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ONCC Advanced Certification Undergoes Changes
 Wendy
H. Vogel, MSN, FNP, AOCN®
Bristol, TN
wvogel@charter.net
Note.
This article originally appeared in the Nurse Practitioner SIG
Newsletter (Vol. 15, No. 2, July 2004).
Several members of the
Nurse Practitioner (NP) SIG attended the meeting at the 29th Annual ONS
Congress, “Advanced Certification for Advanced Practice Nurses (APNs):
What Does the Future Hold?” The following is a summary of the information
given, questions that were asked, and answers that were given.
The
meeting was held on Saturday and was conducted by Cyndi Miller Murphy, RN,
MSN, CAE, executive director of the Oncology Nursing Certification
Corporation (ONCC); Barbara Rogers, CRNP, MN, AOCN®, chair of
the Advanced Practice Test Development Committee; and Julie Ponto, RN, MS,
APRN-BC, AOCN®, president of the ONCC Board of Directors.
Murphy discussed the history of regulation of advanced nursing
practice. State legislatures enact the Nurse Practice Act, which defines
the authority of the state board of nursing. The board of nursing then
develops rules and regulations that are consistent with the Nurse Practice
Act. She discussed the differences between RN licensure and specialty
certification, recognizing that certification does not include a legal
scope of practice and that certification is voluntary and issued by
nongovernmental organizations, usually reflecting a higher standard of
specialty knowledge.
Murphy discussed the role that the National
Council of State Boards of Nursing (NCSBN) has played in the regulation of
advanced practice nursing. NCSBN is an umbrella organization that supports
the 60 state boards of nursing in the United States and its territories in
providing leadership to advance regulatory excellence for public
protection. All of the individual state boards are members of NCSBN and
comprise the NCSBN delegate assembly. In 1995, the NCSBN began to
collaborate with NP specialty certification organizations to make progress
toward psychometrically sound and legally defensible NP examinations that
would be sufficient for regulatory purposes. This was also the year that
the first AOCN® examination was administered. From 1996–1999,
NCSBN and NP certification organizations continued to collaborate, and
accreditation by the National Commission for Certifying Agencies was
determined to be acceptable criteria for use of certifying examinations
for regulatory purposes. In 2000, NCSBN developed the Uniform Advanced
Practice Registered Nurse Licensure/Authority to Practice Requirements,
which were adopted by state boards of nursing. These requirements include
an unencumbered RN license, graduation from an accredited graduate-level
APN program, national APN certification appropriate to educational
preparation, and maintenance of certification. Because only 15%–20% of
AOCN® candidates graduate from oncology-focused programs and
the number of oncology-focused programs is sparse, ONCC does not require
an oncology-focused master’s degree and therefore does not meet the
criterion of APN certification appropriate to educational preparation. In
2002, NCSBN developed updated criteria for the state boards to use in
evaluating certification programs. ONCC meets all of the recommended
criteria, except the criterion that requires consistency between
educational preparation specialization and certification. This criterion
indicates that the certifying body should require each candidate to have
had graduate education with concentration in the advanced practice
specialty, 500 supervised clinical hours, and clinical experience directly
related to the knowledge and role of the specialty and category within the
educational program. NCSBN also developed a position paper in 2002 about
the regulation of advanced practice nursing stating that certification
programs must meet established criteria and be based in broad categories
only, not subspecialties such as disease entities (e.g., cancer). Examples
of these broad categories are adult, pediatric, and psychiatric nursing.
NCSBN is not a regulatory body in and of itself but rather a
membership organization for state boards. Therefore, state boards are
under no obligation to adopt the policies or rules recommended by NCSBN,
even if they are approved by the NCSBN delegate assembly. As a result, the
regulation of APNs varies widely from state to state and even among APN
categories (NP versus clinical nurse specialist [CNS]) within a state. In
1994, ONCC began communicating with NCSBN and individual state boards of
nursing regarding the recognition of AOCN® certification. The
AOCN® credential currently is recognized in 26 states. However,
the NCSBN APRN advisory panel recently has communicated to ONCC that it
considers oncology a subspecialty, especially in the NP role, and does not
consider oncology certification suitable for the purposes of licensure.
ONCC will continue to communicate with NCSBN and apply for recognition of
the new examinations in each state and communicate regularly with oncology
APRNs about this issue. More information about NCSBN can be found at www.ncsbn.org.
Following this presentation, Rogers described the ONCC Role
Delineation Study (RDS) of oncology APNs that was conducted during 2003.
Accrediting agencies such as the American Board of Nursing Subspecialties
and the National Commission for Certifying Agencies indicate that RDSs be
conducted on a regular basis to validate that the content of a
certification examination is representative of practice of the profession.
