Psychometric evaluation of the United States-adapted perceived perioperative competence scale-revised: A national survey.

Background: Nursing competence is integral to ensuring patient safety, especially in high-risk environments such as the operating room. Instruments which facilitate self-assessment of specialty specific nursing competence allow nurses to gain important insights into their practice to facilitate continuous growth in their professional practice. Currently, there are no psychometrically tested tools to assess perioperative competence applicable to the United States context. Objective: Test the psychometric properties of the Perceived Perioperative Competence Scale-Revised in the United States context. Methods: A cross-sectional survey design was used. Perioperative nurses were recruited via four professional associations and the survey was administered online. Construct validity of the six-dimensional Perceived Perioperative Competence Scale-Revised was tested using a multidimensional item response theory model known as the graded response model. Measurement invariance was assessed relative to years of perioperative experience. Internal consistency was estimated using McDonald's Omega and Cronbach's alpha reliability coefficients. Results: Responses from a total of 1,581 participants were analyzed in the psychometric analysis. The six-dimensional graded response model of the Perceived Perioperative Competence Scale-Revised displayed satisfactory model fit for the sample (Chi-square(df) = 5,699.09(725); root mean square error of approximation = 0.066, 90% confidence interval: 0.064, 0.067; comparative fit index = 0.955; Tucker-Lewis index = 0.952; standardized root mean squared residual = 0.045). Scalar invariance was established when assessing the psychometric equivalence of the scale across years of perioperative experience (<10 years, ≥ 10 years) (Chi-square(df) = 5,785.29(1,573); root mean square error of approximation = 0.058, 90% confidence interval: 0.057, 0.060; comparative fit index = 0.959; Tucker-Lewis index = 0.959). Reliability across the six subscales ranged from alpha = 0.87 - 0.94 and Omega = 0.93 - 0.97. Conclusions: Results suggest that the Perceived Perioperative Competence Scale-Revised is suitable to use with perioperative nurses practicing in clinical settings in the United States. Measurement invariance testing indicates the scale is measuring the same construct and is being interpreted in a conceptually similar manner across groups based on years of perioperative experience.

Using Innovation in Credentialing to Foster Meaningful Transitions to Practice and Support Continuing Professional Development.

Certification within specialized areas in nursing has long been an avenue by which nurses demonstrate competence and dedication toward professional development. Because of innovation within the credentialing arena, certification also can serve as an avenue that supports nursing professional development practitioners who are assisting nurses transitioning into new roles or new practices. [J Contin Educ Nurs. 2023;54(9):413-420.].

Differences in Perioperative Nurse Job Satisfaction by Specialty Certification Status.

PURPOSE: To describe differences in perioperative RN job satisfaction by specialty certification status. DESIGN: A retrospective, exploratory, cross-sectional design. METHODS: We conducted a secondary analysis of annual data from the National Database of Nursing Quality Indicators (NDNQI) RN Survey with 12 Job Satisfaction Scales. The sample consisted of 776 perioperative units in 206 hospitals with 13,061 study participants. We used multilevel mixed modeling to examine differences in job satisfaction for nurses holding CAPA (Certified Ambulatory Perianesthesia Nurse), CPAN (Certified Post Anesthesia Nurse), CNOR (certification for perioperative registered nurses), CRNFA (Certified RN First Assistant), other specialty certification, and not specialty certified. FINDINGS: Twelve percent of RN participants held a perioperative nursing certification (CAPA, CPAN, CNOR, CRNFA), 15% held other nursing specialty certifications, and 73% were not certified. Regardless of certification status, nurses were the most satisfied with nurse-nurse interactions and task. They were the least satisfied with nursing administration, decision-making, and pay. CNOR certified nurses reported the lowest levels of job satisfaction in the study. CAPA and CPAN certified nurses reported higher job satisfaction than their noncertified colleagues on multiple job satisfaction scales (ie, CAPA 10 of 12; CPAN 5 of 12). CNOR certified nurses did not report meaningful differences in job satisfaction from non-certified nurses. CONCLUSIONS: As job satisfaction impacts retention, productivity, and patient care quality, our findings have important implications for hospital leaders, nurses, and health care consumers. Based on our findings, we identified nursing professional development as a potential gap in job satisfaction that leaders can target for improvement. Our findings suggest that higher specialty nursing certification rates in perianesthesia nurses may potentially improve job satisfaction and retention of nurses.

What Is the Perceived Value of Certification Among Registered Nurses? A Systematic Review.

