CHN Certification: Striving for Excellence Community Health Nurses of Canada Conference

1. CHN Certification: Striving for Excellence Community Health Nurses of Canada Conference May 17, 2011 Katie Dilworth kdilwor@toronto.ca Debra Williams-Conliffedwillia5@toronto.ca Kim Dalla Bona KDallaBona@saintelizabeth.com

2. Objectives • Learn about strategies to increase the number of nurses who attempt certification. • Learn the relationships and connections between support, information and encouragement to help nurses to strive for certification.

3. Agenda • CHN certification • Describe the collaborative study group • Recruitment history • Review Literature • Revised recruitment strategies

4. CHN was designated by CNA as specialty nursing practice in 2005 • first exam was launched by CNA in 2006 • CHN is the fastest growing certification specialty with an increase of 36.1% in 2009 • Recertification rate in 2011 - 61% CHN Certification

5. Why encourage certification? • Indicates qualified, competent and current in CHN’s • Indicates knowledge and skills are comprehensive • Validates your competency • Provides for Career advancement • Provides recognition • Provides university credit • Helps with participation in CHN development • Certification is a way of striving to meet CCHN Standards

6. CHNC study: Influence of Certification on Community Health Nursing Practice (2010) • Identify the influences of CNA’s community health nursing certification on nursing practice • Identify the influences of CNA’s community health nursing certification on employing agencies • Identify organizational facilitators and barriers for CCHN(C) renewal National Study

7. Personal (Intrinsic) • Enhanced feelings of personal accomplishment • Higher personal satisfaction • Validation of specialized knowledge • Better professional growth • Attainment of practice standard or competency • Evidence of professional commitment and • Acceptance of professional challenge Facilitators for Certification

8. Organizational • Reimbursement for examination costs • Work time to study • Provision of mentors • Reference materials • Continuing education onsite • Celebration and recognition of achievement Facilitators of Certification

9. Organizational • Absence of salary adjustment • Perceived lack of recognition of expertise • Perceived lack of support by the employer Barriers of Certification

10. SEHC and TPH Collaborative study group • The whole greater than the parts: community health nurses working in virtual environments: • SEHC – Team of more than 5,000 nurses, therapists and personal support workers delivering 4 million health care visits annually. • TPH – TPH is the largest PHU in Canada. 35 offices, 800 nurses in 12 offices with nurses • Other community agencies (PH and HH)

11. TPH/SEHC collaborative Study group • Why: Intent to address both HH and PH content of the certification exam • How: teleconference, virtual Community of Practice, Collaborative planning and, facilitation.

12. Organizational commitment • Organizational support from both organizations (e.g., Senior Nurse/Chief Nursing Officer, Practice councils, PPL nursing positions) • Consultant staff time to facilitate • Library resources • Financial support • Support for time for participant time to participate

13. Curriculum Structure • Collaboration between participants facilitated by consultant staff from each organization • Dates • Competencies • Facilitators • Mentors

14. Schedule example

16. Recruitment Challenges • Initial recruitment in 2006 saw a healthy group of nurses (n=10) participating in the study group. • This number remained constant in 2007 then declined in 2008 and 2009 to only two participants.

17. Dillman- Survey recruitment • Frequent reminders • Provide incentives • Diffusion of Innovation theory • explains how, why, and at what rate new ideas spread – critical mass creating desire for innovation • Organizational change theory • increased visible support from senior staff Sources of inspiration

18. Dillman Frequent reminders • Emails from: Senior nurse to staff, Professional practice leader to staff, NPC • Literature sent: Packages to managers with letter from Senior nurse, CNA pamphlets, posters, • TPH pamphlets, newsletter articles, posters in offices, town hall display Incentive • Congratulations letter from Senior nurse, • Recognition at nursing week event • Colleague and manager recognition,

19. Diffusion of innovation • Critical mass creating desire for innovation • Involved past participants: Q and A, professional development events and PHN competencies launch, accumulation of expertise.

20. Diffusion of innovation • Questions asked to certified nurses: • Why I should write the exam? • How much preparation time is required to study for the exam? • What is it like to write the exam? • What support can I expect from Toronto Public Health if I write my exam. • If I get my certification will I get paid more?

21. Diffusion of innovation • Example: • Answer of certified nurses: Why I should write the exam? • “I’m proud to have those credentials after my name and I know others respect it as well.” • “I was amazed at how much I learned.” • “Why, to validate knowledge and re-assess assumptions that gather like an extra 10 lbs as your experience matures.” • “since studying and writing the exam I have a better understanding about other community health.”

22. Organizational change: • visible senior leader support • Email messages from Senior nurse to staff nurses and to managers, also e-mail message from Senior Nurse to managers re support of their staff: “I hope you will support your staff who wish to participate in this study group with time to do so.” • Several managers certified and supportive

23. Results • The number of nurses attempting certification in 2010 tripled, 2011 numbers sustained this change!

24. Discussion and recommendations • 1) Dillman, Diffusion of Innovation theory and Organizational change theory can inform strategy to increase participation in certification • 2) Get creative and look for innovative solutions

25. References • Dillman D, Smyth, J., Christian L. (2009). Internet, mail, and mixed-mode Surveys. J Wiley and Sons; New Jersey p20. • Dllman, d. (1978). Mail and telephone surveys: the total design method / Dillman, Don A. -- New York, NY: John Wiley & Sons, 1978. • Dillman D, Smyth, J., Christian L. (2009). Internet, mail, and mixed-mode Surveys. J Wiley and Sons; New Jersey p22. • Nutbeam D., Harris H., Wise M., (2010) Theory in a nutshell a practical guide to health promotion theories. McGraw Hill: Sidney Australia. P23 • Pederson A., O’Neill M., Rootman I. (1994). Health Promotion in Canada, Provincial, National and International Perspectives. W.B. Sanders Canada: Torotno P287. • Rogers, E. (1962). Diffusion of Innovations. Glencoe: Free Press.

26. Thank you • Questions ?