- Email: [email protected]
Feelings about certification rooted in values
Feelings about certification rooted in values Some of the comments and questions heard at the Miami Congress concerning whether or not AORN should be involved in professional nurse certification stem, I believe, from deeply rooted values that lie at the core of American culture. Those values are consciously or unconsciously shared by a large segment of our society, including nurses. Two values associated with the basic concern-why certification of nurses for excellence?-are work and power as equated with success in work. Young, rural America had no room for the drones of society. Life was too hard, and survival too precarious to sanction extensive welfare support for nonproductive persons. Every citizen was expected to contribute his share, by the labors of either his back or his brain, so that he was not an economic drain on the community, thus establishing his right to live within the group. As the frontier advanced and the West settled, this philosophy continued. By the time America moved into the industrial period and an urban society, this belief, developed out of necessity, had become deeply ingrained in the majority of the population. It is still there and still viable-the belief that work or occupation is the way to a successful life whether that be self-esteem, personal recognition, selfactualization, economic and personal independence, power, or all of these.
Given the pervasive value of work, it is not strange that Americans equate success in life with achievement in work. Roughly interpreted, achievement is synonymous with attainment of power in the work setting or occupation. Americans apply two criteria as indicators of success. One is the amount of power and authority attained while climbing through the organized power structure of a particular field or place of employment. The second is the remuneration commensurate with that degree of power and authority. The assumption and expectation are that the more power achieved, the greater are the associated responsibilities, hence, the greater the income. Those who do not subscribe to these criteria for a successful life are frequently criticized in our society. Selection of any method of achieving power and influence outside the accepted pathway brings charges of lack of ambition and competency to perform the work. Certainly, the motives for selecting a different route are suspect and questionable. As one group of the American work force, nurses have internalized these two values long before they enter nursing. The rigid authoritarian hierarchy in most nursing service agencies provides additional reinforcement. Nurses who go into clinical practice enter a system that more firmly entrenches these values. Until recently, a nurse could select from two approaches to demonstrate nursing success to her colleagues and the community-nursing service administration or nursing education. (Throughout American history, educators have had power because
AORN Journal, June 1976, Vol23, No 7
1169
.
supposedly they can influence the controlling human organ, the brain, and through it, behavior.) Any nurse who elected to engage in clinical practice throughout her professional career was not only poorly paid but accorded little prestige and respect from her nursing peers. The implication was that her competency was open to question, and her ambition and motives suspect. In the past 20 years, the belief that nursing is a direct service to the people has received increasing attention. The ranks of those who deliberately commit themselves to clinical involvement with the sick, near sick, and potentially sick have grown. These nurses have demanded that their commitment to the principle value of nursing and their competency in clinical work be recognized by the profession and the community. In other words, they are seeking personal recognition, prestige, and economic reward for remaining at the clinical practice level of the nursing hierarchy. One just and long overdue result of the demand has been the American Nurses’ Association (ANA) implementation of certification for excellence for professional nurses. The title certification was intended to reflect Webster’s definition of certifying, “to attest as to meeting a standard.” As used by ANA, the term also agrees with usage in other occupational fields, which recognize the individual who achieves performance proficiency beyond entry-level competency. The primary goal of certification for excellence in nursing is, “provision of formal recognition of personal achievement and superior performance in nursing.”’ There are several subsidiary purposes that can also be accomplished by such a certification program. One concerns the monetary compensation that accompanies achievement of success in work. It is hoped that the nurse who demonstrates superior performance in clinical nursing via certification will be in great demand by the public and health care agencies. That person ought to command at minimum, a salary equal to that given to the lowest level of nursing service administration, eg, a head nurse. The certified nurse can justifiably expect appropriate remuneration for her clinical skills, just as the head nurse expects it for her administrative skills.
1170
If a nurse receives professional recognition and a salary commensurate with her skills because of certification, another purpose within grasp is the inducement to remain in clinical practice. Her nursing competency is no longer open to question, nor are her motives suspect. She can be comfortable with sharpening old skills and learning new ones and with adding to her theoretical practice base in an area she knows and enjoys most. Thus, she accrues the additional benefits of increased self-respect, self-actualization, internal satisfaction, and inward peace. She need no longer succumb to external pressures to prove herself by becoming a nurse administrator or educator. By virtue of its emphasis on superior performance, certification for excellence should contribute greatly to improving the overall quality of nursing care. The certified nurse practitioner will have demonstrated the currency and excellence of her knowledge base, her reliance on that knowledge base for determining nursing strategies appropriate to a particular patient’s problems, and her ability to make decisions and discover new insights based upon clinical data. As a corollary, it would be expected that such a nurse would also be stimulated to expand her own and the profession’s knowledge base to further enhance clinical practice. Given a sufficient number of these nurses, there seems little doubt that the quality of nursing care would improve. Certification for excellence also acknowledges to the public that the nursing profession recognizes its responsibility for quality nursing care and its commitment to improve that care. Failure to make concrete strides in this direction not only violates the public trust but opens the profession to controls imposed from outside the nursing community. The nurse who is certified superior in clinical performance should always be cognizant of and accountable for actions that physically or morally violate the public belief that in health care matters nurses will serve those whose knowledge does not permit them to serve themselves. Controls imposed from outside signify the inability of a profession to police its practice or practitioners. It implies abdication of responsibility by the profession for the services it purports to provide for the public.
