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What Do Orthopaedic Nurses Do? Implications of the Role Delineation Study for Certifi Cation

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What Do Orthopaedic Nurses Do? Implications of the Role Delineation Study for Certifi Cation RESEARCH 2.5 ANCC Contact Hours What Do Orthopaedic Nurses Do? Implications of the Role Delineation Study for Certifi cation Dottie Roberts ▼ Michele Hughes The Orthopaedic Nurses Certifi cation Board (ONCB) con- National Council on Measurement in Education, 1999). ducts a role delineation study (RDS) every 5 years. Results The ONCB’s three certifi cation programs are accredited identify tasks performed by orthopaedic registered nurses, by the Accreditation Board for Specialty Nursing nurse practitioners, and clinical nurse specialists, and mus- Certifi cation (ABSNC). Repeating the RDS at least every culoskeletal health conditions commonly seen by patients 5 years is consistent with the ABSNC accreditation under their care. standards (ABSNC, 2012). PURPOSE: The purpose of the study was to defi ne current practice patterns among orthopaedic nurses and validate Background content for future certifi cation examinations. Incorporated in 1986, the ONCB offered the fi rst ONC® METHOD: An online survey methodology was used to examination at the Annual Congress of the National identify task and knowledge statements that represented Association of Orthopaedic Nurses (NAON) in Phoenix, orthopaedic nursing practice. AZ, in 1988. Since that fi rst test, more than 10,000 regis- FINDINGS: Of 5,634 e-mails sent, 1,194 valid responses tered nurses have taken the ONC examination. More were returned (response rate 22.7%). This is consistent with than 6,000 nurses currently hold this basic certifi cation results of the Orthopaedic Nurses Certifi cation Board’s 2007 credential. In October 2006, the ONCB launched exami- RDS (23.3% response rate) and is considered acceptable for nations for orthopaedic nurse practitioners (NPs) and an RDS. clinical nurse specialists (CNSs). Slightly more than 100 advanced practice nurses (APNs) now hold the ONP-C® CONCLUSION: Survey results were analyzed with assistance and OCNS-C® credentials. The ONCB has conducted of psychometric staff at Applied Measurement Profession- role delineation studies every 5 years since the inception als, Inc., and used to review and revise examination specifi - of its ONC certifi cation program, with the 2005 and cations for the 3 certifi cation programs. New specifi cations 2010 studies also including NP and CNS roles in sup- were implemented with March 2012 testing. port of the APN certifi cation programs. This article de- scribes the related literature, methodology, and results of the ONCB’s 2010 role delineation study (RDS), and onsumer protection is a primary purpose of implications for orthopaedic nursing certifi cation. specialty nursing certifi cation. Certifi cation publicly demonstrates nurses’ specifi c knowl- edge and their ability to meet specialty practice Literature Review Cstandards. It thus improves patients’ confi dence in their nurses (McMillan, Heusinkveld, Chai, Miller-Murphy, & Specialty nursing certifi cation organizations have used Huang, 2002). various methods to conduct their RDSs. For example, The Orthopaedic Nurses Certification Board the American Board of Occupational Health Nurses has (ONCB®) develops, maintains, and administers the only used a modifi ed Delphi method to describe duties and orthopaedic certifi cation examinations in the United tasks associated with a job, as well as worker character- States. Of critical importance in meeting the goal of istics and working conditions (Salazar, Kemerer, consumer protection is the need to ensure that the blue- prints used to construct the examinations are based on Dottie Roberts, MSN, MACI, RN, CMSRN, OCNS-C, CNE, Executive current practice in orthopaedic nursing. Rapid changes Director, Orthopaedic Nurses Certifi cation Board. in nursing practice require a formal role delineation Michele Hughes, MSN, RN, ACNP, ONP-C, Orthopaedic Nurses study (RDS) to be conducted every 3–5 years to compare Certifi cation Board President. current practice to specifi cations for all certifi cation The authors have disclosed that they have no fi nancial interests to any examinations (American Educational Research commercial company related to this educational activity. Association, American Psychological Association, & the DOI: 10.1097/NOR.0b013e31829a4db9 198 Orthopaedic Nursing • July/August 2013 • Volume 32 • Number 4 © 2013 by National Association of Orthopaedic Nurses Copyright © 2013 by National Association of Orthopaedic Nurses. Unauthorized reproduction of this article is prohibited. NNOR200402.inddOR200402.indd 119898 77/12/13/12/13 22:54:54 PPMM Amann, & Fabrey, 2002). However, the most common However, of 271 APNs already certifi ed by NBCHPN, 59 method for conducting an RDS has long been a survey. (22%) completed and returned the survey. The ONCB has used survey methodology to conduct Nursing members of the American Society for RDSs since its inception. As described later, other certi- Metabolic and Bariatric Surgery began development in fi cation boards also have used this method. 