capstone nursing

  

 Below is an article which will be use to answer the following.

1. Locate the literature review section. Summarize using your own words from one of the study/literature findings. Be sure to identify which study you are summarizing.

2. Discuss how the author’s review of literature (studies) supported the research purpose/problem. Share something that was interesting to you as you read through the literature review section.

3. Describe one strategy that you learned that would help you create a strong literature review/search for evidence. Share your thoughts on the importance of a thorough review of the literature.

July-August 2020 • Vol. 29/No. 4 229

Diane K. Boyle, PhD, RN, FAAN, is retired Professor, Fay W. Whitney School of Nursing,
University of Wyoming, Laramie, WY.

Sarah A. Thompson, PhD, RN, FAAN, is Dean and Professor, Sinclair School of Nursing,
University of Missouri, Colombia, MO.

Funding: Research reported in this publication was supported by the Medical-Surgical Nursing
Certification Board. The content is solely the authors’ responsibility and does not necessarily
represent the official views of the Medical-Surgical Nursing Certification Board.

CMSRNs’ Continuing Competence
Methods and Perceived Value of

Certification: A Descriptive Study

Diane K. Boyle
Sarah A. Thompson

N
ursing specialty certification
builds on nursing licensure.
It acts as a mechanism for

validation or formal recognition by
documenting individual nurses’
knowledge, skills, and abilities spe-
cific to their specialty. To become
certified, nurses are required to
meet predetermined eligibility crite-
ria and achieve standards identified
by a nursing specialty, including
sufficient practical experience and
passing a certification examination
that provides external validation of
knowledge and judgment. The
intended outcome of certification
in nursing is to validate compe-
tence with the overall goal of
improving safety, quality of care,
and health outcomes for people
who use healthcare services.
(Chappell et al., 2019).

For the Certified Medical-Surgical
Registered Nurse (CMSRN®) certifi-
cation, initial eligibility criteria
are registered nursing licensure, 2
years of practice in a medical-sur-
gical setting (may include clinical,
management, or education), and
2,000 hours of medical-surgical

practice in the past 3 years.
Eligible candidates earn the cre-
dential by passing an exam
(Medical-Surgical Nursing Certifi –
cation Board [MSNCB], n.d.). To
recertify, CMSRNs must continue
to practice in a medical-surgical
setting and provide evidence of
continuing competence in the
specialty (MSNCB, 2019).

Continuing competence is “the
ongoing commitment of a regis-
tered nurse to integrate and apply
the knowledge, skills, and judg-
ment with the attitudes, values, and
beliefs required to practice safely,
effectively, and ethically in a desig-
nated role and setting” (Di Leonardi
& Biel, 2012, p. 350). The Con –
tinuing Competence Task Force
(Hospice and Palliative Creden –

tialing Center [HPCC], 2011) estab-
lished this definition to guide estab-
lishment of meaningful recertifica-
tion requirements in nursing.
MSNCB (2012), which administers
the CMSRN credential, has en –
dorsed the definition. MSNCB spec-
ifies an accepted set of methods of
evidence of continuing competence
for CMSRN recertification. Exam –
ples are continuing nursing educa-
tion (CNE) activities, advanced car-
diovascular life support, profession-
al publications, and evidence-based
practice projects (MSNCB, 2019).
The Institute for Credentialing
Excellence (ICE) provides a compre-
hensive list of methods for demon-
strating continuing competence.
Examples listed by ICE, but not
accepted currently by MSNCB,

Instructions for
CNE Contact Hours

MSN J2012
Continuing nursing education (CNE)

contact hours can be earned for
completing the evaluation associated

with this article. Instructions are available
at amsn.org/journalCNE

Deadline for submission:
August 31, 2022
1.4 contact hours

Specialty nursing certification is validation and formal recognition
of nurses’ knowledge, skills, and abilities. The intrinsic and extrinsic
reasons nurses value Certified Medical-Surgical Registered Nurse
certification, as well as facilitators to and barriers of certification,
are discussed. A combination of intrinsic and extrinsic facilitators is
essential for certifying programs and healthcare organizations to
use in achieving higher numbers of specialty-certified nurses.