AORN Journal, June 1976, Vol23, No 7
Certification for excellence, in this sense, becomes a part of the quality assurance program in nursing. Certification of professional nurses for excellence is a relatively new concept in nursing although the goal of the ANA “to establish ways to provide formal recognition of personal achievement and superior performance in nursing” is almost 20 years old.* The decision of the AORN House of Delegates to proceed with the development of an operating room nursing module within the framework of the larger medical-surgical nursing certification for excellence process
represents a commitment to the purposes delineated here. Next month, this column will consider specific aspects of the certification for excellence program. Subsequent Journal issues will present additional information.
Gwen H Dodge, RN, MS Assistant director of education Notem 1 . Medical-Surgical Nursing Certmcation (Kansas City, Mo: American Nurses’ Association, 1974). 2. Ibid.
AORN Journal articles on certification For those who wish to review information on certification for excellence, the following articles on the subject have appeared in the AORN Journal since 1973. Vol 18 (July-December 1973) ANA initiates certification program 1:162 Certification: a recognition of excellence 2:237
In California, continuing education will be mandatory 3:487 Vol 19 (January-June 1974) ANA certification: recognition of excellence 3:675
Certification presents dilemma for OR nurses 3597
Delegates approve resolutions, hear reports 4:890
AORN’s concerns aired at collegial meetings 3:313
CE accreditation, data bank among nursing topics 6:861 How to bone up for certification exam 5820 NAACOG, ANA offer certification 2:144 On certification, Board listens to members’ concerns 1:15 Vol23 (January-April 1976) Board action at Congress meetings 5861 Delegates approve certification, dues increase 5864 Delegates to consider resolution, reports 3:319
Federation asks more cooperation, planning from ANA 4:611 What is certification? 5862
Federation considers issues facing nursing in 1974 3:604
Who should certify OR nurses? 3:758 Vol20 (July-December 1974) Exams launch ANA certification program 2:312
Federation makes progress toward unity 3:398
Vol21 (January-June 1975) Delegates approve statements, resolutions at 22nd Congress 6:1066 Vol 22 (July-December 1975) ANA division supports specialty group certification 5:722
1172
AORN Journal, June 1976, Vol23, No 7
Given the pervasive value of work, it is not strange that Americans equate success in life with achievement in work. Roughly interpreted, achievement is synonymous with attainment of power in the work setting or occupation. Americans apply two criteria as indicators of success. One is the amount of power and authority attained while climbing through the organized power structure of a particular field or place of employment. The second is the remuneration commensurate with that degree of power and authority. The assumption and expectation are that the more power achieved, the greater are the associated responsibilities, hence, the greater the income. Those who do not subscribe to these criteria for a successful life are frequently criticized in our society. Selection of any method of achieving power and influence outside the accepted pathway brings charges of lack of ambition and competency to perform the work. Certainly, the motives for selecting a different route are suspect and questionable. As one group of the American work force, nurses have internalized these two values long before they enter nursing. The rigid authoritarian hierarchy in most nursing service agencies provides additional reinforcement. Nurses who go into clinical practice enter a system that more firmly entrenches these values. Until recently, a nurse could select from two approaches to demonstrate nursing success to her colleagues and the community-nursing service administration or nursing education. (Throughout American history, educators have had power because
AORN Journal, June 1976, Vol23, No 7
1169
.
