The value of nursing certification

Categories: Education.

As the population ages, and with advances in medical treatments and technology, more and more people are living with chronic diseases. As a result, Advanced Illness Management Programs and Palliative Care Programs are being offered in non-traditional hospital or hospice settings while more Medicare beneficiaries are accessing the Medicare hospice benefit.

The demand for highly qualified, competent nursing staff is also growing.

End-of-life care today not only requires the gentle touch and compassion that nurses have traditionally brought to hospice, but also knowledge and skill in providing evidence-based care and symptom relief. And one of the best ways to ensure your nurses are up to the job is through hospice and palliative care certification. 

About Certification
In general, certification is a profession’s official recognition of achievement, expertise and clinical judgment. It’s awarded once the individual demonstrates attainment of knowledge in a specialized field (e.g., through testing) by accrediting bodies and specialty organizations.  

The requirements for Hospice and Palliative Nurse Certification are vigilantly managed by the Hospice and Palliative Credentialing Center (HPCC), formally known as the National Board for Certification of Hospice and Palliative Nursing (NBCHPN) which celebrated its 20th anniversary in 2013.

HPCC offers specialty examinations for all levels of nursing staff:
•    advanced practice nurses (ACHPN)
•    hospice and palliative care nurses (CHPN)
•    nurses who specialize in pediatric care (CHPPN)
•    licensed practical/vocational nurses (CHPLN)
•    certified nursing assistants (CHPNA)

Interdisciplinary certification programs are also offered for hospice administrators (CHPCA) and
perinatal loss professionals (CPLC).

A Closer Look at Testing
HPCC works with the professional testing company, Applied Measurement Professionals, Inc. (AMP), to develop, test and monitor each examination, thereby producing a psychometrically sound and legally defensible examination which meets industry standards.

So how is the test developed? The purpose of the initial certification examination is to test for mastery of a defined body of knowledge that a minimally competent person in the specialty of hospice and palliative care would be expected to attain.

The first step in examination development is the Role Delineation Study (RDS). The RDS is a survey of current professionals in a particular role who are asked to report how much time they spend in various tasks. This information is utilized to create the test content outline that determines the examination content and weight of different items. For instance, symptom management items are weighed differently than scope of practice or research items. The RDS is performed every five years for each HPCC examination to keep the examinations up to date, relevant and reflective of current practice.

From the test content outline, examination questions need to be written. There is actually a tested way to write good questions (who knew!). In collaboration with AMP, HPCC offers a three-part Item Writers Workshop. The first two parts are online and the last part is a live webinar. This is not only a great resource for those who write test questions for their job, but also for those who would like to apply for an Exam Development Committee. (Note that continuing education credits can be accrued for those seeking recertification.)

Each examination has an Exam Development Committee. The committee writes and reviews evidence-based questions which are referenced for accuracy and relevance. Each question is pretested and assessed by AMP and the committee members. For example, did everyone who answered the question get it right or wrong? How about those who did well or failed the entire exam — how many got the question right or wrong?

After pre-testing the question, only questions that performed well are then scored on subsequent examinations. So when an applicant takes the certification examination, there are a number of pretest questions being tested to see how they perform as well as scored questions which determine the applicant’s test score. Applications to become an Exam Development Committee member are found on the HPCC website. This is a great experience. As a member of this committee, one meets peers from all over the country. The experience of referencing exam items helps keep you up to date as well. It is intellectually stimulating and a geeky way to have fun.


Once applicants become certified, recertification every four years is the means by which they renew their certification and build upon basic knowledge and experience. However, taking the same initial examination does not demonstrate that the person has built upon experience or gained more knowledge. All specialty nursing certification bodies, such as HPCC, are challenged to develop a means to assess continuing competence.

One such means is the Situation Judgment Exercise (SJE), which may be a new and very different experience for many certificants.

The SJE follows the same test content outline to develop the questions. It uses patient care scenarios to test critical reasoning and clinical application beyond the level of the initial examination. Performance on the SJE is measured through the skills of information gathering and decision making. Points are accrued and possibly lost based upon the certificant’s ability to read the questions and choose from the available information. It is not a pass/fail examination; certificants receive feedback on their performance as well as on the number of points accrued for recertification. The SJE is a required part of the ACHPN and CHPN recertification process.

How Does Certification Benefit You?

The personal benefits of achieving specialty nursing certification include validation of the current body of knowledge and experience, a sense of personal achievement, and recognition from others. When certification is recognized in the workplace, there is increased job satisfaction — and possibly greater earning potential and career advancement.

Why do employers look to certified staff?  There are actually two important reasons.

First, many employers see certification as a sign of the employee’s commitment to self-learning and the pursuit of excellence. As some of the Magnet research indicates, percentage of certified staff may be a measure of competence and expertise (see References 2, 3, 4 and 6). With increased marketplace competition, certified staff may be a powerful marketing tool.

Secondly, employers have acknowledged and rewarded certified staff in a number of ways. Some pay for certification fees and review courses. Others pay a certification bonus or make certification part of a clinical ladder. In tough economic times, others have chosen to acknowledge certificants at recognition lunches and pinning ceremonies, have prominently placed their certification plaques in the workplace, and/or have announced the achievement in their employee newsletter or the local newspapers. Certified Nurses Day is April 19, 2015. How are you recognizing yourself and your certified colleagues?

How Certification Influences Patient Outcomes
While specialty nursing certification programs have existed for 30 years, research demonstrating the effect of certified staff on patient outcomes is relatively new.

Findings from Magnet hospital research, the Nursing Credentialing Research Coalition, and specialty nursing organizations provide evidence that certified staff positively influence patient outcomes, including fewer adverse events, higher patient satisfaction ratings and specific clinical outcomes such as falls and pain and symptom scores (see References 7, 8, 9, 10).

In the team-based provision of hospice and palliative care services, it is difficult to tease out the influence of certified staff. When you look at your own organization, are patient satisfaction scores higher on some teams and not others? Are there less after-hour calls and the need for crisis visits? Is staff satisfied, resulting in less turnover?

Getting Your Team Certified

Often, it is an experienced certified colleague who gives a gentle nudge to encourage others to pursue certification. Are you that colleague? Whether studying alone or creating a study group, both approaches have proven to be successful preparation examination strategies.

There are now over 19,000 HPCC certified individuals who practice in a variety of health care settings. The hospice and palliative care specialty is clearly valued, and the demand for certified professionals is expected to grow. Strive to support and join their ranks! Information about all of the HPCC examinations is posted on the HPCC website (under the “Competence” tab).


Susan Koff has been employed by Hospice of Palm Beach County, Inc. for the last 15 years, and has been certified in hospice and palliative nursing since 2003. She has also served on the Advanced Practice Exam Development Committee and the HPCC Board of Directors. 

A Great Way to Prepare for a Specialty Exam
If you are now preparing for a nursing specialty exam, consider attending an upcoming certification review courses offered by the Hospice and Palliative Nurses Association (HPNA). These one-day courses encompass the concepts of palliative nursing as well as provide a review of the content area based on the HPCCA detailed test content. The HPNA CHPN Certification Review Course will be offered as part of NHPCO’s 16th Clinical Team Conference and Pediatric Intensive, in Grapevine, Texas, on October 14, 2015.

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