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Credentialing for
Perioperative Nurse

I n the October 2015 issue of the AORN Journal, I wrote a

Guest Editorial about emerging trends affecting nursing
professional development and about the importance of
“. . . developing new skills and areas of expertise that were not
covered in prelicensure education. . . .”1(p325) One of those
This content was built on the foundation of a job analysis
(ie, role delineation study) of the work performed by periop-
erative nursing leaders. A job analysis is “. . . designed to
obtain descriptive information about the tasks performed in a
job and the knowledge needed to adequately perform those
trends is a shift to greater individual responsibility for a tasks.”3(p7) The purpose of the job analysis, which was
nurse regarding lifelong learning. Nurses, including those in sponsored by CCI, was to “. . . develop and validate the
leadership and management roles, are faced with the need listing of the tasks and knowledge related to work performed
for ongoing professional development during the courses of by professionals in the field of surgical services management”
their careers. and to “. . . develop a body of knowledge for the Surgical
Services Management education program.”3(p7)
The need to develop new skills is of particular importance for
perioperative nurse leaders in a time of rapid change. A key The same rigorous process of job analysis supports certification
message from the Institute of Medicine (IOM) report The examinations such as the CNOR credential, which is also
Future of Nursing: Leading Change, Advancing Health echoes administered by CCI. The certificate of mastery program in-
the importance of ongoing education and lifelong learning: cludes a pretest to guide learning and a posttest to measure
“The nursing profession must adopt a framework of participant’s knowledge of the content taught in the course.
continuous lifelong learning that includes basic education, These assessments are critical elements of the program. The
academic progression, and continuing competencies.”2(p213) assessment component and the job analysis foundation
Recognizing this need, AORN has dedicated this issue of distinguish a certificate program from traditional CE activities.
the AORN Journal to providing content on a variety of Through the job analysis, CCI monitors the nature of peri-
management- and leadership-oriented topics that are of operative nurse leaders’ work and stays current with changes in
interest to a wide range of perioperative nurses, including that role.
perioperative nurse leaders.
In frequent interactions with the perioperative leadership
EDUCATION PROGRAMS FOR community and through the job analysis findings, CCI
PERIOPERATIVE NURSE LEADERS learned that certificate of mastery programs are important and
Since 2009, the Competency & Credentialing Institute (CCI) valued, particularly by those who are new to or aspiring to
has offered continuing education (CE) and a certificate of perioperative management. However, we also discovered un-
mastery program (Surgical Services Management) centered on met needs for the community of perioperative nurse leaders.
management and leadership in the perioperative setting; they Those needs were for additional formalized education and a
are available in the form of self-paced individualized learning certification examination based on the body of knowledge
combined with live presentations by subject matter experts. delineated in the job analysis. There is no standardized
ª AORN, Inc, 2016
94 j AORN Journal
August 2016, Vol. 104, No. 2 Guest Editorial

educational program for perioperative nurse leaders working

in the challenging OR setting. There is also a wide variety Table 1. Certified Surgical Services Manager
Certification ExaminationdMajor Topic Areas
of educational and training processes used on entry into this
role. The diversity of approaches contributes to a lack of Communication and Relationship Management
consistency and leaves much room for improvement. Many Operational Management
perioperative nurse leaders develop a level of competency Leadership
without a formalized course of instruction tailored to the Financial Management
unique demands of the field. This is often attained through an Professionalism
arduous process of “learning on the job,” a difficult method
Strategic Management
of competency attainment that may lead to a frustrating, error-
Human Resource Management
prone career development process. A far more desirable option
to learning on the job would be a well-structured program,
perhaps augmented by additional academic coursework.
However, these ideal types of learning paths are infrequent for education. This requirement establishes a common knowl-
perioperative nurse leaders and are typically found only in edge base for all test takers and reflects a known characteristic
larger facilities and health systems. of the nursing communitydthat nearly 50% of nurses have
These unmet needs led CCI to develop the Certified Surgical graduate-level education.5 This eligibility requirement is also
Services Manager (CSSM) certification program in 2015. consistent with the positions stated in the IOM Future of
The CSSM credential and its recertification mechanism Nursing report regarding the need for additional academic
address the identified gaps in the career paths for nurse leaders preparation for nurse leaders.2 The CCI fully supports this
working in the OR setting. In addition, the CSSM credential recommendation; the eligibility criteria for the CSSM
further substantiates one of the career paths available to peri- credential and the recertification processes serve to support
operative nurses. nurses who further their formalized academic education.

