CHAPTER 4. POST EXAM ACTIVITIES

A. Award/Recognition Activities

Recognition of achieving certification is as important to nurses as receiving financial support to prepare and take the exam (Woods, 2002). Providing extrinsic awards (unit, hospital, community, and profession level recognition) is key to increasing the perceived value of certification to nurses (Sechrist, Valentine, & Berlin, 2005).

As soon as you hear that the applicant has passed, contact her supervisor, and together go to the unit in front of the other staff to congratulate her. This identifies the nurse to the other staff as a geriatric resource nurse and gives her positive feedback. It also encourages other staff to consider certification. As more nurses learn they have passed, establish a calling tree to meet all the certified nurses on the home unit of that nurse. This serves to further bond the certified nurses as a special group.

Another way to recognize newly certified nurses is to send a group email to the class congratulating Jane Smith for passing the exam. Certification deserves recognition in front of the full nursing practice of the organization. One hospital used their monthly Nursing Senate meeting as a time to recognize excellence in nursing certification. The certified nurses were recognized in the Nursing Senate briefing as well as on the auditorium stage in front of their peers in the Nursing Senate. See the following example:

• Attachment: Chapter4.A_Council_Briefing_Form_SanfordExample.pdf

The Chief Nurse Executive may choose to host and sponsor a Gerontological Nurse Certification luncheon for the certified nurses and their directors. At the luncheon, the CNE reinforces the importance of certification and appreciation to each nurse for his/her extra efforts to become certified. Each nurse may have favors at her place setting such as a Nursing Excellence pin or a coffee mug of a lab jacket. Certificates of achievement for completing the course and passing the exam are distributed to each nurse to place in her portfolio.

During Nurses' Week, a poster board display with a photograph of the certified nurses and their names is displayed. The organization's publication as well as each patient care unit's newsletter is also a great venue to congratulate and recognize the certified nurse.

A plaque on each patient care unit with the names of all the certified nurses serves to recognize the certified nurses to their colleagues as well as to patients, families and visitors. A framed copy of the certification certificate for each nurse on the unit on one wall makes a strong statement of the importance of certification to that unit. Certified nurses names can be posted on the hospital intranet.

Ask the public relations department to assist you in developing a press release to local papers (Woods, 2002).

Certification may also be used as an objective measure at evaluation time for monetary rewards within a clinical career ladder. The organization might consider reimbursing the certification fee upon successfully passing of the certification exam.

Examples from Nebraska Methodist Hospital include:

Whenever a new nursing certification is obtained it is published in the

• Monthly hospital on-line newsletter "HeartBeat" (nurse managers email the editor) under the Kudos and Congratulations Section.
  • Attachment: Chapter4.A_HeartBeat_NebraskaExample.pdf
• Monthly "Sharing Exchange" newsletter written by nurses for nurses (any nurse can submit certifications) (Posted on Hospital Intranet Home Page, emailed to all nursing staff and the college of nursing, hard copies available in staff lounges)
  • Attachment: Chapter4.A_Sharing_Exchange_0606_NebraskaExample.pdf
  • Attachment: Chapter4.A_Sharing_Exchange_0906_NebraskaExample.pdf
  • Attachment: Chapter4.A_Sharing_Exchange_0107_NebraskaExample.pdf
  • Attachment: Chapter4.A_Sharing_Exchange_0407_NebraskaExample.pdf
  • Attachment: Chapter4.A_Sharing_Exchange_0807_NebraskaExample.pdf
• Acknowledgement in the annual hospital Professional Nurse Recognition Booklet published each year during nurses week
• Posters developed by individual units to recognize their peers
  • Attachment: Chapter4.A_Recognition_Poster_NebraskaExample.pdf
• Acknowledged at nursing Unit Based Councils
• Certification Recognition Plaques at the entrance of each nursing unit (nurse managers submit names to marketing for plaques to be made) are displayed for patients, visitors and professional staff to view.
• Professional Development Council is determining the Peer Review Criteria and certification associated with a monetary reward is being discussed
• Recognition on name badges

B. Tracking: certification status, contact hours

Certification is valid for five years. At that time, re-certification is required either through re-testing or submission of continued education. Fifty percent of the CEUs must be accredited through ANCC. Nurses must also show evidence of practice (1,000 hours). 51% of the re-certification hours must be in gerontological nursing. Submit no more than 10 weeks before renewal date.

To help certified nurses re-certify, regular opportunities for continuing education provide the framework for renewal. Encourage nurses to regularly keep an updated record of their CEUs. See the following example on the first page of this excel spreadsheet:

• Attachment: Chapter4.B_Continuing_Ed_tracking_form.xls

The leading barriers to certification for nurses whose certification lapsed is inadequate or no compensation for certification and inadequate recognition for certification (www.nursingcertification.org/pdf/white_paper_final_12_12_06.pdf ). Consider how your health system can remove these barriers for nurse re-certification.

C. Evaluate

Provide feedback to health system administrators such as the Chief Nursing Executive/Officer to justify continued attention in your organization for promoting nurse certification. Consider the following measures:

Pass Rate

• Assess the pass rate for nurses in your health system and compare it to national statistics. ANCC reports the combined pass rate on all exams for 2006 was 76.6% (www.nursecredentialing.org/cert/index.htm). Less than 5 years ago the national pass rate without a review course or seminar was 50%.

