Over the last 20 years, hospitals in the United States have become increasingly focused on the Magnet Recognition Program® (MRP), a national initiative honoring hospitals that have achieved the highest possible standards of excellence in nursing and patient care. The process of designating outstanding health care facilities as Magnet hospitals first began in the early 1980s during yet another international nursing shortage. Even though many hospitals were struggling to fill their nurse staffing needs, it was apparent that a few facilities were somehow unaffected by the shortage. An investigation of these hospitals, sponsored by the American Nurses Association (ANA) identified 14 key standards and qualities that truly set these facilities apart from the crowd.
As a result, ANA—through its credentialing body, the American Nurses Credentialing Center (ANCC)—developed what is now known as the Magnet Recognition Program. This program recognizes hospitals, medical centers and health systems which, like a powerful magnet, have the ability to attract and retain more registered nurses and other health care workers. Most importantly, the Magnet recognition is more than just an award: It is a systematic approach to the ongoing pursuit of excellence in patient care.
More recently, medical centers within the Department of Veterans Affairs (VA) have decided to join their private sector peers in the pursuit of this coveted recognition. Of the 155 VA medical centers (VAMCs) in the U.S., only three have earned the Magnet designation. The first was James A. Haley Veterans’ Hospital in Tampa, Fla., followed by the Michael E. DeBakey VAMC in Houston, Texas, and most recently, Portland (Ore.) VAMC in 2007. The medical center where I am employed, Overton Brooks VAMC in northwest Louisiana, has also decided to join the ranks of these prestigious facilities by pursuing Magnet status.
One of the criteria for Magnet recognition is that at least 20% of all direct care staff nurses hold a current nursing certification in their area of specialty. Simultaneously, there is also a national initiative within the VA’s Office of Nursing Services (ONS), encouraging certification by at least 25% of a VA facility’s direct care nursing staff.
Certification is the formal recognition of a nurse’s specialized knowledge, skills and experience that promote optimal health outcomes. It is documented by successful completion of a national standardized certification exam and adherence to practice standards identified by a professional nursing organization in a defined clinical area. It represents a benchmark and indicator of increased clinical knowledge and experience, analogous to board certification in other disciplines. Nursing certification is not a routine competency expected of all nurses practicing within a certain specialty (e.g., CPR training).
Benefits of Certification
For VA hospitals, the benefits of certification are exponential to the organization, the individual nurse and, most importantly, to the veterans we care for. Certified nurses are more competent, accountable and confident in their practice. Moreover, studies have shown that certified nurses practice in a manner that is most likely to improve patient outcomes.1 Other research has revealed that three out of four patients are much more likely to select a hospital employing a high percentage of certified nurses.2
Furthermore, nurses who hold a certification report higher levels of empowerment, which is a characteristic associated with job satisfaction and intent to stay in their current position.3 High percentages of certified nurses are found in facilities that have a reputation for recruiting and retaining the best nursing talent—for example, 26.4% of nurses in Magnet hospitals are certified.4
For the individual VA nurse, becoming certified in your competency area can:
• validate your knowledge and expertise;
• build confidence in your professional ability;
• demonstrate that you meet high national standards;
• demonstrate your dedication to nursing as a profession;
• provide opportunities for career advancement;
• validate you as a credible resource for your colleagues and patients; and
• promote personal growth and satisfaction as a professional nurse.
Nursing certification is reflective of the Veterans Health Administration (VHA)’s current transformational performance measure to distinguish VA facilities as learning organizations, charged with creating an integrated and synergistic educational environment for all staff. In addition to the MRP, certification is used as an indicator of nursing excellence in other national health care recognition programs, including the American Association of Critical-Care Nurses (AACN) Beacon Award for Critical Care Excellence and the National Institute of Standards and Technology (NIST)’s Malcolm Baldridge National Quality Award.
