14.12 Describe how professional certification across all nursing roles (administration and clinical practice) is promoted by the healthcare organization. The Massachusetts General Hospital Department of Nursing (DON) promotes certification across all nursing roles. The DON supports certification because it is a tangible measure of specialized knowledge, skills, and experience by a professional nursing organization, representing professional achievement in a specialty or clinical area of nursing. As is stated on the DON Website: Professional certification is a credential given to a practicing registered nurse in a particular specialty. The credentials represent the RN as having a concentrated knowledge and skill in the specialty area. Professional certification in a specialty: Enhances and validates your nursing specialty knowledge and competence. Builds confidence in you as a professional, demonstrating that you meet nationally recognized standards in your specialty. Serves as a testimonial to your dedication to nursing, bringing a greater accountability to the profession. Recognizes you as a resource and leader to your colleagues in your specialty. Promotes increased patient and family satisfaction and confidence in their care. Provides a valuable credential for your professional curriculum vitae (CV), resume or portfolio. The DON provides fiscal support for this achievement by reimbursing nurses for the cost of professional certification and re-certification examinations offered by nationally recognized nursing organizations. A specific Sundry Fund is designated for this purpose. The DON policy related to reimbursement for certification expense, Professional and Specialty Certification/ Recertification Examinations: Demetri Souretis Fund, is included as attachment 14.12.a. In 2006, 107 registered nurses, representing every practice area in the hospital, were reimbursed through the fund. The related expense for this reimbursement exceeded $29,000. As of August 2007, 58 Registered Nurses have availed themselves of this benefit receiving over $15,000 of reimbursement. The DON also provides on site educational preparation programs for some types of certification. In 2006 and 2007, The Norman Knight Nursing Center for Nursing Clinical & 131
Professional Development offered the following preparation programs for Staff Nurses who were interesting in pursuing professional certification: Program Dates # of Attendees Cardiovascular Certification Review January 25, 2006 40 Neuroscience Review Course September 15 & 18, 2006 68 Medical Surgical Review Course September 20, 2006 20 Cardiovascular Certification Review October 4, 2006 12 Medical Surgical Review Course March 20 & 27, 2007 29 Neuroscience Review Course September 7 & 17, 2007 74 Cardiovascular Certification Review Oct. 3, 2007 Pending Medical Surgical Review Course Nov. 5 & 12, 2007 Pending There are also unit-based efforts to support professional certification. Staff Nurses in the Post Anesthesia Care Unit (PICU) are encouraged to seek certification from the American Society of Post Anesthesia Nurses (ASPAN). A PACU Staff Nurse coordinates the unit-based preparation for the CPAN (Certified Post Anesthesia Nurse) examination, providing materials and a list of examination dates. Current preparation materials, such as review books, DVD s and practice examinations are available on the unit. When Staff Nurses are successful in obtaining certification, they are recognized with a CPAN Certification pin and their achievement is announced on a board in the Staff Nurse lounge. Approximately one third of the PACU Staff Nurses have achieved professional certification between 2002 and 2007. In the MGH Endoscopy Unit, the Nursing Director encourages Staff Nurses to pursue professional certification through the Society for Gastroenterology Nurses and Associates (SGNA). She discusses professional certification with staff during their annual evaluations as part of their annual performance goals. The Nursing Director also supports Staff Nurse attendance at the annual certification review course offered annually by SGNA by approving paid educational time to attend the course. The Staff Nurses who are successful in achieving certification are recognized during Endoscopy weekly staff meetings. At the present time, approximately one third of the Endoscopy Unit Staff Nurses have become certified. The work of the NICHE-65 Plus Committee (see Force 7.9) provides an example of a current initiative promoting professional certification. The Committee received a $5000 grant from 132