July-August 2020 • Vol. 29/No. 4230

include obtaining a new certifica-
tion in a related field, simulations,
and oral, written, or performance
competency assessments (Plaus et
al., 2013).

To assure the continuing compe-
tence of specialty certified nurses,
Di Leonardi and Biel (2012) asserted
certification and recertification pro-
grams should employ periodic indi-
vidual competency assessments and
subsequent development of indi-
vidualized learning plans to address
learning needs noted in the evalua-
tions. Consequently, some nursing
specialty certification programs

responded by pioneering recertifica-
tion requirements that include
competency assessments and tai-
lored learning strategies (HPCC,
n.d.; Oncology Nursing Certifica –
tion Corporation, 2020).

Purpose
MSNCB is reviewing strategies

and requirements to demonstrate
continuing competence for nurses
who hold the CMSRN credential.
However, no decisions have been
made about specific changes in
requirements (T. Hinkley, personal

communication, August 26, 2019).
To inform these decisions and the
general ongoing dialogue about
continuing competence, MSNCB
conducted a national online survey
to determine CMSRNs’ methods of
continuing competence, facilitators
and barriers to continuing compe-
tence and certification, and percep-
tions of the value of certification.

Review of the Literature
Literature was identified via

PubMed and CINAHL for three con-
tent areas for 2015-January 2020.
For continuing competence, search
terms were continuing competence,
continuing competency, continued
competence, continued competency,
continuing competence methods, and
continuing competence requirements.
For the value of certification, search
terms were the value of certification,
perceived value of certification, and
nursing. For facilitators and barriers,
search terms were certification facili-
tators, certification barriers, certifica-
tion benefits, and nursing.

Continuing Competence
Di Leonardi and coauthors

(2020) reported a comprehensive
literature review on continuing
competence that included 50 arti-
cles published since 2012. The
review was preliminary work for
purposes of revisiting the earlier
definition of continuing compe-
tence given in this article’s intro-
duction (Di Leonardi & Biel, 2012).
Literature findings were reported in
four categories: identifying specific
competencies, validating compe-
tencies, international competency
assessment, and competencies in
disciplines other than nursing.

Review findings in the category
of validating competencies were rel-
evant to the current study. The cat-
egory focused on how proficiencies
required for specific credentials
such as certification can be “validat-
ed and revalidated periodically in a
defensible yet financially and logis-
tically feasible way” (Di Leonardi et
al., 2020, p. 19). Attendance at for-
mal or informal educational ses-
sions was one of the most common
methods for maintaining continu-

Background

The Medical-Surgical Nursing Certification Board is reviewing strategies
and requirements for demonstrating continuing competence for the
Certified Medical-Surgical Registered Nurse (CMSRN®) credential.

Aim

Determine current methods of continuing competence, facilitators and
barriers of continuing competence, and perceptions of the value of certi-
fication by CMSRNs.

Method

A national online survey was disseminated to CMSRNs who were 3-5
years after initial certification or 3-5 years after recertification.

Results

CMSRNs mainly used continuing education to demonstrate continuing
competence. Certificants highly valued intrinsic aspects of certification,
such as personal satisfaction and accomplishment. The extrinsic benefit
of increased marketability was valued highly as well. Main facilitators of
continuing competence and certification were reimbursement of costs
and paid time off for continuing education and conferences. Main barri-
ers were costs, lack of paid time off, and tracking education for various
recertification requirements.

Limitations and Implications

A convenience sample and low response rate limit generalizability of
results. A combination of intrinsic and extrinsic facilitators is important
for certifying organizations and healthcare leaders to use to achieve high-
er numbers of specialty-certified nurses. In addition, certifying organiza-
tions may need to improve mechanisms to assist certificants as continu-
ing competence requirements for recertification change.

