Does Certification Status of Oncology Nurses Make a Difference in Patient Outcomes?
Purpose/Objectives: To test hypotheses that patients cared for by Oncology Certified Nurses (OCNs®) have superior outcomes compared to those cared for by noncertified nurses.
Design: Descriptive ex post facto.
Setting: A homecare agency in the midwestern United States.
Sample: 20 nurses (7 certified and 13 noncertified) and charts for 181 of their patients.
Methods: Retrospective chart review.
Main Research Variables: Symptom management (i.e., pain and fatigue), adverse events (e.g., infection and de-cubitus ulcers), and episodic care utilization (e.g., visits to care facilities, admissions to care facilities, unscheduled home visits).
Findings: Contrary to hypotheses, the two groups did not differ with respect to assessment of pain at admission, number of pain assessments subsequent to admission, assessment of fatigue at admission, number of unplanned visits to care facilities, admissions to care facilities, and number of unscheduled home visits. As hypothesized, the OCNs® documented a higher number of postadmission fatigue assessments (p < 0.05). Contrary to hypotheses, patients of OCNs® had a greater number of infections and fewer documented instances of patient teaching regarding infection.
Conclusions: Little support was found for the hypothesis that nursing care by OCNs® results in superior patient outcomes in comparison to care by noncertified nurses.
Implications for Nursing: Further research is needed to examine the dimensions of clinical practice that may demonstrate the benefits of care by OCNs®.
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References
Aiken, L.H., & Sloane, D.M. (1997). Effects of specialization and client differentiation on the status of nurses: The case of AIDS. Journal of Health and Social Behavior, 38, 203-222.
Aiken, L.H., Sochalski, J., & Lake, E.T. (1997). Studying outcomes of organizational change in health services. Medical Care, 35(Suppl. 11), NS6-NS18.
American Association of Colleges of Nursing. (1996). Certification and regulation of advanced practice nurses. Journal of Professional Nursing, 12, 184-186.
Anderson, G.M., Brook, R., & Williams, A. (1991). Board certification and practice style: An analysis of office-based care. Journal of Family Practice, 33, 395-400.
Cary, A. (2000). International survey of certified nurses in the U.S. and Canada. Sponsored by Nursing Credentialing Research Coalition and American Nurses Credentialing Center.
Catolico, O., Navas, C.M., Sommer, C.K., & Collins, M.A. (1996). Quality of decision making by registered nurses. Journal of Nursing Staff Development, 12, 149-154.
Coleman, E.A., Frank-Stromborg, M., Hughes, L.C., Grindel, C.G., Ward, S., Berry, D., et al. (1999). A national survey of certified, recertified, and noncertified oncology nurses: Comparisons and contrasts. Oncology Nursing Forum, 26, 839-849.
Donabedian, A. (1966). Evaluating the quality of medical care. Milbank Memorial Fund Quarterly, 44(Suppl. 3), 166-203.
Donabedian, A. (1992). The role of outcomes in quality assessment and assurance. Quality Review Bulletin, 18, 356-360.
Ellenbecker, C.H., & Shea, K. (1994). Documentation in home health care practice. Nursing Clinics of North America, 29, 495-506.
Haas, J.S., Orav, E.J., & Goldman, L. (1995). The relationship between physicians' qualifications and experience and the adequacy of prenatal care and low birthweight. American Journal of Public Health, 85, 1087-1091.
Henry, S.B. (1991). Effect of level of patient acuity on clinical decision-making of critical care nurses with varying levels of knowledge and experience. Heart and Lung, 20, 478-485.
Holzemer, W., & Henry, S.B. (1999). Therapeutic outcomes sensitive to nursing. In A. Hinshaw, S. Feetham, & J. Shaver (Eds.), Handbook of clinical nursing research (pp. 185-198). Thousand Oaks, CA: Sage.
Hughes, K.K. (1988). Decision-making in clinical nursing practice: Consistency with decision analytic outcomes. Unpublished doctoral dissertation, University of Illinois, Chicago.
