Editorial

ANA zaps credentialing center with plans for own national center Since the Credentialing Study was released in 1979, nursing has been looking at the possibil- ity of a freestanding credentialing center gov- erned by a federation of nursing organiza- tions.’

Specialty nursing organizations, such as AORN, have attended meetings, contributed modest sums of money, and given the concept their support. The center looked like an oppor- tunity for nursing to cooperate to achieve a unified system of credentialing.

But now that dream has faded. Perhaps the center was too visionary. Or perhaps nursing is not ready to join in a collaborative effort.

The fault was not in the plan. The Committee for the Study of Credentialing in Nursing did impressive work in its research and in its rec- ommendations. Its major recommendation was a freestanding credentialing center to coordinate all nursing credentialing, govern- ment and private, into a comprehensive inte- grated system. The plan was flexible. Although there were controversial recommendations, they were intended as a starting point for dis- cussion. For the past two years, the Task Force on Credentialing has worked to educate nurses and move the center toward imple- mentation. They have involved 146 resource groups in discussions.

In April, the task force asked 15 organiza- tions to come to a meeting in Bloomington, Minn, to form a coalition to establish the cre- dentialing center.2 But the meeting was sort of like a wake-and not an Irish one. There was

little enthusiasm for a coalition, and the con- cept of a credentialing center appears mori- bund.

The death blow was the American Nurses’ Association (ANA) announcement that it was planning to form its own national credentialing center. In essence, ANA sees credentialing as the responsibility of the professional organiza- tion, which means ANA.

In its resolution, which was to be presented to the ANA House of Delegates in June, the ANA Board stated that ANA, “as the profes- sional organization for registered nurses, has major responsibilities in providing leadership and setting standards for the profession.”

Without ANA’s support, a credentialing cen- ter with shared governance has little chance. The specialty organizations and other nursing groups, even if they combined forces, are in neither a strategic nor financial position to carry on the plans for a credentialing center.

Why did ANA decide to create its own cre- dentialing center? Remember that ANA spon- sored the credentialing study. The initial idea was for ANA to get more of the credentialing action; not less.

In 1974, ANA delegates directed its board to examine the feasibility of ANA accreditation of basic and graduate education as well as con- tinuing education. The idea was to take the accreditation of nursing education away from the National League for Nursing (NLN). The resolution referred to the 1965 ANA position paper, which stated the professional society should be the source of determinations about education of practitioners.

In the resolution on continuing education, ANAs intent was stated bluntly: The profes- sion should be self-regulating in education, and the responsibility for regulation of nursing

14 AORN Journal, July 1982, Vol36, No 1

education presently rests with an organization separate and apart from the professional soci- ety. This, of course, referred to the League, which did not take this quietly. It fired off a couple of resolutions of its own, saying it had no intention of relinquishing its accreditation role. ANA established the National Accredita- tion Board to approve continuing education programs. But it was going to be harder to get the other accreditation piece-basic and graduate education. It was going to take a more sophisticated approach.

ANA started with a series of invitational con- ferences, then determined accreditation could not be separated from other forms of creden- tialing, including certification and licensure. Everyone agreed that credentialing in nursing was fragmented, so why not come up with a plan to coordinate all of nursing credentialing into a comprehensive credentialing system? Initiated in 1977, the study on credentialing was published in 1979. The major recom- mendation was a credentialing center gov- erned by a federation of nursing interests. That seemed fair enough, since many nursing or- ganizations are currently involved in credential- ing. NLN and the American Association of Nurse Anesthetists accredit educational pro- grams, and many of the specialty groups cer- tify individual practitioners. ANA accredits con- tinuing education and also offers certification.

But there were rumblings in ANA. At the 1980 convention, delegates were less than en- thusiastic about a resolution supporting the credentialing center. Most critical was the New York state delegation, which asserted that credentialing should remain with the profes- sional society. It introduced a resolution, passed with strong support, directing the board to protect ANA’s role in credentialing. The board was to present its plan at the 1982 convention.

Looking at this history, it should be no sur- prise that ANA did not support a credentialing center with shared governance. ANA commis- sioned the study, it spent $500,000, but it didn’t agree with the recommendations, so ANA kill- ed it. Nursing credentialing is right back where it was in 1974.

ANA’s current plan calls for negotiation with other nursing organizations that engage in credentialing to develop a plan for funding and for participation. ANA is not asking for any help

in running the center. At the task force meeting in April, it was clear most organizations weren’t interested in participating in an ANA-spon- sored credentialing center. NLN was willing to keep talking about a center with shared gover- nance but made it clear no one was going to take away its accreditation. Some specialty organizations have had bad experiences try- ing to collaborate with ANA on certification, and they weren’t too eager to jump back into that situation.

