CERTIFIED NURSES SPECIAL ISSUE 2021
Editor’s Notebook Celebrating Leadership During a Pandemic
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ment to stay on top of the latest developments in their respective specialties and pursue certification to advance their careers. Even in the wake of the COVID-19 pandemic and the spread of misinformation regarding the
virus, nurses have remained steadfast in their pursuit for knowledge to achieve the best patient outcomes possible.
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Last fall, the American Association of Critical-Care Nurses acknowledged the challenges
CERTIFIED NURSES SPECIAL ISSUE
of pursuing certification with test centers closing over safety concerns and nurses working longer hours to combat the virus and they introduced what is known as a “micro-credential.” Unlike full certification, this does not have any eligibility criteria and offers nurses providing acute/critical care to COVID-19 patients an opportunity
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Other organizations have taken similar measures to counter the challenges posed by the pandemic, such as: extending renewal dates, offering discounted rates or waived fees for those experiencing financial hardship, and doubling the testing window from 90 to 180 days. All of these steps taken show a commitment to nursing leadership while offering the flexibility needed for nurses struggling to maintain a healthy work-life balance right now. Because of the pandemic, there is also a stronger emphasis on public health—and it will likely continue to be at the forefront in the future. The American Nurses Credentialing Center may have retired the Advanced Public Health Nurse (APHN) certification, but baccalaureate-prepared nurses with at least five years of experience in public health may wish to obtain a Certification in Public Health (CPH) through the National Board of Public Health Examiners. Professional development may be low on your current list of priorities if you are worried about the health and safety of loved ones, but pursuing certification is still a worthy (and achievable) goal. Nurses continue to be the backbone of health care and should be heralded for the heroes they are. —Megan Larkin
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Certified Nurses Special Issue 2021
Certification in the Time of COVID-19 BY LOUIS PILLA Certification, like nursing itself, has faced challenges during the COVID-19 pandemic. But earning certification remains a vital sign of expertise and achievement.
n this article, we’ll discuss the specific impacts the pandemic has had on nursing certification, with a look at ways certification bodies have helped nurses cope with the pandemic and potential lasting changes in certification. But first, let’s take a brief look at the overall state of nursing certification.
Demand Remains High The desire for nursing certification continues unabated. “In general, nursing certification has been in high demand for many years now,” says Lisa Falcón, MSN, RN, TCRN, NE-BC, chair of the board of directors of the American Association of CriticalCare Nurses (AACN) Certification Corporation. In January 2020, almost 3,000 nurses became certified through the AACN Certification Corporation, a record month.
“The interest in specialty certification has continued to increase,” says Kathy Chappell, PhD, RN, FNAP, FAAN, Senior Vice President of Accreditation, Certification, Measurement, and the Institute for Credentialing Research and Quality Management at the American Nurses Credentialing Center (ANCC). She notes, however, that it is “often dependent on whether an employer supports and compensates the nurse for pursuing certification.” ANCC supports 18 active board certification exams. The most popular ANCC certifications include family nurse practitioner, psychiatric mental health nurse practitioner, med/surg nursing, and nurse executive/nurse executive advanced. “We have seen steady growth, probably not as much growth as we would have seen had we not had a pandemic,” says Janie Schumaker, MBA, BSN, RN, CEN, CENP, CPHQ, FABC,
chief executive officer of the Board of Certification for Emergency Nursing (BCEN). “But we’ve seen about a five percent overall growth for all of our certifications combined in 2020, which I think is remarkable given that we’ve had a pandemic.” BCEN’s fastest growing certification is also its newest one, the Trauma Certified Registered Nurse. According to one estimate, there are 183 different nursing certifications. Types include specialty and subspecialty practice certifications, interprofessional certifications, and advanced practice certifications.
