From Committee to Commission: The History of the NLN’s Academic Certified Nurse Educator Program [Nursing Education Perspectives]

Abstract

AIM To describe the historical events surrounding the development of the National League for Nursing (NLN) Academic Nurse Educator Certification Program (ANECP) and document its transition from a committee to a commission.

BACKGROUND During the latter half of the 20th century, certification became a demonstrated standard of excellence in nursing. A few visionaries suggested that nursing education itself was a specialty, but the timing for certification was not right.

METHOD The events have been studied through three primary sources: archived minutes, oral interviews, and the authors' eyewitness accounts.

RESULTS Growing pains, personnel changes and the rapid growth from committee to commission occurred during a few short years. While the NLN made sound decisions during the change process by seeking evidence and the guidance of experts and consultants, unexpected challenges occurred.

CONCLUSION The tremendous growth of the ANECP in its first years demonstrated that change was clearly desired so long as it was anchored in an evidence-based process focused on quality.

key WOrdS

Change Theory - Organizational Transition - Certified Nurse Educator - Certification Commission - Historical Research - Practice Analysis

In response to several 21st-century challenges - among them, the mandate to provide safe, high quality care while implementing elec- tronic medical record systems - the nursing profession has emphasized certification as a demonstration of clinical competency. That successful model has spilled over into nurs- ing education.

This article provides an accounting of the creation and maturation of the National League for Nursing (NLN) Academic Nurse Educator Certification Program (ANECP). Particular attention is paid to its transition from a committee of the NLN Board of Governors to its current status as the semi-autonomous NLN Certification Commission.

theOry aNd backgrOuNd

We sought to analyze the evolution of the ANECP using the theories of Kurt Lewin, a social psychologist who articulated a model of organizational change (1999). Lewin the- orized that change occurs linearly through three stages - unfreezing, changing, and freezing - that require continual adjustment. This work led to the development of further theories about the experience of change, such as Bridges' theory of transition. Bridges (2001) observed that change forces people through a process of psychological adjust- ment and reorientation; transition is contin- ual, the theory holds, and the outcomes of a planned change cannot be fully anticipated. Bridges stated that role ambiguity during or- ganizational transition is common, a theme also supported by Rich (2010), Ponte, Gross, Winer, Connaughton, and Hassinger (2010), and others. Therefore, organizations going through change cannot and should not try to plan for every occurrence. Such attempts will only heighten tensions and increase mistrust when problems arise. The key is to be open about the constancy of change, expect the un- expected, and anticipate bumps in the road. By so doing, participants in the change will be psychologically ready to solve problems. Such a shift in thinking will facilitate acceptance of the changes, reduce resistance to them, and quiet the fretfulness from unmet expectations.

During the latter half of the 20th century, certification became a demonstrated standard of excellence in nursing. Two related move- ments arose that, in our view, affected the de- velopment of the ANECP: the certification of advanced practice nurses at the master's-degree level and the specialty certification of bedside clinicians. Both projected a level of expertise within areas of specialization. At the time, the adoption of specialty certification was due in large part to organizations such as the American Nurses Association (ANA), the International Council of Nurses, the Pew Health Professions Commission, and the Institute of Medicine, all of which documented that nurses holding spe- cialty certification improved care quality and outcomes (ANA, 1991; Cary, 2001; National Research Council, 2003; Styles & Affara, 1998). The nursing community also recognized that those holding nursing certification had better professional outcomes. Research was showing nurses' increased empowerment and self-effi- cacy, as well as greater knowledge, attainment of practice standards, and professional com- mitment and credibility (Fitzpatrick, Campo, Graham, & Lavandero, 2010; Gaberson, Schroeter, Killen, & Valentine, 2003).

In the 1980s, a few visionaries suggested that nursing education itself was a specialty, but the timing wasn't right. Lewin (1999) provided an explanation as to why the idea did not take flight. When a concept (in this case, specialty certification) is very new and still forming, it is not ready to be transferred to another system.

