1.5 ANCC Contact Keeping Up With Current Orthopaedic Hours Practice

Results of the ONCB 2016 Role Delineation Study

Dottie Roberts ▼ Kathleen Pirri ▼ Margaret Hanes

BACKGROUND: The Orthopaedic Nurses Certifi cation practitioners (ONP-C). Over the years since the fi rst ONC Board (ONCB) conducts a role delineation study (RDS), also examination in 1988, nurses from Canada and Hong known as a job task analysis, every 5 years. Results identify Kong also have tested and earned certifi cation. To meet tasks performed by orthopaedic registered nurses and nurse the goal of consumer protection and to continue to rec- practitioners, as well as musculoskeletal health conditions ognize current expertise and knowledge, ONCB mem- commonly experienced by their patients. bers must ensure the examinations are always based on current practice in orthopaedic nursing. Along with PURPOSE: The purpose of this study was to defi ne current rapid changes in orthopaedic nursing practice, certifi ca- practice patterns among orthopaedic nurses and nurse tion program accreditors such as the Accreditation Board practitioners to determine content for future certifi cation for Specialty Nursing Certifi cation (ABSNC, 2017) re- examinations. quire accredited program such as the ONC and ONP-C to METHOD: An online survey methodology was used to conduct a role delineation study (RDS) at least every 5 identify task and knowledge statements representative of years. This allows representative subject matter experts orthopaedic nursing practice. to aid the ONCB in identifying necessary changes to the FINDINGS: Of 6,462 e-mails sent, 904 valid responses examination specifi cations. were returned (response rate 13.9%). This is lower than results of the Orthopaedic Nurses Certifi cation Board’s 2010 Background RDS (22.7% response rate) but is considered acceptable for an RDS. After the ONCB was incorporated in 1986, volunteers began developing a certifi cation examination appropri- CONCLUSION: Survey results were analyzed by ONCB ate for RNs. The fi rst ONC examination was offered at Test Committee members with guidance from psychomet- the Annual Congress of the National Association of ric staff at PSI/AMP. PSI/AMP staff were used to review Orthopaedic Nurses (NAON) in Phoenix, AZ, in 1988. and revise examination specifi cations for the Orthopaedic Since that date, more than 10,000 RNs have taken the Nurse Certifi ed (ONC) and Orthopaedic - ONC examination. Almost 7,000 nurses currently hold Certifi ed (ONP-C) certifi cation programs. New examination this credential to indicate their specialty expertise in or- specifi cation and passing points were implemented with thopaedic nursing. In October 2006, the ONCB launched April 2018 testing. examinations for orthopaedic NPs and clinical nurse specialists (CNSs). Although testing for the CNS

s an umbrella, the term credentialing refers to three forms of recognition for individuals in Dottie Roberts, EdD, MSN, MACI, RN, OCNS-C, CMSRN, CNE, has different areas of healthcare: licensure, regis- served as the Executive Director of the Orthopaedic Nurses Certifi cation Board since 2005. She has been involved in four role delineation studies tration, and certifi cation (Chappell et al., 2018). during her tenure as ONCB member and staff. Although A gaining licensure earns a nurse the opportu- Kathleen Pirri, MSN, RN, ARNP, ONC, AGNP, ONP-C, is currently a nity to practice professionally, certifi cation by an inde- director of the Orthopaedic Nurses Certifi cation Board. She was a long- pendent organization supports his or her specialty ex- time member of the Test Committee and most recently served as chair pertise and knowledge (Kitto, Grant, Chappell, & of the Exam Prep Committee. Lundmark, 2017). Similar to licensure, the purpose of Margaret Hanes, BSN, RN-BC, ONC, is currently the chair of the Test specialty nursing certifi cation is consumer protection. Committee. She served as an ONC member of the committee during the The Orthopaedic Nurses Certifi cation Board (ONCB) reported study. is the only certifi er of orthopaedic nurses in the United The authors have disclosed no confl icts of interest . States, offering credentials for RNs (ONC) and nurse DOI: 10.1097/NOR.0000000000000571

