Do you have a particular area of nursing you are passionate about? Maybe it’s time for you to carve some time out of your crazy busy schedule to get a specialty board certification.
Obtaining a specialty certification can help your career in several different ways, but it also helps you personally.
“Certification validates our specialized knowledge,” says Al Rundio, PhD, DNP, RN, APRN, CARN-AP, NEA-BC, DPNAP, FIAAN, and associate dean for post licensure nursing programs at Drexel University College of Nursing and Health Professions.
As the most trusted profession in the country (reported by Gallup), all nurses with that extra certification are making a statement. Whether it’s a nurse executive or a staff nurse, Rundio says having the specialty board certification is a way to publicly demonstrate that your knowledge is specialized, up-to-date, and officially recognized.
Rundio says he’s passionate about helping nurses get certification because it’s a career and a confidence boost. “It puts them at a higher level,” he says, “and it validates to them that they can do it.”
What holds nurses back? Time, of course, is precious to nurses and often finding extra time for certification is tough. But Rundio also says nerves about passing the certification test also keeps some knowledgeable nurses from even taking it. But often you’re tested on the skills you use every day in your normal course of work. Acknowledging your testing fears might be allayed once you realize that you’ll likely have no problems passing.
Once you receive a board certification, it’s good for several years and you can continue to explore as you look at recertification. Those requirements might be continuing education or they could be something like publishing an article or even becoming active on a professional board.
Over the years, Rundio has obtained several certifications, some that remain current and some he has let lapse according to his interests and work. Nurses should go for certification in the areas they practice, says Rundio. They are already experienced in the specialty (like addictions or infection control, for example) and getting the certification is just an official recognition of your expertise. “You’re validating what you do,” says Rundio, “but you’re doing this every day.”
And if you’re looking for a job, specialty certification shows you have gone above and beyond expectations and requirements, says Rundio. If an employer is considering two nearly identical candidates, but one has certification and one does not, Rundio says the one who is certified will most likely win out.
“If we look at nursing as a profession and not a job, there are certain things we need to do to be professional,” says Rundio.
Getting certification takes time and effort, but the results are well worth it. In the end, you’re making a personal statement about your work and a professional statement about your skills and knowledge.
Do you work at one of the more than 400 Magnet-recognized hospitals around the world? It has been said that minority nurses who work at these recognized facilities have the benefit of flourishing in a positive environment with employers who value their skills and career goals.
However, the results of Minority Nurse’s 2014 best companies survey suggest that nurses value other qualities far more than Magnet status when it comes to selecting an ideal employer. The survey, which was conducted late last year, asked nurses how important certain qualities (such as salary, benefits, and flexibility of hours) were to them when considering an employer. The results revealed that Magnet status ranked near the bottom of the list, only ranking ahead of one category: workplace size.
For some health professionals, the question of whether or not Magnet status is important can’t be fully answered until they know more about the designation, and that includes those nurses who work at Magnet-designated facilities, says Kristin Baird, RN, a hospital consultant.
“In some programs, people talk about ‘Magnet’ but people don’t understand it,” she says. In turn, they may be less likely to advocate for it or share its benefits with their colleagues. If a facility has already achieved the designation by the time a nurse is hired, then the nurse who didn’t go through the certification process may have a harder time understanding its importance and impact, especially when speaking with fellow nurses, Baird argues.
“If it’s just part of who [their hospital] is and people stop talking about it, and they don’t embrace what it means, they’re not going to be promoting it,” she says.
However, many nurses who work at Magnet hospitals and who do understand the program believe that it is a very important ideal. “Having Magnet status heightened our visibility in the community and state for being a leader for health care,” says Cabiria Lizarraga, RN, manager of telemetry at Sharp Grossmont Hospital in San Diego, California. Sharp Grossmont Hospital first received Magnet status in 2007.
Other hospitals likely receive positive coverage in their communities as well, Lizarraga adds. In fact, according to the American Nurses Credentialing Center (ANCC), 15 of the 18 medical centers on the 2013 US News Best Hospitals in America Honor Roll and all 10 of the US News Best Children’s Hospital Honor Roll for the same year are recognized by the ANCC as Magnet-recognized organizations.
“It’s very important to have because it shows we are committed. When people see we are a Magnet facility, they know the employer is committed to nursing excellence,” says Lizarraga.
