Certification is defined by the American Board of Nursing Specialties as the formal recognition of specialized knowledge, skills, and experience demonstrated by achievement of standards identified by a nursing specialty to promote optimal health outcomes. ^2,3 Certification in nursing first began in the 1940s. Since that time, the number of certifications offered in nursing and other healthcare-related professions has greatly increased.

Several studies have shown the value of certification. ^{6.7.8.9. and 10.12} The benefits of certification include increased job satisfaction, personal achievement, demonstration of knowledge of a specific body of nursing, commitment to the profession of nursing, increased credibility, indication of professional growth, enhancement in personal confidence in clinical abilities, and promotion of recognition from other health professionals. ^{6.7.8.9. and 10.} The American Association of Critical Care Nurses in a study published in 2002 also found that certification has a significant impact on patient safety and patient care. ¹

Each certification has various requirements for one to sit for the examination. Examples include: years of experience in a particular specialty, number of hours of clinical practice, membership in a professional association, and licensing in a certain profession. Table 3-1 provides a summary of some of the certifications that may be used in transport nursing practice and the requirements for one to sit for the examinations.

The length of time that a nurse is certified varies among nursing specialties. How recertification is achieved also varies. Because of the growing trend that questions whether continuing education provides a measurement of competency; various methods other than continuing education are now being developed for recertification. Some certifications require a written examination as the only method of recertification, whereas others may require a certain number of hours worked in the specialty or completion of specific learning modules.

Variations also exist in the methods of test administration. Certifications in nursing are considered “high-stakes” certifications, which means that the examinations must be administered in a controlled environment and secured at all times. Feedback regarding the answers to questions cannot be given. At the present time, most certification examinations are administered in one of two formats: computer or paper and pencil. Paper and pencil examinations are generally offered during a national conference. However, most associations do provide an opportunity to schedule a paper and pencil test.

With computer-based examinations, the applicant must schedule a time before taking the examination, but the examination may be offered more frequently than paper-and-pencil tests. For example, the Certified Flight Nurse (CFRN) examination was offered two times a year as a paper and pencil test, but the computer-based version is now offered two times a day, 5 days a week (except holidays), 50 weeks of the year.

Certification examinations are primarily administered at a testing center that has contracted with the certifying organization. Computer-based examinations do not require computer experience, and most certifying examinations provide a tutorial before the examination.

The applicant is given an allotted time to take the examination. Computer-based examinations do allow the applicant to review questions, change answers, and skip questions to return to them later. The examination is composed of a set number of questions.

Most organizations also have a number of pretest questions in the examination. These questions are not counted into the final score; they are new questions that are being tried as statistically good questions to be used in the future. Many certifications that use computer-based testing also provide applicants with their scores before they leave the testing facility.

Preparation for a certification examination varies based on the examination. General information includes clinical experience and a review of information that may be presented on the test. Nursing specialties (e.g., transport nursing) have core curriculums that address the elements of that specialty. These books should be reviewed. Review courses are also provided that may assist with examination preparation.

Other important information includes the location of testing sites and the types of identification that may be required for one to sit for the examination. This information is usually provided by the certifying organization before the applicant takes the examination. The information is available on the certification examination’s web site or from the professional association that supports the examination.

With the vast overlap of knowledge among nursing specialties, nurses sometimes are unsure about which certification they should obtain. A point to consider is what knowledge is needed by the specialty one practices in. For example, the transport nurse may choose to take the Certificate for Emergency Nursing (CEN), Critical Care Registered Nurse (CCRN), CFRN, or Certified Transport Registered Nurse (CTRN). Each tests specific areas pertinent to transport nursing. For example, the CFRN addresses issues specific to flight nursing, such as landing zone and scene safety and aircraft operations.