234 Orthopaedic Nursing • July/August 2019 • Volume 38 • Number 4 © 2019 by National Association of Orthopaedic Nurses Copyright © 2019 by National Association of Orthopaedic Nurses. Unauthorized reproduction of this article is prohibited. credential was suspended in December 2014, more than clinical hemodialysis technician (CCHT), identify prac- 125 advanced practice registered nurses (APRNs) now tice differences between entry-level and advanced tech- hold the ONP-C credential. The ONCB has conducted nicians, and determine practice differences between an RDS every 5 years since the inception of its ONC cer- hemodialysis technicians and licensed practical nurses tifi cation program, with the 2005, 2010, and 2015 stud- (LPNs)/licensed vocational nurses (LVNs) in hemodialy- ies including APRNs. In this article, the relevant litera- sis settings ( Garbin & Chmielewski, 2013). The plan was ture, methodology, results, and implications of the to begin the study in 2006. However, NNCC members ONCB’s 2015 RDS are discussed. learned the Centers for Medicare & Medicaid Services (CMS) was revising the Conditions for Coverage for end-stage renal disease facilities to require all hemodi- Literature Review alysis technicians to be certifi ed by mid-April 2010 (or To refl ect best practices and to comply with certifi cation within 18 months of initial employment). New regula- program accreditation requirements, certifying organi- tions also specifi ed minimum education for technicians zations routinely conduct RDSs. Study results must be as well as changes to the education program. These submitted as part of applications for accreditation and changes prompted the NNCC to delay the RDS until the reaccreditation. Many nursing certifying organizations regulations were implemented; the project resumed in also publish their study results to increase understand- 2010 and data collection was completed in 2011. ing of the nursing role in each specialty. Organizations Analysis of practice differences by a national task often respond to calls for a new certifi cation by fi rst con- force was based on the three purposes of the RDS ducting an RDS. ( Garbin & Chmielewski, 2013). The NNCC accepted the For example, the Certifi cation task force recommendations to continue current exami- Board (PNCB) received regular input from primary care nation specifi cations for the CCHT program, develop a providers who identifi ed a need to expand their focus to new certifi cation examination for advanced hemodialy- include the mental health needs of children and adoles- sis technicians, and develop a new certifi cation exami- cents (Hawkins-Welsh & Van Cleve, 2013). In response nation for LPNs/LVNs working in dialysis settings. The to a mental health provider shortage and in recognition CCHT-A certifi cation program was developed for tech- of the need for timely identifi cation of behavioral prob- nicians with 5 or more years of experience, and the lems in children, the PNCB launched a national survey CD-LPN/LVN certifi cation program was developed for to determine interest in a specialty certifi cation as a nurses with 2 or more years of experience with patients pediatric mental health specialist (PMHS) to serve as a on dialysis. Both programs were launched in 2012, re- value-added credential for nurses with advanced prac- fl ecting the CMS specifi cation that an interprofessional tice licensure. According to Hawkins-Welsh and Van team is needed and a critical part of the care of patients Cleve, “Specialty certifi cation was seen by 86% of these receiving hemodialysis. respondents as adding value and enhancing recognition Also in response to a change in practice, the Oncology of their skills and knowledge in mental health, and 77% Nursing Society (ONS) and the reported that they would seek a new certifi cation in this Certifi cation Corporation partnered in conducting an area if it were available” (p. 144). RDS on the oncology nurse navigator (ONN) role The PNCB convened an expert task force in February ( Lubejko et al., 2017). The ONS had conducted a previ- 2009 to review the survey results (Hawkins-Welsh & Van ous RDS in 2011, when the navigator role was relatively Cleve, 2013). After it recommended development of a new to oncology, but no unique skill set was identifi ed. specialty certifi cation, the PNCB undertook an RDS In 2016, the ONS and the ONCC completed a second with a survey methodology to identify content specifi ca- RDS to redefi ne the role and determine whether a certi- tions for certifi cation as a PMHS. Survey respondents fi cation examination was warranted. Expansion of the rated the importance of 86 distinct tasks in the follow- navigator role in oncology had been driven in particular ing categories: primary mental health promotion, his- by the Commission on Cancer. The role also had been tory taking, diagnostic decision-making, collaboration expanded to support organizational strategies from in diagnostic process, early management, and ongoing screening and diagnosis to survivorship and end-of-life management. They also identifi ed which diagnoses they care. saw most often and whether they diagnosed, managed, The two organizations followed the prescribed steps referred, or comanaged a patient with the disorder. of a well-executed RDS (Lubejko et al., 2017). These in- Other areas of practice also were explored in the survey cluded confi rming the defi nition of ONN , reviewing and (e.g., use of specifi c screening tools, treatment and man- revising task statements from the 2011 RDS, and devel- agement, professional issues). After the expert panel re- oping a draft survey to pilot. Feedback from the pilot viewed survey results, the PNCB developed a detailed survey group was used to create the fi nal survey, which content outline for a new PMHS certifi cation examina- was distributed to more than 5,300 members and non- tion (Hawkins-Welsh & Van Cleve, 2013 ). The examina- members in the ONS database. After return of 498 com- tion was beta tested in early- to mid-2011 and launched pleted survey (9% response rate), evaluation of data in December 2011. Authors concluded the RDS strongly demonstrated the responses were suffi ciently represent- supported “current understanding of the ways in which ative of the sample to allow statistical analysis. APRNs can fi ll the need for the PMHS” (p. 147). Results supported the belief that the ONN role had An RDS conducted by the Nephrology Nursing been expanding since the 2011 RDS ( Lubejko et al., Certifi cation Commission (NNCC) had a triple purpose: 2017). New foci in the role included psychosocial as- to revalidate the current specifi cations for the certifi ed pects of care (e.g., survivorship communication) and