The impact of the COVID-19 pandemic falls into two main areas: the temporary closing of testing centers and the increased stress and workload the pandemic posed on nurses with the resulting challenges in obtaining certifications.
capacity, which still continues to be the case, notes Schumaker. Falcón at AACN notes that its exam administration partner closed all test centers nationally in April due to COVID-19, but that “during the summer and fall of last year, we were right on pace with the number of certificants.” With the rise in COVID-19 cases this winter, AACN has again seen a slowdown in certification. Similarly, the American Academy of Nurse Practitioners Certification Board experienced closing of test centers, notes Mary Ellen Roberts, DNP, APN-c, FAANP, FAAN, chair of the board and associate professor at Seton Hall University’s College of Nursing. But the test centers reopened in May, responding to the argument that if students were not allowed to take the certification exam, there would be no new group of certified nurse practitioners who could work in COVID-19 units.
Limits to Time Impact of COVID The impact of the COVID19 pandemic falls into two main areas: the temporary closing of testing centers and the increased stress and workload the pandemic posed on nurses with the resulting challenges in obtaining certifications. The BCEN certification program was going “gangbusters” before the pandemic hit, says Schumaker. Like other certifying bodies, the BCEN saw its testing centers close at the start of the pandemic. The centers reopened at limited
Beside testing centers closing, the pandemic meant that nurses were working long hours under highly stressful conditions, limiting the time and energy they could devote to certification activities. Imagine, for instance, a nurse who has small children at home and is exhausted from working clinically during the day. If she were to then want to study for her certification exam, “that presents a significant challenge,” says Chappell. Some nurses may have been stressed due to being furloughed early in the
Certified Nurses Special Issue 2021
pandemic and then stressed when they were asked to put in long hours as patient loads increased, notes Schumaker. If a nurse was being overrun with patients, she didn’t
crisis response nurses going from one hot spot to another,” she says. The micro-credential, she notes, is “portable” and, like other AACN credentials, is nationally recognized.
“One of the trends that we’re seeing in nursing care right now is a lot of travel nurses and crisis response nurses going from one hot spot to another,” she says. The micro-credential, she notes, is “portable” and, like other AACN credentials, is nationally recognized.
have time to study. “That just couldn’t be your priority if you were working twelve hours a day,” she says.
Going “Micro” One development in certification related to COVID-19 was the October 2020 introduction by AACN of a “microcredential.” The “COVID-19 Pulmonary and Ventilator Care” micro-credential validates entry-level knowledge of direct care clinicians who provide pulmonary and ventilator care to COVID-19 patients, says AACN. Unlike a certification, the 38-question micro-credential exam has no eligibility criteria. Providers other than nurses can take the online exam. Micro-credentialing is seen as a “way to validate knowledge without going for a fullblown nursing certification,” says Kiersten Henry, DNP, ACNP-BC, CCNS, CCRN-CMC, a director on the AACN board of directors. This represents the “first venture into microcredentialing for AACN but a very logical one,” says Henry. “One of the trends that we’re seeing in nursing care right now is a lot of travel nurses and
Making Accommodations The era of COVID-19 did cause organizations to make various accommodations to ease the certification burden for nurses. For instance, the ANCC has extended renewal dates so that nurses can obtain continuing education, says Chappell. ANCC has also provided discounts or waived fees due to hardship. Likewise, BCEN, says Schumaker, has offered a discount on recertification since March. Also, BCEN allowed applicants to use clinical hours instead of continuing education, realizing that conferences were being cancelled and CE hours could be more difficult to come by. Similarly, AACN doubled the testing window from 90 to 180 days, giving applicants twice the normal amount of time from when they first signed up for the exam to when they take the test.
Changing with the Times Certification exams change to reflect advances in nursing practice, and the era of COVID-19 may prompt modifications. For example, the pandemic may spur inclusion
of more content on telehealth “because we’ve seen with the COVID pandemic that care has had to be delivered in different ways,” says Chappell. Certification exams may also begin to include topics such as maintaining patient privacy online and establishing a connection with a patient virtually. Certification exams may also adjust, Chappell notes, to reflect
Certification exams change to reflect advances in nursing practice, and the era of COVID-19 may prompt modifications.
greater interest in public health and infectious disease. Exams for nurse leaders may incorporate managing a public health crisis, with topics such as supporting staff and ensuring the interprofessional care team remains connected. Chappell also notes an increased interest in psychiatric mental health nursing. “We see a lot of nurses picking that up as a second board certification, because I think it’s complementary no matter where you are in your practice. Mental health is not well-resourced in the United States and nursing has an opportunity to address health and well-being in a way that is desperately needed,” Chappell notes.
