Constructing a Sensitizing Definition of Certification in Nursing for Research Purposes: A Hybrid Methodology Using Consensus-Building Approach.

OBJECTIVE: The aim of this study was to construct a sensitizing definition of certification in nursing for research purposes that can provide a foundation from which to further develop a coherent research program building evidence about the impact of certification on healthcare outcomes. BACKGROUND: The lack of a single definition of certification in nursing makes it difficult to draw conclusions about the relationship between specialty certification and patient outcomes. METHODS: This study was guided by the Delphi-Chaffee hybrid methodology proposed by Grant et al. DISCUSSION: Constructing a single, sensitizing definition of certification: 1) provides coherency for direction of certification research; 2) serves as a guide for researchers; and 3) facilitates multimethodological approaches to exploring the relationship among the different components of the definition of certification. CONCLUSION: A sensitizing definition of certification provides an opportunity for researchers to study the relationship between nursing certification and patient outcomes.

Conceptualization and Operationalization of Certification in the US and Canadian Nursing Literature.

OBJECTIVE: To identify how certification is defined, conceptualized, and discussed in the nursing literature. BACKGROUND: Although it is hypothesized that credentialing is associated with better patient outcomes, the evidence is relatively limited. Some authors have suggested that the lack of consistency used to define certification in nursing literature may be one of the dominant obstacles in credentialing research. METHODS: This scoping review was guided by Arksey and O'Malley's framework, and quantitative and qualitative analyses were conducted. RESULTS: The final data set contained a total of 36 articles, of which 14 articles provided a referenced definition of certification. Thematic analysis of the definitions yielded 8 dominant themes. CONCLUSION: The lack of a common definition of certification in nursing must be addressed to advance research into the relationship between certification processes in nursing and healthcare outcomes.

Nurse specialty certification, inpatient mortality, and failure to rescue.

PURPOSE: To determine if hospital proportion of staff nurses with specialty certification is associated with risk-adjusted inpatient 30-day mortality and failure to rescue (deaths in surgical inpatients following a major complication). DESIGN: Secondary analysis of risk-adjusted adult general, orthopedic, and vascular surgical inpatients discharged during 2005-2006 (n= 1,283,241) from 652 nonfederal hospitals controlling for state, hospital, patient, and nursing characteristics by linking outcomes, administrative, and nurse survey data (n= 28,598). METHOD: Nurse data, categorized by education and certification status, were aggregated to the hospital level. Logistic regression models were used to estimate effects of specialty certification and other nursing characteristics on mortality and failure to rescue. FINDINGS: Hospital proportion of baccalaureate and certified baccalaureate staff nurses were associated with mortality and failure to rescue; no effect of specialization was seen in the absence of baccalaureate education. A 10% increase in hospital proportion of baccalaureate and certified baccalaureate staff nurses, respectively, decreased the odds of adjusted inpatient 30-day mortality by 6% and 2%; results for failure to rescue were identical. CONCLUSIONS: Nurse specialty certification is associated with better patient outcomes; effect on mortality and failure to rescue in general surgery patients is contingent upon baccalaureate education. CLINICAL RELEVANCE: Investment in a baccalaureate-educated workforce and specialty certification has the potential to improve the quality of care.

Competence and certification of registered nurses and safety of patients in intensive care units.

BACKGROUND: Adverse events that place patients at risk for harm are common in intensive care units. Clinicians' level of knowledge and judgment appear to play a role in the prevention, mitigation, and creation of adverse advents. Research suggests a possible association between nurses' specialty certification and clinical expertise. The relationship between specialty certification and clinical competence of registered nurses and safety of patients is a relatively new area of inquiry in nursing. OBJECTIVE: To explore the relationship between the proportion of certified staff nurses in a unit and risk of harm to patients. METHODS: Hierarchical linear modeling was used in a secondary data analysis of 48 intensive care units from a random sample of 29 hospitals to examine the relationships between unit certification rates, organizational nursing characteristics(magnet status, staffing, education, and experience), and rates of medication administration errors, falls, skin breakdown,and 3 types of nosocomial infections. Medicare case mix index was used to adjust for patient risk. RESULTS: Unit proportion of certified staff registered nurses was inversely related to rate of falls, and total hours of nursing care was positively related to medication administration errors. The mean number of years of experience of registered nurses in the unit was inversely related to frequency of urinary tract infections; however, the small sample size requires that caution be exercised when interpreting results. CONCLUSIONS: Specialty certification and competence of registered nurses are related to patients' safety. Further research on this relationship is needed.

