A theoretical framework for specialty certification in nursing practice1

Nurses are committed to the safety and welfare of their patients. However, the Institute of Medicine’s reportthat 44,000 to 98,000 deaths occur per year because of health care errors demands attention from every health-related discipline. The profession of nursing is accountable for the clinical competence of its practitioners. This accountability is achieved in three ways. First, each state regulates the practice of professional nursing through the statutes of its Nursing Practice Act. Therefore, the license of a registered nurse is a contract between an individual nurse and the citizens of that state for health care. These statutes legally define the scope and parameters of basic and advanced nursing practice in each state. The second form of accountability includes the scope and standards of clinical nursing practice. These standards are developed by members of the nursing profession, not members of state legislatures. The standards serve as guidelines for a competent level of nursing care across settings. The American Nurses Association and specialty nursing organizations have developed specialty specific scope and standards of nursing practice. The third form of accountability is certification. Certification is a valued credential offered by the American Nurses Association and many specialty nursing organizations. Certification is 1 means of demonstrating clinical competence in a particular role. More than 350,000 nurses in the United States and Canada hold certification. A recent study conducted by the Nursing Credentialing Research Coalition found that certification dramatically affects the personal, professional, and practice outcomes of nurses. The study’s findings indicated that certified nurses felt more confident and experienced fewer errors in patient care since they had become certified. The study linked improved health care to certification. In recognition that certification is an important method of increasing the accountability of nurses to the public, the American Nurses Credentialing Center made certification in the 21st century accessible to all qualified registered nurses. This policy change was made on the basis of the evolution of the credentialing processes and the need for quality indicators of competence in nursing practice. The process of certification includes meeting eligibility criteria and successfully completing a nationally administered examination. A certification board, usually appointed by the parent nursing specialty organization, establishes the eligibility criteria and maintains the content validity of the certifying examination. The blueprint of the content of a certification examination has its basis on the nursing activities and knowledge of that nursing specialty. Job analysis is the accepted method for defining and maintaining the validity of this content. Maintaining the content validity of certifying examinations is an ongoing process that must be done periodically or whenever significant practice changes occur. When initiating a role delineation study for the National Board for Hospice and Palliative Nurses, one author of this article (C. A.) found that the methodology of job analysis (or role delineation) is well established and replicable. However, rarely does a theoretical framework explain the concepts and relationships of the process. On the basis of the assumption that the discipline of nursing is striving to build a theory and evidence-based practice, this is a critical gap in the nursing literature. In addition, if certification is valued as a major way to increase nursing’s accountability to health care consumers, the certification process must be theoretically sound. The purpose of this article is to describe the theory of job analysis and a practice model that supports the certification process in nursing.