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American Journal of Critical Care. 2009;18: 106-113 doi:10.4037/ajcc2009487
Copyright © 2009 by the American Association of Critical-Care Nurses.
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CE Article

Competence and Certification of Registered Nurses and Safety of Patients in Intensive Care Units

By Deborah Kendall-Gallagher, RN, JD, MS, PhD and Mary A. Blegen, RN, PhD. Deborah Kendall-Gallagher is a postdoctoral research fellow at the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, in Philadelphia.Mary A. Blegenis a professor in community health systems and director of the Center for Patient Safety in the School of Nursing at the University of California, San Francisco.

Corresponding author: Deborah Kendall-Gallagher, RN, JD, MS, PhD, Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104-6096 (e-mail: debk{at}nursing.upenn.edu).

Background Adverse events that place patients at risk for harm are common in intensive care units. Clinicians’ level of knowledge and judgment appear to play a role in the prevention, mitigation, and creation of adverse advents. Research suggests a possible association between nurses’ specialty certification and clinical expertise. The relationship between specialty certification and clinical competence of registered nurses and safety of patients is a relatively new area of inquiry in nursing.

Objective To explore the relationship between the proportion of certified staff nurses in a unit and risk of harm to patients.

Methods Hierarchical linear modeling was used in a secondary data analysis of 48 intensive care units from a random sample of 29 hospitals to examine the relationships between unit certification rates, organizational nursing characteristics (magnet status, staffing, education, and experience), and rates of medication administration errors, falls, skin breakdown, and 3 types of nosocomial infections. Medicare case mix index was used to adjust for patient risk.

Results Unit proportion of certified staff registered nurses was inversely related to rate of falls, and total hours of nursing care was positively related to medication administration errors. The mean number of years of experience of registered nurses in the unit was inversely related to frequency of urinary tract infections; however, the small sample size requires that caution be exercised when interpreting results.

Conclusions Specialty certification and competence of registered nurses are related to patients’ safety. Further research on this relationship is needed.

Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe the underlying premises of the certification process.
  2. Understand the relationship between nursing specialty certification and competence.
  3. Recognize the findings of the study as they relate to the relationship of certification of intensive care unit nurses and patient outcomes.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.


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