Hughes, L.C., Ward, S., Grindel, C.G., Coleman, E.A., Berry, D., Hinds, P., et al. (2001). Relationships between OCN® certification and job perceptions of oncology nurses. Oncology Nursing Forum, 28, 99-106.
Iberti, T.J., Daily, E.K., Leibowitz, A.B., Schecter, C.B., Fischer, E.P., & Silverstein, J.H. (1994). Assessment of critical care nurses' knowledge of pulmonary artery catheter. Critical Care Medicine, 22, 1674-1678.
Kremer, B.K. (1991). Physician recertification and outcomes assessment. Evaluation and the Health Professions, 14, 187-200.
Laffoon, T.A. (1994). Certification in perioperative nursing: A descriptive study of certified and non-certified nurses working in the operating room setting. Unpublished master's thesis, University of Iowa, Iowa City.
Lang, N., & Marek, K. (1992). Outcomes that reflect clinical practice. In Patient outcomes research: Examining the effectiveness of nursing practice. (NIH publication No. 93-3411, pp. 27-38). Rockville, MD: National Institutes of Health.
Leggett-Frazier, N., Swanson, M.S., Vincent, P.A., Pokorny, M.E., & Engelke, M.K. (1997). Telephone communications between diabetes clients and nurse educators. Diabetes Educator, 23, 287-293.
Nail, L., Barsevick, A., Meek, P., Beck, S., Jones, L., Walker, B., et al. (1998). Planning and conducting a multi-institutional project on fatigue. Oncology Nursing Forum, 25, 1398-1403.
Perez-Woods, R., & Dvorak, E.M. (1990, April). Measurement of practice outcomes: Use of an expert consensus panel to define a method to measure the impact of certification in neonatal nursing on the outcomes of neonatal intensive care nursing. Paper presented at the annual meeting of the American Educational Research Association, Boston, MA.
Pettinger, A.M., Woods, S.L., & Herndon, S.P. (1993). Pediatric critical care nurses' knowledge of cardiac dysrhythmias. American Journal of Critical Care, 2, 378-384.
Pew Health Professions Commission. (1995). Reforming health care workforce regulation: Policy considerations for the 21st century. San Francisco: Author.
Pew Health Professions Commission. (1998). Strengthening consumer protection: Priorities for health care workforce regulation. San Francisco: Author.
Redd, M.L., & Alexander, J.W. (1997). Does certification mean better performance? Nursing Management, 28(2), 45-49.
Rogers, F.B., Simons, R., Hoyt, D.B., Shackford, S.R., Holbrook, T., & Fortiage, D. (1993). In-house board-certified surgeons improve outcome for severely injured patients: A comparison of two university centers. Journal of Trauma, 34, 871-877.
Spencer-Cisek, P., & Sveningson, L. (1995). Regulation of advanced nursing practice: Part two-certification. Oncology Nursing Forum, 22(Suppl. 8), 39-42.
Stetz, K., Haberman, M., Holcombe, J., & Jones, L. (1995). 1994 Oncology Nursing Society Research Priorities Survey. Oncology Nursing Forum, 22, 53-79.
Verran, J.A., & Mark, B. (1992). Contextual factors influencing patient outcomes individual/group/environment: Interactions and clinical practice interface. In Patient outcomes research: Examining the effectiveness of nursing practice. (NIH Publication No 93-3411, pp. 121-142). Rockville, MD: National Institutes of Health.
Walthall, S.A., Odtohan, C.B., McCoy, M.A., Fromm, B., Frankovich, D., & Lehmann, M.H. (1993). Routine withholding of digitalis for heart rate below 60 beats per minute: Widespread nursing misconceptions. Heart & Lung, 22, 472-476.
White, J.E., Nativio, D.G., Kobert, S.N., & Engberg, S.J. (1992). Content and process in clinical decision-making by nurse practitioners. Image: Journal of Nursing Scholarship, 24, 153-158.