© 2019 by National Association of Orthopaedic Nurses Orthopaedic Nursing • July/August 2019 • Volume 38 • Number 4 235 Copyright © 2019 by National Association of Orthopaedic Nurses. Unauthorized reproduction of this article is prohibited. the process of care (e.g., identifi cation of patients for 6. Discuss the linkage between the knowledge genetic counseling). Some differences between the ONN and task statements, and how they will be used and clinical nurse roles also were identifi ed. However, to create examination specifications. both roles were determined to require similar knowl- 7. Integrate the components of the survey in edge and skills. According to Lubejko et al., “About 74% preparation for pilot testing. (Fabrey & of the knowledge statements on the 2016 ONN RDS Kassam, 2016a , 2016b , p. 1) were an exact match or aligned with a very similar item found on the OCN® Test Content Outline” (p. 48). Results did not support the need for a new ONN certifi cation. Sample Instead, they reinforced the ONS position statement The ONCB Role Delineation Task Force broadly defi ned supporting ONNs in their attainment of one of the cre- the target orthopaedic nursing RNs and NPs. dentials offered by the ONCC. Other organizations have published the results of the An orthopaedic nurse is an RN who has recent most recent RDS. These include the American Holistic relevant work experience, which may have Nurses Credentialing Corporation ( Erickson, Erickson, occurred in any setting with a variety of patient Campbell, Brekke, & Sandor, 2013 ) and the American populations with musculoskeletal conditions. Nurses Credentialing Center (pain management certifi - cation) ( Willens, DePascale, & Penny, 2010 ). Although An orthopaedic NP is a who is not every organization publishes the results of every licensed as an NP and has recent relevant work RDS, the practice of publication is common and pro- experience as an NP with patients who have mus- cesses tend to be consistent across all nursing certifi ca- culoskeletal conditions. ( Fabrey & Kassam, 2016a , tions. This is in large part due to requirements of the 2016b , p. 5) ABSNC and the National Commission on Certifying Potential participants in the study fi rst had to agree Agencies. These accreditation agencies publish stand- these descriptions applied to them. ards that identify expectations in examination develop- To gather data from those who considered them- ment and maintenance. selves orthopaedic nurses and NPs, task force members distributed an e-mail invitation—with a link to the role Purpose delineation survey—to orthopaedic certifi ed RNs and NPs. The survey also was sent to RNs and NPs who were The purpose of the 2016 ONCB RDS was to identify cur- not certifi ed but may have been practicing in musculo- rent orthopaedic nursing practice patterns and deter- skeletal health. The two primary sources of names and mine content for future certifi cation examinations. e-mail addresses were certifi cants of the ONCB and members of the NAON. Prospective participants had Methodology known e-mail addresses and had previously indicated a general willingness to be contacted by the organiza- As in past studies, a survey methodology was used for tions. After merger of the two lists and exclusion of any the 2016 RDS. Orthopaedic certifi ed nurses were invited duplicate entries, 6,462 potential participants were con- to serve on a Role Delineation Task Force, which had tacted. The invitation e-mail explained the purpose of diversity in terms of educational preparation, years in the study and indicated completion of the survey would nursing, years in orthopaedic nursing, and geographic take approximately 30 minutes. The e-mail further con- distribution. In accordance with ABSNC standards in fi rmed all responses would be held confi dential. effect at the time of the study, members of the ONCB’s Completion of the survey was taken as informed standing Test Committee could not comprise a majority consent. of the task force; only three of 13 task force members also served on the Test Committee. Members of the Advisory Committee used various re- Survey Design sources to confi rm their understanding of the responsi- Because this study was national in scope, task force bilities of orthopaedic nurses. The previous RDS survey members determined demographic questions should be and detailed content outline were the primary resources included to assess the characteristics of survey respond- for their work. Psychometric staff provided background ents. Members identifi ed 14 questions to address spe- information on the role delineation process, including cifi c qualities, including size and type of practice, certi- its relationship to examination development and main- fications held, percentage of time dealing with tenance. Advisory Committee members completed musculoskeletal conditions, medical conditions seen in seven activities as their part of the RDS: patient population, and number of years as an ortho- 1. Develop a sampling plan. paedic nurse. Task force members then identifi ed task 2. Identify tasks and knowledge statements for and knowledge statements for the survey. Results of the the survey instrument. previous RDS and existing examination specifi cations 3. Identify major classifications of tasks and fi rst were considered. Task force members refl ected on knowledge statements. tasks related to individual job responsibilities and 4. Determine the rating scale(s). knowledge statements from the current test specifi ca- 5. Determine the relevant demographic variables tions in creating the survey. PSI/AMP psychometricians of interest. also encouraged members to suggest new tasks or

