1. Mason, Diana J. PhD, RN, FAAN


Original research in this issue raises questions about nursing certification.


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The consensus among nurses at the hospital was that she was the physician to go to for gynecologic disorders, particularly cancer. She had a sterling reputation as an excellent surgeon and practitioner of humanistic care. One morning, I watched as she responded to a terminally ill patient's distress at having a "Do Not Resuscitate" sign posted over the bed, in accordance with hospital policy. As she overruled the policy, putting the patient's comfort before hospital regulation, I made a mental note to place her name at the top of my list of GYN-ONC physicians. FIGURE

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So I was shocked to learn that she had failed in her most recent attempt to become board certified and that the hospital had terminated her employment. Can I keep her at the top of my list?


Would you seek care from a physician who isn't board certified? Perhaps so, particularly if you knew the physician and had worked with her. But would you recommend a physician who isn't board certified, one unknown to you and your colleagues?


Increasingly, consumers are questioning the competence of providers. But although it's hard to know for sure (some nurses hold more than one certification), only about 16% of all nurses are certified.


Why should nurses seek certification? In some states, advanced practice nurses must pass a certification exam in order to practice. But what about nurses who aren't required to be certified? Susan King, MS, RN, administrator of Professional Services, Oregon Nurses Association, asked an audience of nurses, "What would you say to the patient who asks you how he can be assured that you're competent to provide his care?" If you are among the 84% of nurses who aren't certified, what would you say?


In this issue we highlight findings of the largest survey of certified nurses to date. Conducted by Ann Cary, director of the International Program of Research on the Certified Nurse Workforce, the study raises more questions than it answers, some of which should be addressed through rigorous research. Other questions call for further discussion, and I invite readers to participate in it through letters to the editor.


* How confident are we of certification as an indicator of competence? Cary's findings suggest that some newly certified nurses (fewer than five years since certification) perceive an improvement in their clinical practice. But the findings don't explain why more certified nurses don't see certification as a benefit to practice (see the accompanying commentary by AJN Editorial Board member Julie Sochalski).


* Why do so few nurses choose to become certified? If you are eligible for specialty certification and have decided not to pursue it, tell us why not.


* What encourages nurses to seek certification? If you're a nurse administrator, what institutional supports and rewards have you provided for nurses seeking certification? Or do you think certification isn't so important? Does your institution take the same position on both nursing and physician certification? Should nurses find certification financially rewarding? (Most nurses Cary surveyed said they did not.) Should board certification be a condition of continuing employment? (It was required in the case of my physician colleague.) Do such conditions ensure competence, or do they discount other indicators of competence?


We need research findings that link certification to competence; in the meantime, why not use certification as a mark of competence that we present to our patients when they question our qualifications?


I would still go to the GYN-ONC physician because I know how she practices, and because what she values is important to me. But I continue to advise friends and family to seek out board-certified physicians about whom I know nothing else. And I'm beginning to advise the same about nurses.