the John Hartford Foundation NYU Division of Nursing, to develop a gerontology certification program for nurses at MGH. The grant proposal was sponsored by three Associate Chief Nurses and recognizes the importance of assuring gerontology nursing competence. The long-term goal of the project is to have Staff Nurses certified in gerontology to support unit-based care of the older adult on at least 23 adult inpatient units. Those Staff Nurses who obtain gerontology certification will be encouraged to become active participants in the NICHE planning team and to assist in the further development of the MGH NICHE program. Interest in gerontologic professional certification or certification of any type starts at the unit level with the support and encouragement of the nursing leaders on the unit. With close to 3,000 nurses practicing in 47 patient care units, unit-based Nursing Directors and Clinical Nurse Specialists are the key to successfully communicating this initiative to Staff Nurses. Units will be provided tools that they can use to engage staff in discussions about certification, to increased gerontology certification and raise awareness of the importance and value of this certification. The grant will support the development of the promotional campaign and the Gerontology Certification Tool Kit (e.g., PowerPoint Presentation, brochures, posters) for all the adult inpatient units. Unit-based leadership will then be asked to identify staff nurses on their units who demonstrate an interest in caring for older patients and who express a desire to pursue certification. Using the Hartford Institute for Geriatric Nursing on-line review course as the educational framework, gerontology certified Advance Practice Nurses will mentor and support staff as they prepare for the certification exam. The number of Staff Nurses who take the gerontology certification exam over the next three years will be tracked as a key measure of success. Outcomes to date include the development of the educational, marketing and tool kit materials. In addition, a Geriatric Clinical Nurse Specialist was hired in August 2007 to fully implement the NICHE-65 Plus Program. In work that mirrors the intent of and value of professional certification, The Norman Knight Nursing Center worked closely with the Oncology Clinical Nurses Specialists to develop and offer the Oncology Nursing Society's (ONS) Chemotherapy and Biotherapy Course at MGH staring in April 2005. Although this is not a certification offered by a professional organization, the program was established based on the desire to provide a national, standardized knowledge base for nurses who administer chemotherapy at MGH. The course information includes a comprehensive, detailed presentation of the nursing knowledge needed to administer the cytotoxic and biotherapeutic agents. 133
Nurses who complete this two-day course receive an ONS Chemotherapy and Biotherapy Provider Card which validates that the participant has the theoretical foundation needed to administer these high risk agents. Participants also receive 13.5 contact hours awarded by ONS as approved by the American Nurses Credentialing Center. Reference Manual published by the Oncology Nursing Society and provided to all participants in the Chemo/Biotherapy Course. The MGH Oncology CNSs are all ONS certified Chemotherapy and Biotherapy Course Instructors. The ONS Chemotherapy and Biotherapy Course is offered to Staff Nurses every other month. To date, 185 MGH nurses have successfully completed the ONS Chemotherapy and Biotherapy Course (attachment 14.12.b). Each course offering is also listed on the Oncology Nursing Society's master calendar encouraging attendance from outside MGH. The Knight Center supports the course by coordinating enrollment, providing classroom space and ordering supplies. A nurse who was a Clinical Nurse Specialist for the inpatient Gynecology unit offered the following thoughts, related to participation in the professional certification process: In 1984 the Oncology Nursing Society offered certification for the first time. As a nurse whose focus is cancer nursing, I took that exam and passed. Certification is a mechanism to demonstrate the knowledge and skills needed in the specialty. Eligibility requirements reflect the clinical requirements and practice experience needed for certification. The test was developed with the national test development corporation professionals responsible for other examinations, such as, PSATs and SATs used by colleges for admission requirements. Later as a volunteer item writer, I began to understand how much effort is involved in writing a single question. One has to determine the verifiable correct answer and provide credible incorrect choices. 134