Don’t Overlook LPNs
In general, hospitals’ efforts to increase their number of certified nurses have usually concentrated on professional nurses (RNs). But this overlooks the important role licensed practical nurses (LPNs) play in the VA health care system. Therefore, our medical center, in recognition of our LPNs’ system-wide contribution to patient care, is also including this group in our initiative to increase certification among all direct care nurses.
Overton Brooks VAMC currently employs approximately 75 LPNs serving in various areas, such as our primary care and specialty clinics, medical-surgical and mental health units, community-based outpatient clinics and community health nursing. In most instances, the LPN is working as a team member led by the RN. However, on many occasions the LPN is directly assigned to a specific provider, such as a physician or advanced practice nurse. This expanded role remains within the LPN’s designated scope of practice, in support of the veteran’s plan of care.
Several nursing associations and certifying boards, such as the Society of Urologic Nurses and Associates (SUNA) and the National Board for Certification of Hospice and Palliative Nurses (NBCHPN), offer various types of certifications for LPNs/LVNs. However, the VA Office of Nursing Services only recognizes two specific certifications offered by the National Association of Practical Nurse Education and Service (NAPNES) and the National Federation of Licensed Practical Nurses (NFLPN). The VA-approved certification offered by NAPNES is in long-term care (LTC) and the NFLPN certification is in gerontology. (See Table 1.)
The average age of a veteran at Overton Brooks VAMC is 60, and this near-geriatric population is increasing within the VA health care system in general. Therefore, it will be extremely beneficial for VA hospitals to have a pool of talented gerontology nurses on staff. For this reason, and in the absence of an LTC unit within our facility, we concentrated our efforts on the certification in gerontology offered by NFLPN.
This certification evaluates competency in four specific domains:
1. Phases of the Nursing Process: Gathering information regarding the patient; identifying the patient’s health needs and selecting appropriate goals of care; designing a strategy to achieve the goals established for the patient; initiating and completing actions necessary to accomplish goals; and determining the extent to which the goals have been achieved.
2. Areas of Patient Needs: Provision of coordinated and goal-oriented care; evaluation of patients’ basic physiological care; psychosocial, coping and adaptation needs of the patient; and developmental changes that occur in older persons.
3. Critical Thinking Skills: Identifying, gathering, discriminating and prioritizing data collection; discovering and then discerning the nature of relationships between concepts; determining how and why concepts are related; developing a process for establishing goals; and using problem-solving to achieve patient-specific outcomes.
4. Gerontology-Specific Topics: Nursing of elderly patients with physical and psychological disorders; special issues in gerontological care; foundations of gerontology; and promoting health and wellness in the geriatric patient.
Case Study: How We Did It
As the Magnet program director (MPD) for Overton Brooks VAMC, I was responsible for spearheading the LPN certification efforts. First, we sent out a call for participation to all LPNs within our medical center. The purpose of this initial call was to determine the number of LPNs who might be interested in certification, and in attending a dedicated review session to prepare for taking the gerontology certification exam. The LPNs were informed that all materials would be supplied by the medical center, the review session would be held on a Saturday and the test would be given at our facility, once again on a Saturday.
Answering this call for participation were 15 LPNs with varying levels of experience, employed in a variety of inpatient and outpatient settings. The LPNs were then asked to sign a letter of commitment acknowledging their individual willingness to attend the Saturday review session and the Saturday test. These were not scheduled workdays, and participating LPNs who worked on Saturdays were to use vacation time or request these days as scheduled days off. Unfortunately, this decreased the size of our participant group from 15 to 12. Even so, we moved forward with our initial plans to increase the number of certified LPNs.
Our next step was to obtain funding for the certification project. Initially, the project was discussed with nursing leadership, who viewed the certification in gerontology as a continuing education opportunity. Subsequently, the proposal was presented to the medical center’s executive leadership group, who determined that this very worthwhile professional development activity was appropriate for funding through continuing education funds. This enabled us to order the materials we needed.
Education Resources, Inc. (ERI) sponsors the certification testing and credentialing offered by the NFLPN. ERI has a long history of assisting practical nurses with various types of educational opportunities. The paper/pencil examination may be administered at the place of employment for LPNs or at an approved testing facility. Hence, the test was administered at our hospital and I served as the proctor.