Organizational Outcomes
Compare the cost of certification for your health system with potential organizational benefits, such as:

• Nurse Outcomes
  • Evaluate hospital based geriatric nursing competencies in care of older adults among certified and non-certified nurse (www.hartfordign.org/resources/education/competencies.pdf). These competences can be incorporated into annual competency reviews and on performance evaluations. This can promote accountability and responsibility in applying evidence-based gerontological nursing practice.
  • Assess nurse retention rates among certified and non-certified nurses.
  • Compare certified and non-certified nurses in nurse's perception of their work environment. Use The Practice Environment Scale of the Nursing Work Index (PES-NWI) from the National Database of Nursing Quality Indicators (NDNQI).
  • Compare certified and non-certified nurses in nurse's perception of the geriatric work environment. Use the Geriatric Institutional Assessment Profile (GIAP – see www.nicheprogram.org/benchmarking) from The NYU Hartford Institute NICHE Benchmarking Service that includes a scale to measure nurses perception of the geriatric care environment. References:
    • 1. Kim, H., Capezuti, E., Boltz, M., Fairchild, S., Fulmer, T., & Mezey, M. (2007). Factor structure of the geriatric care environment scale. Nursing Research, 56 (5), 339-347.
    • 2. Boltz, M., Capezuti, E., Bowar-Ferres, S., Norman, R., Kim, H., Fairchild, S., Fulmer, T., & Mezey, M. (in press, 3rd quarter, 2008). Hospital nurses' perceptions of the geriatric care environment. Journal of Nursing Scholarship.
• Patient/Clinical Outcomes
  • Assess process measures (assessments appropriately used when indicated, documentation of individualized interventions) for a particular patient group (using a group or DRG of patients, e.g., CHF, pneumonia, GI bleed) associated with care provided by gerontological certified nurses that can be compared with the care delivery provided by non-certified nurses. Computerized clinical documentation systems facilitate this process.
  • Assess outcomes measures such as falls, fall-related injury, pressure ulcers and restraint use from the NDNQI) from units with gerontological certified nurses and compare to those unit with non-certified nurses.

D. Disseminate Your Success

Summarize your findings and disseminate via articles, presentations or posters at local, state, or national conferences or venues.

See Attachment: Chapter4.D_Certification_Presentation_SanfordExample.pdf for an example of a presentation by nurses from Sanford USD Medical Center (Sioux Falls, SD).

E. Follow-up Education

Ongoing education for the newly certified gerontological nurses serves multiple purposes. First, it provides the needed education required to re-certify in five years. Next, it provides an opportunity to reinforce geriatric syndromes, assessment tools, or clinical practice concerns. And finally, ongoing education provides a forum to cement the work of the geriatric resource nurse to infuse evidence based practices at the bedside.

Education might occur on a monthly or quarterly basis as a noon brown bag or an evening journal club. A gerontological quarterly newsletter might be another resource to continue to grow the geriatric resource nurse. Support for attendance at a local, regional, or national conference may also prove to be an incentive for continued growth.

F. Embedding Gerontologic Knowledge into Practice

The gerontological certified nurse's work does not end with passing the examination. The call to infuse best geriatric practices can take many forms. Once certified the Geriatric Resource Nurse can act as an expert on his/her unit for various clinical practices such as the early removal of an unwarranted Foley urinary catheter or promoting early recognition of dementia symptoms. The Geriatric Resource Nurse may champion evidence based practices such as inappropriate medications or early mobilization for older adults. With multiple demands on the nurse at the bedside, the Geriatric Resource Nurse can emerge as a pivotal leader in implementing National Patient Safety Goals, JCAHO regulations, or core measures. Power in numbers may also be helpful if there are several certified nurses located on a particular unit. Elder friendly principles may be rolled out systematically or piloted on one unit and then moved out to the entire organization.

Certified nurses may take leadership roles within an Acute Care for the Elderly (ACE; www.nicheprogram.org/about/models) unit - acting as facilitators spark to improve practices for older adults. On this unit the Try This Series might be used as a screen saver on the computers or kept at the nurses' station in a 3 ring binder.

There are several approaches to assist nurses in applying their gerontologic knowledge to affect improved care for the older adult patient, and to remain current with the science of gerontological nursing. Examples include:

• Develop/implement an evidence-based practice Journal club and reviewing gerontological nursing journal articles is another way to incorporate gerontological nursing concepts into a health system. See the following example of a poster:
  • Attachment: Chapter4.F_EBP_JournalClub_Poster_NebraskaExample.pdf
• Develop/implement a geriatric performance improvement project. The certified Geriatric Resource Nurse could be asked to select a geriatric issue on their unit with their director. Topics could be fall prevention strategies, geriatric depression screening, the use of SPICES for bedside shift report, or increasing the use of Advance Directives. See the following example:
  • Attachment: Chapter4.F_Gero_PI_Guidelines_SanfordExample.pdf
• Integration of gerontological nursing principles into the patient plan of care (computerized documentation systems) is another way to hardwire the implementation of geriatric care.