PURPOSE: To explore how registered nurses (certified, noncertified, and managers) value certification as determined by the Perceived Value of Certification Tool, review the psychometric properties of the instrument, and ascertain the benefits and barriers to nursing specialty certification. DESIGN: Systematic review (without meta-analysis) of 18 studies representing 26,534 registered nurses. METHODS: Rigorous processes were used to minimize bias; to identify, appraise, and synthesize studies to explore how registered nurses value certification; and to ascertain the benefits and barriers to nursing specialty certification. Psychometric properties of the Perceived Value of Certification Tool were also reviewed and evaluated. Methods and results are presented in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. FINDINGS: All studies included in the review were cross-sectional studies with observational, descriptive designs published between 2003 and 2019. The average study participant was a 49-year-old Caucasian woman with a bachelor of science in nursing degree and 20 years of experience working as a staff nurse in a hospital. In accordance with the results reported in all studies included in the systematic review, the highest level of agreement and strong agreement occurred with the intrinsic value statements of enhances feeling of personal accomplishment (n = 16,697; 97.8%), provides personal satisfaction (n = 16,607; 92.7%), and validates specialized knowledge (n = 16,697; 97%). The lowest levels of agreement and strong agreement occurred with the extrinsic value statements of promotes recognition from employers (n = 16,607; 78.6%), increases consumer confidence (n = 16,607; 73.3%), and increases salary (n = 16,607; 41.9%). CONCLUSIONS: The vigorous statistical work completed on the developmental study for the instrument conducted in 2003 has yet to be duplicated in the multiple studies published subsequently. The chiefly descriptive studies detailed in this systematic review are of limited usefulness in guiding future research. The Perceived Value of Certification Tool has proven useful in stimulating interest; however, a revision of the instrument is now required to promote research and patient outcome studies regarding the self-perceived value of certification in nursing specialties. CLINICAL RELEVANCE: This report systematically reviews 18 studies that have used the Perceived Value of Certification Tool, a tool that has been widely used since 2003, to measure the perceptions of registered nurses regarding specialty certification. This review provides evidence that the instrument has potential for expanded use in patient outcomes studies and should be revised to better serve the needs of researchers.

From Competence to Continuing Competency.

In 2011, a task force sponsored by an organization that has Accreditation Board for Specialty Nurse Certification-accredited programs published a definition of continuing competence. Eight years later, the organization sponsored the work of another task force to revisit that definition, with the 2018-2019 task force broadening its focus beyond the U.S. borders and beyond nursing. After an extensive literature review, task force members collated their findings into four categories: Identifying Competencies, Validating Competencies, The International Perspective on Competency Assessment, and Competency in Disciplines Other Than Nursing. The task force identified perspectives on continuing competency and found that although licensing and credentialing organizations addressed the topic thoroughly, little attention was devoted to the perspectives of the public, individual clinicians, and recipients of clinicians' services. This article identifies that little consensus exists on definitions of competence and competency, international perspectives have much to offer, and theoretical frameworks for research on competence and competency are lacking. [J Contin Educ Nurs. 2020;51(1):15-24.].

CNOR Recertification: Why Continuing Education Alone Is No Longer Sufficient.

Health care certification programs are experiencing a period of great change because of increased public expectations and recent accreditation requirement changes. Nursing certification programs, including the CNOR credential administered by the Competency & Credentialing Institute (CCI), are not immune to these changes. The CNOR credential is the most common perioperative nursing certification and has more than 40,000 certificants worldwide. In response to updated accreditation standards, CCI recently announced CNOR credential recertification process changes. This article provides perioperative nurses with information on the effectiveness of continuing education for recertification, accreditation processes for certification programs, the nature of the new recertification mechanism and the process by which CCI revised and strengthened it, and specific information for CNOR-certified nurses on the timeline for recertification changes.

Exploring the Relationship Between Nursing Specialty Certification and Surgical Site Infections.

OBJECTIVE: The aim of this study is to explore the relationship between nursing specialty certification and surgical site infections (SSIs) for colon (COLO) and abdominal hysterectomy (HYST) surgical procedures. BACKGROUND: SSI following COLO and HYST procedures is a preventable complication now included in the Centers for Medicare & Medicaid Services' Hospital Inpatient Quality Reporting Program. METHODS: Data from 69 hospitals, 346 units, and 6585 RNs participating in the National Database of Nursing Quality Indicators and SSI data on 22 188 patient COLO and HYST procedures from the National Healthcare Safety Network were examined in multivariate logistic regression analysis. RESULTS: Magnet® status was associated with lower SSI occurrence after adjusting for other variables. Higher American Society of Anesthesiologists scores, longer surgical procedure time, and wound class were associated with higher SSI occurrence. CONCLUSIONS: Future theory-based research should examine the association of nursing specialty certification with patient outcomes and investigate the effect of Magnet status on SSI.

The relationship between direct-care RN specialty certification and surgical patient outcomes.

Specialty certification enhances patient safety in health care by validating that practice is consistent with standards of excellence. The purpose of this research was to explore the relationship between direct-care, specialty-certified nurses employed in perioperative units, surgical intensive care units (SICUs), and surgical units and nursing-sensitive patient outcomes in SICUs and surgical units. Lower rates of central-line-associated bloodstream infections in SICUs were significantly associated with higher rates of CPAN (certified postanesthesia nurse) (ß = -0.09, P = .05) and CNOR/CRNFA (certified nurse operating room/certified RN first assistant) (ß = -0.17, P = .00) certifications in perioperative units. Unexpectedly, higher rates of CNOR/CRNFA certification in perioperative units were associated with higher rates of hospital-acquired pressure ulcers (ß = 0.08, P = .03) and unit-acquired pressure ulcers (ß = 0.13, P = .00), possibly because of a higher risk of pressure ulcers in the patient population. Additional research is needed to clarify this relationship. Our findings lend credence to perioperative, SICU, and surgical nurses participating in lifelong learning and continuous professional development, including achievement of specialty certification.

Perioperative nursing competency.

OR managers face increasing pressure to ensure nursing competency. Subspecialty education programs provide a critical foundation upon which eventual clinical competency will be built, but the relationship between competency and clinical performance is not yet well understood. A variety of perioperative nursing subspecialty programs are described in the literature. These programs were examined in the context of the theoretical connection between education, clinical experience, and nursing competency.