In 1999, the NLN conducted a survey structured on the Delphi method that includ- ed two questions regarding interest in seeking certification and having the NLN develop a certification program (NLN, 2003). Thus be- gan the creation of the ANECP. We sought to document the history of the ANECP: how it started as a committee and transitioned into a commission.

methOd

Our historical method involved studying three primary sources of data. No secondary sources were used.

The first sources were the formal minutes of the certification committee and other NLN publications referring to the certification pro- gram. These documents were processed and ar- chived by the NLN, thus establishing external criticism (that is, the documents' authenticity) as well as internal criticism (accuracy of the pri- mary documents). The second source consisted of oral histories obtained from six NLN staff and committee members (past and current) who were involved at the inception of ANECP or during its transition. Unstructured ques- tions were used in the interviews. Informants allowed the authors to corroborate the ANECP story, further establishing authenticity. The last primary data source was the authors' accounts of the events we had witnessed as they took place. One author (JMN) took part in the origi- nal item writing in 2005, served on the national committee from 2006 to 2012, and experienced the committee's transition to a commission. The second author (NCS-H) was part of the original ad hoc committee in December 2004 that laid the groundwork for the certification program. She served on the committee before, during, and after its transition to a commission, as well as chaired the commission for two years. The third author (DWL) completed a six-year term on the committee and experienced its transition to a commission.

To strengthen positive criticism (that is, the meaning of the primary sources), we read min- utes, NLN documents, and interview notes sev- eral times and re-contacted some informants for clarification of events. Also, a past commission chairperson, a past NLN staff member, and a current NLN staff member, all members of the certification commission during this transition, reviewed the article for accuracy.

The Institutional Review Board from the institution of one author (NCS-H) approved the study. Confidentiality was assured when obtaining verbal consent from informants. Hence, comments do not carry identifying information.

reSuLtS

An informant said of the first 2003 survey that the results "caught the attention" of the chief executive officer (CEO) at the time, Ruth Corcoran: "Ruth saw that all of a sudden there was a jump in the percentage of people expressing interest in certification." Another informant said that the CEO saw a need to better prepare nursing educators; certification would reinforce basic standards for educators. This assertion was supported by research and position statements of the day (ANA, 1995; Benner, Hooper-Kyriakidis, & Stannard, 1999; Diekelmann, 2002; Diekelmann & Ironside, 2002; NLN, 2002).

Phase 1, Unfreezing

Stemming from the response to increasing interest, the NLN conducted a formal needs analysis in early 2003 to investigate interest in nurse-educator specialty certification. From a random mailing, the NLN received more than 3,000 responses from nurse faculty and academic nursing administrators in 46 states; 92 percent of faculty and 84 percent of ad- ministrators viewed the nurse educator role as a specialty role, equivalent to that of clini- cal specialties. Also, 76 percent of faculty and 62 percent of administrators indicated they would be interested in becoming certified as nurse educators, especially since 81 percent of faculty and 88 percent of the administrators held no nursing certifications (NLN, 2003).

These results helped convince the NLN board to approve the new program. An in- formant said that the board deliberated for several months before voting to develop the certification program, perhaps because a great deal of change was already taking place within the organization. Another informant, who held a position at the NLN, said that the certification program had been conceived alongside other new initiatives at the NLN, including the Centers of Excellence program, the Academy of Nursing Education fellows recognition program, the Excellence Model, and the Hallmarks of Excellence. The NLN Board of Governors approved the ANECP in May 2003 because it was viewed as evidence of excellence in teaching.

A staff member who took on the project hired a nurse consultant with extensive expe- rience in running the clinical certification pro- gram at the Emergency Nurses Association. Over the next year, the consultant devised a business plan for the development of the certification for nurse faculty. This informant said, "It turned out to be the right decision - the consultant proved to be an excellent resource and guide during the construction of the survey and data gathering."