On passing the CSSM certification examination, each nurse

receives a detailed score report relative to his or her perfor-
THE CSSM CREDENTIAL mance on each of the seven major subject areas covered on the
The certificate of mastery program in Surgical Services exam (Table 1) and a tailored professional development plan.
Management represented an ambitious but early attempt to Nurses who wish to maintain their CSSM certification have
meet the need for additional quality education and training for two options. They may retake and pass the certification
the perioperative community. With the CSSM certification examination or fulfill that professional development plan,
examination, there now exists a standardized test of the which addresses deficits relative to the major subject areas
knowledge needed to lead and manage an OR. Although the found on the certification examination.
test itself is a significant accomplishment, the strength of the
credential and its value to the profession lie in the recertifi- Figure 1 shows this CSSM recertification pathway in graphic
cation mechanism. form. To fulfill that customized plan, those holding CSSM
certification must have access to quality CE materials aligned
The CSSM certification and recertification process is funda- with their learning needs. This special edition of the AORN
mentally different from the processes for other perioperative Journal can meet at least part of that need with content
nursing certifications.4 First, a nurse wishing to take the covering several of the domains found on the CSSM exam.
certification examination must substantiate recent learning The CE activities in this issue may also be used to meet the
activity (eg, CE or academic coursework on the subject education requirements for CSSM eligibility.
matter covered on the test). This education must have been
completed within the two-year period immediately before
the nurse registers for the certification examination. This Continuous Professional Development
requirement substantiates recent learning in the field and The CSSM certification examination and the information
some degree of current knowledge of the material that will presented in the Surgical Services Management materials pro-
be on the test. vide both the content to support lifelong learning and a
mechanism by which to engage in ongoing professional devel-
Second, all nurses wishing to take the CSSM certification opment relevant to the role. In addition, these materials change
examination must have a minimum of baccalaureate-level the paradigm of learning for the nurse from a passive, directed AORN Journal j 95

Stobinski August 2016, Vol. 104, No. 2

Figure 1. The Certified Surgical Services Manager (CSSM) recertification pathway.

model of learning to a proactive model of planned professional on certification against which the CSSM credential could be
development requiring active participation by the candidate. benchmarked. A review of that summary demonstrates that
the CSSM credential represents a progressive program that is
Nurses holding the CSSM certification will be at the well positioned for the future.
forefront of the latest trends in professional credentialing.
As the first candidates for this credential, they will experi- Among the sections of that report germane to the issue of how
ence a far more personalized and directed professional to address the knowledge gaps of nurses were the comments of
development path than those holding other nursing certi- Patricia Flatley Brennan, RN, PhD, FACMI, an associate
fications. These perioperative nurse leaders will be well professor of nursing at Case Western Reserve University,
positioned to assist their staff members, who almost Cleveland, Ohio, who said, “Some certification requirements
certainly will experience a similar certification process in the may not adequately reflect the changing knowledge and skill
near future. Accreditation agencies for certification organi- sets required to practice in today’s health care environ-
zations are now examining fundamental issues such as the ment.”6(p8) She also stated that emerging technologies in
link between certification processes and competency. The health care have the potential to fundamentally change the
guidance of these accreditation groups will compel organi- practice of nursing. Based on this statement, we can see the
zations like CCI to make these changes to a more robust potential for the development of a gap between prelicensure
and personalized professional development plan in the cer- education and the real-life needs of the changing work-
tification mechanism. place. This gap, when we consider the lack of standardized
educational preparation, is especially noteworthy for peri-
THE LARGER PICTURE IN HEALTH CARE operative nurse leaders. Certification programs like the CSSM
In the larger context of US health care, the discussion program, if properly configured, could be part of the solution
regarding career paths and professional development for to addressing this knowledge and skills gap.
perioperative nurse leaders is similar to discussions occurring
Also in the report, Robin Newhouse, PhD, RN, NEA-BC,
for other groups in nursing and other health care professions.
FAAN, dean and professor of the Indiana University School
Two recent publications reinforce the rationale underlying
of Nursing, Indianapolis, suggested that “credentialing pro-
the CSSM credential. The first publication is from the IOM
grams could be used to standardize and validate specific
and the second is from the American Board of Medical
knowledge sets and encourage nurses to develop advanced
Specialties (ABMS).
leadership skills.”6(p9) Her rationale was that the certification
mechanism could be constructed to require knowledge of
The Future of Credentialing in Nursing current standards of care but also mandate that candidates
In 2015, the IOM published a summary of a series of work- “continually demonstrate appropriate knowledge, skill, and
shops on the subject of nursing certification research titled competency to meet credentialing requirements.”6(p9) The
Future Directions of Credentialing Research in Nursing: net result would be to validate knowledge sets and skills,
Workshop Summary.6 The report provided the latest thoughts perhaps necessitated by rapid changes in job requirements.