Conclusion

Intrinsic and extrinsic values of certification, as well as the facilitators of
and barriers to certification, have remained stable over time and across
various types of specialty certifications. Future research should examine
specific levels and types of certification needed to achieve optimum out-
comes.

July-August 2020 • Vol. 29/No. 4 231

ing competence. Some evidence
supported educational sessions as a
method to increase knowledge and
perceived competence. Alternately,
the review reported professionals
might attend educational courses
that are convenient and affordable,
but not of high quality or not in the
area of greatest learning need.
Atten dance at educational pro-
grams does not ensure changes in
practice. Authors suggested partici-
pants may not “be able to under-
stand, retain, or use the informa-
tion that was provided” (p. 19).

Other continuing competence
methods used for recertification
included completion of a written
examination, documentation of
practice hours in the specialty,
scholarship through publication
and professional presentation, port-
folios, and performance of a formal
360-degree assessment (Di Leonardi
et al., 2020). Although simulation
(patient and virtual) is accepted as a
teaching tool, less evidence existed
for using simulation as a method
for evaluating continuing compe-
tence in credentialing and certifica-
tion.

The Value of Nursing
Specialty Certification

Whitehead and colleagues (2019)
reported a systematic review of the
relationship between specialty nurs-
ing certification and patient, nurse,
and organizational outcomes. The
review included 41 articles pub-
lished 2000-2018. Nurse-related
outcomes were reported in the cate-
gories of personal and professional
incentives, knowledge and skills,
job satisfaction, organizational
commitment, empowerment, and
confidence.

Review findings in the nurse out-
come categories of personal and pro-
fessional incentives were relevant to
the current study (Whitehead et al.,
2019). In 13 studies representing a
variety of specialty areas, respon-
dents completed the Perceived
Value of Certification Tool (PVCT),
which measures the value of certifi-
cation in two domains: intrinsic and
extrinsic rewards, specified as per-
sonal and professional incentives
respectively by Whitehead and

coauthors. The three highest-rated
intrinsic rewards for certified nurses
were consistent across all 13 studies.
These were enhances feeling of person-
al accomplishment, provides personal
satisfaction, and validates specialized
knowledge. Based on seven of the 13
studies, the average agreement rate
was 98.45%, 97.93%, and 97.13%,
respectively.

Among the PVCT extrinsic values,
Whitehead and colleagues (2019)
reported the three highest-scoring
statements were certification pro-
motes recognition from peers, promotes
recognition from other health profes-
sionals, and promotes recognition from
employers. The average levels of
agreement were 85.96%, 78.68%,
and 84.45%, respectively. Across
studies in the review, extrinsic fac-
tors scored lower than intrinsic fac-
tors, but were still high, with one
exception. Increases salary consistent-
ly had the lowest average of 41.1%.

Since the review by Whitehead
and coauthors (2019), two studies
on the perceived value of certifica-
tion have been published. Barbe
and Kimble (2018) surveyed 92
nursing academic faculty members
who were certified nurse educators.
The three highest-rated intrinsic
items were validates specialized
knowledge (99%), enhances feelings of
personal accomplishment (98.9%),
and provides personal satisfaction
(97.9%). For extrinsic items, the
three highest scored items were pro-
motes recognition from peers (91.3%),
increases marketability (80.4%), and
promotes recognition from employer
(76.1%). Increases salary was the
lowest scoring item (13.1%).

Garrison and associates (2018)
surveyed 143 specialty-certified
nurses at one midwestern commu-
nity hospital. The two highest-scor-
ing intrinsic items were enhances
feeling of personal accomplishment
(97.2%) and validates specialized
knowledge (97.2%). Promotes personal
satisfaction, enhances professional
credibility, and provides professional
challenge all received 96.5% agree-
ment. The three highest-scoring
extrinsic factors were increases mar-
ketability (95.1%), promotes recogni-
tion from employers (95.1%), and
increases salary (88.1%).