236 Orthopaedic Nursing • July/August 2019 • Volume 38 • Number 4 © 2019 by National Association of Orthopaedic Nurses Copyright © 2019 by National Association of Orthopaedic Nurses. Unauthorized reproduction of this article is prohibited. Members of the Role Delineation Task Force then TABLE 1. S INGLE SIGNIFICANCE SCALE completed the survey draft as a pilot. A discussion and How important is the following knowledge to your current prac- review of results followed with no substantive changes tice? If you do not use the knowledge, select “Not part of my to the survey. The fi nal online survey then was pre- practice.” pared and invitation messages containing a link to the 0 = Not part of my practice survey were e-mailed to individuals by PSI/AMP. One 1 = Part of my practice but not very important week before the survey deadline, a reminder message was sent to persons who had not yet completed the 2 = Important survey. As an added incentive to complete the survey, 3 = Very Important all respondents who provided their names and contact information at the end of the survey were entered to 4 = Essential win a 16G iPad Mini, free recertifi cation, or a free cer- tifi cation examination (if eligibility requirements were met). knowledge statements that could be pertinent to current practice. At the conclusion of the fi rst meeting, a draft list of tasks and knowledge statements was completed. Findings and Discussion The fi nal survey included 54 knowledge statements (in- Of the 6,462 e-mails sent, 904 valid responses were con- cluding some skills) and 158 task statements for both sidered after allowance for incorrect e-mail addresses RNs and NPs. and incomplete surveys (13.9% response rate). To refl ect current orthopaedic nursing practice accu- Comparably, this rate was lower than the previous RDS rately, task force members worked to ensure each task in 2010 (22.7%). However, the 2015 RDS response rate could be paired with a knowledge statement and each was considered very acceptable. Notably, of the re- knowledge statement was relevant to a task. Six content sponses, 827 individuals responded as RNs (91.48%) domains were identifi ed for RNs and the ONC examina- and 77 responded as NPs (8.51%). Task force members tion, under which 54 knowledge statements and 104 agreed the high number of RN respondents was repre- task statements were categorized. Content domains in- sentative of the specialty. cluded self-management, pain, complications, activity, Task force members reviewed demographic informa- nutrition, and psychosocial. Five role domains were tion in aggregate and then separately by RN and NP identifi ed for NPs and the ONP-C examination, under roles (Fabrey & Kassam, 2016a , 2016b). Both groups which 54 knowledge statements and 54 task statements shared similar results in regard to the percentage of were categorized. Role domains included clinician/ time treating patients with similar orthopaedic condi- practitioner, educator, manager, consultant, and re- tions (see Figure 1). Both groups also reported working searcher. Survey respondents would be asked to rate more than 36 hours per week caring for patients with knowledge and task statements using a single signifi - musculoskeletal health concerns. cance scale (see Table 1 for example of single scale for Nurse practitioner respondents indicated they had knowledge statements). After initial consideration of worked in orthopaedics an average of 20 years, whereas the extent to which the knowledge or task is necessary RNs indicated they had worked in orthopaedics for at to job performance, respondents would indicate their least 5 years. The number of years caring for patients combined judgments regarding importance and perfor- with musculoskeletal health conditions for both groups mance frequency ( Fabrey & Kassam, 2016a , 2016b ). ranged from zero to just under 45.

