Implementation of an Intervention to Increase Number of Certified Nurses in an Emergency Medicine Department

Background: In the evolving health care marketplace, competition between health care organizations is driven by accreditation requirements, patient driven outcomes, and controlling costs. Nursing specialty certification has been shown to have a positive impact on patient clinical outcomes and contributes to staff development and a sense of accomplishment.   Evidence-based literature has revealed that specialty certification fosters empowerment, improves confidence and clinical competency in nurses. In varied inpatient settings, specialty certification among nurses has been associated with lower fall rates, improved symptom management, improved pressure ulcer management, and reduced central line associated bacterial site infection rates. Perceived barriers for achieving specialty certification for nurses include cost and lack of institutional support and limited access to preparatory materials for certification exams.  In addressing these barriers we developed a cohort-based intervention to promote nursing specialty certification among nurses in an adult emergency department (ED). The cost of the preparatory course for the certification exam is $250 per person which was paid by the hospital.  The cost of the preparatory course for a group is $500 per cohort of 20 nurses.  The ED at Johns Hopkins Hospital has a staff of 110 nurses with 13% of nurses certified prior to the intervention.  The purpose of this study was to describe the effect of an intervention to promote certification among nurses in the ED while reducing the cost of institutional support for the certification.

Methods: A descriptive design was used to determine the association between an educational intervention and the percentage of certification among nursing staff in the adult ED and the cost of the certification.  Hypothesis: A cohort support intervention to promote certification will be more effective than individualized support in promoting certification in nurses in the adult ED setting and reducing institutional cost of support for certification. Our program provided 40 ED nurses access to preparatory materials at no cost to them. A cohort of 20 nurses interested in certification was created to prepare for the certification examination. We purchased access to the self-paced online exam review module. This increased the certification among nurses in

Findings: Following the intervention there was an increase in the number of nurses who were certified as ED nurses from 13% to 40%, reducing the costs from $250 per nurse to $500 per cohort of 20. This resulted in a 90% reduction in cost per nurse for preparing ED nurses for the certification exam.

 Discussion: The cost savings impact of this intervention was valuable to the unit.  However, even more valuable was the increase in certified ED nurses and the expected positive impact on patient outcomes.

Implications for Staff Education and Practice: A cohort intervention to promote certification is an effective and cost savings approach to the promotion of certification.  Further study should examine nurses who chose not to participate in the intervention to determine if other approaches may be more effective for selected groups. Enhanced support of ED nurses will result in higher specialty certification.