Future Directions of Credentialing Research in Nursing Workshop Summary (2015) / Chapter Skim
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2 A New Framework for Credentialing Research in Nursing
2 A New Framework for Credentialing Research in Nursing
Pages 11-26
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The workshop planners envisioned a forward-looking agenda, with a focus on developing a national agenda for research, identifying critical knowledge gaps, and sparking ideas to use existing research tools and databases and develop new ones. UNDERSTANDING THE LANDSCAPE AND STATE OF SCIENCE IN CREDENTIALING RESEARCH IN NURSING Robin Newhouse, University of Maryland School of Nursing This presentation provided important background information and context to help frame the workshop's goals.
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For example, nursing credentialing may contribute to standardized care quality and promoting nurse participation in leadership roles. The issue of credentialing research in nursing complements some of the major initiatives to improve U.S.
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Credentialing programs can be used to help implement these recommendations by standardizing and validating specific knowledge sets, skills, and competencies to improve the quality of patient care. Furthermore, nurses with advanced leadership skills can help identify problems in health care access and quality, develop related solutions, and translate research to practice for specific populations, she said.
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These intervening variables (e.g., work context or factors that affect a nurse's ability to FIGURE 2-1 ANCC Research Council Model for Credentialing Research. NOTE: This figure has been updated by Hickey and colleagues (2014)
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Although the ANCC Model is a highly simplified model, it identifies the basic relationships among large categories of factors and reflects what has been learned to this point about these complex interactions. Research that elaborates on and clarifies the interactions in this conceptual model may lead to better understanding of the link between credentialing and outcomes, especially patient outcomes.
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Conceptual modeling of the causal pathways between credentials and outcomes offers a promising framework for addressing this challenge. In his workshop presentation, Needleman proposed such a model, compared conceptual models to other research frameworks, and discussed the relationship of research to funding as one of many key issues facing nursing credentialing researchers.
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It is important to note that the factors which individually contribute to the complexity of patient care may also interact with each other in a "non-linear fashion," said Needleman, further complicating the health care environment and increasing the challenges for researchers trying to study factors, such as credentialing, which might influence the environment. For example, patient to nurse ratios and the quality of work environments affect patient outcomes individually and in combination (Aiken et al., 2011; McHugh et al., 2013)
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A New Framework for Credentialing Research In the ANCC model, the relationship between credentials and outcomes is mediated by a set of "intervening variables." These intervening variables, however, are not specified in detail, and the nature of the causal pathways linking credentialing and outcomes were not fully explained, 2 Natural experiments occur when people or organizations differ in isolated and measurable ways that are outside their control. Needleman provided the example of a hypothetical case, where "some states have one set of credentialing requirements and other states have different credentialing requirements." All else being equal, investigators can "compare the experience across states," and conclude that differences in experience may be due to variability along this one parameter.
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Needleman proposed an Expanded Conceptual Model (see Figure 2-2) , which is a new framework that builds on the ANCC Model and attempts to map unique intervening variables to different types of outcomes in order to assess causality.
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NOTE: Models for research on organizational credentialing and individu l g ual credent tialing might be modified to emphasize different com mponents of t the expand framework. ded SOURC Needlema et al., 2014.
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Nurse outcomes interact reciprocally with patient care, and are affected by each of the three intervening variables. In this way, the Expanded Conceptual Model manages to capture the interactions among outcomes
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By indicating how a unique stakeholder can benefit from credentialing, it allows scientists to tailor research objectives to the interests of consumers, care providers, and health care organizations. The singular importance of funding to credentialing research is acknowledged in the "Business Model" box at the bottom of the Expanded Conceptual Model, into which all causal pathways feed.
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Neither a conceptual framework that identifies potential causal pathways connecting credentials to outcomes, nor the stakeholdertargeted research it is designed to inform, are comprehensive solutions to the questions and challenges of nurse credentialing research. Rather, they constitute significant and necessary steps along the road to a research agenda and the potential it holds for improved outcomes for patients, nurse, and institutions alike, concluded Needleman.
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However, team practice and work organization patterns can complicate credentialing research. For example, patients at high risk for falls will continue to experience a greater number of falls (though lower than they would have had otherwise)
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Which data elements from electronic health records would be sought for this research? Needleman suggested that, at a minimum, researchers would need to be able to identify specific credentials, including baccalaureate preparation, beyond credentials such as RN or licensed practical nurse.
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