F IGURE 1. Percentage of patients treated by musculoskeletal condition.

© 2019 by National Association of Orthopaedic Nurses Orthopaedic Nursing • July/August 2019 • Volume 38 • Number 4 237 Copyright © 2019 by National Association of Orthopaedic Nurses. Unauthorized reproduction of this article is prohibited. F IGURE 2. Highest level of nursing education. NP = nurse practitioner; RN = registered nurse.

See Figure 2 for data on the highest level of nursing accomplished by prompting the respondents to create a education for RNs and NPs. In addition, many respond- list of statements. In addition, respondents were asked ents indicated they have a degree in a fi eld other than to answer the following question: “How well do you feel nursing (see Figure 3). Most RN respondents (92.7%) and this survey covered orthopaedic nurses?” Six respond- NP respondents (94.7%) received their initial education ents (< 1%) selected inadequately , 439 (48.9%) selected in the United States. A clear majority of RNs (90.1%) and adequately , and 453 (50.4%) selected completely . These NPs (79.2%) indicated they were certifi ed in orthopaedic assessments confi rmed strong support for the adequacy nursing. In addition, the majority of respondents worked of the instrument. with adults (aged 19–65 years) or older adults (older than Adequacy of the instrument as it relates to reliability 65 years). Approximately one third of respondents in is also important. Reliability (coeffi cient α ) between both groups worked in hospitals with 100–299 beds survey items (tasks or knowledge statement) estimates (33%). Task force members concluded the demographic the extent to which each scale represents a consistent results were expected, and a suffi cient number of re- collection of items ( Fabrey & Kassam, 2016a , 2016b ). sponses were received to facilitate this analysis. Interrater reliability is more important as it indicates Another important aspect of the RDS was respond- the degree to which raters agree on the signifi cance of ents’ views of the adequacy of the instrument. After rat- an item. This calculation also indicates how likely it ing the signifi cance of all task and knowledge state- would be that another sample of raters from the same ments, respondents were asked to address any population would give similar ratings to the present statements related to orthopaedic nursing they believed sample. Table 2 depicts the tasks and knowledge state- may not have been included in the survey. This was ment reliability for the overall respondent group.