supposedly they can influence the controlling human organ, the brain, and through it, behavior.) Any nurse who elected to engage in clinical practice throughout her professional career was not only poorly paid but accorded little prestige and respect from her nursing peers. The implication was that her competency was open to question, and her ambition and motives suspect. In the past 20 years, the belief that nursing is a direct service to the people has received increasing attention. The ranks of those who deliberately commit themselves to clinical involvement with the sick, near sick, and potentially sick have grown. These nurses have demanded that their commitment to the principle value of nursing and their competency in clinical work be recognized by the profession and the community. In other words, they are seeking personal recognition, prestige, and economic reward for remaining at the clinical practice level of the nursing hierarchy. One just and long overdue result of the demand has been the American Nurses’ Association (ANA) implementation of certification for excellence for professional nurses. The title certification was intended to reflect Webster’s definition of certifying, “to attest as to meeting a standard.” As used by ANA, the term also agrees with usage in other occupational fields, which recognize the individual who achieves performance proficiency beyond entry-level competency. The primary goal of certification for excellence in nursing is, “provision of formal recognition of personal achievement and superior performance in nursing.”’ There are several subsidiary purposes that can also be accomplished by such a certification program. One concerns the monetary compensation that accompanies achievement of success in work. It is hoped that the nurse who demonstrates superior performance in clinical nursing via certification will be in great demand by the public and health care agencies. That person ought to command at minimum, a salary equal to that given to the lowest level of nursing service administration, eg, a head nurse. The certified nurse can justifiably expect appropriate remuneration for her clinical skills, just as the head nurse expects it for her administrative skills.
1170
If a nurse receives professional recognition and a salary commensurate with her skills because of certification, another purpose within grasp is the inducement to remain in clinical practice. Her nursing competency is no longer open to question, nor are her motives suspect. She can be comfortable with sharpening old skills and learning new ones and with adding to her theoretical practice base in an area she knows and enjoys most. Thus, she accrues the additional benefits of increased self-respect, self-actualization, internal satisfaction, and inward peace. She need no longer succumb to external pressures to prove herself by becoming a nurse administrator or educator. By virtue of its emphasis on superior performance, certification for excellence should contribute greatly to improving the overall quality of nursing care. The certified nurse practitioner will have demonstrated the currency and excellence of her knowledge base, her reliance on that knowledge base for determining nursing strategies appropriate to a particular patient’s problems, and her ability to make decisions and discover new insights based upon clinical data. As a corollary, it would be expected that such a nurse would also be stimulated to expand her own and the profession’s knowledge base to further enhance clinical practice. Given a sufficient number of these nurses, there seems little doubt that the quality of nursing care would improve. Certification for excellence also acknowledges to the public that the nursing profession recognizes its responsibility for quality nursing care and its commitment to improve that care. Failure to make concrete strides in this direction not only violates the public trust but opens the profession to controls imposed from outside the nursing community. The nurse who is certified superior in clinical performance should always be cognizant of and accountable for actions that physically or morally violate the public belief that in health care matters nurses will serve those whose knowledge does not permit them to serve themselves. Controls imposed from outside signify the inability of a profession to police its practice or practitioners. It implies abdication of responsibility by the profession for the services it purports to provide for the public.
AORN Journal, June 1976, Vol23, No 7
Certification for excellence, in this sense, becomes a part of the quality assurance program in nursing. Certification of professional nurses for excellence is a relatively new concept in nursing although the goal of the ANA “to establish ways to provide formal recognition of personal achievement and superior performance in nursing” is almost 20 years old.* The decision of the AORN House of Delegates to proceed with the development of an operating room nursing module within the framework of the larger medical-surgical nursing certification for excellence process
represents a commitment to the purposes delineated here. Next month, this column will consider specific aspects of the certification for excellence program. Subsequent Journal issues will present additional information.
Gwen H Dodge, RN, MS Assistant director of education Notem 1 . Medical-Surgical Nursing Certmcation (Kansas City, Mo: American Nurses’ Association, 1974). 2. Ibid.
AORN Journal articles on certification For those who wish to review information on certification for excellence, the following articles on the subject have appeared in the AORN Journal since 1973. Vol 18 (July-December 1973) ANA initiates certification program 1:162 Certification: a recognition of excellence 2:237
In California, continuing education will be mandatory 3:487 Vol 19 (January-June 1974) ANA certification: recognition of excellence 3:675
Certification presents dilemma for OR nurses 3597
Delegates approve resolutions, hear reports 4:890
AORN’s concerns aired at collegial meetings 3:313
CE accreditation, data bank among nursing topics 6:861 How to bone up for certification exam 5820 NAACOG, ANA offer certification 2:144 On certification, Board listens to members’ concerns 1:15 Vol23 (January-April 1976) Board action at Congress meetings 5861 Delegates approve certification, dues increase 5864 Delegates to consider resolution, reports 3:319
Federation asks more cooperation, planning from ANA 4:611 What is certification? 5862
Federation considers issues facing nursing in 1974 3:604
Who should certify OR nurses? 3:758 Vol20 (July-December 1974) Exams launch ANA certification program 2:312
Federation makes progress toward unity 3:398
Vol21 (January-June 1975) Delegates approve statements, resolutions at 22nd Congress 6:1066 Vol 22 (July-December 1975) ANA division supports specialty group certification 5:722
1172
AORN Journal, June 1976, Vol23, No 7