Patients who are seeking hospitals may also look for the Magnet designation as an objective benchmark to help them choose where they’ll do business, says Nick Angelis, CRNA, MSN, a nurse anesthetist in Pensacola, Florida. Angelis has worked at Magnet and non-Magnet hospitals throughout his career.
Understanding the Magnet Designation
According to the ANCC, which is the Magnet credentialing organization, there are three goals for the program:
• Promote quality in a setting that supports professional practice;
• Identify excellence in the delivery of nursing services to patients/residents; and
• Disseminate best practices in nursing services.
The process to achieve Magnet status is identified by the ANCC as the “Journey to Magnet Excellence.” Facilities have to show that they have strong nurse leaders who are able to guide teams, develop professionally, take the lead in research efforts, and can show good empirical outcomes and the impact of those results. The certification lasts for four years, after which time the facility can re-apply.
Angelis, who has served on several committees on hospitals seeking Magnet status, says it is an expensive and time-consuming process, but it’s a good way for hospitals to prove that they value nurses. “A Magnet designation can be a hint that a hospital has a culture that respects the contributions its nurses make,” he explains.
Enhanced Recruiting
“Nurses want to work for an organization that really strives to empower them, one that has opportunities in place for them to do research or advance their degrees,” says Lizarraga. Facilities that have Magnet status can attract some of the best nurses available, she adds. “It is used as a recruiting tool because nurses would know about Magnet nursing excellence.”
Angelis says that if a hospital has low morale among nurses, achieving Magnet status can provide positive motivation. “It’s an opportunity for the hospital to change their culture,” he says. “Facilities that empower their nurses can improve morale, and that can help with job recruiting and retention.”
Some Nurses Left Behind?
Having an environment that encourages professional development among nurses is a positive, but there is a concern among some professionals, particularly those who don’t have advanced degrees, about where they fit in under a Magnet facility, explains Lizarraga.
Will the jobs be there for LPNs and for associate degree and diploma nurses? “There is some concern about whether or not they’d be able to practice in an acute care hospital or Magnet facility,” says Lizarraga. It may be understandable why many Minority Nurse survey respondents viewed Magnet status as only “somewhat important.”
But that issue is bigger than Magnet certification, Lizarraga argues. In 2011, the Institute of Medicine released a report recommending that the proportion of nurses with baccalaureate degrees be increased to 80% by 2020. This recommendation affects all nurses, not just those at Magnet hospitals, she adds.
However, many nurses who have more advanced degrees obviously have an advantage, states Baird. “It’s not to say there’s not a place for LPNs, but if you’re a Magnet hospital you’re looking at advancing nursing as a profession and making sure you’re finding nurses who want to be at the peak of the profession,” she explains.
Find the Best Match
So what’s a nurse to do? According to Baird, nurses of all education levels should first identify their career goals and factors that are personally important, such as career growth potential, flexibility options, and income. Then, identify an employer that seems to offer the best environment.
“I’m a big advocate of hiring for fit and choosing a job for fit,” says Baird. “Identify your core values, then find an organization that’s in alignment with those values.”
If you plan to obtain an advanced degree or would like the opportunity to go into research or academia, working at a Magnet facility may be able to provide you with more opportunities than a non-Magnet facility, she says.
However, if a potential employer is not a Magnet facility, but has other benefits that may be important to you—such as more flexible scheduling or a generous tuition reimbursement program—that could be the way to go, says Baird. Whether nurses work at Magnet hospitals or not, identifying employers aligned with their values puts them in the best position possible to benefit their patients and their careers.
Margarette Burnette is a freelance writer based in Georgia.
Advanced education and specialty certifications can help minority nurses take their careers—and their ability to improve health outcomes—to a whole new level.
Carmen Paniagua has so many educational and professional credentials after her name that she practically needs an oversized business card to fit them all. In addition to being an RN, she is an ANP (Adult Nurse Practitioner), a board-certified ACNP (Acute Care Nurse Practitioner) and AGACNP (Adult-Gerontology Acute Care Nurse Practitioner), an APNG-BC (Advanced Practice Nurse in Genetics), and a FAANP (Fellow of the American Academy of Nurse Practitioners). She’s also a CPC (Certified Procedural Coder) and a CMI (Certified Medical Interpreter), and she holds MSN and EdD (Doctor of Education) degrees.