F IGURE 3. Highest level of education—other than nursing. NP = nurse practitioner; RN = registered nurse.

238 Orthopaedic Nursing • July/August 2019 • Volume 38 • Number 4 © 2019 by National Association of Orthopaedic Nurses Copyright © 2019 by National Association of Orthopaedic Nurses. Unauthorized reproduction of this article is prohibited. Force determined the ONC examination specifi cations TABLE 2. T ASK AND KNOWLEDGE STATEMENT RELIABILITY should continue to be organized primarily by patient Reliability (Consistency) conditions and content areas that defi ne primary knowl- Number of Between Between edge domains for orthopaedic RN practice. They organ- Task Tasks Respondents ized the 102 task statements and 47 knowledge state- Survey Sections Statements (Coeffi cient α ) (Intraclass) ments on the RDS survey into these patient conditions RN and content areas. With psychometric guidance, mem- Self-management 8 .92 .89 bers judged a 135-item examination would be suffi cient to sample examinees’ mastery of knowledge in those do- Pain 20 .95 .98 mains. They reviewed participants’ responses regarding Complications 34 .97 .88 the percentage of examination items that should be allo- Activity 22 .98 .88 cated to each domain and considered the mean signifi - cance ratings of knowledge statements in each domain. Nutrition 6 .93 .99 As subject matter experts, ONC task force members also Psychosocial 12 .97 .98 considered the breadth of content within each knowledge All tasks 102 .99 .84 area. Each member then independently identifi ed a rec- All knowledge 47 .99 .91 ommended item allocation in each area; these allocations statements were aggregated and present to the task force for discus- sion. Analysis of these results in relation to orthopaedic NP nursing practice led task force members to revise the Clinician 20 .9 .91 number of questions for each patient condition and each Educator 12 .84 .87 content area for future forms of the ONC examination Manager 5 .85 .91 (see Tables 4 and 5). ONC examination specifi cations are available to candidates to use for test preparation. Consultant 9 .89 .92 Researcher 8 .94 .19 All tasks 54 .95 .84 ONP-C Examination All knowledge 54 .96 .80 ONP-C members of the Role Delineation Task Force statements completed the same process as ONC members in ana- lyzing results from NP respondents. However, the ex- = = Note . NP nurse practitioner; RN registered nurse. amination specifi cations were organized by APRN roles rather than by content areas. As previously noted, each respondent used the single Survey results and the revised examination specifi ca- signifi cance scale (see Table 1) to classify tasks and tions pinpoint the changing practices in orthopaedic knowledge statements as they pertained to his or her nursing (see Tables 6 and 7 ). Interestingly, both RN and nursing practice. Mean ratings then were calculated NP respondents indicated they are providing care for using only responses considered most signifi cant to more patients with degenerative disorders. Given the nurses’ jobs. When comparing items, the higher the increasing numbers of aging adults, this fi nding was not mean rating, the more signifi cant the item to practice. surprising; task force members increased the items in Table 3 depicts the range ratings, mean rating, and this area on both examinations. Since the 2010 survey, standard deviations by respondent group. The two sports injuries are being seen with much less frequency groups rated the signifi cance as 0 (not part of my prac- by RNs, the majority of whom work in acute care set- tice ), 1 ( not very important ), 2 (important ), 3 ( very impor- tings. For NPs with practice most often in ambulatory tant ), or 4 (essential ). To ensure continued refl ection of care settings, this area of the examination was mini- current orthopaedic nursing practice, task force mem- mally changed. bers used these results to consider changes to the speci- fi cations for the ONC and ONP-C examinations. Passing Point Determination Because the ONCB’s certifi cation programs are accred- ONC Examination ited by the ABSNC (2017), the ONCB must conduct a Survey results related to the ONC examination will be ad- passing point study (also known as standard setting pro- dressed fi rst. ONC members of the Role Delineation Task cedure ) whenever a new examination form is developed.