ONCC conducts RDSs every five years for each certification offered. The
first step in the RDS process was the development of the survey. The
purpose of the survey is to determine the roles and responsibilities of
advanced practice oncology nurses, as well as the knowledge required to
carry out the responsibilities. The Internet-based survey was disseminated
to 4,447 oncology APNs, including all AOCNs® and ONS members
with a master’s degree in nursing. The response rate was 565 (12.7%). Upon
analysis, Chauncey Group International, a subsidiary of Education Testing
Services, which conducted the survey, indicated that, although low, the
responses received were representative of the advanced oncology nurse
population and therefore sufficient to meet the purpose of role
delineation. Rogers went on to describe the results of the survey. The RDS
provided evidence that although oncology NPs and oncology CNSs share a
core knowledge base, discernable differences exist in work
responsibilities between the two advanced practice nursing roles. A
17-person task force of AOCNs®, including NPs and CNSs, met
for two days to review survey results, identify tasks and knowledge
appropriate for future examinations, and link tasks to knowledge
statements. Test blueprints for each role were developed and refined. The
Oncology NP Certification Test Blueprint and the Oncology CNS Test
Blueprint for the two new certification examinations are available on the
ONCC Web site at www.oncc.org.
Ponto then presented
information regarding the phase-in of the new ONCC examinations. The
AOCN® item bank has been reviewed, and all items were recoded
based on the new blueprints. The content areas in which new questions are
needed have been determined and the Advanced Practice Item Writing Council
has been assigned to write items about these topics. In addition, an
item-writing workshop was held at the ONCC National Office in Pittsburgh,
PA, to generate items for the new examinations. Fourteen AOCNs®
participated as item writers. Item writers and council members are
eligible to take any of the advanced examinations. The AOCN® Test
Development Committee has been renamed the Advanced Practice Test
Development Committee and will be expanded to consist of four oncology NPs
and four oncology CNSs. ONCC currently is seeking three new members for
this committee. To be eligible for the committee, current AOCN®
certification and attendance at an ONCC item-writing workshop are
required. Test Development Committee members are responsible for
assembling and reviewing all forms of the examination and therefore are
not eligible to take the examinations while on the committee and for three
years thereafter.
The new certification examinations will be
administered via computer for the first time in January, April, July, and
October 2005. Paper-and-pencil forms will be administered at the ONS 30th
Annual Congress in Orlando, FL, on April 27, 2005. The new certification
for NPs is Advanced Oncology Certified NP (AOCNP) and for CNSs is Advanced
Oncology Certified CNS (AOCNS). Eligibility criteria for the NP
examination include (a) a current RN license, (b) a master’s degree or
higher in nursing from an accredited institution, (c) completion of an
accredited NP program, and (d) a minimum of 500 hours supervised clinical
hours as an oncology NP. These hours may be obtained within the NP program
or following graduation. Eligibility criteria for the CNS examination
include a (a) current, active, unrestricted RN license, (b) master’s
degree or higher in nursing from and accredited institution, and (c)
minimum of 500 hours of supervised practice in an advanced practice role
in oncology nursing. These hours may be obtained within the graduate
educational program or following graduation from the program. Renewal of
these certifications will be every four years, either by retesting or by
Oncology Nursing Certification Points Renewal Option (ONC-PRO).
The
final administration of the AOCN® examination will be October
2004. Candidates for the new examinations must meet the eligibility
requirements and pass the respective examination to earn the AOCNP or
AOCNS credentials. Those who wish to maintain their AOCN®
certification must recertify every four years by ONC-PRO.
Many
questions and concerns were expressed at the meeting, and I have attempted
to summarize them below.
- Is this session being recorded so that we can take it back
to our colleagues? No, this is not an official Congress session
for continuing education credit and, therefore, it has not been
recorded.
- Were the results of the RDS published? ONCC is in
the process of developing publications.
- Why wasn’t this discussed with the CNS and NP SIGs and input
and opinions sought? This was the first opportunity to
summarize and disseminate the information in an organized manner. The
results of the RDS were presented at the ONS APN retreat on March 18–20,
2004. The opinions of all oncology CNSs and NPs were sought in several
ways. Several e-mail “calls” were issued to all AOCNs® who
are certified and APN members of ONS seeking volunteers for the various
task forces, interviewees, and pilot test participants who worked on the
RDS. Sixty APNs participated in this way. Keep in mind that an RDS is a
scientific process, and decisions regarding changes to a certification
examination are data driven. Input was sought from all AOCNs®
and APNs who are members of ONS through the survey process.
- What about “grandfathering” present AOCNs®
in? Because the eligibility criteria and content of the new
examinations will differ significantly from the current AOCN®
examination, those who hold AOCN® certification cannot be
grandfathered. The standards of certification-accrediting agencies
indicate that granting a credential in the absence of evaluating the
knowledge and/or skill of an individual is not acceptable. Part of the
purpose of certification is to inform the public of the particular
specialized experience and knowledge of the individual who holds the
credential. The certifying organization is responsible to ensure that
the individual has the experience required and has demonstrated the
knowledge through an objective assessment.