The intrinsic value findings from
Barbe and Kimble (2018) and
Garrison and coauthors (2018) mir-
rored the conclusions of the system-
atic review by Whitehead and col-
leagues (2019). However, unlike the
work by Whitehead and coauthors,
increases marketability was among
the top three extrinsic values in
both studies and increases salary was
among the top three in the
Garrison study.

Facilitators and Barriers of
Nursing Certification

In the literature search, only
three studies were found that
reported barriers to certification.
None discussed facilitators other
than the perceived value of certifi-
cation. Therefore, two large-sample
classic studies that include facilita-
tors and barriers of certification are
included in this review. In the first
study, the American Board of
Nursing Specialties (ABNS) surveyed
8,615 certified nurses from 20 ABNS
member organizations (Niebuhr &
Biel, 2007). MSNCB conducted a
second study of 1,383 MSNCB certi-
ficant respondents (Haskins et al.,
2011).

Both the ABNS (Niebuhr & Biel,
2007) and MSNCB (Haskins et al.,
2011) studies found the top three
facilitators for obtaining and main-
taining certification were reim-
bursement for exam fees, renewal
fees, and continuing education;
recognition such as having creden-
tials listed on nametag, publication
of name in institutional newsletter,
and name on plaques; and bonuses
and increases in salary. The top bar-
riers identified included the cost of
the examination, lack of institu-
tional support, and lack of time and
access to materials to prepare for
the exam. No response percentages
were reported in either study.

Three recent studies explored
barriers to nursing certification,
including those by Barbe and
Kimble (2018) and Garrison and
coauthors (2018) as described previ-
ously. Also, McLaughlin and Fetzer
(2015) surveyed 305 nurses in two
New England community hospitals
to determine the perceived value of
certification and barriers to certifi-

CMSRNs’ Continuing Competence Methods and Perceived Value of Certification: A Descriptive Study

July-August 2020 • Vol. 29/No. 4232

cation; results for the perceived
value of certification were included
in the systematic review by
Whitehead and colleagues (2019).
Barbe and Kimble (2018) found the
top three barriers were lack of time
(38.5%), cost (17.2%), and no
desire/no interest (11.8%). Garrison
and associates (2018) identified not
enough time (36%), cost of the
exam (30%), and not yet eligible
(28%) as the top three barriers. The
top three barriers identified by
McLaughlin and Fetzer (2015) were
lack of institutional reward (39.1%),
inadequate compensation for certi-
fication (37.1%), and cost of the
examination (33.7%).

Ethics
Approval for the project protocol

was obtained from the University of
Wyoming Institutional Review
Board. Although MSNCB sent the
recruitment emails, only the study
researchers had access to the online
survey account and other research
files. The cover page of the online
survey contained the consent form.
Respondents indicated they had
read the consent form and volun-
tarily agreed to participate by click-
ing on the link that continued to
the survey. Respondents were
offered a chance to win one of 20
$50 gift certificates as an incentive
to complete the survey. Interested
respondents were given a link to
send their email addresses to the
research team. Twenty participants
were chosen at random to receive
the gift certificate at the close of the
survey.

Sample Selection
Because the CMSRN credential is

valid for 5 years (MSNCB, 2019),
the target population was nurses 3-
5 years after initial certification or
recertification. These certificants
were more likely to be gathering
and submitting evidence of contin-
uing competence for recertification.
At the time of the survey, the total
population was 16,195 CMSRNs; all
were invited to participate.

Design and Method

Survey Construction and
Content

Survey items were constructed by
the researchers in collaboration
with the MSNCB staff. The survey
was pilot-tested with a convenience
sample of registered nurses. Pilot
survey feedback regarding the
wording of items and instructions
was incorporated into the final sur-
vey. Items in the online survey were
categorized under the following
variables.