TABLE 3. R ANGE AND MEAN RATINGS BY RESPONDENT GROUP

Task Statements Knowledge Statements Standard Standard Range Ratings Mean Rating Deviation Range Ratings Mean Rating Deviation RN 2.59–6.3 3.2 0.25 2.13–3.65 2.97 0.25 NP 2.18–3.81 3.01 0.83 1.13–3.84 3.03 0.9 Note . NP = nurse practitioner; RN = registered nurse.

© 2019 by National Association of Orthopaedic Nurses Orthopaedic Nursing • July/August 2019 • Volume 38 • Number 4 239 Copyright © 2019 by National Association of Orthopaedic Nurses. Unauthorized reproduction of this article is prohibited. TABLE 4. R EVISED ONC EXAMINATION PATIENT CONDITIONS TABLE 7. REVISED ONP-C EXAMINATION APRN ROLES Items After Items Accepted Items After Items Accepted Patient Condition 2010 Survey May 2016 Content Area 2010 Survey May 2016 Degenerative disorders 42 51 Clinician/practitioner 85–95 88–98 Orthopaedic trauma 28 26 Educator 13–23 13–23 Sports injuries 26 15 Manager 3–9 3–0 Infl ammatory disorders 10 12 Consultant 11–19 8–18 Metabolic bone 12 11 Researcher 3–9 3–9 disorders Note . APRN = advanced practice registered nurse. Pediatric/congenital 6 7 disorders Musculoskeletal tumors 5 7 examination candidates in terms of educational prepa- Neuromuscular 6 6 ration, years in nursing, years in orthopaedic nursing, disorders and geographic distribution. The Angoff procedure was recommended by psy- chometricians and selected by the task force as the pro- cedure for estimating the pass/fail cutoff score ( Fabrey TABLE 5. R EVISED ONC EXAMINATION CONTENT AREAS & Hellrung, 2017a , 2017b ). This process is based on a Items After Items Accepted statistical technique that sets the standard as it relates Content Area 2010 Survey May 2016 to item diffi culty, specifi cally diffi culty expected of mini- Self-care 22–32 21–31 mally qualifi ed examination candidates. Each member Pain 35–45 36–48 of the task force completed the appropriate new test form (ONC or ONP-C) for his or her current credential, Complications 31–41 25–35 providing an expected performance rating for each test Activity 15–25 18–28 item by answering the following question: “What per- Nutrition 3–9 5–10 centage of minimally qualifi ed candidates will answer this question correctly?” Under the guidance of the psy- Psychosocial 3–9 4–9 chometric staff, task force members reviewed the re- sults and identifi ed recommended passing points for each of the two ONCB examinations. These were ap- TABLE 6. R EVISED ONP-C EXAMINATION PATIENT proved subsequently by the ONCB. Information on the CONDITIONS passing point for each examination is available on the ONCB website ( www.oncb.org). Items After Items Accepted Patient Condition 2010 Survey May 2016 Degenerative 48 53 Conclusion disorders To refl ect current orthopaedic practice on certifi cation ex- Orthopaedic trauma 27 24 aminations, the ONCB will continue to conduct an RDS Sports injuries 20 19 approximately every 5 years. Data from the study assist in the evaluation of current test specifi cations and guide any Infl ammatory 12 11 disorders necessary changes pertinent to nursing practice for RNs and NPs. Results of the study assist task force members to Metabolic bone 11 11 develop updated examination specifi cations (content out- disorders line) that are made available to candidates, item writers, Pediatric/congenital 7 8 and any other interested individuals. Content outlines disorders could be considered as frameworks for the examinations. Musculoskeletal 5 4 The current examination specifi cations can be found on tumors the ONCB website (www.oncb.org ). Neuromuscular 5 5 disorders REFERENCES Accreditation Board for Specialty Nursing Certifi cation After completion of the RDS and revision of the exami- (ABSNC). (2017 ). Accreditation standards for examina- nation content outlines, PSI/AMP psychometricians tion-based certifi cation programs as of June 30, 2017 . and test specialists developed new examination forms to Retrieved from https://www.absnc.org/accreditation- standards-examination-based-certifi cation use for standard setting. In mid-August 2017, the Chappell , K. , ElChamaa , R. , Jeong , D. , Kendall-Gallagher , Passing Point Task Force of fi ve ONCs and six ONP-Cs D. , Salt , E. , Reeves , S. , ... Kitto , S. (2018 ). met to begin the process of recommending a passing Conceptualization and operationalization of certifi ca- point for the new forms. These volunteers had been se- tion in the US and Canadian . The lected primarily to be representative of prospective Journal of Nursing Administration , 48 ( 5 ), 238 – 246 .