Competence and certification of registered nurses and safety of patients in intensive care units.

BACKGROUND: Adverse events that place patients at risk for harm are common in intensive care units. Clinicians' level of knowledge and judgment appear to play a role in the prevention, mitigation, and creation of adverse advents. Research suggests a possible association between nurses' specialty certification and clinical expertise. The relationship between specialty certification and clinical competence of registered nurses and safety of patients is a relatively new area of inquiry in nursing. OBJECTIVE: To explore the relationship between the proportion of certified staff nurses in a unit and risk of harm to patients. METHODS: Hierarchical linear modeling was used in a secondary data analysis of 48 intensive care units from a random sample of 29 hospitals to examine the relationships between unit certification rates, organizational nursing characteristics (magnet status, staffing, education, and experience), and rates of medication administration errors, falls, skin breakdown, and 3 types of nosocomial infections. Medicare case mix index was used to adjust for patient risk. RESULTS: Unit proportion of certified staff registered nurses was inversely related to rate of falls, and total hours of nursing care was positively related to medication administration errors. The mean number of years of experience of registered nurses in the unit was inversely related to frequency of urinary tract infections; however, the small sample size requires that caution be exercised when interpreting results. CONCLUSIONS: Specialty certification and competence of registered nurses are related to patients' safety. Further research on this relationship is needed.

A nursing perspective of interprofessional work in critical care: Findings from a secondary analysis.

PURPOSE: This article presents a secondary analysis of nurse interviews from a 2-year comparative ethnographic study exploring cultures of collaboration across intensive care units (ICU). Critically ill patients rely on their interprofessional health care team to communicate and problem-solve quickly to give patients the best outcome available. Critical care nurses function at the hub of patient care giving them a distinct perspective of how interprofessional interactions impact collaborative practice. MATERIALS AND METHODS: Secondary analysis of a subset of primary qualitative data is appropriate when analysis extends rather than exceeds the primary study aim. Primary ethnographic data included 178 semistructured interviews of ICU professionals from 8 medical-surgical ICUs in North America; purposeful maximum variation sampling was used to represent each profession accurately. Fifteen anonymized ICU nurse interview transcripts were coded iteratively to identify emerging themes impacting interprofessional collaborative practice. RESULTS: Findings suggest that quality of interprofessional collaboration is a product of a multitude of factors occurring at multiple levels within the organization. Managerial and organizational factors related to ICU nurse training and staffing may impede development of nurses' interprofessional skills. CONCLUSION: Deliberative development of ICU nurses' interprofessional skills is essential if nursing is to move from primary coordinator to active collaborator in patient management.

Developing DNP students as adaptive leaders: a key strategy in transforming health care.

The success of graduates with a doctor of nursing practice (DNP) degree in transforming health care will depend significantly on their leadership ability to think strategically, innovate, and engage stakeholders in meaningful system improvement. Known as adaptive work, these graduates will need a portfolio of adaptive leadership skills that prepare them to move health care from a volume-driven to value-based system. This article describes development of a core DNP leadership course in a postmaster's point of entry DNP program at an academic health science center school of nursing. The course, designed as DNP students' initial step on their professional development journey to becoming adaptive leaders capable of driving transformative change, created an alternative lens for students to undertake strategic adaptive change initiatives within themselves and their organizations.