96 j AORN Journal

August 2016, Vol. 104, No. 2 Guest Editorial

Table 2. The August 2016 AORN Journal Continuing Education Articles and the Corresponding Domains of the
Certified Surgical Services Manager Certification Examination
Article Author(s) Domain
Perioperative Nurse Leaders and Dawn Whiteside, MSN, RN, CNOR Professionalism
Effective Perioperative Communication J. Hudson Garrett, Jr, PhD, MSN, MPH, Communication and Relationship
to Enhance Patient Care FNP-BC, CSRN, PLNC, VA-BC, IP-BC, Management
Strategies for Successful Perioperative Joseph K. Mollohan, MSN, RN, CNOR, Human Resource Management
Orientation CSSM; Maria Morales, MSN, RN, CPAN
Improving OR Efficiency Patricia Vassell, DNP, MBA, BSN, RN, CNOR Operational Management
Leadership and Management Roles: Joyce A. Cox, MBA, MSN, CNP, CNOR, Leadership
Challenges and Success Strategies CRNFA, OCN, CHPN

The need to develop new skill sets is exemplified by the The ABMS released a special report in 2015 titled The Future
changes coming from the implementation of the Centers of Practice: Transformation to Patient-Centered Systems; Insights
for Medicare & Medicaid Services Hospital Value-Based and Opportunities.9 In the report, the ABMS authors also
Purchasing Program. This transition to value-based care speak to the evolving physician view of professionalism and
versus volume-centered care has required nurses to master how it can be developed during a career.9(p8) The work CCI
new skills and build their knowledge in new areas. has done on the CSSM certification examination is entirely
consistent with the perspective presented in the ABMS
One key recommendation from the IOM Future of Nursing paper. In addition, the report highlights the need to develop
report states that “nurses should be full partners, with new skills for the transition to value-based care. These
physicians and other health professionals, in redesigning skill sets, which are not major components of current
health care in the United States.”2(p29) Should such medical training, include strategic management, leadership,
partnership opportunities arise, nursing leaders must be professionalism, and financial management. It should be noted
ready to actively participate. These opportunities may be that these areas, which ABMS maintains will be integral for
presented in the near future, and the CSSM credentialing health care leaders, comprise four of the seven major subject
process can facilitate nurses being better prepared to meet areas from the surgical services manager job analysis.
these challenges. Knowledge of these subjects is both taught in the Surgical
Services Management materials and tested on the CSSM
The Future of Practice certification examination.
The ABMS is a nonprofit organization that “serves the public
and the medical profession by improving the quality of health Amid the transition in US health care described in the
care through setting professional and educational standards ABMS report, nurses are well positioned to add value to the
for medical specialty practice.”7 This organization is addressing greater health care system. This added value is predicated on
the question of how physicians in various specialties can nurse leaders learning the skills needed to function in a
maintain competency in the face of rapid change in value-based system. Perioperative nurse leaders have a long
US health care. The following quote is from the ABMS history of coordinating the various elements of perioperative
web site: care. As health care roles and responsibilities evolve, nurses
may be able to increase their power and influence in
With more options for patients to receive care and more va- leveraging their areas of strength. In doing so, they can
rieties of medicines, devices, and procedures which physicians gracefully and skillfully alter long-standing power gradients in
can choose from in providing care, it is important that phy- the perioperative setting and perhaps improve the nursing
sicians remain knowledgeable and skillful in their disciplines work environment for perioperative nurses. But new
and are attentive about providing safe, evidence-based, and knowledge and skills will be needed to make this transition.
compassionate care to patients.8 These attributes, such as communication and relationship AORN Journal j 97

