W
ound prevention and healing are two critical aspects of patient care. Frequently, wounds are symptoms of larger underlying health issues.1 Holistic patientassessment and treatment are needed to determine the etiology of the various types of wounds and properly implement care.
Wounds have become the focus of government regulations for long-term-care, home care, and acute care. They are among the most often-litigated
health issues. The Nursing Home Quality Initiative,2
a Medicare program designed to help nursing homes improve their quality of care in key areas, lists “pressure sores” as one of five quality measures for post-acute care; “low risk pressure sores,” “high risk pressure sores,” and “pressure ulcers–short stay” are three of the 15 quality measures for chron-ic care. In home health, 73.1% of patients are reported to have a wound or lesion, 34% have sur-gical wounds, and 6.8% have pressure ulcers.3
Wound Care Organizations,
Programs, and Certifications:
An Overview
Laurie M. Rappl, PT, CWS; Cynthia Fleck, MBA, BSN, RN, ET/WOCN, CWS, DNC, DAPWCA, FACCWS; Debbie
Hecker, RN, MBA, WCC; Kathleen D. Wright, RN, MS, CWOCN, APRN; Cary Fredericks; and Donald Mrdjenovich,
DPM, CWS, FACCWS
The number and variety of wound care organizations and certification programs have increased considerably in recent years. Many healthcare professionals interested in pursuing certification, employers who want to hire them, and the public at large are con-fused about the plethora of certification designations, program names, and requirements. Some of the largest wound care organ-izations in the US support or develop educational programs and meetings or support credentialing programs. Two of the four largest credentialing organizations are accredited. Information about the effect of credentialing on healthcare provider knowledge and clinical skills is not available and standards are needed to help healthcare providers and employers decide which program best serves their needs. Most importantly, research to ascertain the effects of educational programs and credentialing on patient outcomes must be conducted to help improve the quality of care and substantiate the goals of the credentialing programs. KEYWORDS: education, credentialing, accreditation, wound care
Ostomy Wound Management 2007;53(11):28–39
Ms. Rappl is the Patient Board Member, Association for the Advancement of Wound Care (AAWC) Board of Directors; and Clinical Support Manager, Span-America, Greenville, SC. Ms. Fleck is President, American Academy of Wound Management; Nurse Board Member, AAWC Board of Directors; and Vice President of Clinical Marketing, Medline Industries, Mundelien, Ill. Ms. Hecker is Executive Director, National Alliance of Wound Care®. Ms. Wright is President, Wound, Ostomy and Continence Nursing Certification Board®. Ms.
Fredericks is Administrative Coordinator, Dermatology Nurses’ Association. Dr. Mrdjenovich is Chair, American College of Certified Wound Specialists. Please address correspondence to: Laurie M. Rappl, PT, CWS, 205 Staffordshire Way, Simpsonville, SC 29681; email: lrappl@span-america.com.
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Under pay-for-performance in home care, pressure ulcer development will negatively affect an agency’s reimbursement.3
In an August 2007 update to the acute care inpa-tient prospective payment system,4 the Centers for
Medicare and Medicaid Services (CMS) cite the devel-opment of pressure ulcers as one of eight conditions that will be subject to payment reductions as of October 1, 2008. The CMS considers the development of a Stage III or Stage IV pressure ulcer to be a pre-ventable event. The update also notes that, compared to many other conditions, a pressure ulcer is a high-cost, high-volume condition. In fiscal year 2006, 322,946 Medicare patients with pressure ulcer as a sec-ondary diagnosis were reported and their average hos-pital stay charge was $40,381. Therefore, healthcare professionals specializing in wound prevention and management have become sought-after employees in all areas of patient care and wound care is becoming recognized as a specialty area of practice.
To further their knowledge, skills, and marketabili-ty, healthcare professionals at various disciplinary lev-els seek advanced training specifically related to wound care. Over time, various certifications have become available but people are confused about certi-fication meaning, qualicerti-fications, accreditation, and whether a certified employee will meet their needs. In addition, credentialing programs often are confused with membership organizations that do not certify but provide a shared voice and professional development. This article provides an overview of currently available certification programs in order to 1) foster a better understanding of the differences between and benefits of the individual programs and certifications, 2) encourage discussion regarding the role graduates of these programs and the certifications play in the total healthcare picture, 3) assist in the selection of an appropriate program and/or certification, and 4) encourage pursuit of higher education and skill in wound care.
The Difference between Accreditation
and Certification
Accreditation is earned by a certifying or
education-al program after extensive review by an externeducation-al, inde-pendent accrediting body. The accrediting body
deter-mines that the program has met predetermined and standardized criteria. Accreditation reflects the achievement of a level of excellence and distinguishes the program as one of quality according to industry standards. Certifying programs can vary widely in their character, composition, and quality; they seek accredi-tation as a measure and testament to their worth.
