Certification of Holistic Nurses
Certification of Holistic Nurses
By Lynn Rew, EdD, RNC, HNC, FAAN
Professional nursing is evolving in the direction of increased complexity and accountability. Managed care, advanced technology, ethical dilemmas, and advanced nursing science all contribute to this complexity and require that the nursing profession develop and maintain standards to ensure the highest quality of care. Educational preparation to enter the professional practice arena comprises a minimal standard that must be met by all registered nurses, but does not address the specialized knowledge and skills that are required for advanced and expanded practice roles.
Nursing Certification
Increased understanding of the physical, genetic, and psychosocial causes of illness and disease has led patients to demand access to high-quality health care services. As society has become more technologically advanced, the need for nurses to develop skills in managing the care of patients who may benefit from such technology has increased. For example, the expansion of knowledge and procedures to induce anesthesia in surgery patients and to attend to these patients’ special needs following surgery led to new roles for nurses as Certified Nurse Anesthetists as well as nurses certified in peri-anesthesia nursing. Unique and distinctive bodies of knowledge in such specialties as oncology, emergency, orthopedic, rehabilitation, perioperative, and holistic nursing, to name a few, have resulted in certifications that reflect specific expertise. (For more information, see "Nursing Certification: A Decentralized Model" below.)
Current competition in the ever-changing health care delivery system also has made certification more popular and essential to continued and improved nursing practice. Administrators of managed care facilities and programs, for example, are exploiting nursing certification as a way to market their organizations.1 Many nurse entrepreneurs in holistic nursing practice and home health care also recognize the value of their own certification, as well as that of their employees, in marketing high-quality health care services to the public.
Holistic Nursing Certification
The American Holistic Nurses’ Association (AHNA) was founded in 1980 to advance holistic nursing by integrating principles of health and preventive education with Western and complementary healing modalities. In 1992, the AHNA established Holistic Nursing Certification (HNC), a process that involves five phases. The first four phases include completion of a certificate program that addresses the philosophy of holistic nursing; core concepts found in the AHNA Standards of Holistic Nursing Practice;2 an independent practicum in holistic nursing; and advanced concepts in holistic nursing.3 After completing these four phases of education and practice, a nurse must submit a qualitative portfolio to the American Holistic Nurses’ Certification Corporation (AHNCC) for assessment related to established criteria.
The AHNCC was established in 1997 as a separate non-profit organization whose sole mission is to "standardize holistic nursing certification requirements, promote recognition of holistic nursing as a specialty area that is based on a core of knowledge and competencies, and to advance the legitimate role of holistic nursing in the health care system."4 Governed by a board of directors (five voting members and two non-voting members), the AHNCC is responsible for the development and administration of the HNC examination and for ensuring the security and integrity of the certification process. The two non-voting members of the board are the president of the AHNA and a public member who is not a nurse. All voting members have HNC and doctorates in nursing or related disciplines. The board members serve a three-year term with the possibility of one renewal.
At present the only route to certification as a holistic nurse is by way of the certification examination process. Prior to the formation of the AHNCC, the AHNA contracted with the National League for Nursing to conduct a three-year study and develop a valid test of holistic nursing knowledge. A practice analysis study was initiated to create a blueprint of the professional activities and knowledge areas needed for holistic nursing expertise. More than 700 practicing holistic nurses responded to the practice analysis and validated the blueprint. The certification examination, which was developed from the blueprint results, addresses each of the following domains of holistic nursing practice: philosophy, foundation, ethics, theory, research, healing modalities, meaning and wholeness, self-care, and health promotion.3 Examination items are framed within the nursing process, including assessment of client needs, plan of care, anticipated outcomes, implementation, and evaluation. The examination taps into cognitive domains of comprehension, application, analysis, synthesis, and evaluation.4 In addition to the quantitative, multiple-choice examination, AHNCC agreed to retain a portion of the portfolio process that addressed a nurse’s ability to integrate foundational concepts of holism into her/his own life and professional practice. Thus, a qualitative examination serves as a screening assessment for all applicants who wish to take the written examination.
The Certification Process
To begin the certification process, a nurse must first submit an application demonstrating minimal educational preparation with a baccalaureate degree; unrestricted current RN licensure; active practice of holistic nursing for a minimum of one year full-time or 2,000 hours within the last five years part-time; and completion of a minimum of 48 contact hours of continuing education in holistic nursing within a two-year period preceding application. After successful review of the application, a qualitative screening assessment is administered followed by a quantitative examination. A candidate must receive AHNCC approval before progressing from one step to the next.
Certification is valid for five years. To be eligible for recertification, the nurse must remain in good standing and meet recertification requirements by submitting evidence of completion of 100 contact hours of continuing education in nursing within the previous five years (at least 20% of these must be directly related to holistic nursing) or by successfully repeating the full certification examination process.4
As described by the AHNCC,4 HNC requires that a nurse:
• Aspire to practice holistic nursing in a manner which promotes health, facilitates healing, and alleviates suffering, and strive to meet the responsibilities described by AHNA’s Code of Ethics.
• Conduct oneself in accordance with AHNCC’s Professional Code.
• Notify AHNCC of any information that might lead to revocation of certification.
• Maintain a Continuing Education record so that requirements can be verified at any point in time.
• Notify AHNCC of an address, name, or telephone change.
• Submit a renewal application packet to AHNCC within 60 days prior to certification expiration date.
The quantitative written exam will be conducted in 16 cities around the country during 2000. (For AHNCC contact information, see "Focus on Organizations" at right.)
Future Directions
Although nursing certification is still a relatively new phenomenon, increasing demands for professional accountability, evidence-based nursing outcomes, and competition within the work force converge to create an environment in which more and more nurses will seek and benefit from obtaining such a credential. In a cross-sectional survey conducted by members of the Oncology Nursing Society, nurses obtained and retained certification because they were motivated by personal achievement and professional growth and development.5 Those who were certified claimed greater job satisfaction than those who were not certified.5 Similarly, nurses certified in orthopedic nursing reported that they obtained certification for professional growth and personal satisfac-tion.6
The benefits and rewards of certification are many. But in a discipline such as holistic medicine, where public interest and demand are growing and definitions vary greatly, certification remains one validated and substantiated way to distinguish qualified practitioners.
Dr. Rew is Professor and Graduate Advisor at the University of Texas School of Nursing in Austin.
References
1. Report of a state-of the-knowledge conference on U.S. nursing certification. ONCC Research Committee and Executive Staff. Image J Nurs Sch 1999;31:51-55.
2. American Holistic Nurses’ Association. American Holistic Nurses’ Association Standards of Holistic Nursing Practice. Raleigh, NC; 1997.
3. Dossey BM, et al. Inventory of professional activities and knowledge of a holistic nurse (IPAKHN). J Holist Nurs 1998;16:33-56.
4. American Holistic Nurses’ Certification Corporation. Handbook and Application to Qualify for Certification in Holistic Nursing. Flagstaff, AZ; 1998.
5. Coleman EA, et al. A national survey of certified, recertified, and noncertified oncology nurses: Comparisons and contrasts. Oncol Nurs Forum 1999;26: 839-849.
6. Nance JA. Professional certification in orthopaedic nursing. Orthop Nurs 1999;18:48-52.
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