Although the credentialing task force mem- bers knew ANA was not going to support its credentialing center, what they had not antic- ipated was that no organization came to the April meeting prepared to make a commitment to the coalition. In this, they were naive about nursing politics-a lesson they could have learned at any meeting of the Federation for Specialty Nursing Organizations. The first law of nursing politics is that no one attending a meeting can make a commitment to anything without approval of the organization’s board. A corollary of that law is that the board of a spe- cialty group always meets three months after the present meeting. The second law is that nursing organizations do not commit them- selves to anything that costs money. It was obvious that being a member of the coalition was going to cost money, but there was virtu- ally no information about how much. Nursing organizations don’t have money to throw around. It was unreasonable of the task force to ask for a financial commitment from these organizations without extensive financial in- formation available to the groups for prior study. The idea was to get foundation funding eventually, but that is sort of like a teenager getting a job. There’s a lot of uncertainty about when and how much.

Is there anything that can be done to keep alive the concept of a credentialing center with shared governance? There will be a special meeting, to which all organizations involved in credentialing will be invited. Perhaps those or- ganizations involved in certification can look at establishing some kind of center that would provide services for certification, such as test construction and validation. Such a center could consider approving certification pro- grams of individual groups, giving consistency to nursing certification. Then certification for the operating room nurse, for example, would

16 AORN Journal, July 1982, Vol36, No 1

mean the same thing as certification for a criti- cal care nurse.

There was obviously a great deal of disap- pointment and frustration at: the April meeting. Many had hoped that nursing would be able to unite on credentialing, laying aside differences and even some vested interests. For a time, ANA had appeared to be willing to work cooperatively with other nursing organiza- tions. Other nursing organizations responded positively. But now, many of these groups may feel a little bit used. We’ve spent time and money considering a credentialing center. But

it turned out it was completely ANA’s show.

Elinor S Schrader Editor

Notes 1. Committee for the Study of Credentialing in

Nursing, The Study of Credentialing in Nursing: A New Approach, Vol 1 (Kansas City, Mo: American Nurses’ Association, 1979).

2. Elinor S Schrader, “Nursing groups fail to form credentialing center coalition,” AORN Journal 35 (June 1982) 1258.

18 AORN Journal, July 1982, Vol36, No 1

Evacuating facilities topic of new film The National Fire Protection Association (NFPA) has announced the release of a new training film for employees of hospitals and nursing homes entitled Evacuation of Medical Facilities.

The film stresses the importance of emergency training for health care personnel and provides information about their role in emergency evacuation. Topics include disaster planning, staff training, evacuation procedures, alarm and safety systems, and correct emergency response. The film points out information essential to a safe evacuation: coordination of evacuation plans by fire departments, hospitals, and emergency relief agencies: the importance of evacuating patient charts; the equipment and medication needed to sustain critical care patients: basic evacuation procedures: the types of evacuations necessary under various emergency conditions; and how to act decisively to confine the fire and summon aid.

Evacuation of Medical Facilities presents two case studies that show how preparation and training paid off when disaster struck. At both Allegheny General Hospital in Pittsburgh and the University Nursing Home in Silver Spring, Md, fire broke out, and the order to evacuate was given. Dramatic documentary photography shows how trained staff members followed established procedures and were able to evacuate these facilities safely and efficiently.

The film is available from NFPA, Publications Sales Division, Batterymarch Park, Quincy, Mass 02269, (61 7) 328-9230. Purchase price for the film (FL-59) is $350. It is available in 16 mm film and all video formats.

Illinois council studies hospital-based schools The Illinois Council of Hospital Schools of Professional Nursing has undertaken a statewide study to determine the effectiveness of hospital-based nursing education. The study is being conducted by the Institute for Inquiry in Education, Inc, a Chicago-based research and consulting firm that specializes in work with health profession groups.

The purpose of the study is to determine how well hospital schools of nursing prepare professional nurses. The study will attempt to determine which aspects of the hospital schools’ curricula are particularly effective in preparing professional nurses. The council said the study will be the first of its kind and expects it to have important local, state, and national implications.

Graduates of 19 Illinois hospital nursing programs from 1975 to 1980 and their immediate supervisors will be asked to complete questionnaires on the graduates’ professional performance. Data supplied by the schools and from visits to the schools will be analyzed in the study.