Nursing Specialty Certification and Patient Outcomes: What We Know in Acute Care Hospitals and Future Directions

Purpose: To discuss the current research evidence about the relationship of nursing specialty certification and patient outcomes in acute care hospitals, interpret research findings within Needleman's Expanded Conceptual Model for Credentialing Research, provide future direction for research using Needleman's model, and discuss how Needleman's model applies to vascular access certification. Review of Literature: Studies have found relationships between higher rates of nursing specialty certification and lower rates of total patient falls, pressure injuries, selected hospital-acquired infections, failure to rescue, and death. Inconsistent or contradictory evidence exists for the association of specialty certified nurses and lower total patient fall rates, selected hospital-acquired infection rates, and hospital-acquired pressure injuries. In addition, many of the significant associations supporting a relationship between specialty certified nurses and better patient outcomes are weak and may not be clinically meaningful. Many completed studies were not guided by a conceptual framework or model. Conclusions: Needleman's Expanded Conceptual Model for Credentialing Research provides a mechanism for driving theory-based research about the association of specialty certification and patient outcomes by providing specific intervening variables: invisible architecture, work organization, and performance. Specific aspects of the model can be studied using large datasets such as the National Database of Nursing Quality Indicators.