- If ONCC cannot grandfather in present AOCNs®,
then can it allow them to test for free? ONCC pays a
significant amount of money to the agency with which it contracts to
administer the examination and therefore cannot offer free testing. ONCC
will, however, offer a $100 discount for those taking the new
examinations during the first two administrations of the examinations in
January and April 2005.
- Won’t these new certifications make AOCNs®
obsolete? Will they be seen as dinosaurs? ONCC will endeavor to
ensure that employers and other stakeholders understand that the
AOCN® credential is still valid because it was the highest
certification in oncology at the time the participants obtained it.
- Will ONCC make some written statement about the continued
credibility of the AOCN® such as a position
statement? ONCC will consider this.
- If the goal of NCSBN is to make certification more broad
based, why is ONCC separating APNs yet again and making two more
specific and focused tests? The decision to develop role-based
examinations is based on the results of the RDS. ONCC would be remiss if
it ignored the results of this research. NCSBN does not take issue with
role-specific examinations at all. In fact, the opposite is true, in
that role-specific CNS and NP examinations are recognized readily by
state boards of nursing. Several state boards of nursing have refused to
recognize the AOCN® examination because it is not role
specific. NCSBN has recommended the recognition of adult, pediatric, and
geriatric NP examinations, as well as the critical care CNS examination.
When NCSBN recommended the recognition of broad-based examinations, it
was not referring to combining NP and CNS roles but rather focusing on
broad-based (not disease-specific) care within advanced practice roles.
NCSBN has labeled oncology a subspecialty. However, NCSBN has not really
specified its definition of a specialty versus a subspecialty. ONCC has
requested that NCSBN provide its definition of a specialty.
- Who may supervise or document the supervision of the NP or
CNS? If the hours are obtained within the educational program,
faculty or the preceptor may provide documentation of supervision. For
the hours obtained after graduation, a supervisor, physician, or APN may
provide the documentation.
- If anyone may supervise or document supervision, where is
the validity? ONCC trusts candidates’ professionalism and
integrity and also will audit a percentage of applications.
- What study materials will be available and when?
The new test blueprints currently are available on the ONCC Web site.
New reference lists also will be available soon. Many of the references
on the current AOCN® list will be used for the new
examinations. ONCC cannot provide test preparation because it is a
conflict of interest. This will be up to ONS and/or Oncology Education
Services, Inc. As with any new examinations, it may take some time for
the preparatory materials to catch up.
Several concerns also
were expressed.
- Some were concerned that this RDS could impact billing and
prescriptive authority. ONCC will work with the Centers for Medicare and
Medicaid Services and state boards of nursing regarding recognition of
the new credentials.
- Advanced nursing educators were concerned that when the new
certifications come out they will be subspecializing themselves out of a
job. The role of CNSs and NPs are well defined within other specialties.
Role specificity is quite different than subspecialization.
- This could be a problem for nurses who already are performing the
tasks of NPs or CNSs and to certify would mean that possibly additional
education would be a requirement. All currently certified
AOCNs® may maintain certification through ONC-PRO. The ONCC
Board of Directors, along with the Advanced Practice Task Force,
established the eligibility criteria for the new examinations in an
effort to provide public protection while meeting the needs of oncology
APNs.
- Some were concerned about the communication between ONS, ONCC,
and the NP and CNS SIGs. Some believed that they have been "left out of
the loop" on something that affects their practice. ONCC maintains very
high standards for the development and administration of its
certification programs. Standard procedure calls for completing regular
RDSs for each certification program. RDSs were completed for the
OCN® examination in 1989, 1995, and 2001. RDSs were completed
for the CPON® examination in 1997 and 2003. Because of the
evaluation of advanced practice nursing in oncology, RDSs were completed
more frequently for advanced certification in 1994, 1998, and 2003. For
the most recent advanced practice RDS, batch e-mails were sent to all
APNs in ONCC's database calling for volunteers to participate on the
content expert panels. Sixty AOCNs® participated on the
various panels that developed the new test blueprints. In addition, the
survey was disseminated to all AOCNs® and all APN members of
ONS (a total of 4,447). Role delineation is a scientific process, and
input is obtained through the survey instrument rather than by opinion.
Changes to a certification examination are based on the date obtained
through the scientific process.
I am sure that many of you will have more questions or concerns. If you
do, please contact Pearl Moore, chief executive officer, or Cynthia Miller
Murphy, executive director, both at 877-769-ONCC, as soon as possible and
copy your question or concern to Diane Cope (ecope@attglobal.net) or me (wvogel@charter.net). We want to hear
from you! This is our certification. Where we are 10 years from now
depends on our response today!
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Cecilia
Barron, PhD, RN
Gwen
Wyatt, RN, PhD
Alyssa
Coe, BSN, RN, OCN®, HHP
Cyndi
Miller Murphy, RN, MSN, CAE