The impact of specialty nursing certification on patient outcomes and costs in acute care: An individual value-added performance analysis

Contact PD/PI: Yakusheva, Olga PROJECT SUMMARY Specialty registered nurse (RN) certifications can be a popular choice for practicing RNs to to advance their knowledge and expertise and are one way hospitals invest in their nursing workforce. An estimated 40% of acute care RNs hold specialty certification and as many as 55% of hospitals offer tuition reimbursement and paid time off for completion potentially costing organizations several mission dollars annually. While RN specialty certification is a multi-million dollar industry, surprisingly little evidence exists about the value added by RN specialty certifications in terms of improved nurse performance and patient and organizational outcomes. Evidence that does exist is inconclusive and judged as low quality due to cross-sectional study designs, aggregation of data at the hospital- or unit-level, and poor quality of certifications data in most hospital human resource databases. Lack of robust evidence may lead to broad-scale under- (or over-) investment in specialty RN certification in the healthcare industry, potentially contributing to excessive costs and suboptimal patient outcomes. In collaboration with the 4th largest healthcare system in the United States (CommonSpirit Health, over 140 hospitals across 21 states), we will conduct nurse-patient linked analyses of the impact of RN specialty certification on nurse performance, patient outcomes, and costs. Our proposal draws on our team’s prior and current expertise in nurse-patient linked analyses of electronic health record data, individual nurse value-added performance measurement, and quasi-experimental regression methods for causal inference (i.e. difference-in-difference with time-varying treatment effects). In Aim 1, we will determine whether RN specialty certifications improve nurse performance using a one-nurse-to-many-patients linking approach we developed, allowing us to test the causal effect of obtaining a specialty certification on nurse performance and whether the effect of specialty certification on nurse performance depends on the type of certification (e.g. critical care, medical-surgical, wound/ostomy) and on nurse characteristics (education, experience). In Aim 2, using a one- patient-to-many-nurses linking approach we have developed, we will determine if patient outcomes and organizational financial outcome improve with a higher proportion of specialty-certified nurses; this Aim allow us to examine whether patients who receive a greater proportion of care from specialty certified nurses have improved outcomes and lower costs, and the financial impact (cost-benefit) of increasing the proportion of specialty certified nurses in different types of organizations (e.g. Magnet/non-Magnet, teaching/non-teaching). In Aim 3, we will explore the contexts and mechanisms that support or hinder the impact of specialty nurse certification on patients, costs, and organizational outcomes, through focus groups and interviews with nurses and nurse leaders. Taken together the aims of this mixed methods study will provide the most robust, causal, and generalizable evidence to inform investments in nurse human capital to optimize nurse performance, achieve targeted patient outcomes, and reduce costs of care. Project Summary/Abstract Page 7