The National Organization for Competency Assurance (NOCA) is the national membership organization for professional certification organiza-tions. This organization provides accreditation through its National Commission for Certifying Agencies (NCCA), the international leader in setting quality standards for credentialing organizations.5
The NCCA has set forth a stringent and compre-hensive set of criteria to evaluate certification pro-grams. The 21 criteria are divided into five categories: 1) Purpose, Governance, and Resources, containing five Standards, 2) Responsibilities to Stakeholders, containing four Standards, 3) Assessment Instruments, containing nine Standards, 4) Re-certifi-cation, containing two Standards, and 5) Maintaining Accreditation, containing one Standard. The criteria include evaluation of bylaws, policies, and procedures; eligibility requirements; examination development; validity and reliability of the examination; examina-tion administraexamina-tion and scoring; and governance by a board that is independent of education and member-ship organizations to prevent undue influence. Programs that meet the standards and are granted accreditation are expected to continuously improve and are required to submit an annual update to main-tain their accreditation.
KEY POINTS
•
This article was written to help healthcare profes-sionals interested in pursuing wound care informa-tion and certificainforma-tion, as well as employers interest-ed in hiring them.•
The credentialing and accreditation process and the structure and goals of the largest US-based wound care organizations and credentialing organizations are described.Ostomy Wound Management 2007;53(11):28–39
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Accreditation demonstrates that the credentials given by an accredited program are based on a valid and reliable testing process — that the structures in place to administer the examinations meet and exceed the standards of the certification industry from a legally defensible perspective. The NCCA is to certifi-cation organizations what the Joint Commission (JCAHO) is to hospitals. Only two wound care pro-grams are accredited by the NCCA.
Certification is bestowed by a certifying program
on the person who successfully meets a set of criteria, which may include examination following a course of study or a portfolio that demonstrates advancing lev-els of specialty practice. Certification focuses specifi-cally on the individual and is an indication of current proficiency in a specialized field. A profession or occu-pation uses certification to differentiate among its members using standards based on legal and psycho-metric requirements.
Certification bodies are subject to few if any legal restrictions from state or federal agenies. Therefore, nearly any organization can claim to be a creden-tialing association. The lack of a professional organization for wound care (such as the American Medical Association for physicians or the American Nurse Association for nurses) has led to the rise of various certifications and created confusion in the industry. This poses a risk to both the regulatory agencies and to the public health. Accreditation can help lessen the confusion — persons interested in pursuing certification in wound care should investi-gate whether the credentialing program is accredit-ed and if so, by whom.
Certifying Organizations: American
Academy of Wound Management (AAWM)
6The AAWM is a national, voluntary, not-for-profit, multidisciplinary certifying board for healthcare pro-fessionals involved in wound care. It operates inde-pendent of any membership or education organization.
Goal. The purpose of the AAWM is to establish and
administer a certification process to elevate the stan-dard of care across the continuum of wound manage-ment. The Academy is dedicated to an interdiscipli-nary approach in promoting prevention, care, and treatment of acute and chronic wounds.
History and structure. Established in 1995, the
AAWM was founded by experienced wound care prac-titioners dedicated to helping patients with acute and chronic wounds of various etiologies. The volunteer Board of Directors is an interdisciplinary panel of wound care experts and comprises practitioners, aca-demicians, and researchers.
Accreditation and quality testing oversight. The
AAWM is accredited by the NCCA and is a full voting member of the NOCA.
Credentials offered.
• Certified Wound Specialist — CWS®
• Certified Wound Care Associate — CWCA®
Testing. The CWS® and CWCA® examinations are
administered by the Professional Testing Corporation (PTC, New York, NY). The PTC’s psychometricians assist the AAWM with a number of issues that include program development and credentialing feasibility; role delineation studies; test and item development, including conducting question writing workshops; correlation studies; and test validation. Additionally, the PTC oversees examination scoring and results. The AAWM strives to write questions at multiple levels of cognitive domain so the test is not purely recall. Additionally, the AAWM does not endorse any text-books, journals, or educational materials, nor teach or sanction any course.
Certified Wound Specialist — CWS®.
CWS® examination eligibility requirements. To be
eligible to sit for the CWS®exam, an applicant must 1)
possess a Bachelor’s degree, 2) hold a license or desig-nation as one of the following: MD, DO, DPM, PA, DMD, or equivalent; VDM or equivalent; RN, PT or OT, and 3) be able to document 3 years of clinical wound care-related experience, including direct patient care.
CWS® preparation for certification. At this time, the
CWS® examination requires self-preparation. The
AAWM does not produce/provide any seminars or review courses. A number of wound care meetings, seminars, and courses are available to wound care pro-fessionals, including those qualified and endorsed by the American College of Certified Wound Specialists (ACCWS™) (see the description of ACCWS™ to fol-low). Several current wound management textbooks are recommended for self-study; test questions may
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come from these texts as well as from industry journals.
CWS®examination, certification
maintenance, and re-certification.
