Registered Nurses Perception of Specialty Certification

Name of student: Melissa Somerville

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Chapter 1. 2

Introduction. 2

Statement of the Problem.. 5

Significance of the Problem.. 7

Purpose of the Study. 8

Research Question. 9

Definition of Terms. 9

Theoretical Framework. 10

Assumptions and Limitations. 12

Summary Paragraph. 12

References. 13

Chapter 1


Certification is one of the ways of empowering nurses since it validates their competence and increases their chances of experiencing professional growth. However, certification comes at a cost and one has to spend time pursuing the certification process. Certified nurses are often regarded as specialty leaders in their practice.


For a nurse to get a certification, many hours have to be spent in a program that facilitates the certification process. Therefore, the initials that are found in the names of some nurses indicate more than professional excellence; they also indicate the efforts that the nurse made in pursuing a program that would facilitate the recognition of her individual nursing excellence in a particular specialty.

            While certification plays a very important role in the nursing profession, it also has a share of problems. The implication created by certification by specialty is that nurses practice as autonomous groups. These groups are established in the process through which different nurses are required to meet different qualifications in order to be certified. Practice, education and experience requirements differ from one specialty to another.

            Specialty organizations have in the past been trying to propose the creation of a nursing specialty board at the national level whereby certification criteria and standards would be established uniformly. The presupposition of this proposal was that this would increase the value of credentials in a scenario where there is a wide variation in nursing certification programs, thereby improving professionalism in nursing. 

Certification is a means of empowering nurses. Specialty certification benefits the individual nurse, the area of specialty where the nurse practices, (and generally, the nursing profession), the institution and the entire community.  Gibson (1989), (cited in Tenney et al, 1992) revealed in a research study on nurses’ perceptions of specialty certification that nurses anticipated an automatic validation of professional achievement as well as an improvement in their self-image upon becoming certified. The study also revealed that 84% of all the 493 respondents who were surveyed said that certification would enable them to make improvements in patient care skills.

            Nurses with specialty certification tend to get respect and great admiration from their peers because of their expertise and advanced knowledge. Certification stimulates many nurses to stay up-to-date with knowledge and practice since they are often exposed to continuing education. Additionally, certification makes it easy for nurses to find opportunities for private practice, where they can take up career roles as expert witnesses or consultants (Tenney et al, 1992)

This research explores the perceptions that influence nurses in seeking specialty certification. The research delves into the benefits of getting nursing certification with a view to find different perceived benefits and inherent, self-evident benefits. The main aim of this research, therefore, is to clarify the validity of different benefits of getting certified.

Tenney et al, (1992) list five main different areas where benefits are achieved through specialty nursing certification: (a) to the individual nurse, (b)areas of specialty practice, (c) the nursing profession, (d) the nursing institution, and (e) the community. This research will explain the benefits of nursing in all these different areas, although the main emphasis will be on the benefits that accrue to the individual nurse, the main aim being to try and disentangle inherent benefits from mere perceptions.

             To the specialty practice, certification makes it easy for different levels of competence in the practice to be clearly drawn out and defined. Through certification, the legitimacy of a certain specialization is guaranteed. To the nursing profession, a certification is a form of self-regulation. A nurse is recognized through the validity of his proficiency. A nurse who is certified in certain areas is considered to have mastered a certain body of highly specialized knowledge, has adhered to certain established standards and has become competent in terms of practice and experience.

The nursing institution, too, derives many benefits through certification, one of them being the creation of a basis for hiring, promotions, wage increases, and provision of practice privileges. Certification is a good basis for third-party payment (Edari and Staff, 1979 cited in Tenney et al, 1992). The community benefits through certification through improvement in quality in the care given to patients.