Phase 2, Changing

With interest in a certification program now widespread, the NLN set in motion two major projects. First, the NLN organized a new com- mittee - the Nurse Educator Certification Examination Governance, Policy and Procedure Committee (hereafter known as the certification committee) - which met several times in the ensuing months. It established eligibility requirements for the certification exam, compiled a list of materials for those studying for the certification exam, and print- ed the practice competencies obtained from an outside testing service's practice analysis (National League for Nursing, Certification Governance Committee, 2004). An informant said that it was worth the effort; the committee sought to make a difference in nursing educa- tion and this was an avenue to reach that goal.

Second, the NLN sought to define the full scope of the academic role by conducting a practice analysis and identifying nurse edu- cator competencies. The board authorized the outside testing service, Applied Measurement Professionals, Inc. (AMP), to assist the NLN in all phases of the practice analysis. During this time, an ad hoc Practice Analysis Committee (PAC) was formed to identify potential tasks of the nurse educator to be included in the prac- tice analysis instrument. Ortelli (2006) pub- lished the process used by the PAC to identify tasks, develop the survey, and identify a priori decision rules for eliminating tasks during the analysis phase. In February 2005, AMP sent out the survey to 7,381 nurse faculty and ad- ministrators employed in practical nurse, asso- ciate degree, diploma, baccalaureate, master's and doctoral nursing programs; slightly less than 30 percent responded. Using the deci- sion rules, the PAC eliminated 24 of the orig- inal 143 nurse educator tasks. The results of this survey provided the first practice-related content for the certification examination that would soon be developed.

It was time to construct the examination. In the fall of 2004, the NLN had advertised on its website and in its newsletter for nurse educa- tors to apply as item writers for the first certifi- cation examination. Potential writers had to be current NLN members, demonstrate expertise in nursing education, and meet criteria for ap- plicants sitting for the certified nurse educator (CNE) exam. Preference was given to appli- cants with experience in item writing.

Months later, on a blustery day in March 2005, 20 nurse educators from around the country convened in Kansas at the AMP head- quarters. On the first day, writers received formal training in item writing; the intention was to create a baseline expectation for the next two days as well as orient participants to the software used. Using the results from the recent practice analysis, the nurse educators constructed hundreds of items. AMP refined these items for the upcoming NLN Education Summit. One informant praised the NLN for holding off on creating the exam until fin- ishing the competencies work and using the results to guide in formulating the exam; the competencies were an important synthesis of the research and literature about the faculty role and how faculty teach, that person said.

Using a paper-and-pencil test, on September 28, 2005, the NLN piloted the certification examination in conjunction with its Summit in Baltimore, Maryland. A former NLN staff member recalls that she came out of a board meeting and saw a long line of peo- ple in the hallway. She said, "It was so thrill- ing to see the number of people and feel the level of excitement that there is something in place, there really is something to know and competencies for nursing faculty to master." Two hundred six candidates sat for the exam- ination at the Summit; 85 percent passed, be- coming the first to receive the CNE credential. In January 2006, the certification committee voted to offer the examination year-round as a computer-assisted test through AMP testing centers. In the first two years, the program manager monitored characteristics of the first 917 nurse educators who took the examination and found that career advancement may have played a significant role (Ortelli, 2008).

The groundwork had been laid, setting off several major changes within the parent orga- nization. True to the framework, these changes led to confusion. These bumps in the road are discussed using Bridges' framework to explain the unanticipated consequences of a changing committee structure. Rich (2010) and Ponte et al. (2010) support Bridges' transitional theory, holding that role ambiguity and unforeseen difficulties occur during times of transition.

personnel changes The first challenge encountered was the fluidity of the person- nel closely associated with the certification committee. A number of executive-level staff moved on to other jobs or retired. The CNE manager left to pursue an academic position, and her replacement, though capable, worked only part time. New NLN staff were assigned to the committee. All these personnel chang- es caused an incomplete "hand-off" of infor- mation between the parent organization and the committee.