ERI provided a review DVD, test booklet, pencils and proctor verification forms for each participant. They also provide each LPN participant with a diagnostic report, listing on the national LPN registry and individual certificates (for those who pass the exam).
When the DVD review materials arrived, my next job was to evaluate them to determine their adequacy in preparing our LPNs for this examination. I was qualified to do this because I have experience in working with practical nursing schools and NCLEX-PN® and -RN® preparations, and I hold an advanced degree in public health education and a doctoral degree in health policy. I also have more than 15 years experience in curriculum design, development and evaluation.
My initial review of the materials determined that further enhancement would be beneficial to this LPN group. Therefore, I developed our own additional review materials, including over 300 PowerPoint slides covering topics such as normal aging changes (physical and emotional), major disease processes affecting the elderly, and test-taking strategies. Additionally, the DVD was transcribed verbatim to a hard-copy format to facilitate adult learning.
As with any review course, it’s important to know your audience. Standardized review courses are generally tailored to a large audience. That’s why it’s so crucial to determine if the majority of your group members are functioning at the same knowledge level prior to conducting a group review.
In early May 2008, we conducted the review session with our 12 LPN participants. It lasted six hours, with three 15-minute breaks. Participants were encouraged to bring beverages and light snacks to the session; however, lunch was not provided.
The LPN group returned later that month to write a 105-item certification exam. They had two hours to complete the exam, though most were finished within one hour.
When ERI sent us the examination results, they arrived at my office in individual sealed envelopes to ensure confidentiality. In turn, the LPNs were notified that the results were available. Individually, each one came to my office, received their envelope and anxiously reviewed their results. Nearly all of the participants—11 out of 12—successfully passed the certification exam and are now proudly identified as certified LPNs in gerontology, holding the LPN, GC [Gerontology Certified] designation.
Cost-Effective and User-Friendly
The cost to our medical center was minimal. As itemized in Table 2, the estimated total cost was around $1,900. I volunteered a total of 12 hours of my time for the review session and the test proctoring.
In conclusion, this certification strategy has proven to be a worthwhile professional development opportunity involving a successful collaboration between direct care nurses, medical center leadership and our facility’s Education and Training Service, which provided financial resources. The benefits to our facility and our LPNs are evident. The group certification enabled us to:
• increase the professional role of the LPN;
• improve career advancement opportunities for these nurses;
• help LPNs meet their personal and self-improvement goals; and
• provide an avenue for LPNs to highlight their special skills and talents in gerontology.
We have rewarded each newly certified LPN with a within-grade step increase. The next phase of the project will be to replicate this user-friendly approach to group certification with other licensed nursing staff (RNs and advanced practice nurses), as well as unlicensed staff (nursing assistants and health care technicians). Our VAMC is well on its way to obtaining 20-25% certification among its direct care nurses—the first step in our journey toward achieving Magnet recognition. n
References
1. Cary, A.H. (2001). “Certified Registered Nurses: Results of the Study of the Certified Workforce.” American Journal of Nursing, Vol. 101, No. 1, pp. 44-52.
2. American Association of Critical-Care Nurses and AACN Certification Corporation (2003). “Safeguarding the Patient and the Profession: The Value of Critical-Care Nurse Certification.” American Journal of Critical Care, Vol. 12, No. 2, pp. 154-164.
3. Piazza, I.M., Donahue, M., Dykes, P.C., Griffin, M.Q., and Fitzpatrick, J.J. (2006). “Difference in Perceptions of Empowerment Among Nationally Certified and Noncertified Nurses.” Journal of Nursing Administration, Vol. 36, No. 5, pp. 277-283.
4. Shirey, M.R. (2005). “Celebrating Certification in Nursing: Forces of Magnetism in Action.” Nursing Administration Quarterly, Vol. 29, No. 3, pp. 245-253.
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