Why Certification?

Claiming and Validating Our Expertise

The time is right for hospice and palliative care professionals to recognize our expertise. Never before has this type of care been spotlighted as it is in today’s healthcare environment. The public’s right to choose the focus and type of care they will receive with a life limiting illness and at the end of life has finally been established. As a result:

  • More people are electing to have comfort and quality at the end of life for themselves and those they love
  • Pain and symptom management competencies are receiving increasing emphasis by accrediting and credentialing bodies,
  • Funding for research and projects related to end-of-life care is increasing. Funded efforts are providing new approaches, tools, and programs to improve care and outcomes.

As practitioners in hospice and palliative care, each of us should take great pride in our expertise and commitment to quality at the end of life. Many professionals have years of clinical experience, evidence-based practice, and education to draw upon. Knowing the needs of patients and families facing life-limiting disease and loss, we must be advocates as well as teachers.

Overview on Certification

One way to validate our expertise is through certification as a specialist. Certification involves a process that validates and evaluates one’s expertise in a specialty area. While licensure assures minimal competency to practice in a field, certification indicates mastery of a defined body of knowledge. The application process involves verification of licensure and any other requirements (some certification programs require a specific amount of work experience in a specialty area).

Knowledge of the specialty area is most often validated via testing. After achieving a passing score, the individual is certified for a period of 4 years. Renewal of certification before expiration of the initial period may be done by retesting, or by participating in a process called HPAR (Hospice and Palliative Accrual for Recertification) which assigns points for continuing education and other professional activities.

It was visionary leadership that took the first step and formed the National Board for Certification of Hospice Nurses in 1992 with the goal of initiating a certification process for hospice nurses. That core group developed and implemented the first certification exam in 1994, building the exam upon early research in hospice nursing and their own expertise.

Value of Certification
  • Certificants achieve a tested and proven competence across the spectrum of hospice and palliative care.
  • Certificants increase their knowledge of hospice and palliative care by seeking and maintaining certification.
  • Certificants demonstrate a commitment to their specialty practice by pursuing certification.
  • Certificants demonstrate dedication to professional development in their careers by attaining the credential.
  • Certificants are assets to themselves because the commitment to certification improves patient outcomes, provides compensation incentives, and gains industry-wide recognition.
  • Certificants are assets to their employers, because board certification is a recognized quality marker by patients, physicians, providers, quality organizations, insurers, credentialers, and the federal government in an atmosphere of increasing awareness regarding quality in health care and appropriate utilization of services.

Benefits of Certification

Once certified, the individual is:

  • Entitled to use the appropriate credentials: ACHPN®-Advanced Certified Hospice and Palliative Nurse; CHPN®-Certified Hospice and Palliative Nurse; CHPPN®-Certified Hospice and Palliative Pediatric Nurse; CHPLN®-Certified Hospice and Palliative Licensed Nurse; CHPNA®-Certified Hospice and Palliative Nursing Assistant; CHPCA®-Certified Hospice and Palliative Care Administrator; CPLC®-Certified in Perinatal Loss Care
  • Eligible to serve on the HPCC Board of Directors, Examination Development Committee or join HPCC project teams
  • Honored at the annual certification recognition event
  • Provided the HPCC certification newsletter
  • Eligible for a discount with renewal of certification
  • Eligible for HPCC and Hospice and Palliative Nurses Foundation awards, scholarships, and grants
  • Able to access a national network of experienced and knowledgeable hospice and palliative professionals

The Role Delineation Study (Practice Analysis) and Certification

In 1998, the Board took a second major step and invested in a Role Delineation Study to identify the responsibilities of hospice and palliative nurses and to incorporate this knowledge into the continuing development of the certification process. The Role Delineation Study not only clarified the responsibilities of the hospice nurses but also verified that palliative nurses share many of the same responsibilities. This study formed the basis for expanding the certification exam to include both hospice and palliative nurses; the first such certification test was given in March, 1999.

A nurse certified prior to 1999 was certified as a CRNH (Certified Registered Nurse Hospice). Those taking the test after 1/1/99 when palliative nursing was included are known as CHPN®s (Certified Hospice and Palliative Nurses).

HPCC now provides specialty examinations for all levels of nursing: advanced practice nurses, registered nurses, licensed practical/vocation nurses, nursing assistants and administrators. There are currently over 17,000 certificants.

A Role Delineation Study (RDS) was done prior to the initiation of each new certification examination. The results of each RDS was used to develop test specifications and examination contents. Industry standards recommend that a RDS is conducted every 5 years or so to determining any change in practice.

Why Certification?

Even during this time of opportunity and increased exposure, the demands upon hospice and palliative care are increasing and often influence our commitment to our specialty. We all know the stresses of our daily work: the sometimes overwhelming demands of working with the terminally ill, the sense of duty we feel to our team, the personal stamina it takes to daily confront life and death issues. Too often, the financial rewards are not great, and our compensation is not likely to increase significantly in a climate of decreasing reimbursement for healthcare whether we are certified or not.

So why, after a difficult day that often includes overtime, would we want to consider giving more of our own time to preparation for a certification test?

Why, when perhaps our employer offers no incentive or financial reward, would or should we be willing to invest time and money in the certification process?

The certification process can have intrinsic rewards for the professional who commits to preparation and testing. These include:

  • a comprehensive review of the current body of knowledge for which the hospice and palliative professional is accountable,
  • participation with and learning from other colleagues in review courses or study groups,
  • sharpening of skills and knowledge in areas not utilized daily,
  • recommitment to excellence and expertise in the area of practice,
  • increased competence and confidence in practice,
  • recognition by peers and others in the field through credentialing and ongoing use of the title, and
  • future employment possibilities as certification becomes the expectation of employers of hospice and palliative care professionals.

We can and must be personally accountable for our practice. Our patients and families deserve the very best from each of us.

Several directors of large hospice programs have found certification to be of such benefit among their staff that they are sponsoring review courses and providing funds to offset the costs of certification for the staff. Others are giving certified staff increased wages. The National Hospice and Palliative Care Organization has a Quality Partners program which defines the components necessary for achieving excellence. Certified staff would be one quality indicator.

Individual practitioners have confirmed the value of certification. One nurse said, “I didn’t know how much I didn’t know until I started studying for the exam.” Another claimed, “Preparing for certification helped me to define the body of knowledge for which I’m accountable in my practice. It gave me new confidence in approaching physicians and advocating for my patients.” (Home Healthcare Nurse Vol.18 no.3 March 2000).

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