Answers must reflect national norms rather than regional practices. Each item is ranked for its degree of difficulty and fit into a framework for critical dimensions of nursing practice. For me, certification in nursing means the completion of a credential that is part of what we as nurses can offer to our patients. Certification in nursing allows patients access to nurses who have demonstrated achievement of a national standard of knowledge-based practice for their care. Research in nursing has demonstrated better patient outcomes in organizations with certified nurses. There is a constantly growing body of knowledge in Nursing. Certification is one way of maintaining up to date practice in a complex care environment such as MGH. Joan Gallagher, Ed.D, RN, BC, AOCN 135
Attachment 14.6.a MASSACHUSETTS GENERAL HOSPITAL Department of Nursing TITLE: PROFESSIONAL AND SPECIALTY CERTIFICATION RECERTIFICATION EXAMINATIONS: DEMETRI SOURETIS FUND POLICY: Registered Nurses in the MGH Department of Nursing are reimbursed for the cost of professional and specialty certification and re-certification examinations offered by a nationally recognized professional nursing organization. The reimbursement does not include costs for programs or other requirements necessary for certification or recertification. PURPOSE: Credentialing boards that are associated with nationally recognized professional nursing organizations develop and implement certification examinations and procedures for nurses who want to have their specialty practice recognized by the profession. Certification is a judgment of competence made by nurses who are themselves practicing within the area of specialization (Nursing s Social Policy Statement, 1995). One component of the required evidence is successful completion of an examination that tests the knowledge base for the selected area of practice. Other requirements relate to the content of course work and amount of supervised practice. The Department of Nursing believes that certification provides tangible recognition of professional achievement in a defined functional or clinical area of nursing. A nurse who has taken this extra step demonstrates commitment to his/her own professional growth and will use this expertise in providing competent, compassionate nursing care to patients and families. ELIGIBILITY: Regular full-time or part-time staff in the Department of Nursing (temporary/per diem staff are not eligible). ADMINISTRATIVE PROCEDURE: 1. Complete the Demetri Souretis Fund for Certification/Recertification Exam Reimbursement Request and obtain the signature of the Nursing Director at the time of application for the certification exam. 2. Obtain documentation on the day of testing that you have taken the examination. 3. Submit the Request, the above documentation, and your cancelled check or valid receipt to The Knight Center for Clinical & Professional Development: Attn: Demetri Souretis Fund, FND 644. 136
Attachment 14.6.a continued 4. Reimbursement is contingent upon taking the exam, not upon receiving certification. 5. Each nurse will be afforded the appropriate time away from the practice setting for the purpose of taking the exam. Approved: Department of Nursing (12/09/02) Revised and approved: Nursing Executive Operations (08/03) Revised and approved: Nursing Executive Operations (08/06) 137
Attachment 14.6.a continued MASSACHUSETTS GENERAL HOSPITAL Department of Nursing CERTIFICATION/RECERTIFICATION: DEMETRI SOURETIS FUND FEES REIMBURSEMENT REQUEST Name Unit. No. Job Title Unit Social Security /Tax ID number Name of Certifying Nursing Organization Type of Certification Date of Examination Cost Employee Signature Date 1. Attach documentation that you have taken the exam. 2. Attach cancelled check or valid receipt for the exam. 3. Submit Request to the Knight Nursing Center for Clinical & Professional Development, Attn: Demetri Souretis Fund, FND 644. 4. The Accounts Payable Department requires that all checks be mailed directly to your home. Please mail my check to the address below: Address City State Zip code 138
Attachment 14.12.b ONS CHEMOTHERAPY AND BIOTHERAPY COURSE ENROLLMENTS AT THE MASSACHUSETTS GENERAL HOSPITAL Number of Enrolees Date MGH Non-MGH Total 4/14&15/05 16 0 16 8/18&19/05 12 0 12 10/20&21/05 15 0 15 12/8&9/05 6 0 6 Totals 2005 49 0 49 2/16&23/06 11 0 11 4/10&17/06 22 0 22 6/15&22/06 15 0 15 8/17&14/06 15 0 15 10/12&19/06 16 1 17 12/7&14/06 15 1 16 Totals 2006 94 2 96 2/6&7/07 10 3 13 4/3&4/07 10 6 16 6/5&6/07 16 3 19 7/12&19/07 6 0 6 Totals 2007 (as of 7/20/07) 42 12 54 Grand Totals 185 14 199 139