Nurses associate certification with pay increase, better-paying jobs, respect and improved self-image. However, not all 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 nursing profession is far from settled and the certification designs to be adopted in future certifications remain uncertain. Tenney, Demoucell and Wians (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 positive effect collaboration among team members in the healthcare system. Despite the potential for these rewards to accrue to nurses, there is lack of extrinsic value to people who are in the nursing profession, making it unlikely that a higher number of nurses will be attracted into certification programs unless opportunities for recognition and greater compensation are put in place by administrators.
Certification brings about intrinsic value to nurses. Intrinsic values are non-tangible benefits such as indication of professional growth, validation of knowledge, personal satisfaction, 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 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 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 shortage of nurses, increased call duty on nurses’ days off and limited time spent on oneself and family.
There is 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 indicate 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 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 a 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 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 the 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
- The nature of perceptions of empowerment among nationally certified nurses
- Relationship between professional characteristics and clinical nursing expertise: focus on the role of certification.
- Perceptions on the value of specialty nursing certification
In each unit of analysis, 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.
Does specialty certification give intrinsic and extrinsic rewards that are necessary for 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 indication of professional growth, validation of knowledge, personal satisfaction, 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 mislead by atypical scenarios, so competent nurses apply critical thinking and analytical skills while assessing multiple relevant elements present in patient’s condition in order to devise treatment plans encompassing both short-term and long-term goals (Benner, 1984). In Benner’s theory, 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”, 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 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 which 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’ perception s towards 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.