“Some people probably look at my CV and think this is just a lot of ‘alphabet soup,’” says Paniagua, a faculty member at the University of Arkansas for Medical Sciences College of Medicine in Little Rock. “But advanced degrees and certifications are more than just a collection of letters. They’re the evidence and recognition of your competence and clinical expertise. They enable nurses to take pride in the accomplishment of advanced practice knowledge and to demonstrate their specialty expertise to both employers and patients.”
Jose Alejandro, president of the National Association of Hispanic Nurses and corporate director of case management at Cornerstone Healthcare Group in Dallas, agrees that it’s what those abbreviations really stand for that counts.
“You can have all the degrees and certifications you want, but it’s the tools you learn from having them that’s the biggest benefit,” says Alejandro, an RN-BC (Registered Nurse-Board Certified), CCM (Certified Case Manager), FACHE (Fellow of the American College of Healthcare Executives), and a MBA who recently earned his PhD. “They give you additional skills and what I call your ‘chops.’ That’s primarily what has enabled me to move up in my career, because I can accomplish things based on more than just having experience.”
Opening Doors
There are many compelling reasons for minority nurses to pursue graduate education and specialty nursing certifications. Acquiring these credentials opens the door to a wide new horizon of rewarding advanced practice careers and leadership roles—from nursing professor and nurse scientist to nurse practitioner, nurse anesthetist, nurse executive, and more. Furthermore, the Institute of Medicine’s (IOM’s) landmark 2010 report The Future of Nursing: Leading Change, Advancing Health calls for all nurses to “achieve higher levels of education and training” and “attain competency in specific content areas” in order to respond more effectively in today’s rapidly evolving health care environment.
But the IOM report also underscores an even more persuasive reason. Advanced degrees and certifications—or more precisely, the specialized knowledge and skills nurses gain from them—are linked to improved patient outcomes and better nurse-led interventions for eliminating minority health disparities.
“This is a wonderful time for all nurses, and particularly nurses of color, to seriously look at graduate education, because of the millions of uninsured and underinsured people who will now be coming into the health care system as a result of the Affordable Care Act,” says Kem Louie, PhD, RN, PMHCNS-BC, APN, CNE, FAAN, professor and director of the graduate nursing program at William Paterson University in Wayne, New Jersey. “Many of these new patients will be members of medically underserved minority populations. The other issue is that there’s a shortage of primary care physicians. So there’s a tremendous need to increase the number of culturally competent advanced practice nurses who can meet these patients’ primary health care needs.”
Of course, it’s also hard to ignore the “what’s in it for me?” benefits. Becoming certified in an in-demand specialty—for example, emergency nursing, perioperative nursing, critical care, or pediatrics—increases your value to employers. Plus, it’s no secret that many advanced practice (APRN) specialties that require a master’s degree and board certification—such as Certified Registered Nurse Anesthetist (CRNA) and Certified Nurse-Midwife (CNM)—pay substantially higher salaries than the typical staff RN position (see sidebar). In fact, according to the most recent (2008) Health Resources and Services Administration (HRSA) National Sample Survey of Registered Nurses, RNs with graduate degrees earn an average of at least $20,000 more per year than nurses with lower education levels.
But it’s not just about the money, argues Henry Talley V, PhD, CRNA, MSN, MS, director of the nurse anesthesia program at Michigan State University College of Nursing in East Lansing and treasurer of the American Association of Nurse Anesthetists. “Advanced degrees and specialty certifications do increase your earning powers,” he says. “But they also increase your ability to make change happen in health care. They make you an expert in your particular field, and they put nurses on an equal footing with other health professionals.”
Breaking Down Barriers
Minority enrollments in graduate nursing programs have nearly doubled over the past decade, according to the American Association of Colleges of Nursing (AACN). Yet racial, ethnic, and gender minority nurses continue to be underrepresented among the ranks of APRNs and certified RNs—primarily because they’re still underrepresented in the nursing population as a whole. Fortunately, numerous nursing organizations, from AACN to the American Board of Nursing Specialties, are recognizing the need to identify and remove barriers that may prevent nurses from diverse backgrounds from earning the advanced credentials they need to succeed.
Traditionally, one of the biggest challenges in going back to school—for majority and minority nurses alike—is finding the funds to pay for it. And thanks to the current economy, with its skyrocketing tuition rates and burgeoning student loan debt, figuring out how to afford graduate school can be a trickier task than ever. Then there’s the cost of certification examinations, which in some cases can range from about $300–$400 to as high as $725 for the CRNA exam. But even though finances can be a formidable obstacle, they’re not an insurmountable one.
