integrity” (which includes behavioral interventions, coping mechanisms, family dynamics, mental health concepts, psychopathology, religious and spiritual influences on health, and support systems). Another 13–19 percent relate to “management of care” (content includes continuity of care, referrals, and collaboration with interdisciplinary teams), and 6–12 percent to “health promotion and maintenance” (which includes self-care, lifestyle choices, principles of teaching and learning, health screening, health promotion programs, and disease prevention) (NCSBN, 2006a). However, recent revisions to the exam reduced the content on “psychosocial integrity” (Stuart, 2006), which suggests a decreased focus on psychosocial issues.

The scope of practice of RNs is defined by the state in which the nurse practices. Currently, 20 states participate in a Nurse Licensure Compact Agreement, whereby a nurse with a license in his/her state of residency is allowed to practice in another, subject to each state’s practice law and regulation (NCSBN, 2006b).16 All states require nurses to renewal their license periodically, which sometimes requires continuing education.

Specialty Certification and Continued Competency

Nurses can obtain specialty certification from various organizations to focus their practice in a certain field. For example, the American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association, certifies nursing specialties such as psychiatric nursing and mental health. The Oncology Nursing Certification Corporation (ONCC) also offers examinations in oncology nursing for care of both pediatric and adult patients, including exams for certification as an Oncology Certified Nurse (OCN), Certified Pediatric Oncology Nurse (CPON), Advanced Oncology Certified Nurse Practitioner (AOCNP), and Advanced Oncology Certified Clinical Nurse Specialist (AOCNS) (ONCC, 2006). Thirty-six percent of the content of the test for certification as an OCN addresses knowledge of “quality-of-life” issues, including (but not limited to) pain; fatigue; sleep disorders; coping (risk factors, prevention, and management); spiritual distress; financial concerns; emotional distress; social dysfunction; loss and grief; anxiety; altered body image; cultural issues; loss of personal control; depression; survivorship issues; sexuality (risk factors, prevention, and management); reproductive issues; supportive care; dying and death; local, state, and national resources; and rehabilitation. Eight percent of the content of the CPON certification examination addresses psychosocial issues, and an additional 8, 3, and 6 percent, respectively, addresses growth and development, health promotion, and end-of-life care. Fifteen


Colorado, Kentucky, and New Jersey have enacted but not yet implemented the compact agreement (National Council of State Boards of Nursing, 2006).

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