2005 of a specialty nursing certifi cation program based The National Certifi cation Board of Pediatric Nurse in care for morbidly obese and bariatric surgery patients Practitioners and Nurses established an advisory com- (Berger et al., 2010). Consistent with certifi cation indus- mittee of subject-matter experts to oversee the survey try best practices, the group conducted a practice analy- process for the RDS (Barnsteiner, Richardson, & Wyatt, sis as an empiric foundation for the new examination. 2002). These experts determined that pediatric nurses Because this represented the fi rst practice analysis for practice in a number of functional roles: “direct car- the specialty, a task force was convened to defi ne the egiver, educator, counselor, consultant, advocate, care practice of bariatric nursing. Tasks initially were identi- coordinator, or health systems manager” (p. 166). The fi ed in three roles: bariatric nurse coordinators, bariatric survey, which sought to defi ne the domains of practice program directors, and direct-care nurses for morbidly and functional roles, was distributed to more than 1,300 obese and bariatric surgical patients. A larger group of certified pediatric nurses in the United States, nurse volunteers representing the three roles of interest 400 noncertifi ed pediatric nurses in the United States, participated in interviews, focus groups, and surveys. and 600 noncertifi ed pediatric nurses in Canada. Their work led to a fi nal description of bariatric nursing Respondents indicated if a task was part of their regular practice in four domains: clinical management, multidis- practice and, if so, the importance of the task to their ciplinary team collaboration, outreach, and program role as pediatric nurses. They also were asked about the administration; 45 specifi c tasks and 54 knowledge state- percentage of time they spent in the identifi ed func- ments were identifi ed as the basis for a web-based survey. tional roles. Finally, survey respondents indicated the After a pilot of 60 nurses, the survey was determined to top-fi ve children’s conditions with which they spent demonstrate content and face validity. It was distributed most of their nursing time. to 1,084 nurses from American Society for Metabolic and The American Board of Neuroscience Nurses also Bariatric Surgery membership, academic, and bariatric used a task force of expert nurses to develop the survey programs across the United States. Of 1,028 eligible par- for the RDS (Villaneuva, Thompson, Macpherson, ticipants, 504 surveys were returned (49% response rate). Meunier, & Hilton, 2006). Board members selected In 2011, the National Board for Certifi cation and nurses with experiential and geographic diversity, as Recertifi cation of Nurse Anesthetists (NBCRNA) con- well as diversity in educational preparation. The task ducted its most recent professional practice analysis to force reviewed previous RDSs and other materials, ensure that its national certifi cation examination con- developing a list of interventions and disorders with rat- tinued to identify the knowledge and skills needed by ing scales for the new survey. An online 255-item survey newly certifi ed nurse anesthetists in providing compe- was designed to gain three types of information: demo- tent care (Muckle, Plaus, Henderson, & Waters, 2012). graphic data, specifi c neurological disorders encoun- The National Board for Certifi cation and Recertifi cation tered in nursing practice, and nursing interventions per- of Nurse Anesthetists’ previous practice analyses had formed (with ranking of importance). As with other been conducted in 1996, 2001, and 2007. The 2011 study surveys, the section on nursing interventions asked began with performance of a gap analysis of the current respondents to identify both frequency and importance examination outline, resulting in minor revisions to sev- as they related to actual nursing practice. Surveys were eral knowledge statements. The modifi ed content out- e-mailed to more than 3,000 AANN members as well as line then was adapted to an online survey format. Three nonmember certifi ed neuroscience nurses. scales were used by respondents: performance expecta- Beginning in 2001, the American Nurses Credentialing tion, criticality, and frequency. All 36,123 active nurse Center and the National Board for Certifi cation of anesthetists were surveyed; 9,003 qualifi ed, usable Hospice and Palliative Nurses (NBCHPN) began to responses were obtained (24.9% response rate). develop a specialty certifi cation for advance practice Statistical analyses were completed on returned sur- nurses in hospice and
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