Developments in Nursing Certification in Patient Blood Management

1. Developments in Nursing Certification in Patient Blood Management Jo Valenti, BSN, RN Director, Blood Management Temple University Hospital Philadelphia, PA SABM Annual Meeting September 19-21, 2013 Los Angeles, California

2. No Disclosures

3. Forward This initiative was nurtured by many SABM nurses for a number of years. Special thanks are due to Aryeh Shander who believed in our dreams and commissioned the project. This lecture is dedicated to Michelle Thomas, APN

4. Inspiration “Everyone here has the sense that right now is one of those moments when we are influencing the future”. Steve Jobs

5. Our Group • Amelia Baffa, MSN, RN • Marianne de Bretan-Berg, RN, CFRN • Mary Ghiglione, MHA, MSN, RN • Loretta Humes, MS, RN,CHES • Amy Lombardo, ADN, RN • Tiffany Nelson, BSN, RN • Shelly Moore, BSN, MBA, CNOR • Sharon Sledge, MS, MA, RN • Elora Thorpe, MSN, RN • Jo Valenti, BSN, RN

6. Expert ReviewersThe nurses would like to thank the following SABM members who reviewed the curriculum content: • Arthur Bracey, MD • Nabil Hassan, MD • Pat Ford, MD • Arnold Friedman, MD • Steven Hill, MD • Ananthi Krishnamoorthy MD • Lleana Lopez-Plaza MD • Mark Lucas, MPS, CCP • James Reynolds • Keith Samolyk CCP, LCP  • Rita Schwab, CPCS, CPMSM • Aryeh Shander, MD       • Ariel Shapiro, MD • Pierre Tibi, MD  • Nathaniel Usoro, MD

7. Objectives Define certification/ certificate Give a brief history of Nursing Certification Enumerate benefits of Nursing Certification Apply principles of nursing certification to PBM Preview newly developed curriculum

8. Institute of Medicine 2010 Consensus Report: The Future of Nursing: Leading Change, Advancing Health “What roles can nursing assume to address the increasing demand for safe, high-quality, and effective health care services?”

9. The Future of Nursing: Leading Change, Advancing Health ““What nursing brings to the future is a steadfast commitment to patient care, improved safety and quality, and better outcomes. How well nurses are trained and do their jobs is inextricably tied to most health care quality measures that have been targeted for improvement over the past few years.” Institute of Medicine 2010 Consensus Report:

10. Definition of Nursing Certification “The formal recognition of specialized knowledge, skills, and experience demonstrated by achievement of standards identified by a nursing specialty to promote optimal health outcomes. An accepted method to validate that nurses have the knowledge, skills, and abilities that are fundamental to accomplishing their job functions.” American Board of Nursing Specialties

11. Definition of Nursing Certification “While basic nursing licensure indicates a minimal professional practice standard, certification denotes a high level of knowledge and practice, with the intent to protect the public.” American Board of Nursing Specialties

12. Definition of Certification “Certification is a voluntary process by which a non-governmental body grants limited-time recognition and use of a credential to individuals who have demonstrated that they have met predetermined and standardized criteria for knowledge, skills or competencies.” Institute for Credentialing Excellence

13. Definition of Credential Credential – attests to the qualification, competence or authority of an individual granted by a third party. Example: Mary Smith, BSN, RN, CNOR credential education licensure

14. Certificate or Certification? Assessment-based certificate – provides education or training with an assessment to confirm that participants have achieved intended learning outcomes. No credentials are given.

15. Certificate or Certification? Certification confirms that an individual has achieved a high level of knowledge, skills and competencies. Credentials are given and usually required to be renewed periodically.

16. History of Nursing Certification In a fascinating book entitled Nurse Anesthesia authors Naglehout and Plaus explain the development of the first specialty in nursing: The nurse anesthetist.

17. History of Nursing Certification During the 1880’s physicians thought that providing anesthesia was ‘beneath them’. Therefore nurses became skilled anesthesia providers.providers.