            For a nurse to become certified, he has to commit some time, money and energy into the certification process. There are exams to be taken, and this means drawing up study plans for several months that precede the exam. Demauro (2008) says that today, certifications are available for almost every nursing specialty such as the American Nursing Credentialing Center (ANCC) or Board of Certification for American Nurses). The ANCC certifies nurses in more than 20 different specialties. Certification, adds Demauro, which is a good basis for getting a pay increase, whereby certified nurses according to national salary statistics, earn more compared to their uncertified colleagues with the same level of academic qualifications.

According to Demauro (2008), many nurses are motivated to seek certification since it carries the same connotation regardless of where one works – in the military, NGOs, private practice and so on. National salary surveys indicate that it becomes easy for certified nurses to get better-paying jobs that fall squarely along their chosen career paths.

Statement of the Problem

Nurses associate certification with a pay increase, better-paying jobs, respect, and improved self-image. However, not all the benefits of certification are real. Some people may question the rationale of a nurse having to incur additional expenses in terms of time, money and energy merely to put additional initials in front of his name. This, though, is not where the main problem lies. The main problem is with the perceptions associated with certification.


The state of affairs in the nursing profession is far from settled and the certification designs to be adopted in future certifications remain uncertain Tenney et al, (1992). Woods (2009) notes that in the year 2001, 341,000 certifications were made, spanning in 134 specialties. The certifications were made by 67 different certifying organizations.  The main reason for this high number of certifications was the marketing potential that nurses believed, and continue to believe certification has. However, these figures are an indication of a reduction in the number of nurses who have been seeking certification since the early 1990s.

According to recent research, specialty nurse training and education can improve the quality of care given to patients. Specialty nurse certification can also improve the job satisfaction of nurses, leading to a sense of empowerment. Additionally, it may result in a positive effect collaboration among team members in the healthcare system. Despite the potential for these rewards to accrue to nurses, there is a lack of extrinsic value to people who are in the nursing profession, making it unlikely that a higher number of nurses will be attracted to certification programs unless opportunities for recognition and greater compensation are put in place by administrators.

            Certification brings about the intrinsic value to nurses. Intrinsic values are non-tangible benefits such as an indication of professional growth, validation of knowledge, personal satisfaction, an indication of attainment of a practice standard and a feeling of personal accomplishment. It fails to bring about extrinsic benefits. Although intrinsic rewards by far outnumber intrinsic rewards, extrinsic rewards appear to be the main driving force that motivates nurses into deciding whether to become certified or not. Some of the most referred to extrinsic rewards include increased knowledge, enhanced collaboration between a member of the medical profession and improved skills. This research sets out to find out whether nurses are motivated by extrinsic or intrinsic rewards with the basis of the investigation being the perceptions that dominate the nurses’ understanding of extrinsic and intrinsic rewards.

            This research will be beneficial to all stakeholders of health care, especially those involved in setting up of policy frameworks in the nursing profession. For nurses, this research will shed light on the real benefits of getting specialty certification. For employers, the findings of this research will be useful in setting up frameworks that ensure that the needs of nurses are met, the most important of which is recognition of those nurses who have dedicated their time, money and energy into efforts to get specialty certification.

Significance of the Problem

            Certification, in most cases, is a matter of a nurse’s individual efforts. Even in cases where reimbursements and additional payments are made for nurses who pursue certification, this scenario is more of an exception rather than a rule. When nurses register for certification, this results in a shortage of nurses, increased call duty on nurses’ days off and limited time spent on oneself and family.

There is a need for an assessment to be made on the true cost of certification and whether the accruing benefits are worth the efforts made. Against this backdrop, this research may be a good reference point for policymakers in the healthcare sector. Through proper policies, some fundamental stressors that nurses encounter can be eliminated and nurses may get better rewards for their efforts at certification.

            Wade (2009) notes that a better understanding of the enticements and interventions that would make more nurses seek certification certified can prove beneficial to the health care industry, patients and the nursing profession.