Taking the Next Step Of late, notes Schumaker, nurses have had a lot of rightfully deserved attention. “I think nurses are proud and that’s really driven more nurses to pursue that next step in their career, which might be specialty certification. I think they want to demonstrate their expertise in a lot of different ways and specialty certification is one of them.” Louis Pilla is a seasoned publishing expert with over 20 years of experience in providing content and digital products to health care audiences.
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BECOMING CERTIFIED IN PUBLIC HEALTH Unlike in many other facets of the nursing field, nurses do not have their own certification for public health. Luckily, there is one they can earn. BY MICHELE WOJCIECHOWSKI
Certified Nurses Special Issue 2021
Nurses working in the public health sector who wanted to earn certifications used to be able to attain an Advanced Public Health Nursing certification, which was offered by the American Nurses Credentialing Center (ANCC). That certification, however, was retired, and while nurses who earned it can renew it, it is no longer offered on its own.
ince 2016, though, nurses with the appropriate education and work experience have been able to earn a Certification in Public Health (CPH) through the National Board of Public Health Examiners (NBPHE). Allison Foster, MBA, CAE, president of the NBPHE, states that for nurses to be eligible
for a CPH, they would need at least a bachelor’s degree as well as five years of work experience in the field of public health or they would need a graduate-level degree and at least three years of work experience in public health. As soon as nurses become eligible, they can take the exam as quickly as they want to.
“Public health focuses on populations-based problems with an emphasis on health promotion and prevention. This approach is necessary to having healthier communities,” she says. Foster adds that the CPH is different from other certifications because it certifies people in all areas of public health.
“It is fairly common for candidates to take a few months to review the study materials that are available on our website. We suggest candidates start by doing a self-assessment through our practice exam so they can map out a study strategy,” explains Foster. “Most candidates take a few months to review the materials, which
Since 2016, though, nurses with the appropriate education and work experience have been able to earn a Certification in Public Health (CPH) through the National Board of Public Health Examiners (NBPHE).
include webinars and study guides. But we do occasionally see candidates choose to take a class or two in domains where they have the least knowledge.” Zenobia Harris, DNP, MPH, CPH, president of the Association of Public Health Nurses as well as the Executive Director of the Arkansas Birthing Project, earned a CPH, she says, “Because it demonstrates that one has knowledge of key public health sciences and commitment to the field of public health. It requires that one regularly earn continuing education regarding current
made me even more motivated to remain certified by seeking opportunities to work and volunteer in various capacities in public health,” she says. Harris didn’t earn her CPH until after she had gotten her DNP. “I sought the CPH…to assist me in solidifying my personal commitment to being the best public health nurse administrator/practitioner I could be,” she says. “It has been helpful to me in several ways. I hope that the CPH certification would indicate to others that I am dedicated to the upward movement in my
In terms of what kinds of jobs nurses are qualified for after receiving their CPH certification, Harris says that there are a number of different ones in the fields of community health, population health, and public health including: PHN general-
and emerging public health challenges and needs.” When preparing for her CPH exam, Harris studied for about two hours per week. And it was worth it. “Earning the CPH has
work in Public Health in general. Keeping my certification current assures that I remain knowledgeable about current practices, issues, and challenges in the field.”
ist or specialist roles in communicable disease, immunizations, maternal and child health, emergency preparedness, public health programs, and more. “A nurse who has earned the CPH demonstrates a commitment to closing the gap between public and population health,” says Harris. “Nurses are an incredibly important part of the public health system. They comprise
Foster adds that the CPH is different from other certifications because it certifies people in all areas of public health.
Certified Nurses Special Issue 2021
“A nurse who has earned the CPH demonstrates a commitment to closing the gap between public and population health,” says Harris.
a large percentage of health workers at state and local health departments and are an essential part of the frontline public health,” says Foster. “The workforce is strengthened if its professionals have the skills and knowledge deemed essential by the public health community and have a common body of knowledge. Because the standards for the CPH exam are built through a Job Task Analysis process, the CPH exam tests candidates on the skill and knowledge needed to work in contemporary public health.”
