Future Directions of Credentialing Research in Nursing Workshop Summary (2015) / Chapter Skim
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4 Challenges and Opportunities in Credentialing Research Methodologies
4 Challenges and Opportunities in Credentialing Research Methodologies
Pages 41-52
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From page 41... ...
For example, if the goal is to increase the number of credentialed individuals, the signaling theory implies that only certain classes of employee (i.e., those with the necessary underlying traits) will benefit from credentialing programs.
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From page 42... ...
The natural tension between those who subscribe to the signaling theory versus the human capital theory "is at the forefront of the credentialing research challenges," McHugh said. As Needleman suggested earlier, McHugh also believes that voluntary certification reflects assumptions of both signaling and human capital theories, and the balance varies across individuals, institutions, and certification programs.
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From page 43... ...
He suggested regression analyses, propensity matching techniques, use of instrumental variables, and longitudinal research that includes counterfactual testing. As noted by other speakers, research designs will also have to account for additional challenges, such as selection bias and a lack of data and standardized data across multiple certification and credentialing programs to improve interoperability.
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Similarly, employers may view nurses with voluntary credentials as employees who are more motivated and committed than their counterparts, leading to better hiring opportunities and compensation. However, there are problems with ignoring causality and relying on signaling theory to support credentialing.
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For example, failure-to-rescue research suggests that high-quality organizations and high-quality nursing care improve patient outcomes by quickly identifying patients with complications rather than by preventing complications. Nurses observe and recognize warning signs and symptoms, interpret these signs and symptoms as problems that threaten a patient's recovery, collect the additional information necessary to engage team members and facilitate decision making, quickly communicate this information to other team members, suggest specific treatments or additional tests, implement these interventions quickly and effectively, evaluate their impact in a timely and accurate manner, and finally communicate these findings back to the team.
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Some of the opportunities for new or improved research methods will arise from the availability of electronic health records (EHRs) , which can link patient care to individual clinicians.
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. Describing some of her work, Monsen demonstrated how knowledge discovery data analytics methods can be used to identify hidden patterns in nursing data (Monsen et al., 2010)
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. Figure 4-2 provides exam p mples of the types of "su unbursts, which illus ," strates four unique patient risk patter u ts' rns, created u using puublic health nuursing assessmment data.
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From page 49... ...
Relevant research involves aligning payment incentives, health information technology, quality improvement collaboratives and learning networks, and efforts to improve training of clinicians and multidisciplinary teams. Existing activities within the Innovation Center are generating new data sources that could be used for credentialing research, said Whelan.
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In the future, Whelan believes quality measures will move away from narrow, setting-specific snapshots of care delivery and toward a reorientation and alignment of measures around patient-centered 3 Whelan also briefly mentioned providing money directly to governors to encourage blended funding streams, with a specific emphasis on reducing barriers to full practice; leveraging state licensure renewal processes to identify workforce shortages and better understand the geographic distribution of providers; and asking Health Care Innovation program awardees to consider how workforce roles will change as the delivery system changes.
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is also sought. For example, nurse practitioners and certified nurse midwives receive reimbursement for their services in some programs, and new Medicaid regulations permit states to reimburse nonlicensed clinicians for some community health work.
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If research indicated that identifying high-risk patients and modifying factors to reduce this risk improves outcomes, then certification programs can target development and maintenance of the most relevant skills to reduce risk. 4 The NICHE program, Bolton said, has a specific patient population, has data about advanced-practice nurses certified in gerontology and about staff nurses, and shows early evidence of the nurses' ability to identify patients at risk and intervene early (see NICHE, 2014)
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