Claiming and Validating Our Expertise
The time is right for hospice and palliative care professionals to recognize our expertise! Never before has this type of care been spotlighted as it is in today's healthcare environment. The public's right to choose the focus and type of care they will receive with a life limiting illness andat the end of life has finally been established. As a result:
o More people are electing to have comfort and quality at the end of life for themselves and those they love
o Pain and symptom management competencies are receiving increasing emphasis by accrediting and credentialing bodies,
o Funding for research and projects related to end-of-life care is increasing. Funded efforts are providing new approaches, tools, and programs to improve care and outcomes.
As practitioners in hospice and palliative care, each of us should take great pride in our expertise and commitment to quality at the end of life. Many professional nurses have years of clinical experience, evidence-based practice, and education to draw upon. Knowing the needs of patients and families facing life-limiting disease and loss, we must be advocates as well as teachers.
Enter Certification!
One way to validate our expertise is through certification as a nursing specialist. Certification involves a process that validates and evaluates one's expertise in a specialty area. While licensure assures minimal competency to practice in a field, certification indicates mastery of a defined body of knowledge. The application process involves verification of licensure and any other requirements (some certification programs require a specific amount of work experience in a specialty area).
Knowledge of the specialty area is most often validated via testing. After achieving a passing score, the individual is certified for a period of 4 years. Renewal of certification after expiration of the initial period may be done by retesting, or by participating in a process calledHPAR (Hospice and Palliative Alternative Recertification) which assigns points for continuing education and other professional activities for APNs and RNs.
It was visionary leadership that took the first step and formed the National Board for Certification of Hospice Nurses in 1992 with the goal of initiating a certification process for hospice nurses. That core group developed and implemented the first certification exam in 1994, building the exam upon early research in hospice nursing and their own expertise.
The Role Delineation Study ( Practice Analysis) and Certification
In 1998, the Board took a second major step and invested in a Role Delineation Study to identify the responsibilities of hospice and palliative nurses and to incorporate this knowledge into the continuing development of the certification process. The Role Delineation Study not only clarified the responsibilities of the hospice nurses but also verified that palliative nurses share many of the same responsibilities. This study formed the basis for expanding the certification exam to include both hospice and palliative nurses; the first such certification test was given in March, 1999.
A nurse certified prior to 1999 was certified as a CRNH (Certified Registered Nurse Hospice). Those taking the test after 1/1/99 when palliative nursing was included are known as CHPN®s (Certified Hospice and Palliative Nurses).
NBCHPN® now provides specialty examinations for all levels of nursing: advanced practice nurses, registered nurses, licensed practical/vocation nurses, nursing assistants and administrators. There are currently over 16,000 certificants.
A Role Delineatin Study (RDS) was done prior to the initiation of each new certifcation examination. the results of each RDS was used to develop test specifications and examination contents. Industry standards recommend that a RDS is conducted every 5 years or so to determing any change in practice.
Why Certification?
Even during this time of opportunity and increased exposure, the demands upon hospice and palliative care nurses are increasing and often influence our commitment to our profession. We all know the stresses of our daily work: the sometimes overwhelming demands of working with the terminally ill, the sense of duty we feel to our team, the personal stamina it takes to daily confront life and death issues. Too often, the financial rewards are not great, and our compensation is not likely to increase significantly in a climate of decreasing reimbursement for healthcare whether we are certified or not.
So why, after a difficult day that often includes overtime, would we want to consider giving more of our own time to preparation for a certification test?
Why, when perhaps our employer offers no incentive or financial reward, would or should we be willing to invest time and money in the certification process?
The certification process can have intrinsic rewards for the nurse who commits to preparation and testing. These include:
o a comprehensive review of the current body of knowledge for which the hospice and palliative nurse is accountable,
o participation with and learning from other nurses in review courses or study groups,
o sharpening of skills and knowledge in areas not utilized daily,
o recommitment to excellence and expertise in the area of practice
o increased competence and confidence in practice
o recognition by peers and others in the filed through credentialing and ongoing used of the title, and
o future employment possibilities as certification becomes the expectation of employers of hospice and palliative nursing.
We can and must be personally accountable for our practice. Our patients and families deserve the very best from each of us.
Several directors of larges hospice programs have found certification to be of such benefit among their nurses that they are sponsoring review courses and providing funds to offset the costs of certification for the nurse. Others are giving certified staff increased wages. The National Hospice and Palliative Care Organization has a Quality Partners program which defines then components necessary for achieving excellence. Certified staff would be one quality indicator.
Individual practitioners have confirmed the value of certification. One nurse said, “I didn’t know how much I didn’t know until I started studying for the exam.” Another claimed, “Preparing for certification helped me to define the body of knowledge for which I’m accountable in my practice. It gave me new confidence in approaching physicians and advocating for my patients.” (Home Healthcare Nurse Vol.18 no.3 March 2000)
What About YOU?
Isn’t it time you considered validating your knowledge and expertise?