“What I have personally observed is that our potential minority nursing students are much more hesitant to take out loans and incur debt than majority students,” says Courtney Lyder, ND, ScD(Hon), GNP, FAAN, dean and professor at UCLA School of Nursing. “And what I tell them is: Nurses make good salaries. Compared with other academic disciplines, the compensation in nursing makes it one of the few professions in which you can actually pay off student debt in a timely manner.”
“One of the benefits of coming to graduate school now is that there are still scholarships and federal financial assistance programs available,” adds Louie, who is also the founding president of the Asian American/Pacific Islander Nurses Association. She cites HRSA programs like the National Health Service Corps, which provides scholarships for nurse practitioner and nurse-midwife students in return for a commitment to practice in a medically underserved area for at least two years after graduation, and the Nurse Faculty Loan Program, which forgives 85% of student loan debt for RNs who complete a graduate degree at a participating school and agree to serve as full-time nursing faculty.
Talley and his wife, a Clinical Nurse Specialist (CNS), recently conducted research examining some of the other factors that impede minority nurses from pursuing advanced degrees in general and nurse anesthesia degrees in particular. Lack of knowledge about APRN and specialty nursing career paths is another big barrier, he says.
“There are still people of color out there who have just not had the exposure to these career options,” Talley explains. “Nursing specialties have to get the message out to them about these opportunities and what the requirements are. Nurses need to know early on that they will want an advanced degree, because the key to opening that door will be how well they do in their undergraduate studies. Otherwise, they’ll find out about advanced practice specialties later in their BSN programs and decide ‘I want to do that’ when their GPAs will not support it.”
But Alejandro believes that perhaps the hardest hurdle for minority nurses to clear is the surprisingly common “fear factor.”
“It’s the fear of failure, fear of the unknown, fear of whatever,” he says. “I tell all the students I mentor: ‘The very first barrier you have to overcome in pursuing any advanced education or any certification is removing that fear.’ In my case, once I was over that fear, I was able to ask questions. If I didn’t understand something in a particular class, I went ahead and asked classmates who understood it a little better.”
Starting the Journey
So you’ve decided it’s the right time to return to school, earn an advanced degree, and chart your course toward a fulfilling specialty nursing career. Congratulations! But where do you start? How do you choose which graduate program to apply to? And what type of degree should you go after? Is a terminal master’s enough or will you need a doctorate?
Lyder, who made history by becoming the first male minority dean of a school of nursing in the United States, as well as the first African American dean at UCLA, says it all boils down to answering one basic question: What do you want to do?
“Find your bliss,” he advises. “Is it pediatrics, geriatrics, psych/mental health, administration, nurse-midwifery, nurse anesthesia? Once you’ve figured that out, the next step is to identify schools in your community that may have those programs. Then, contact those schools and schedule a time to talk with the admissions counselors—and I don’t mean an e-mail—to see if this is something you really want to pursue. Also, try to find an opportunity to shadow someone who’s in that role. Identify that CRNA or that psychiatric nurse practitioner and say, ‘Can I shadow you for a day to get a sense of whether this is what I want to do?’”
Getting over the fear of speaking directly with admissions officers or the graduate program director to get the facts you need to make well-informed decisions about a school is key, Louie emphasizes.
“You have to tell yourself, ‘Just pick up the phone,’” she says. “Graduate programs in nursing are competitive and some of them can be very daunting. But I find that I have to invite students to talk to me, to ask me, ‘What support services are available? Tell me about the admission requirements. Help me through the application process.’”
As for what kind of advanced degree to get, once again it all depends on your goals.
“Some nurses are confused about advancing their education. They think they all have to be PhDs,” says Paniagua. “Well, if you’d like to be a nurse researcher, then a PhD is fine, because it’s primarily a research-focused doctorate. But then there are other avenues. You can get a doctorate in nursing practice (DNP), which is a professional practice degree, or you can get an EdD, which is an education-focused doctorate. So if you’re planning to have a career in academia, you should pursue either an EdD or a PhD. If you’re planning to practice or to work in the clinical setting, you should get your DNP. Or you can just get a master’s degree [in your specialty area of interest, such as an MBA or an MSN in nursing informatics].”
Above all, the most important thing to consider when shopping around for a graduate program is finding one that’s the right fit for your specific needs—both academic and personal.
