1.5 ANCC Contact Keeping Up With Current Orthopaedic Hours Nursing 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 Nurse Practitioner- 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. AAlthough 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 Pediatric Nursing 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 Oncology Nursing 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 ).