Methods of maintaining continuing
competence. Two sources for ongoing
competence methods were used.
1. The CMSRN Recertification Guide

(MSNCB, 2019) was used to iden-
tify methods currently allowed
by MSNCB for maintenance of
continuing competence and
recertification. Each method was
listed, and respondents indicated
if they had used the technique.

2. The ICE document Methods for
Ensuring Continuing Competence
(Plaus et al., 2013) was used to
identify other methods not cur-
rently accepted by MSNCB.
These methods could be ap –
proved for evidence of continu-
ing competence and recertifica-
tion by MSNCB. Survey respon-
dents were asked to indicate
which of ICE-identified methods
they would like to have accepted
for evidence of continuing com-
petence by the MSNCB.
Perceived value of certification. The

perceived value of certification was
measured by the 18 value state-
ments (items) of the Perceived
Value of Certification Tool© (PVCT©)
(Competency and Credentialing
Institute [CCI], n.d.; Sechrist & Ber –
lin, 2006). The value statements are
divided into two domains: intrinsic
rewards (12 value statements/items)
and extrinsic rewards (6 value state-
ments/items). Intrinsic rewards are
“motivators internal to an individ-
ual and linked to personal develop-
ment and self-concept values.” In
contrast, extrinsic re wards are
“external to an individual and
defined by others” (Niebuhr & Biel,
2007, p. 177). Respondents indicat-
ed their level of agreement or dis-

agreement with each PVCT state-
ment on a 4-point Likert-type scale
(1=strongly agree, 4=strongly disagree).
The reliability and validity of the
PVCT have been established (CCI,
n.d.; Sechrist & Berlin, 2006). In the
current study sample, coefficient
alpha for the entire PVCT was 0.95,
which compares to 0.92 reported by
CCI (n.d.) and 0.93 reported by
Haskins and coauthors (2011).

Facilitators and barriers to achieve-
ment of certification and continuing
competence. Items were constructed
from a literature review of facilita-
tors of and barriers to achievement
of certification and continuing
competence. Survey respondents
indicated their level of agreement
or disagreement with each facilita-
tor or barrier on a 4-point Likert-
type scale (1=strongly agree, 4=strong-
ly disagree).

Survey Procedures
A modified Dillman’s Tailored

Design Survey Method (2000) was
used to recruit eligible CMSRN cer-
tificants. Steps included the follow-
ing: (a) deployment email with a
study explanation and the survey
link, (b) 2-week reminder email
with the survey link, (c) 4-week
reminder email with the survey
link, and (d) final 6-week reminder
email with the survey link. The sur-
vey closed at 8 weeks following
deployment.

Findings

Response Rate
Of 16,195 CMSRN certificants in –

vited to participate in the survey,
1,167 completed the survey (response
rate 7.2%).

Participant Characteristics
The typical respondent was fe –

male (93.8%, n=990), held a bacca –
laureate degree in nursing (52.4%,
n=554), had 6-15 years of experi-
ence as a medical-surgical nurse
(43.7%, n=463), and was age 40-59
(53.8%, n=566). The primary roles
of respondents included clinical
nurse (61.5%, n=651), unit manager
(10.7%, n=113), hospital educator
(5.9%, n=62), and academic faculty

July-August 2020 • Vol. 29/No. 4 233

member (5.1%, n=54). Most were
employed in an inpatient acute set-
ting (73.2%, n=774). Many respon-
dents were employed in a Magnet®
(43.9%, n=462) or Pathway to
Excellence® (8.7%, n=92) facility.

Continuing Competence
Methods Currently Used by
CMSRN Certificants

Of the continuing competence
methods accepted by MSNCB, survey
respondents indicated they most fre –
quently used CNE (92.8%, n=1,080)

and continuing medical education
(CME) applicable to nursing (75.3%,
n=876). See Table 1 for MSNCB-
accepted methods for maint enance
of continuing competence in the
order of highest to lowest percent-
age of use.