“You need to make sure that your value system is in sync with the mission and vision of the institution,” Lyder says. “For example, here at UCLA we are a research-intensive school of nursing. Our professors infuse research and evidence-based practice into every course, every lecture, everything they do. If that’s not the type of learning environment you want, then this isn’t going to be a good match for you.”
Louie recommends investigating different program formats to find options that will accommodate what she calls “your life needs.” For instance, if you have to keep working at your job while going to school, or you have young children or other family obligations, the traditional full-time, brick-and-mortar campus model may not work for you. “You need to know that there are online programs, there are blended online/on-campus programs, there are part-time and weekend programs,” she says.
Another alternative worth exploring is the accelerated (fast track) format. These programs include RN-to-MSN—also known as a Master’s Entry Program in Nursing (MEPN)—which bypasses the traditional BSN degree, and BSN-to-PhD, which bypasses the master’s. Their greatest advantage is that they enable nurses to earn graduate degrees more quickly and earlier in their careers. However, because the accelerated time frame makes the academic workload extremely intensive, these programs aren’t for everybody.
Taking the Plunge
Achieving the advanced degrees and certifications that will boost your career to a higher level can be an arduous process. But all the nurse leaders interviewed for this article agree that the rewards are worth it. In fact, with the right preparation, the right program, and strong support networks (family, friends, faith, colleagues, mentors, and minority nursing associations), it might just be easier than you think.
Talley offers this advice: “Don’t be afraid to take the plunge. I think sometimes we [minority nurses] doubt ourselves, and there’s no reason to. Believe in yourself, have faith in yourself, and don’t let anyone interfere with your dreams.”
According to a report published in the May issue of the Journal of the American College of Surgeons, results of a study found that women and minorities going through general surgery training are relatively underrepresented among general surgeons, particular those certified by the American Board of Surgery (ABS).
Study authors Dorothy A. Andriole, M.D., F.A.C.S., and Donna B. Jeffe, Ph.D. researched 3,373 medical school graduates between 1997–2002 who had planned on becoming board certified in surgery after graduation, and followed the graduates for seven years or more, depending on general surgery residency training. The research looked at women and men who intended on getting certified for surgery after graduation, and found that women were more likely to leave surgery and pursue certification in other specialties. Women make up about 50% of total U.S. medical graduates.
In the study, 60% of the graduates achieved ABS certification, 10% were certified by another American Board of Medical Specialties (ABMS) member board, and 30% were not certified by any ABMS member board.
Researchers, however, did not evaluate why the medical school graduates chose to become certified in other specialty areas, or why some remained in surgery but didn’t become board certified.
Do credentialing examinations for nurses, such as the NCLEX-RN and specialty certification exams, put minority and foreign-educated candidates at a disadvantage? Or are these tests indeed culturally sensitive and fair to all who take them, regardless of race, ethnicity or national origin? There are no easy answers to this thorny question, which is currently the subject of much debate among minority nursing leaders.
One way the organizations that create these exams can maximize the chances of the playing field being level is to make sure nurses from culturally diverse backgrounds are involved in the test development process. The American Nurses Credentialing Center (ANCC), an ANA subsidiary that offers more than 40 certification exams in a wide range of specialties, is seeking qualified nurses of color to write examination items (questions) or to serve on content expert panels (CEPs) that review the items and develop test content outlines. Item writers and reviewers don’t have to be academics or have test development experience, but they must be certified in their nursing specialty.
Why is it so important to have more racial and ethnic minority nurses serving in these capacities? “One of the advantages of having minority nurses involved in developing exams is that they can look for bias [in questions] against a particular group,” says Dr. David Paulson, ANCC’s director of Measurement Services. The CEPs generally convene twice a year for three-day test review workshops in Washington, D.C. At these workshops, Paulson explains, “if any cultural or ethnic issues come up regarding a test question, it is helpful to have minority nurses represented there to discuss any items that may be biased.”
Item writers participate in an intensive three-day training session in Washington (all expenses paid). They are then required to research, write and submit 80 exam questions over a one-year period. Content expert panel members must attend the review workshops plus participate in approximately three conference calls a year. Some at-home review work may also be required. While writers and reviewers are not paid for their services, they do receive a substantial reduction in the number of continuing education contact hours required for their recertification.
For more information, contact Jamila Odom, (800) 284-7291, [email protected].