Michele Wojciechowski is a national award-winning freelance writer based in Baltimore, Maryland. She loves writing about the nursing field but comes close to fainting when she actually sees blood. She’s also author of the humor book, Next Time I Move, They’ll Carry Me Out in a Box.
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BY JULIA QUINN-SZCESUIL
Certified Nurses Special Issue 2021
Pave a Leadership Path with Certification
If you’re thinking about a career that includes leadership roles, obtaining certification in one or more specialty areas will help you reach those goals. Becoming certified requires a commitment to life-long learning and to meeting the highest standards in the nursing profession—both qualities expected of nursing leaders.
f you’ve been working in a nursing specialty for a few years, you already have an excellent grasp of
the certification exam material, and the preparation will enhance what you know. Taking this career-advancing
step gives you advanced clinical knowledge and brings you closer to moving into a leadership role. “Certification represents that the nurse took their career to the next level,” says Charles “Wes” Foster, MSN, BA, RN, CMSRN OCN, president elect of the MedicalSurgical Nursing Certification Board (MSNCB). “Employers
want certified nurses, and being certified in many institutions advances you on the clinical ladder. Certified nurses are the experts on the latest information on patient care.” Nurses find they can take the additional skills that come with certification and apply them almost immediately with patients and peers. And, if your supervisors aren’t
noticing your professional efforts and you’re thinking of a job change, certification is essential when you’re looking for a job with more responsibility or where you can make a real impact through advocating for policy changes in local organizations and at a national level.
Nurses find they can take the additional skills that come with certification and apply them almost immediately with patients and peers. According to Cr ystal Lawson, DNP, RN, CENP, education director of the American Organization for Nursing Leadership, many organizations prefer or even require certification for leadership positions. The credential demonstrates a competency that reinforces professional credibility, and it frequently begins valuable professional growth. “Certified nurses are often members of a specialty nursing association, which connects them to a network of peers, mentorship, professional development, and leadership opportunities,” Lawson says. “Through achievement of certification, many nurses find themselves leading in shared governance, laying the foundation for future leadership roles.” Certification’s immediate benefits are obvious—you learn new standards and practices to provide the best care— and those skills can be used right away. Other benefits are less evident, but are equally important to augmenting your
leadership abilities. Nurse leaders set an example by continually striving to improve themselves and their teams and also by demonstrating the motivation to do better. Their work as a role model is expected and frequently is inspiration for others working in the same unit. “Employers also love that the nurses are participating in unit-based practice councils and are making positive changes for health care delivery,” says Foster. “Certification demonstrates that the nurse has set the bar high for their performance, and they maintain that standard.” Some certifications even focus specifically on leadership qualities and skills, such as the Clinical Nurse Leader certification. Your certification status shows you have the ambition to do better and to become a better nurse and your peers take notice. “Being a certified nurse also helps in formal leader roles,” says Foster. “Leaders are
words of wisdom. “You’re the expert in your field,” he says. “You know this stuff. It’s stuff you would see on a daily basis—it’s not something you saw in school and then forgot about.” And for nurses concerned about how not passing could impact their career trajectory, Foster has a simple solution. “I didn’t tell anyone when I took my test,” he says. “If I failed it, the only one who knew was me.” And, he says, if you don’t pass, the result is like a guide for how to prepare for the next time you take it. Career advancement and leadership are excellent motivators for taking on the additional work toward certification. It’s often contagious when nurses see peers succeed because they see how the credential improves outcomes for their patients. “I know of organizations that do see that their patient satisfaction scores are higher on units where most of the clinical nurses are certified,” says Foster.