18. History of Nursing Certification During the Civil War, WW I and WWII nurses provided anesthesia to wounded soldiers. Later on physicians unsuccessfully objected to nurses providing anesthesia. A legal battle ensued. 1931 National Association of Nurse Anesthetists was formed. 1945 first specialty certification program – for nurse anesthetists. Needed to demonstrate education/training.

19. Certification through ANCC(American Nurse Credentialing Center) • Today there are: • 25 RN specialty certifications • plus • 12 for nurse practitioners • and • 10 for clinical nurse specialists

20. Benefits of Certification Employers prefer certified nurses over uncertified nurses. Enhanced collaboration between healthcare providers. Fewer work-related injuries. Higher patient satisfaction ratings. Fewer adverse events. Empowerment of nurses to achieve a higher level of autonomy.

21. Benefits of Certification • There are also intrinsic benefits: • Enhanced feeling of personal accomplishment • Personal satisfaction • Validation of knowledge • Professional growth • Attainment of a practice standard

22. Benefits of Certification • Marketing • Increasing the number of certified nurses in the facility significantly improves the hospital's demographic profile that is a required element of the Magnet application process. • Even in hospitals not achieving Magnet status, a high percentage of certified nurses will attract customers since the public perception is that certified nurses are more qualified.

23. Am I preaching to the choir? So…. Nursing certification is a very positive thing.

24. We want what we want! And….. PBM nurses want their own certification…..

25. But…. there are big obstacles

26. Large numbers are needed As of 2008, the four most frequently conferred specialty nursing certifications were: The American Association of Critical Care Nurses' (AACNs') Critical Care Registered Nurse (CCRN)—40,000 certificates conferred The Competency & Credentialing Institute's CNOR—30,000 certificates conferred The Oncology Nursing Society's (ONS') Oncology Certified Nurse (OCN)—22,825 certificates conferred The American Nurses Credentialing Center's (ANCC's) Medical-Surgical Nurse (MSN)—20,752 certificates conferred

27. How many PBM nurses are there? There are 349 members of SABM 83 listed as nurses (some are not working in PBM) +31 ONTraC nurses +50 TSOs +10 other Canadian PBM nurses = 174 approximate total There's not enough of us !

28. What have our perfusionist colleagues done?AmSECT (AMERICAN SOCIETY OF EXTRACORPOREAL TECHNOLOGY or the International Society of Perfusionists) created the International Board of Blood Management

29. http://www.intbbm.org/ “The International Board of Blood Management shall strive to promote education and sound scientific principles to advance the safe and competent practice of perioperative blood management, which will lead to recognition of this specialization through examination and certification.”

30. http://www.intbbm.org/ “To address the absence of a formal certifying agency, and improve the safety and care that blood management clinicians provide to their patients, AmSECT is working closely with the AABB to coordinate this rapidly developing field. Since 1998 the Perioperative Blood Management Taskforce, consisting of over 70 members from diverse clinical specialties, has worked diligently to create a process for formal recognition of individuals involved in blood management.”

31. http://www.intbbm.org/ “One of the first steps was the creation of the International Board of Blood Management that has as its mission to promote education and sound scientific principles to advance the safe and competent practice of perioperative blood management, which will lead to recognition of this specializationthrough examination and certification".

32. Two certifications: CURRENT: PBMT – Patient Blood Management Technician (for perfusion technicians and nurses) IN PROCESS: PBMS – Patient Blood Management Specialist (for perfusionists, med techs, residents, nurses and PBM coordinators)

33. What are their numbers?3400 perfusionists internationally2400 members of AmSECT

34. Statistics200 certified PBMT technicians since 2008PBMS in progress and on target for 2014

35. Steps to Create Certification • 1. Determine audience • What professional group (s) are interested? (Survey) • What pre-requisites for the course? • How many applicants? • 2. Assemble panel of experts • 3. Develop curriculum • 4. Engage Instructional Designer • 5. Obtain accreditation of the certification program.