Second, to decrease conflict of interest, the NLN transferred the ANECP from one depart- ment (Research and Professional Development) to another (Testing Services). Although it was necessary to separate the testing and test-prepa- ration functions, this transition caused role am- biguity between the certification chair and the new department chair. (The certification com- mittee had been in existence for several years before moving under Testing Services.)

from committee to commission For some time, the CNE manager had been asked wheth- er the CNE program was accredited. After discussion, the certification committee recom- mended that the NLN Board of Governors seek accreditation. In early spring of 2008, the board approved the recommendation and chose ac- creditation by the National Commission for Certifying Agencies (NCCA). Why was ac- creditation important? One informant said that the board felt that accreditation would give the program parity with other professional certifications. Another stated that the NCCA accreditation was like a symbol of quality: "It was important to receive national recognition of the quality certification program offered by the NLN, as well as give assurance to prospec- tive applicants' desiring to obtain certification from an accredited program." The board knew it was the right time, instructing the committee to retain a consultant from SeaCrest Company, which specializes in assisting organizations in accreditation, and an attorney experienced with professional certifications.

The decision carried hefty consequences. National accreditation required a semi-auton- omous commission rather than a committee under board government. Two informants ex- pressed "being taken by surprise by this move." One said that between June and October 2008, the board voted for the committee to be a com- mission, "but the implications of the change took many commissioners by surprise." A long- term commission member said that "all of a sudden, we were expected to be a self-sufficient entity. The program budget was made tangible to us, and we were constrained by the revenues that the program could generate." Fortunately for the emerging commission, the chairperson at the time was a past president of the NLN who mobilized the committee through the needed changes, including the following:

* Analyzing financial statements, which pre- viously had been done by the NLN board;

* Drafting potential changes to NLN by- laws specific to the CNE committee;

* Revising application and recertification forms;

* Updating policies and procedures;

* Establishing a nominating committee for the commission;

* Holding elections.

One final challenge was the persisting con- fusion about the process of electing members. Under the proposed commission bylaws, would members of the certification committee have to stand for re-election? And what would the pro- cess be for nominations? The commission clari- fied the membership composition, changed to a requirement of equal term lengths, and rotated off approximately one third of the members each year. Since this was part of changes to the bylaws, constituents voted on the changes electronically, and the bylaws were official- ly amended during the 2008 Summit in San Antonio, Texas. Commission status became fi- nal at that time. With the enactment of the clar- ified bylaws, though, several members found their terms were over sooner than expected.

Phase 3, Refreezing

The commission made accreditation a high priority and completed it in just over a year. The ANECP demonstrated compliance with the NCCA's Standards for the Accreditation of Certification Programs and was accredited in 2009. The increased autonomy of the com- mission eventually reduced role ambiguity, improved communication, and increased orga- nizational collegiality - all unforeseen benefits of the transition. Members could better articu- late what was under the commission's domain and make their own decisions, rather than waiting for the parent organization. A longtime commissioner said that "there is more openness now on the commission; people seemed better able to nicely say what they wanted to say.. ..We also have increased accountability, which we wanted. I think there is more trust."

At the end of an interview, one informant summed things up by saying, "The most im- portant thing for us to remember is that it requires redefining the relationship with the parent organization.. It is important to care- fully and appropriately redefine relationships and not go off in a different direction, but create an appropriate separation."

Since receiving national accreditation, the certification commission is experiencing refreezing: the stabilization of personnel has allowed it to refine the process while further- ing the NLN's mission of recognizing excel- lence in academic nurse educators.

dIScuSSION

We view the development of the ANECP as an important step in the growth of nursing as a science. The CNE credential communicates to all stakeholders that the highest standards of knowledge are being met by the nurse edu- cators who are certified. The certification was developed as the result of many changes that took place at the NLN and within the nursing profession; for example, the evidence for and acceptance of clinical specialty certification at both advanced practice and basic nursing lev- els made way for nurses to view the educator role as a specialty area of practice.

As we have seen, the NLN developed the ANECP as a process, one involving the gath- ering of evidence indicating that there was interest in certification. This strategy was fol- lowed repeatedly, through the use of a needs analysis, a practice analysis, and a survey of applicants' reasons for seeking certification. It is wise for organizations to be sensitive to the social context and do thorough assessments prior to launching new services.

