1. Fitzpatrick, Melissa A. RN, MSN, FAAN, Editor-in-Chief

Article Content


Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

While our industry cuts costs and faces shortages of essential personnel, how can we assure our patients-and ourselves-that we'll deliver on the sacred trust to do no harm and to achieve the best possible outcomes?


Agencies regulate nursing as a profession because of the potential harm faced by patients in our care. Ideally, such regulation helps ensure that care providers possess the required level of competency to practice. But, licensure, the first step in professional regulation, ensures only that a nurse has acquired basic knowledge and skills. It doesn't prepare her to provide the specialized care that more and more of our patients require, such as high-risk obstetrical care, critical care, and trauma care. Once a nurse obtains licensure, how does he continue to build on that basic knowledge, obtain skills and experiences to care for increasingly complex patients, and maintain competence over time?


Ensuring continued competence remains the primary regulatory issue for state boards of nursing. License renewal alone doesn't guarantee continued competence, as most states don't require evidence of continued competence and continuing education to renew. Nurses in many states can practice for decades without ever demonstrating more than their initial license examination results.


Life after licensure

This situation forces employers to pick up where licensure leaves off. Orientation programs, in-service education, and mentors/preceptors exist to facilitate the development of advanced clinical skills and the attainment of learning opportunities. Many nurses participate in professional organizations, read the current nursing literature, and attend conferences and seminars to learn more about a particular specialty and the profession at large. Still others, and sometimes those same nurses, advance their formal education by attaining higher degrees in nursing and other majors. All of these methods contribute to the continued competence of practicing nurses and to the enhancement of the profession.


Certification provides a way to document that competence. While licensure measures entry-level competence, certification validates specialty knowledge, experience, and clinical judgment. 1 Since the creation of the first certification exams for nurse-anesthetists in 1945, approximately 400,000 American and Canadian nurses have achieved certification in more than 130 specialties.


Sixty-seven different organizations award these certifications, offering more than 95 different credentials to designate them. 2 To renew certification, a nurse must document continuing education and clinical practice requirements or pass the certification exam again. Such examinations must be legally defensible, psychometrically sound, and based on a comprehensive job analysis of the measured nursing practice.


Validating the certified nurse's specialized knowledge and experience promotes continued competency and provides a patient safeguard. Nursing views certification as a mark of excellence, one that requires rigor and competence to attain and maintain. In a time of increased scrutiny by the media and the public, certification provides an important indicator of quality nursing care. With increased competition, hospitals can market certification as a key differentiator between themselves and other hospitals within a community. The sense of achievement, professional validation, and confidence enhances certified nurses' careers. We should support, recognize, and reward certification for its impact on patient care and for its influence on nurse satisfaction and retention.


What to do?

Nurses are more likely to become certified when encouraged by their managers. Do you provide the resources and time necessary to promote certification? Does your organization pay for test preparation courses and reimburse the examination fee? Do your identification badges help to proudly display staff's credentials? Does your organization's compensation model reward certification? Do you publicly celebrate and acknowledge the certification achievements of your colleagues?


Gather the support you need to make the answers to these questions a resounding "YES!" Remember, certification makes a difference for nurses, patients, and employers. YOU can make it happen!




1. American Association of Critical-Care Nurses and the AACN Certification Corporation: Safeguarding the Patient and the Profession: The Value of Critical Care Nurse Certification. December 2002. [Context Link]


2. Cary, A.: "Certified Registered Nurses: Results of the Study of the Certified Workforce," American Journal of Nursing. 101( 1):44-52, 2001. [Context Link]