36. Steps to Create Certification In 2008 SABM nurses surveyed several nursing schools to find out if any included Patient Blood Management in their current curriculum. None did! The original idea was to create a curriculum for nursing schools.

37. Steps to Create Certification ABNSC “ certification examination program is based on a distinct and well-defined field of nursing practice that subscribes to the overall purpose and functions of nursing.” And there is.. “Evidence of the professional and scientific status of the specialty exists.”

38. Steps to Create Certification Patient Blood Management is a distinct and well-defined field of nursing practice that subscribes to the overall purpose and functions of nursing. And .. Evidence of the professional and scientific status of the specialty exists.

39. PBM Nursing Scope of Practice “The PBM nurse is a licensed professional nurse specializing in the care of hospitalized or out-patients at risk of receiving a blood component transfusion at any point in the continuum of care whether adult or pediatric.  Recognizing that exposure to allogeneic blood transfusions carry inherent risks, the PBM nurse collaborates with the treatment team in creating a plan of care focused on reduction of that particular risk to the patient.  The PBM nurse focuses on improving patient outcomes by (1) managing anemia (2) optimizing coagulation (3) employing interdisciplinary blood conservation modalities and (4) facilitating patient-centered decision making”.

40. Pre-requisites • Candidate must • Hold a current, active RN license within a state or territory of the United States or the professional, legally recognized equivalent in another country. • Have practiced the equivalent of 2 years full time as a registered nurse. • Have a minimum of 2,000 hours of clinical practice in PBM. • Completed 30 hours of continuing PBM education.

41. Panel of Experts • Ten Nurses with: • 287 total years of nursing experience. (8 – 43) • Degrees ranging from ASN through Masters. • 93 years of PBM experience. • 19 PBM publications. • 129 regional, national & international PBM lectures. • and multiple volunteer positions within SABM(including 3 SABM Board members)

42. Our Curriculum Content 1. Introduction 2. Law, Ethics Patient Rights 3. Anemia 4. Coagulation 5. Intra-operative PBM 6. Oxygen Physiology 7. Cell Salvage 8. Volume Management 9. Management of Profound Anemia 10. Pre-op Evaluation of the Surgical Patient 11. Leadership, Teamwork, Change Management 12. Blood Administration Safety 13. Evaluation of Transfusion Practice 14. PBM in OB/GYN 15. PBM in Pediatrics & Neonatology 16. PBM in Gastroenterology 17. PBM in Hematology/Oncology

43. Where are we now? We have not finished all of the work to implement a PBM Nursing Certification. There are a few steps left and we are determined to see the project through.

44. Where are we now? So….Stay tuned Check www.sabm.org after the Annual Meeting for updates

45. References Byrne, M.; Valentine, W.; Carter, S.; The value of certification – a research journey. AORN. April 2004. Vol. 79, Issue 4, pp 825-828, 831, 833-835. Cliff, B.; Martinez, J. HPNA Position Paper. Journal of Hospice & Palliative Nursing. Issue: Volume 6(3), July/August/September 2004, pp 191-192. Nagelhout, J. J., & Plaus, K. L. (2013). Nurse anesthesia. Elsevier Health Sciences Niebuhr, B.; Biel, M. The value of specialty nursing certification. Nursing Outlook. July-August 2007. pp 176-181.

46. References Shirey, M. Celebrating certification in nursing: forces of magnetism in action. Nursing Administration Quarterly. Issue: vol. 29(3), July/September 2005, p 245-253. Stromborg, M.; et. al. Specialty certification: more than a title. Nurse Manage 2005:36(5): 36-46. Wade, C. Perceived effects of specialty nurse certification: a review of the literature. AORN. January 2009, vol. 89, issue 1, pp 183-188 http://www.credentialingexcellence.org http://www.nursecredentialing.org http://www.nursingcertification.org

47. Thank you Any questions?