Other Desired Methods of
Continuing Competence

Table 1 also lists other potential
methods of continuing competence
suggested by ICE (Plaus et al., 2013),
but not accepted currently by
MSNCB. Obtaining (85.5%, n=977)

and maintaining (88.9%, n=1,013)
certification in a related field were
the most highly desired alternative
methods for evidence of continuing
competence.

Facilitators of and Barriers
to Continuing Competence
and Certification

The top three facilitators of con-
tinuing competence and mainte-
nance of certification for CMSRNs
were it’s fun to learn (98.3%,
n=1,087), reimbursement for attend-
ing continuing education courses and

CMSRNs’ Continuing Competence Methods and Perceived Value of Certification: A Descriptive Study

TABLE 1.
Methods for Maintaining Continuing Competence

MSNCB-Accepted Methods % Using this Method

CNE activities 92.8

CME when content is applicable to nursing 75.3

ACLS 58.3

Preceptorship and mentoring 56.7

Academic courses 53.3

Presentations for academic courses and CNE credit 35.1

Research and EBP projects 29.0

Member of a national nursing organization board or national committee chair 22.9

Conference poster presentations 21.0

Professional publishing 13.6

Multimedia program development 9.4

Test development/item writing for MSNCB 3.7

CMSRN Recertification Committee member 3.0

Other Potential Methods*

% Who Would Like
Method Accepted

Maintaining certification in a related field 88.9

Obtaining certification in a related field 85.6

Independent study 76.7

Engaging in professional advocacy 73.7

Clinical simulations 72.2

Self-assessment performance 70.1

Self-assessment written 67.8

Test development/item writing for related certification boards 61.8

Self-assessment oral 39.4

ACLS = advanced cardiovascular life support, CME = continuing medical education, CMSRN = certified medical-surgical
registered nurse, CNE = continuing nursing education, EBP = evidence-based practice, MSNCB = Medical-Surgical Nursing
Certification Board

*Institute for Credentialing Excellence (Plaus et al., 2013)

July-August 2020 • Vol. 29/No. 4234

conferences (98.2%, n=1,086), and
personal sense of professionalism
(98.2%, n=1,084). The top three bar-
riers for CMSRNs were cost (84%,
n=899), making sure continuing edu-
cation fulfills needed requirements
(78.9%, n=845), and lack of paid time
off (74.8%, n=800). Table 2 lists 10
of the highest rated facilitators of
and barriers to continuing compe-
tence with respective affirmation
rates.

Perceived Value of
Certification to CMSRN
Certificants

The three intrinsic value state-
ments with the highest affirmation
rates were provides personal satisfac-
tion (97.8%, n=1,034), enhances feel-
ing of personal accomplishment

(97.6%, n=1,035), and provides evi-
dence of professional commitment
(97%, n=1,023). The lowest ranking
intrinsic value item was enhances
professional autonomy (85.5%,
n=871). The three extrinsic value
statements with the highest affirma-
tion rates were increases marketability
(88.8%, n=898), promotes recognition
from peers (84.1%, n=865), and pro-
motes recognition from employers
(83.6%, n=869). The lowest rated
statement overall was increases salary
(46.3%, n=475). Except for the
extrinsic value statement of increases
marketability, all intrinsic value
statements had higher affirmation
rates than the extrinsic statements.
Table 3 lists the value statements of
the PVCT and respective affirmation
rates by CMSRN respondents.

Discussion
Data indicate CMSRNs mainly use

CNE and CME (when relevant to
nursing) to demonstrate continuing
competence. The findings are consis-
tent with findings of Di Leonardi
and coauthors (2020). However,
heavy reliance on continuing educa-
tion may call into question if
CMSRN practice is changed as a
result.

