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Real value of seeking credentialing lies in the journey

Alexandra Wilson Pecci, for HealthLeaders Media, January 24, 2012

How much does designation as an American Nurses Credentialing Center Magnet Recognition Program® (MRP) hospital matter? The results of a recent study call into question the value of attaining credentials from the ANCC, a division of the American Nurses Association.

A study published last month in the Journal of Nursing Administration has found worse patient outcomes at hospitals with MRP accreditation than at non-MRP facilities. According to the study:

Non-[MRP] hospitals had better patient outcomes than [MRP] hospitals. [MRP] hospitals had slightly better outcomes for pressure ulcers, but infections, postoperative sepsis, and postoperative metabolic derangement outcomes were worse in [MRP] hospitals. [MRP] hospitals also had lower staffing numbers.

So that logically raises the question: Is the designation worth it? Is it worth the time, effort, and money it takes to reach? After all, it can take years and tens of thousands of dollars—if not more—to achieve the coveted designation.

Despite all that, for two nurse leaders at Catholic Medical Center in Manchester, NH, the answer is still a resounding "yes." And they haven't even achieved their goal yet.

"I think the biggest thing we've learned on our [MRP] journey is that it's about the journey itself," Emily Sheff, MS, RN, CMSRN, FNP-BC, Catholic Medical Center's nursing practice and standards coordinator, tells HealthLeaders. "We've learned and restructured and grown so much, just from the parts we've been able to look at thus far. I definitely think as an organization it's served us well."

Catholic Medical Center is about a year and a half into the process, and already, it has established shared decision-making and developed a professional practice model. It is in the process of promoting leadership, certification, and professional development among its nurses, says Administrative Director of Nursing Jennifer L. Torosian, RN, MSN, NE-BC.

"Whether we achieve the [MRP] certification or not, the components of [MRP] set a really good foundation for the profession of nursing," Torosian tells HealthLeaders.

For example, because MRP emphasizes professional certifications, the hospital started reimbursing nurses for obtaining certification, which the hospital thought would remove "98% of the barriers," Sheff says.

But when reimbursement alone didn't boost certifications the way nurse leaders expected, more subtle barriers came to light. The hospital found  that nurses were afraid they wouldn't have enough time to study; that they were unsure about what they wanted to become certified in; and that some weren't aware of how to become certified in the first place.

"We're now looking at the potential of offering onsite courses," Sheff says.

For Torosian and Sheff, the process for MRP certification has already been worth it for them because it gives their nurses a stronger voice and greater autonomy over their practice.

"Let's hear from the bedside nurse and [let that help] guide and direct our vision rather than going from the top down," Sheff says.

And the nurses feel increased job satisfaction because the hospital is investing in them.

"You're really upping the standards for nursing," Torosian says. "I think there's evidence out there that if your staff is happy, your patients are going to be happier and your care is going to be better."

For example, a separate study in the Journal of Nursing Administration found that "[MRP] hospital nurses were 18% less likely to be dissatisfied with their job (P < .05) and 13% less likely to report high burnout (P < .05). [MRP] hospitals have significantly better work environments than non-[MRP] hospitals." Burnout has long been linked to poorer patient care.

Of course, simply pointing to happier nurses doesn't really answer the questions raised in patient outcomes study. But Sheff counters that the outcomes measured in the study don't just depend on nursing.

"Those are outcomes in terms of things that nursing itself doesn't have total control over," she says. For example, there are a lot of factors that go into whether a patient develops postoperative sepsis; one recent study found that "the development of postoperative sepsis is multifactorial,"  and that "factors associated with the development of sepsis included race, age, hospital size, hospital location, and patient income."

"There's a lot more that goes into that picture," Sheff says. "You can't just look at nursing for that one metric."

In response to that point, the lead author of the study, Colleen J. Goode PhD, RN, FAAN, NEA-BC, professor at the College of Nursing, University of Colorado, Denver, tells HealthLeaders via email:

"There are many factors that influence the development of each of the outcomes. Sepsis and the others we used have been shown in the past to be influenced by nurse staffing. They are called 'Nursing Sensitive Indicators,'" she says. "By doing the multivariate analyses, we controlled for hospital characteristics such as the average severity of patient's at each hospital. The outcome measures we used adjusted for risk from patient characteristics that are often associated with the development of each of the outcomes such as age, gender and co-morbidities."

But even in light of her findings, Goode says she "absolutely" believes that hospitals should pursue the certification, especially since MRP is increasingly focused on patient outcomes.

"I am big believer in [MRP]," she said in a telephone interview. "I hope people don't think because of this study I am not."

For Sheff and Torosian, the study doesn't sway their choice to pursue MRP certification, mostly because they feel like they've already benefited from the process. In fact, to hear them talk about it, the certification itself seems almost beside the point.

"It's so empowering, so wonderful to be able to give the bedside nurse that voice," Sheff says. "It's been so rewarding and so fulfilling."

Source: HealthLeaders Media