            For the nursing profession, the findings of this research have very far-reaching implications. Wade (2009) reports fears that there are too many nurses leaving the profession and at the same time, there are too few nurses entering the profession. However, he expresses the hope implied by recent researches, which indicates that nurses who feel empowered in their work environments, and who are recognized for their contributions are likely to stick to their profession.

            Certification is one of the ways through which the experience, competence, knowledge, and contribution of nurses to the healthcare sector is recognized. Therefore, argues Wade (2009), it has the potential to bring about the retention of nurses in the profession. By addressing the issue of perception towards intrinsic and extrinsic rewards of certification, this research highlights the true meaning of this process, what it takes to become certified, the policy implications and most importantly, the potential of certification to bring about satisfaction and retention of nurses.

            This research has far-reaching theoretical implications on Benner’s theoretical model, which ranks proficiency from the level of a novice to that of an expert (Benner, 1984 cited in Wade, 2009). According to this model, nurses gain knowledge and develop skills of nursing practice by passing through five levels: novice, advanced beginner, competent nurse, proficient nurse, and expert nursing professional. When nurses opt-out of the nursing career on account of lack of satisfaction, Benner’s model may be seen to be an ineffective tool for explaining this scenario. When there is a proper assessment of the certification factor in research such as this one, Benner’s theoretical framework becomes a credible tool of explaining career progression in the nursing profession.

Purpose of the Study

            The aim of this study is to find out whether nurses are motivated to seek certification by extrinsic benefits or extrinsic rewards. The case study method of inquiry will be used to gather qualitative data for purposes of identifying the reasons that motivate nurses into seeking certification. The analysis of these findings will be done in such a way that perceptions about the rewards of certification will be highlighted.

            Perceptions that nurses have concerning certification determine how motivated they feel to undertake a certification education and exam. For this reason, any study of intrinsic and extrinsic benefits of nursing, whether perceived or real, has to focus on what nurses’ perceptions about certification really are.

            The main units of analysis will include

  1. The nature of perceptions of empowerment among nationally certified nurses
  2. Relationship between professional characteristics and clinical nursing expertise: focus on the role of certification.
  3. Perceptions of the value of specialty nursing certification

In each unit of analysis, the focus will be on the motives that drive nurses into seeking specialty certification and these professions perceive the relationship between empowerment through certification and career progression as described in Benner’s theoretical model. An assessment will be made on the likelihood of a perceived intrinsic or extrinsic reward driving a nurse into seeking specialty certification. Different relevant case studies will be analyzed based on the gaps in knowledge indicated in the literature review section.

Research Question

Does specialty certification give intrinsic and extrinsic rewards that are necessary for the build-up of proficiency from the level of novice to expert among nurses?

Definition of Terms

Extrinsic benefits————-these are the benefits that accrue as extra rewards upon compliance by professionals. They include increased pay, free food at the hospital’s cafeteria, free long-distance calls over the hospital’s cyber café, transport, remuneration packages for overtime-hour schedules and so on.

Intrinsic benefits———— Intrinsic values are non-tangible benefits such as an indication of professional growth, validation of knowledge, personal satisfaction, an indication of attainment of a practice standard and a feeling of personal accomplishment. Intrinsic benefits are very integral sources of job satisfaction.

Specialty certification——this is the mechanism through which the nurses are recognized for their professional qualifications, practice, and experience, mainly for purposes of validating clinical competency and bringing about professional growth.

Theoretical Framework

Benner’s theoretical model that involves ranking proficiency from the level of a novice to that of an expert will guide this study. According to this model, as nurses continue to develop skills as well as to gain knowledge through nursing practice, they pass through five levels of proficiency. This theory is based on the proposition that each level is always built heavily upon the experiences that have been generated at lower levels (Benner, 1984).