Respondents indicated they are
interested in using continuing com-
petence methods beyond those
accepted by MSNCB. A large pro-
portion of CMSRN certificants
would like obtaining and maintain-
ing certification in a related field to
be accepted as evidence of continu-
ing competence. Respondents also
indicated high interest in methods

TABLE 2.
Top 10 Facilitators and Barriers to Continuing Competence

Facilitators % Strongly Agree/Agree

Fun to learn 98.3

Reimbursement for attending continuing education courses and conferences 98.2

Personal sense of professionalism 98.2

Availability of continuing education in specific interest area 97.9

Employing organization encouragement 97.7

Keep me current with latest advancements 97.5

Employer values professionalism for my role 97.5

Paid time off for attending continuing education courses and conferences 97.2

Reimbursement for academic courses 97.1

Availability of continuing education in employing organization 97.1

Barriers % Strongly Agree/Agree

Cost 84.0

Making sure continuing education fulfills needed requirements 78.9

Lack of paid time off 74.8

Tracking continuing education for various requirements 71.0

Lack of access to conferences 66.0

Lack of employing organization resources 64.9

Lack of rewards 64.8

Lack of recognition 62.4

Lack of organizational/managerial support 62.4

Time consuming 61.2

July-August 2020 • Vol. 29/No. 4 235

such as clinical simulations and
assessments (performance or writ-
ten). Results suggest CMSRNs may
be open to periodic individual com-
petency assessments with resulting
targeted learning plans.

Current findings are mostly con-
sistent with other literature (Barbe
& Kimble, 2018; Garrison et al.,
2018; Whitehead et al., 2019). The
two most highly rated intrinsic
value statements remained the
same: provides personal satisfaction
and enhances feeling of personal
accomplishment. However, the third-
highest rated item in this study was
provides evidence of professional com-
mitment rather than validates special-
ized knowledge, which was a close
fourth. Extrinsic values of recogni-
tion from peers and employers were
among the top three in the present
study. However, current study
respondents rated increases mar-
ketability as the highest extrinsic
value; this was not in the top three

extrinsic values in the systematic
review by Whitehead and col-
leagues (2019). Marketability was
rated in the top three in studies by
Barbe and Kimble (2018) and
Garrison and coauthors (2018).

Facilitators and barriers of certifi-
cation and continuing competence
are similar to previous studies. Paid
time off and reimbursement for
attending continuing education
courses and conferences are consis-
tently among top facilitators. In the
current study, additional top facili-
tators were identified as fun to learn
and keeping current with the latest
advancements. Cost, lack of institu-
tional rewards and support, and
lack of access to continuing educa-
tion courses were among top barri-
ers across all studies. Respondents
in the current survey reported an
additional top barrier: making sure
continuing education fulfills recer-
tification requirements.

Limitations
Study participants were a con-

venience sample of CMSRNs and
may not be representative of all cre-
dential holders. The survey re –
sponse rate was low despite using
Dillman’s (2000) method. Research –
ers were unable to know how many
individuals received or opened the
recruitment email; determination
of the response rate thus is not
accurate. Budget constraints pre-
vented offering an incentive to
everyone who participated, which
might have increased the response
rate. Survey length may have de –
terred potential respondents from
completing the survey, or from
maintaining concentration or inter-
est during completion.

Recommendations for
Future Research

As Whitehead and associates

CMSRNs’ Continuing Competence Methods and Perceived Value of Certification: A Descriptive Study

TABLE 3.
Rates of Affirmation for Perceived Value of Certification Tool® Statements

