Nursing specialty certification and nursing-sensitive patient outcomes in the intensive care unit

To the public and to individual nurses, certification usually means expert, high-quality, competent nursing care. Little research, however, has yielded results that support, or refute, any differences in clinical practice between certified and noncertified nurses.

To determine whether the proportion of certified nurses on a unit is associated with the rate of nurse-sensitive patient outcomes.

A nonexperimental, correlational, descriptive design was used to anonymously survey 866 nurses working in 25 intensive care units in Southeast Michigan. The Conditions for Work Effectiveness Questionnaire-II was used to measure workplace empowerment, and an additional question was asked about certification status. Outcome data were simultaneously collected on 3 nurse-sensitive patient outcomes: (1) rate of central line catheter-associated blood stream infection, (2) rate of ventilator-associated pneumonia, and (3) prevalence of pressure ulcers. Data were aggregated and analyzed at the unit level.

No significant relationship was found between the proportion of certified nurses on a unit and patients' outcomes. The association between nurses' perception of overall work-place empowerment and certification, however, was positive and statistically significant (r=.397, P=.05).

Although a link between certification and nurse-sensitive outcomes was not established, the association between workplace empowerment and the proportion of certified nurses on a unit underscores the importance of organizational factors in the promotion of nursing certification.