1. CHN Certification: Striving for Excellence Community Health Nurses of Canada Conference May 17, 2011 Katie Dilworth kdilwor@toronto.cakdilwor@toronto.ca Debra Williams-Conliffe dwillia5@toronto.cadwillia5@toronto.ca Kim Dalla Bona KDallaBona@saintelizabeth.comKDallaBona@saintelizabeth.com

2. Objectives Learn about strategies to increase the number of nurses who attempt certification. Learn the relationships and connections between support, information and encouragement to help nurses to strive for certification.

3. Agenda CHN certification Describe the collaborative study group Recruitment history Review Literature Revised recruitment strategies

4. CHN Certification  CHN was designated by CNA as specialty nursing practice in 2005  first exam was launched by CNA in 2006  CHN is the fastest growing certification specialty with an increase of 36.1% in 2009  Recertification rate in 2011 - 61%

5. Why encourage certification? Indicates qualified, competent and current in CHN’s Indicates knowledge and skills are comprehensive Validates your competency Provides for Career advancement Provides recognition Provides university credit Helps with participation in CHN development Certification is a way of striving to meet CCHN Standards

6. National Study CHNC study: Influence of Certification on Community Health Nursing Practice (2010) Identify the influences of CNA’s community health nursing certification on nursing practice Identify the influences of CNA’s community health nursing certification on employing agencies Identify organizational facilitators and barriers for CCHN(C) renewal

7. Facilitators for Certification Personal (Intrinsic) Enhanced feelings of personal accomplishment Higher personal satisfaction Validation of specialized knowledge Better professional growth Attainment of practice standard or competency Evidence of professional commitment and Acceptance of professional challenge

8. Facilitators of Certification Organizational Reimbursement for examination costs Work time to study Provision of mentors Reference materials Continuing education onsite Celebration and recognition of achievement

9. Barriers of Certification Organizational Absence of salary adjustment Perceived lack of recognition of expertise Perceived lack of support by the employer

10. SEHC and TPH Collaborative study group The whole greater than the parts: community health nurses working in virtual environments: SEHC – Team of more than 5,000 nurses, therapists and personal support workers delivering 4 million health care visits annually. TPH – TPH is the largest PHU in Canada. 35 offices, 800 nurses in 12 offices with nurses Other community agencies (PH and HH)

11. TPH/SEHC collaborative Study group Why: Intent to address both HH and PH content of the certification exam How: teleconference, virtual Community of Practice, Collaborative planning and, facilitation.

12. Organizational commitment Organizational support from both organizations (e.g., Senior Nurse/Chief Nursing Officer, Practice councils, PPL nursing positions) Consultant staff time to facilitate Library resources Financial support Support for time for participant time to participate

13. Curriculum Structure Collaboration between participants facilitated by consultant staff from each organization Dates Competencies Facilitators Mentors

14. Schedule example

16. Recruitment Challenges Initial recruitment in 2006 saw a healthy group of nurses (n=10) participating in the study group. This number remained constant in 2007 then declined in 2008 and 2009 to only two participants.

17. Sources of inspiration Dillman- Survey recruitment Frequent reminders Provide incentives Diffusion of Innovation theory explains how, why, and at what rate new ideas spread – critical mass creating desire for innovation Organizational change theory increased visible support from senior staff

18. Dillman Frequent reminders Emails from: Senior nurse to staff, Professional practice leader to staff, NPC Literature sent: Packages to managers with letter from Senior nurse, CNA pamphlets, posters, TPH pamphlets, newsletter articles, posters in offices, town hall display Incentive Congratulations letter from Senior nurse, Recognition at nursing week event Colleague and manager recognition,

19. Diffusion of innovation Critical mass creating desire for innovation Involved past participants: Q and A, professional development events and PHN competencies launch, accumulation of expertise.

20. Diffusion of innovation Questions asked to certified nurses: 1.Why I should write the exam? 2.How much preparation time is required to study for the exam? 3.What is it like to write the exam? 4.What support can I expect from Toronto Public Health if I write my exam. 5.If I get my certification will I get paid more?

21. Diffusion of innovation Example: Answer of certified nurses: Why I should write the exam? “ I’m proud to have those credentials after my name and I know others respect it as well.” “I was amazed at how much I learned.” “Why, to validate knowledge and re-assess assumptions that gather like an extra 10 lbs as your experience matures.” “since studying and writing the exam I have a better understanding about other community health.”

22. Organizational change: visible senior leader support Email messages from Senior nurse to staff nurses and to managers, also e-mail message from Senior Nurse to managers re support of their staff: “I hope you will support your staff who wish to participate in this study group with time to do so.” Several managers certified and supportive

23. Results The number of nurses attempting certification in 2010 tripled, 2011 numbers sustained this change!

24. Discussion and recommendations 1) Dillman, Diffusion of Innovation theory and Organizational change theory can inform strategy to increase participation in certification 2) Get creative and look for innovative solutions

25. References 1.Dillman D, Smyth, J., Christian L. (2009). Internet, mail, and mixed-mode Surveys. J Wiley and Sons; New Jersey p20. 2.Dllman, d. (1978). Mail and telephone surveys: the total design method / Dillman, Don A. -- New York, NY: John Wiley & Sons, 1978.Dllman, d. (1978). Mail and telephone surveys 3.Dillman D, Smyth, J., Christian L. (2009). Internet, mail, and mixed-mode Surveys. J Wiley and Sons; New Jersey p22. 4.Nutbeam D., Harris H., Wise M., (2010) Theory in a nutshell a practical guide to health promotion theories. McGraw Hill: Sidney Australia. P23 5.Pederson A., O’Neill M., Rootman I. (1994). Health Promotion in Canada, Provincial, National and International Perspectives. W.B. Sanders Canada: Torotno P287. 6.Rogers, E. (1962). Diffusion of Innovations. Glencoe: Free Press.Rogers, E.Diffusion of Innovations

26. Thank you Questions ?