“Employers also love that the nurses are participating in unit-based practice councils and are making positive changes for health care delivery,” says Foster. “Certification demonstrates that the nurse has set the bar high for their performance, and they maintain that standard.” looked upon as experts in the field and being certified supports that the nurse has expertise in their area.” Once you achieve that credential, you can help others nurses who have questions about how to prepare for the exam or how to use their new skills. Many nurses report anxiety as a barrier to pursuing certification, and Foster has
Certified Nurses Special Issue 2021
Lawson found her certification revealed unexpected opportunities in her own career. “Earning certification in my clinical specialty led me to participate in a professional development program, which was the catalyst to my involvement in professional governance and council leadership,” she says. “These experiences sharpened
Many nurses report anxiety as a barrier to pursuing certification, and Foster has words of wisdom. “You’re the expert in your field,” he says. “You know this stuff. It’s stuff you would see on a daily basis—it’s not something you saw in school and then forgot about.” my leadership competencies. Soon after, I found my passion in nursing leadership and career advancement into formal leadership positions. Achieving my first certification was the spark to my leadership journey.” Julia Quinn-Szcesuil is a freelance writer based in Bolton, Massachusetts.
HONORING THE LEGACY OF HENRIETTA LACKS THROUGH LEGISLATIVE ACTION BY JANICE M. PHILLIPS, PHD, RN, CENP, FAAN
Certified Nurses Special Issue 2021
In The Immortal Life of Henrietta Lacks, author Rebecca Skloot provided a very detailed discussion of the life and times of Mrs. Henrietta Lacks. In 1951, Mrs. Lacks, an African American woman, died from cervical cancer. Unbeknownst to Henrietta or her family, medical personnel acquired samples of her cervical cancer tumor and proceeded to conduct hundreds of scientific studies. These studies culminated in hundreds of innovative breakthroughs in science and health care and even several Nobel prizes.
eferred to as the HeLa cell line, Mrs. Lack’s cervical cells provided the rich foundation for finding treatment solutions for numerous conditions worldwide. The use of these cells, cloned in culture, resulted in unprecedented breakthroughs in molecular biology, genetics, and cancer research methods. Studies using the HeLa cell line also led to effective treatments for conditions such as sickle cell anemia, polio, Parkinson’s disease, leukemia, cervical cancer, and many other conditions. Decades later, individuals and communities continue to highlight the atrocities of conducting research with the HeLa cells without informed consent both here and abroad. Since the 1950s we have stronger precautions to protect human subjects through a stringent informed consent process. Thankfully, we have detailed guidelines along with checks and balances to help protect human subjects and human tissue specimens in biomedical research. Still, many members within communities of color remain skeptical regarding participation in biomedical research. Despite improvements in the protection of human subjects, many underrepresented
minority populations are reluctant to participate in biomedical research or clinical trials and often cite the Tuskegee Syphilis study or the Henrietta Lacks story as a factor for not participating into such studies. Given the importance of medical research, all populations regardless of background or geographic location are critical to advancing science and medical care. This is especially true for communities of color who remain underrepresented in research studies. In recognition of the continuing need to increase minority representation in biomedical research and to the honor the life
and legacy of Henrietta Lacks, the 116th Congress passed the Henrietta Lacks Enhancing Cancer Research Act of 2019. Introduced by the late Representative Elijah Cummings (D-MD) and Senator Chris Van Hollen (D-MD), this legislation aims to ensure equitable access to clinical trials in order to advance cancer research. This Act requires the Government Accountability Office (GAO) to conduct and publish a study that outlines how federal agencies are addressing barriers to clinical trial participation in
federally funded research. There is a specific focus on underrepresented populations who suffer disproportionately from cancer and lack adequate representation in cancer clinical trials. President Trump signed this Act into legislation on January 5, 2021. Janice M. Phillips, PhD, RN, CENP, FAAN, is an associate professor at Rush University College of Nursing and the director of nursing research and health equity at Rush University Medical Center.
For a detail description of this legislation, please visit the following sites: • The Henrietta Lacks Enhancing Cancer Research Act of 2019 https://www.congress. gov/bill/116th-congress/ house-bill/1966/text? format=txt • Office for Human Research Protections https://www.hhs.gov/ohrp/ • A Resource of the Lasting Legacy of Henrietta Lacks https://osp.od.nih.gov/ 2019/06/13/new-nih-resource-lasting-legacy-henrietta-lacks
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