Intrinsic Value Statements % Strongly Agree/Agree

Provides personal satisfaction 97.8

Enhances feeling of personal accomplishment 97.6

Provides evidence of professional commitment 97.0

Validates specialized knowledge 96.7

Indicates professional growth 96.2

Provides professional challenge 95.7

Enhances professional credibility 94.9

Indicates attainment of a practice standard 94.8

Enhances personal confidence in clinical abilities 93.7

Indicates level of clinical competence 92.3

Provides evidence of accountability 91.1

Enhances professional autonomy 85.5

Extrinsic Value Statements % Strongly Agree/Agree

Increases marketability 88.8

Promotes recognition from peers 84.1

Promotes recognition from employers 83.6

Promotes recognition from other health professionals 78.6

Increases consumer confidence 75.8

Increases salary 46.3

July-August 2020 • Vol. 29/No. 4236

(2019) argued, to understand the
cost and value of nursing certifica-
tion better, “models of lifelong nurs-
ing education and training must
include evaluation and determina-
tion of the specific levels of certifica-
tion and types of certification that
are absolutely needed to achieve
optimum patient, nursing, and orga-
nizational outcomes relative to the
investment required” (p. 9). To that
end, existing databases such as
the National Database of Nursing
Quality Indicators® (NDNQI®) could
be used to examine these authors’
recommendations. NDNQI collects
unit-level data that include specific
nursing certifications held by staff
and a variety of patient (e.g., injury
falls, pressure injuries, healthcare-
acquired infections) and nursing
out comes (e.g., job satisfaction, turn –
over). Also, further investigation
using the PVCT might not be war-
ranted because of the lack of variabil-
ity of findings in studies using the
PVCT. Instead, a significant revision
of the PVCT is needed to facilitate
more meaningful variation in the
identification of intrinsic and extrin-
sic rewards for certification.

Nursing Implications

Healthcare Organizations
The financial burden to individ-

ual nurses is the most frequently
cited barrier to certification. Health –
care leaders who encourage the
attainment of specialty certification
need to provide some compensa-
tion, such as reimbursement for cer-
tification expenses, salary in creases,
bonuses, and paid time off for certi-
fication-related activities. Further,
to boost the extrinsic value of spe-
cialty certification, recognition
from others is valued. Organiza –
tional leaders can provide recogni-
tion, for example, by putting cre-
dentials on nametags, publishing

names of certificants in the organi-
zational newsletter, and placing
plaques with certificant names in
respective units.

Certification Programs
Findings may guide MSNCB and

other nursing certification pro-
grams in determining what contin-
uing competence methods to allow.
Also, given the impetus to incorpo-
rate strategies such as individual
competency assessments and indi-
vidualized learning plans to address
identified learning needs, certifica-
tion programs might need to
improve mechanisms to assist certi-
ficants. These mechanisms may
include providing specific guidance
for certificants when developing
strategies and selecting appropriate
learning opportunities, including
encouraging more methods other
than continuing education where
possible. Tracking various recertifi-
cation requirements and ensuring
selected learning activities fulfill
needed requirements were among
the top barriers to maintaining con-
tinuing competence and recertifica-
tion. Certification programs might
need to improve online tracking
mechanisms and provide more
guidance and specificity about
recertification requirements.

Medical-Surgical Nurses
Medical-surgical nurses, certified

and noncertified, are encouraged to
become involved in the Academy of
Medical-Surgical Nurses (AMSN) as
their professional specialty organiza-
tion to facilitate lifelong continuing
competence. In particular, CMSRNs
can engage with AMSN and MSNCB
to provide input into recertification
requirements, clarity of the require-
ments, and support mechanisms
needed to maintain specified levels
of medical-surgical nursing knowl-
edge and skills throughout their
professional car eers.

Conclusion
The intrinsic and extrinsic rea-

sons that nurses value certification,
as well as the facilitators to and bar-
riers of certification, have remained
stable over time. A combination of
intrinsic and extrinsic facilitators is
essential for certifying programs
and healthcare organizations to use
in achieving higher numbers of spe-
cialty-certified nurses. Future re –
search should examine specific lev-
els of certification and types of cer-
tification needed to achieve opti-
mum patient, nursing, and organi-
zational outcomes.

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