            The different levels of nursing described by Benner include novice, advanced beginner, competent nurse, proficient nurse, and expert level. These levels are a reflection of a nurse’s movement from the reliance on abstract principles to repeated use of past education and experience (Benner, 1984)

            Without a proper understanding of the complexities of acute situations that tend to be very perplexing, a novice nurse is very limited to routine task performance that requires little analysis. A step up from the level of a novice, advanced beginners may have the ability to perform simple emergency tasks within a department such as triaging very simple, straightforward cases as well as recognizing and identifying normal variability in vital signs that are common in clinical scenarios.


However, practitioners at the level of an advanced beginner may still be misled by atypical scenarios, so competent nurses apply critical thinking and analytical skills while assessing multiple relevant elements present in the patient’s condition in order to devise treatment plans encompassing both short-term and long-term goals (Benner, 1984). In Benner’s theory, the emphasis is on education and experience as key factors of helping a nurse move from the level of a novice to that of an expert nurse.

In the first unit of analysis entitled “The nature of perceptions of empowerment among nationally certified nurses”, all the levels of professional development that Benner outlines will be the main reference point. Instances where notions of empowerment do not coincide with the needs of professional growth as outlined by Benner, then such notions will be considered to be perceptions. From this point, it will be easy to refer to these perceptions as the basis of determining their influence on nurses’ decision to seek specialty certification.

Benner’s theoretical framework will also be used to research the second unit of analysis entitled, “Relationship between professional characteristics and clinical nursing expertise: focus on the role of certification”. The role of certification in each of Benner’s stages of professional growth will be succinctly defined. A qualitative analysis of different case studies will make it easy for various points at which nurses start to perceive the need for specialty certification to be identified.

In the third unit of analysis, “Perceptions on the value of specialty nursing certification”, the focus will be on the effect of certification towards nurses’ attitude towards challenges in the process of becoming experts. Although the relationship between specialty certification and competence is yet to be examined by researchers in the medical field (Kendall-Gallagher 2009), there are many case studies from which analysis can be made on these relationships. This research will make use of such secondary data in order to derive analyses and arrive at findings. Moreover, the relationship between competence and safety of patients in the hands of caregivers, which in recent years has attracted a large body of research information, will also be explored.

Assumptions and Limitations       

            The most fundamental assumption in this research is that the research findings of all the research studies where secondary data will be gathered will be accurate. It is impossible for abstract notions used by novice nurses to be quantified, which is why the qualitative method suits this research best. Moreover, at the level of a novice, a nurse may lack exposure to the understanding of the notions of empowerment as they apply to more experienced nurses who are seeking specialty certification. They may also follow the crowd when registering for specialty certification exams. The accuracy of analyses derived from this group’s information may be contested.            

            In the first unit of analysis, perceptions will be derived from the lack of congruency between notions of empowerment and the need for professional growth. In this case, the respective nurses will be considered to be making moves towards certification using the wrong arguments. However, there could be other underlying motivating factors that may lie outside the scope of this research.

Summary Paragraph

The need to create a work environment that is conducive to nurses is an important issue in healthcare. Nurses, like all other professionals, love opportunities and if they believe that certification brings them closer to where professional opportunities are, they should be encouraged to seek certification. This goes a long way in analyzing researches that have been done before relating to the nursing professional environment, with and without certification. Within this environment, an analysis of nurses’ perceptions of specialty certification is made. Although it is a nurse’s sole discretion to decide why to get certification and why not to do so, this professional decision is of national significance, something that this research seeks to exemplify.


Demauro, N. 2008. Put Some Letters After Your Name: Why And How To Get Certified In A Specialty, Career Guide. Macmillan: New York

Kendall-Gallagher, D. 2009. Competence and Certification of Registered Nurses and Safety of Patients in Intensive Care Units, American Journal of Critical Care, 18(2), 106-116.

Tenney, J., Demoucell, P. & Wians, K. 1992. Rehabilitation Nursing, Empowerment of Nurses through Certification, 18(4), 231-236.

Woods, D. 2002. Realizing Your Marketing Influence: Professional Certification as A Marketing Tool, JONA, 32(7/8) 379-386.

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