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Nursing Certification Is the Positive Effect on Nursing Care


Keywords: CCRN, critical care, certifications, empowerment, failure to rescue, patient outcomes, magnet, Nursing, satisfaction, specialty

Nurses’ roles and responsibilities are evolving and expanding along with the implementation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Certification in a nurse specialty is predicted to become an issue of major importance for nurses in the acute care setting. The U.S. Bureau of Labor and Statistics (2015) reported there are over 2.8 million registered nurses, comprising the largest healthcare occupation in the United States.

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Over 2.5 million are employed in nursing in various healthcare settings. Given that there are approximately 1.6 million nurses in the acute care setting, nurses must pursue certifications to demonstrate the commitment to advancing their knowledge and skill set. In addition to being a mark of excellence and a distinguishing accomplishment, certification is also an indication of the nurse’s professional achievement, proof of expertise, and clinical judgment in a particular specialty (Medscape, 2013).

The purpose of this review is to offer the reader the information on the state of nursing, the advantages of certification for nurses, the patient receiving care, and the healthcare organization. In addition to the above areas, the review also indicates the ways in which nurses obtain the necessary certification, thereby outlining the peculiarities of this process.



Nursing certifications are beneficial not only to nurses but to the healthcare facility where they are employed and the healthcare consumers to whom care is provided (ANCC, 2013). The American Nursing Credentialing Center (ANCC) has identified eight positive outcomes of nurse credentialing: professional recognition, personal satisfaction, career advancement, professional opportunities, competency assessment, licensure, reimbursement, and increased salary. However, of the 2.5 million nurses employed in the healthcare industry, as of 2013, ANCC reports approximately nurses are credentialed in a specialty (ANCC, 2013).

Definition of Terms


To comprehend the process of certification, one must be able to understand what a credential is. A credential is proof of qualification (Health Care Design, 2011). Accreditation entails a review by the professional organization testing the qualification against certain criteria, thereby creating the message that the organization is qualified to complete selected tasks (ACHC, 2016).


Accreditation is all-encompassing whereby it focuses on the institution and its ability to meet a certain level of standards set by the organization (King & Sally Gerard, 2016). In this case, licensure promises a holistic approach to healthcare whereby the organization must adhere to a myriad of conditions for it to attain any level of success. Accreditation of any organization is not required under the law. However, the opportunity costs of not volunteering the organization for accreditation could be significant. The organization could face the risk of losing customers due to its unaccredited status.

In most instances, the hospitals seek to be accredited and incur the costs as opposed to risking the opportunity cost. Accreditation sends the message of confidence that the organization has attained a certain level of operational excellence which accords it with the right combination of skills, facilities, and experience to handle a certain condition (Reich, Smith & Del Guidice, 2016). This message increases the chances of people using the hospital. Licensure gives permission contingent on time limit and criteria set by the agency issuing the credential (Healthcare Design, 2011).

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Licensure indicates that the nurse has attained the basic skills necessary in a given state in order for him or her to practice nursing in the region. The licensure approach is used to eliminate applicants who do not have the minimum requirements to have the safest practice. The test is often scored; however, it is only geared towards the bare minimums as opposed to exceptional performance. Licensure is a foundation for certification.


Certification is a voluntary process by which a nongovernmental agency grants a time-limited recognition to an individual after verifying that he/she has met standardized and predetermined criteria. (Healthcare Design, 2011). The difference between licensure and certification is that licensure focuses on the individual's testing after his or her working in a certain specialty, while certification centers on the other aspect of nursing which is exceptional performance as opposed to the bare minimums. Therefore, certification indicates that the nurse has attained a certain level of special performance and can work in a particular field.

Nursing Specialty Certification and Employers

When a nurse obtains certification of his or her specialties, it benefits the employers in many ways. It creates an environment of professionalism and subsequent retention, which contributes to nurse certification and continuous education in the field (Medscape, 2010). Studies have shown that professional characteristics of certified specialties, including nurses, can enhance patient safety, better communication within the units, and appreciation of job gratification.

According to AACN (2011), employers are more willing to hire certified nurses due to their knowledge in the field. Additionally, grant funding and joint commission accreditation are easily obtained if the organization has a certified nurse on the payroll. With the medical field being highly competitive, employers that encourage their staff toward earning their certification have a better chance in the demanding health marketplace.

