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Creating a Culture of Certification

Critical care nurses get motivated about their specialty

Vol. 7 • Issue 4 • Page 15

When I was new to critical care a long time ago, I met a nurse named Lisa who was so knowledgeable about our specialty," recalled Cher Hagaman, MSN, RN, CCRN-CSC, CNS, PHN. "She had a little pin on her lapel, and I remember wanting to get the experience I needed, study on my own and be like her. I didn't realize what certification meant at that time, though, or understand the significance of her pin."

Every Nurse Needs a Champion

It wasn't until Hagaman attended a National Training Institute (NTI) program sponsored by the American Association of Critical-Care Nurses (AACN) that the pieces fell into place. "I learned I very much wanted to be able to say with certainty that I'd been validated as an expert critical care nurse," she said. "I read more about CCRN certification online and found out AACN needed ambassadors for certification, so I volunteered."

As a critical care staff nurse and the sepsis resource nurse for Hoag Hospital, Newport Beach, Hagaman was a bit hesitant to articulate her idea, so she wrote out a proposal and shared it with Rick Martin, MSN, RN, senior vice president of clinical operations and chief nursing officer. "I said that if I had $500 for compensation and plaques for nurses who became CCRN-certified, that would be something I could use as a conversation starter," she said. "He agreed, and 10 nurses went to the first CCRN review course under our new plan. Eight of those nurses passed, and I had their names engraved on a plaque in a hallway outside our unit. Patients and families notice the names on the plaques, and the listing of names serves as a challenge for other nurses to earn their specialty certification."

Hagaman firmly believes encouragement and acknowledgement are the best motivators to get colleagues started on the journey to specialty certification. "When I see a colleague who's really grown professionally and is no longer a novice, I write a note," she said. "The message is, 'I'd like to encourage you to take the CCRN exam, and I'll help you with the requirements and the application process.'"

Positive reinforcement goes a long way. "People need to know we have confidence in them," Hagaman said. "The hospital provides a $500 one-time bonus for newly certified nurses and reimburses for the certification exam initial fee and renewal. Every year, Hoag sends two day-shift RNs and two night-shift RNs to the NTI in recognition of their certification achievements. And as a certification ambassador, I personally write each new CCRN a congratulatory note and enclose a CCRN lapel pin."

When Hagaman began implementing the first step toward creating a culture of certification in Hoag's critical care units in 2005, there were five CCRNs. Today, there are 51 CCRN-certified nurses, and she's started encouraging appropriate staff to earn their cardiac surgery certification (CSC) as well. "And five nurses who have been here 1-1/2 years are already studying the book and getting ready to take the exam once they have the required 2 years of experience," she said.

Support for Bedside Clinicians

Judy Crouch, MSN, RN, CCRN, CNS, clinical nurse specialist at Sierra Nevada Memorial Hospital in Grass Valley, found a similar situation when she started introducing herself to staff nurses. "They seemed hungry for an outside influence, so we started talking about how certification in a nursing specialty reignites a passion for nursing and a hunger for learning," she said. "The critical care nurses were very interested in pursuing CCRN certification, and that interest grew into a concentrated focus among nurses in case management, OR, ED and med/surg.

"Pretty soon, my office started looking like a recruitment center for certification, with all the information and applications right at hand," Crouch laughed. "I had to put my money where my mouth was by studying and earning my CCRN as well."

Crouch took her role as certification ambassador very seriously. "As one of my goals, I began to set up lunch-and-learn events for staff to ask questions about certification," she said. "I also began roving recruitment and sent e-mails on the different certifications available. I worked with our hospital library to provide a list of references to purchase."

Prior to Crouch's arrival, Mary Gish, MS, RN, NEA-BC, chief nursing officer, had already laid some of the groundwork for certification. "She made executive rounds and began talking to staff nurses about the value of certification and professional nursing practice," Crouch noted. "She offered to pay for certification prep classes outside the hospital and encouraged me and other educators to offer classes."

As Crouch worked to create a culture of certification, Gish paved the way for some necessary changes. "She worked with human resources to change the scope of tuition reimbursement to include specialty certification classes, provided three hosted brunches and invited schools to [present] information on advancing the students' nursing education," Crouch noted.

Once nurses passed their certification exams, they were honored by their leaders and peers. "On Nurses Day, we recognized all the staff who had applied for certification exams," Crouch said. "We provided monetary recognition and lapel pins, as well as plaques to recognize successful candidates. While some nurses didn't think certification would really make a difference, they became proud and excited when their names were posted. Their colleagues looked at the plaques and said, 'If she can get certified, so can I!'"

Today, 13 of the 24 critical care nurses at Sierra Nevada Memorial are CCRN certified, and eight ED nurses have earned their CEN certification. Ten nurses on the telemetry unit have earned their PCCN (post-coronary care nursing) certification and others are certified in med/surg.

Crouch has noticed a change in the way certified nurses viewed their professional practice. "They started asking questions like, 'If what we learned in our course was right, we should be measuring abdominal pressure on these patients - why aren't we?' or 'Why hasn't this practice changed to reflect new evidence?' We've had some great conversations about their own responsibility for refining bedside care, and how they can affect those changes."

Sandy Keefe is a frequent contributor to ADVANCE.


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