 90% of respondents agreed or strongly agreed with statements about the value of certification related to feelings of personal accomplishment and satisfaction, validating specialized knowledge, indicating professional growth, attainment of a practice standard, personal challenge, and professional commitment, challenge, and credibility.1


Values related to certification can be intrinsic, such as personal satisfaction and/or achievement, or they can be extrinsic, such as an increase in pay or unit/organizational recognition. Whatever motivates individuals toward a goal is driven by values. Does this mean that only certified nurses can be excellent nurses? Of course not. It may just mean that not all nurses value the credential and also believe that it is not necessary to their practice. That is a choice that each individual nurse can make.


In some organizations, there is a push for increasing the number of certified nurses in all units and there are varying reasons for this trend, that is, Magnet designation, Institute of Medicine recommendations etc. What then is driving this trend? Over the past decade, the number of research studies that have explored the relationship between certification and nursing practice has been increasing. The results of these studies could be shifting the value that is currently being placed on nurse certification by those who manage health care organizations.


Evidence Linked to Nurse Certification

To better examine this trend, several studies are highlighted. There is not space for a detailed review of all the research, but it is easy enough for anyone to find online. A recent study, for example, revealed higher rates of CPAN and CNOR/CRNFA certification in perioperative units that were significantly associated with lower rates of central line-associated bloodstream infections in surgical intensive care units.2


Another study found that empowerment scores and intent to leave either their position or the profession did not differ between staff nurses who were certified and those who were not. Perceptions of informal power, opportunity, and support, however, did differ between the 2 groups.3


Other study results showed that hospitals with a larger percentage of nurses who had baccalaureate degrees and certification had lower 30-day mortality and failure to rescue rates for surgical patients.4 Every 10% increase in the percentage of baccalaureate nurses in hospitals was associated with a 6% decrease in the odds of patients dying (this was for both 30-day mortality and failure to rescue) and every 10% increase in baccalaureate nurses with certification was associated with a 2% decrease in these odds.4 Years of experience in the hospital did not have a significant effect on patient outcomes.4


The association between nurses' perception of overall workplace empowerment and certification, in another study, was positive and statistically significant (r = 0.397; P = .05).5 Another researcher noted that studies have shown certified specialty nurses contribute to quality patient outcomes and satisfaction and that those nurses who have achieved their specialty certification have perceived intrinsic value, empowerment, and heightened collaboration with the health care team.6 No significant relationship, however, was found between the proportion of certified nurses on a unit and patients' outcomes.6


Is it important for nurses to feel empowered? A study explored this question and found that nurses who were certified reported higher levels of empowerment, which has shown to be associated with satisfaction and intent to remain in a current position.7 The researchers conclude that certification provides recognition of the nurses' knowledge and expertise in the specialty area, which in turn is empowering.



In addition to the professional development benefits, there may be some tangible financial incentives in the form of career ladder advancement and pay increases for certification. These benefits could easily be applied across the board to nurses practicing in any type of institution.


There are increasing data to support that obtaining specialty certification promotes quality patient care, validates nurses' knowledge and expertise, builds confidence and credibility in professional ability, and demonstrates dedication to nursing as a profession. Does this trend reflect the values of nurses and those who run health care organizations? Again, it is up to all of us as professionals to identify our values and act on them as we deem appropriate. Values can remain stable over our lifetimes but can also change as our situation changes. For now, I will leave you with just 1 question-Do you value certification?




1. Gaberson KB, Schroeter K, Killen AR, Valentine WA. The perceived value of certification by certified perioperative nurses. Nurs Outlook. 2003;51:272-276. [Context Link]


2. Boyle DK, Cramer E, Potter C, et al. The relationship between direct-care RN specialty certification and surgical patient outcomes. AORN J. 2014;100(5):511-528. [Context Link]


3. Fitzpatrick JJ, Campo TM, Lavandero R. Critical care staff nurses: empowerment, certification, and intent to leave. Crit Care Nurse. 2011;31(6):e12-7. [Context Link]


4. Krapohl G, Manojlovich M, Redman R, Zhang L. Does certification of staff nurses improve patient outcomes? Evid Based Nurs. 2012;15(2):54-55. [Context Link]


5. Nursing specialty certification and nursing-sensitive patient outcomes in the intensive care unit. Am J Crit Care. 2010;19(6):490-449.8 [Context Link]


6. Wilkerson BL. Specialty nurse certification affects patient outcomes. Plast Surg Nurs. 2011;31(2):57-59. [Context Link]


7. Piazza IM, Donahue M, Dykes PC, Griffin MQ, Fitzpatrick JJ. Differences in perceptions of empowerment among nationally certified and noncertified nurses. J Nurs Adm. 2006;36(5):277-283. [Context Link]