Nursing Specialty Certification Affects Patient Care

Patients’ and families’ stress levels are intense when they are hospitalized. Knowing that they have a nurse that is well-specialized in the field, often helps ease their anxiety levels. Learning about the nurse's certified status helps the patient know that the latter demonstrates knowledge, skills, and years of experience in the job. A few studies show that certified nurses with judgment and knowledge impact patients' well-being while in the hospital. For example, researchers have found out that certified wound care nurses had a better knowledge of wound care pressure ulcer classification. A different study shows that ICU units with highly certified nurses reported fewer falls (Medscape, 2010).

Nursing Specialty Certification and Nurse

Nurses obtain certification in their specialty for a variety of reasons, such as education and advancement in the field, self-improvement, and validation of their expert knowledge and skills. Being certified puts the nurse in a position for better accomplishments, recognition, and self-assurance. Entry-level competence is what an RN licensure test is for, but when nurses voluntarily decide to test for their certification, it validates clinical judgment, skills, and experience.

One study shows that nurses feel that they make better decisions and have better outcomes due to being validated in their specialties. Moreover, these nurses get better job gratification due to gaining their certification. (AACN, 2011)

How Certification Is Obtained

First of all, one needs to sit for the RN board. Professional regulation is obtained once one has licensure. Having a license means a person obtains the necessary skills and knowledge to care for the sick. Entry-level competencies are gained with one’s licensure. Certification acknowledges one’s skills, clinical decision, and experience.

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The professional nursing Credential of Certified Critical Care Nurse (CCRN) was linked to decreased chances of death, which is clinically important for the profession (Hickey et al., 2013). Many organizations have embraced the need for nursing certification because of patients’ and families’ expectations of certification and the education, knowledge, and experience required to achieve and maintain professional certification. The American Association of Critical-Care Nurses (AACN) awards CCRN certifications to nurses who have worked in critical care for at least 2 years and have successfully passed a rigorous examination, thereby continuing to demonstrate ongoing education and maintenance of critical care knowledge and skills. (Hickey et al., 2013).

The critical care unit type is found in most acute-care hospitals and is among the unit types with the highest starting average certification rate and highest rates of growth. In addition, AACN is the largest specialty nursing organization in the world (JONA 2012). “Authors have suggested a strong association between certification and empowerment” (Beaudonin, 2016 page 216). In addition, “completion of the process was found to generate the feeling of autonomy, self-accomplishment, confidence, and independence” (Beaudonin, 2016 page 216).

The hospitals with specialty certification have an empowered work team. Empowerment is correlated to the perceptions of nurses in the context of the organization. Most of the certified nurses have a sense of autonomy since, with their education, they do not necessarily have to rely on the directions from the doctors or more experienced nurses to fully discharge their duties (Solomon et al., 2016). In most instances, there is a high level of confidence that breeds independence of thought. When nurses have autonomy and independence, they can make split-second decisions that are directly related to patient outcomes. Specialty nurses can identify the potential sources of contention and address them before they result in undesirable patient outcomes. Therefore, the empowerment of nurses through their certification can create a better quality of care (Rounds, Zych, & Mallary, 2013).

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Thus, the literature reviewed testifies to an affirmative link existing between nursing certification and positive patient outcomes. One study demonstrated a reduced rate of falls and nursing certification. Researchers found out that “a plausible explanation for an association between national nursing specialty certification rates and falls is that specialty certified nurses have acquired greater awareness and more general knowledge of patient safety and quality of care, and this results in better patient outcomes overall” (Boyle et al., 2015 page XX).

In addition, the investigations have uncovered growing evidence that specialty certification is associated with lower patient adverse events. The study examined trends in RN specialty certification rates in acute care hospitals and units over a six-year period. Within the longitudinal statistical linear model, it was found out that “a ten percent increase in hospital proportion of baccalaureate and certified staff nurses, respectively, resulted in a decreased odd of adjusted 30-day mortality by six percent and two percent” (JONA, 2012 page 567). Consequently, there are explicit gains in the event when the organization has attained any level of accreditation.

Specialty certification presents the message that the organization is an authority in its field as far as the staff is concerned. Specialty nurses allow the organization to boast a certain level of expertise that cannot be replicated in those organizations that have only certified staff nurses and baccalaureate nurses. Consequently, a healthcare organization is judged based on its patient outcomes (Murphy, Scott, & Pawlak, 2013). When the hospital has specialty certification, there is a lower chance of deaths in the intensive care hospitals and units. Specialty certification enables the hospital to develop and deliver effective patient outcomes that cannot be possibly replicated in hospitals that do not have the same level of qualification (Wu, Hu & Ruan, 2014).

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