The NLN recognized its own strengths, but also acknowledged areas where it lacked expertise. In response, it hired experts and consultants. The use of these experts facilitat- ed the change by being flexible, responsive, and mostly productive. At the initial phase, a nursing certification consultant helped guide the development of the business plan. A second expert, a vendor, was used to handle all aspects of the exam (from interpretation of the practice competencies to the ongoing analysis of the ex- ams). When the NLN sought national accredi- tation, it hired consultants. All outside experts, save one, were cost effective and served the cer- tification program and the parent organization well. The one who did not do so had no clear fee structure or timeline stated in the contract - a learning opportunity for all involved.

The decision by the certification commit- tee to use the lowest form of technology - a paper-and-pencil test - initially reduced technology requirements and thus potential complications. Furthermore, providing the exam during the Summit appeared to be a sound marketing strategy; attendees could see the line of educators ready to take the first exam. Having an onsite examination also di- minished costs for applicants by not requir- ing they take time away from work.

The factors that influenced the com- mittee's transition to a commission were in line with the NLN's value of excellence. By achieving recognition from a national ac- crediting body, the NLN assured the nursing education community that its certification program was of high quality.

The consequences of that transition in- cluded what Lewin calls a period of "unstable change": even when a highly accomplished and dedicated group of professionals oversee a transition, it can be accompanied by miscom- munications, unmet expectations, surprises, and role ambiguity. As those involved in de- veloping the ANECP learned, clearer, more frequent communication between the com- mission and the parent organization would have eased some of the strain associated with the many organizational and personnel chang- es that took place in a short time. A positive consequence of these changes was a sound structure that allowed the commission to achieve accreditation in just over a year.

ImPLIcatIONS fOr further reSearch

Although research supports the benefits of clinical certification on nursing outcomes, lit- tle evidence yet describes the effect of the CNE on faculty or student outcomes. Documenting outcomes is of prime importance in today's cli- mate of evidence-based teaching.

Many research projects could arise from this fertile ground, for example, studying the impact of certification on faculty understand- ing of the role and scope of practice. Also, investigating the effects of certification on nurse faculty members' subsequent academic performance in each of the competencies is extremely important.

The personal and professional benefits of faculty achieving certification, such as the ef- fect on salary and promotion, should be exam- ined as well. Comparing differences in student learning environments by faculty who hold certification and those who do not would help answer questions of the value of certification. Just as clinical certification showed improved outcomes, research is needed to determine the outcomes of holding certification.

Investigating best practices of faculty who are preparing for the CNE exam could provide helpful information on the best time to sit for the exam. In this area, decision-tree analyses of reasons faculty choose to take or not to take the exam could help institutions better pro- vide interventions for faculty. Analyzing CNE candidates' performance on the examination could provide data helpful to applicants in de- termining their readiness for it.

At a number of nursing schools, all fac- ulty have the CNE designation. What envi- ronmental or social factors support or hinder whole nursing departments in moving toward academic certification? What are the percep- tions (and the performance) of students who attend institutions where most faculty hold certification? Such questions should impel further research.

cONcLuSION

The NLN's decision to move ahead with the ANECP was steeped in evidence, supporting the current culture of evidence-based prac- tice. Despite challenges, the program ma- tured because of participants' ability to stay focused and work together. This program's growth demonstrates that organization- al change is not only possible but desirable when common goals are kept in sight.

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abOut the authOrS

Jan M. Nick, PhD, RNC-OB, CNE, ANEF, is associate professor, Loma Linda University School of Nursing, Loma Linda, California, and dean, Department of Nursing, Saniku Gakuin College, Otaki, Japan. Nancy C. Sharts-Hopko, PhD, RN, CNE, FAAN, is professor and direc- tor, Doctoral Program, Villanova University College of Nursing, Villanova, Pennsylvania. Debra Woodard Leners, PhD, RN, PNP, CNE, is vice president, Women's and Children's Services, Sanford University of South Dakota Medical Center, Sioux Falls, South Dakota. Contact Dr. Nick at [email protected] for more information.