Stobinski August 2016, Vol. 104, No. 2

skills, are subject areas delineated in the surgical services References

manager job analysis. 1. Stobinski JX. Nursing’s invisible architecture: individual re-
sponsibility for professional development. AORN J. 2015;102(4):
IN THIS THEMED ISSUE 2. Committee on the Robert Wood Johnson Foundation Initiative on the
I am pleased to point out the features of this special issue on Future of Nursing, at the Institute of Medicine. The Future of
the CSSM certification. First, you should note that these pages Nursing: Leading Change, Advancing Health. Washington, DC:
contain 8.2 CE opportunities. The issue was built on the National Academies Press; 2011.
3. Prometric. Job Analysis of Surgical Services Manager [research
premise that the topics covered would meet education re-
report]. Baltimore, MD: Prometric; 2013.
quirements central to the CSSM certification but also be of 4. CSSM Handbook. Competency & Credentialing Institute. http://
interest to a variety of nurses working in the perioperative
setting. It should be noted that the CE opportunities handbook_2015.pdf?sfvrsn¼2. Accessed June 6, 2016.
found in this issue may also be used by those holding the 5. Stable benefits but lower salaries noted in annual survey. OR
CNOR and CRNFA credentials to meet those recertification Manager.
education requirements. Drawing on the knowledge of -noted-annual-survey. Published September 22, 2015. Accessed
subject matter experts in perioperative nursing leadership June 6, 2016.
6. Institute of Medicine. Future Directions of Credentialing Research in
and management, we have assembled a diverse selection of
Nursing: Workshop Summary. Washington, DC: National Academies
articles that address some of the major subject areas of the Press; 2015.
CSSM certification examination. Each of the CE articles 7. Frequently asked questions. American Board of Medical Specialties.
link to one or more subject areas of the CSSM certification Accessed June 29, 2016.
examination (Table 2). 8. ABMS history of improving quality care. American Board of Medical
Specialties. Accessed
June 6, 2016.
CONCLUSION 9. 2015 National Policy Forum, American Board of Medical Specialties.
One of the goals of the issue was to present materials useful to The Future of Practice: Transformation to Patient-Centered Systems;
perioperative nurses involved in patient care as well as current Insights & Opportunities [special report]. American Board of Medical
and aspiring nurse leaders. The CCI asserts that maintaining Specialties.
digital.pdf. Accessed June 6, 2016.
and enhancing professional competency fulfills an ethical
obligation to our patients to consistently provide high-quality
care. The educational materials contained in this issue afford James X. Stobinski, PhD, RN, CNOR, CSSM, is
one method to enhance the knowledge of perioperative nurses the director of credentialing and education at the
in the area of surgical services management. In this time of Competency & Credentialing Institute, Denver, CO.
increasing complexity in US health care, we see materials such As director of credentialing and education at the
Competency & Credentialing Institute, Dr Stobinski

as these as integral to the continuous professional development
of perioperative nurses. has declared an affiliation that could be perceived as
posing a potential conflict of interest in the publication
Editor’s note: CNOR, CSSM, and CRNFA are registered trade- of this article.
marks of the Competency & Credentialing Institute, Denver, CO.

98 j AORN Journal