Determining the relevance of a certification exam to home health care nursing practice.

Home health care is enjoying increased use and popularity. Unfortunately, in today's cost-cutting environment, home healthcare is also subject to increased scrutiny and inevitable reimbursement limitations. This is borne out by the impact on home healthcare as a result of the Balanced Budget Act of 1997. Berke (1998) reports that those at greatest risk for cutbacks in care are those that can least afford it-the oldest, sickest, poorest, and most frail. Compounding the financial dilemma that home health care clients face are multiple providers of care, an unrealistic media presentation of health care, and less time for anyone to provide psychosocial-focused care (Simmons, 1990). Home health care clients have a desperate need for an advocate to provide expert navigation through the health care system. Home health care providers are aware of and often responsible for bridging gaps in health, medical benefits, and social services. This article describes a process for determining the relevance of a certification to community nursing clinical practice-using the Advanced Certification in Continuity of Care (A-CCC) exam as the example. Community-based delivery of healthcare demands practice beyond the task-oriented skills that may be sufficient for a provider-centered environment. There is a demand in home health care for highly qualified nurses who are autonomous critical thinkers and practitioners. While past definitions of a productive home health care nurse may have focused on the number of visits completed in a day (Benefield, 1996), today's competencies include using a comprehensive approach to the provision of care and recognizing the effects of the interaction of multiple caregivers, systems, and functions. Although the role of an advocate in the delivery of healthcare requires care and involvement that is acknowledged as a function of expert nurses, definitions of expert competencies have yet to be developed (Adams et al., 1997). Certification provides one distinction between individual practitioners with common licensure and educational degrees. Certification is a burgeoning industry. As an example, in 1997, there were at least five entry-level certification programs available for health care professionals such as home health care nurses whose roles included an element of case management ("Scrambling for CM Certification," 1997). Healthcare employers have become increasingly interested in employing certified individuals and are willing to pay them higher salaries ("Health Care Delivery Changes," 1996). Differences in patient outcomes that may be attributed to staff certification of this kind are, as of yet, unidentified. The linkage between certification and patient outcomes depends on the relevance of the expertise being measured to the clients served and the practice setting. Determining whether a certification fits a patient population and practice setting requires some knowledge of the certification process. Attention should be paid to the education, clinical background, expertise, and integrity of the certifying body, the body of knowledge that defines the scope of the exam, the process used in developing and maintaining the exam, and the level of achievement the exam measures. One of the certifications available to home health care professionals is the Advanced Certification in Continuity of Care (A-CCC) from the National Board for Certification in Continuity of Care (NBCCC). The exam is open to multiple disciplines including nursing, social work, therapists, clinical nutritionists, and physicians. During the past 2 years 89% of applicants were nurses and 20% were employed in home health care (Holland, 1999). The A-CCC exam is used as an example for determining the relevance of such a certification to the home health care nursing practice. CERTIFYING BODY The National Commission for Certifying Agencies is the accrediting arm of the National Organization for Competency Assurance (NOCA). …