240 Orthopaedic Nursing • July/August 2019 • Volume 38 • Number 4 © 2019 by National Association of Orthopaedic Nurses Copyright © 2019 by National Association of Orthopaedic Nurses. Unauthorized reproduction of this article is prohibited. Erickson , H. L. , Erickson , M. E. , Campbell , J. A. , Brekke , Hawkins-Welsh , E. , & Van Cleve , S. (2013 ). The pediatric M. E. , & Sandor , M. K. ( 2013 ). Validation of holistic mental health specialist: Role delineation. The Journal nursing competencies: Role delineation study, 2012. for Nurse Practitioners , 9 (3 ), 142 – 148. doi:10.1016/j. Journal of , 31 ( 4 ), 291 – 302 . nurpra.2012.11.017 Fabrey , L. , & Hellrung , J. ( 2017a ). A passing point study for Kitto , S. , Grant , R. , Chappell , K. , & Lundmark , V. (2017 ). the Orthopaedic Nurses Certifi cation . Olathe, KS: PSI . The relationship between specialty certifi cation of in- Fabrey , L. , & Hellrung , J. ( 2017b ). A passing point study for dividual nurses and outcomes: Developing a standard- the Orthopaedic Nurse Practitioner Certification . ized taxonomy for research. The Journal of Nursing Olathe, KS : PSI . Administration , 47 ( 5 ), 245 – 247 . Fabrey , L. , & Kassam , S. (2016a ). Orthopaedic Nurse- Lubejko , B. G. , Bellfi eld , S. , Kahn , E. , Lee , C. , Peterson , N. , Certifi ed (ONC) role delineation study fi nal report . Rose , T. , ... McCorkle , M. (2017 ). Oncology nurse Olathe, KS: AMP/A PSI Business. navigation: Results of the 2016 role delineation study . Fabrey , L. , & Kassam , S. ( 2016b). Orthopaedic Nurse Clinical Journal of Oncology Nursing , 21 ( 1 ), Practitioner-Certifi ed (ONP-C) role delineation study 43 – 50 . fi nal report . Olathe, KS: AMP/A PSI Business. Willens , J. S. , DePascale , C. , & Penny , J. (2010 ). Role de- Garbin , M. G. , & Chmielewski , C. M. (2013 ). Job analysis lineation study for the American Society for Pain and role delineation: LPN/LVNs and hemodialysis tech- Management Nursing . Pain Management Nursing , nicians. Nephrology Nursing Journal , 40 ( 3 ), 225 – 240 . 11 ( 2 ), 68 – 75 .

For additional continuing nursing education activities on orthopaedic topics, go to nursingcenter.com/ce.

© 2019 by National Association of Orthopaedic Nurses Orthopaedic Nursing • July/August 2019 • Volume 38 • Number 4 241 Copyright © 2019 by National Association of Orthopaedic Nurses. Unauthorized reproduction of this article is prohibited.