The advantages of self-regulating

The development of specialist nurse credentialing in Australia has the potential to both empower nurses and improve patient care, writes Kim Ryan.

The International Council of Nurses (ICN) has long recognised that setting standards for nursing education and practice is a major responsibility of organised nursing and a key aspect of nursing's progress as a profession.

This extends beyond initial registration and the ICN refers to the application of these standards as credentialing.

In Australia credentialing refers to a voluntary self-regulation process carried out by the profession - a process of professional validation by which an individual nurse may be designated as having met established professional standards. In other countries the term may be applied more broadly to regulation, with the terms ‘‘credentialing’’ and ‘‘certification’’ used interchangeably.

Credentialing activities internationally appear in the context of nursing specialties. For example, women’s health nurses undertaking Pap smear tests, gastroenterology nurses, critical care nurses and mental health nurses in Australia, while in Canada certification is available for more than 17 nursing specialties.

Trends towards specialist nurse credentialing in Australia began in the 1990s associated with the reforms in nurse education. In 1991, the Australian Nursing Federation sponsored an informal forum of Australian nursing organisations, which has been meeting regularly ever since with the aim of guiding the orderly development of nursing specialities in Australia. The National Nursing Organisations (NNO), as the group became to be known was established and in 1994 the organisation created the first set of principles for the credentialing of nurses in Australia.

While a small number of Australian nursing organisations have developed their own credentialing programs, many others wanting to develop credentialing as a mechanism of recognition of their specialty have been limited by lack of support, resources or both.

In response, the Coalition of National Nursing Organisations (CNNO), as the NNO is now known, sought funding to review the existing Principles of Credentialing (1994) and in July this year, launched its National Nurse Credentialing Framework (2011). The framework was developed with project funding from the Department of Health and Ageing and provides a toolkit including standards, which member organisations can use to implement their own models of credentialing. Importantly, the framework offers a nationally consistent approach to the development of specialist nurse credentialing in Australia.

The slow development of specialist nurse credentialing in Australia generally means little research has been conducted about its benefits. However, there has been strong evidence from research in the US that its value has many benefits for nurses such as enhanced professional credibility and autonomy, as well as favourable associations between certification (credentialing) and knowledge, professional practice, or patient outcomes – it is an advantage for nurses and patients.

One of the first studies in the US to be conducted on the subject yielded a definitive link between certified nurses and better patient outcomes and improved patient safety. In 1999, the Nursing Credentialing Research Coalition asked more than 19,500 specialist certified nurses about a range of personal, professional and performance outcomes.

The study concluded there was evidence of a link between nurses who were certified and improved care for patients. While multiple factors contribute to patients experiencing a safe healthcare experience, “...clearly the delivery of care by practitioners who have earned distinctive credential, such as certification, is a factor to be acknowledged in any system,” it said. The study published in 2000 in the journal American Nurse provided an important understanding of the benefits of credentialing for nurses, patients, employers, and policy-makers.

Similarly, a 2008 study conducted by the Paediatric Nursing Certification Board found that certified paediatric nurses reported confidence in their clinical skills, professional credibility and commitment to learning, and this was linked to the recognition of quality nursing care and job satisfaction. A large number (77 per cent) of nurses who participated in the study also believed that being certified had resulted in a positive effect on patient and family satisfaction.

The American Association of Critical Care Nurses reported in 2008 that certified critical care nurses felt more empowered in their workplaces, compared with those without certification, and were less likely to leave their current position. This study concluded that certified nurses offer knowledge, experience and confidence to their workplace with the advantage of retaining a high level speciality workforce to enhance patient care and the organisation in which they practised.

Credentialing is voluntary, and making comparisons with regard to patient outcomes is challenging. However, these studies help to demonstrate the potential benefits for patients and health services, as well as industrial and professional benefits for nurses.

The Australian College of Mental Health Nurses Credential for Practice Program has been a successful program for professional specialist nurse credentialing in Australia. Since its national launch in 2004, over 1100 nurses have been credentialed as specialist mental health nurses. With the phasing out of direct entry psychiatric and mental health nursing education courses, the college was looking for a way to recognise and offer self-regulation for its own profession.

In keeping with the principles of the ICN, the college proactively increased its self-governance role with the development of mental health nursing standards and subsequently the credentialing program. The development of the Credential for Practice Program was assisted by the former Nursing Board of Tasmania in collaboration with the Tasmanian branch of mental health nurses and the University of Tasmania.

As these studies and the experience of the college clearly indicate, the commitment of the Coalition of National Nursing Organisations to profession-led credentialing, empowering nurses, strengthening the profession and improving outcomes and safety for patients, is a worthwhile endeavour.

Kim Ryan is the CEO of the Australian College of Mental Health Nurses and chair of the Coalition of National Nursing Organisations. A fully referenced version of this article is available upon request.

For more information visit: www.conno.org.au/

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