The National Examination for Board Certification in Wound Management from the AAWM is held every April and October at selected testing centers nation-wide. Applicants for certification must achieve a passing score on the 200-question, multiple-choice examination. Multidisciplinary questions cover general knowl-edge, anatomy, pathophysiology, diagnosis, physiology, therapeu-tics, and psychosocial topics. A minimum of six contact hours of continuing education in wound management are required each year to remain certified. Re-certifi-cation by re-examination takes place every 10 years.
CWS®fees.
• $550 first time examina-tion fee
• $150 yearly maintenance fee • $550 re-certification
exami-nation fee (every 10 years)
Certified Wound Care Associate — CWCA®.
CWCA® examination eligibility
requirements. To be eligible to sit
for the CWCA® exam, an applicant must have 3 years of clinical wound care-related experience including direct patient care. Applicants do not have to have a Bachelor’s degree.
CWCA®examination, certification maintenance, and
re-certification. The exam is given electronically in
August and February during a 2-week period at select-ed testing centers nationwide. The examination con-sists of 150 multiple-choice items and covers the fol-lowing topics: physical assessment, patient prepara-tion, treatment, patient/caregiver educaprepara-tion, and administration.
All CWCAs are required to re-register and pay appli-cable fees to the AAWM annually. In addition, all CWCAs must demonstrate a minimum of 6 hours of continuing education per year in the field of wound care. Certification is valid for 10 years, with re-certifica-tion by self-assessment examinare-certifica-tion every 10 years.
CWCA®fees.
• $300 first time examination fee • $150 yearly maintenance fee
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• $300 re-certification examination fee (every 10 years)
Website. www.aawm.org.
The American College of Certified Wound
Specialists
™(ACCWS)
7The ACCWS™ is a membership organization that
serves as the educational resource and advocate for Diplomate (CWS®) and Associate (CWCA®) status.
Among many member benefits, the ACCWS™ qualifies,
endorses, and offers preparatory courses that can help the candidate prepare for the CWS® examination. The
organization also serves as a provider and political advo-cateto promote to the public and wound care communi-ty an enhanced awareness and understanding of the potential impact the CWS®and the CWCA®can have on
the general healthcare environment. The College pro-vides education, informational resources, and research avenues to enhance the knowledge, skills, professional performance, and relationships required by health pro-fessionals to serve their patients, public, and profession-als in the interdisciplinary field of wound management.
History and structure. In January 2005, the
AAWM Board of Directors sanctioned the foundation of the ACCWS™in response to the need for an
advoca-cy, membership, and educational arm for its Diplomates. While the AAWM functions solely as a certifying organization, the ACCWS™, as an
independ-ent body, serves as the voice for those credindepend-entialed by the AAWM. The Board of Directors is wholly inde-pendent from the AAWM and any other organization.
Credentials offered.
• Fellow of the American College of Certified Wound Specialists — FACCWS
• Associate of the American College of Certified Wound Specialists — AACCWS • Honorary Fellow of the American College of
Certified Wound Specialists — FACCWS
Eligibility requirements. Any CWS® or CWCA®
currently credentialed by the AAWM may join to gain Fellow or Associate status within the College. An Honorary Fellow is an individual of national or international stature, selected by the Board of Directors, who has made an outstanding contribu-tion to the interdisciplinary practice of wound man-agement. Membership is available for industrial-level
professionals who possess an interest in wound care and in promoting the goals of the College but who do not have a CWS®.
Fees. $125.00 per year Website. www.theccws.org.
Wound, Ostomy and Continence Nursing
Certification Board
®(WOCNCB
®)
8The WOCNCB®is the only organization that offers
wound care certification exclusively to nurses.
Goal. The goal of the WOCNCB®is to set,
main-tain, and evaluate national standards for certifica-tion and re-certificacertifica-tion in wound, ostomy and con-tinence care nursing.
History and structure. The WOCNCB® was
established in 1978 to promote excellence in wound, ostomy, and continence nursing through the development, maintenance, and protection of the certification process. The WOCNCB® is
incor-porated as a distinct and financially independent entity from the WOCN and from the tri-specialty educational programs. Volunteer board members are elected by WOCNCB®certificants.
Certification program. The objectives of the
WOCNCB®certification program are to:
• Promote the certification program for wound, ostomy, continence, and foot care nursing practice
• Encourage continued professional growth in these specialized nursing practices
• Provide formal recognition of individuals who meet the certification requirements • Identify nurses who have achieved
WOC-NCB®certification to employing agencies, the
public, and other healthcare professionals.
Accreditation. The WOCNCB® certification
examinations are accredited by the NCCA. The WOCNCB®is a full voting member of the NOCA. In
addition, the WOCNCB® has earned accreditation
from the American Board of Nursing Specialties (ABNS), the only accrediting body specifically for nursing certification. The ABNS adheres to a strin-gent and comprehensive accreditation process; the WOCNCB® provided extensive documentation
demonstrating that it has met the 18 ABNS stan-dards of quality.
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Quality testing oversight. The WOCNCB®
con-tracts with Applied Measurement Professionals (AMP, Olathe, Kan) to ensure the psychometric soundness and legal defensibility of the certification exams via role delineation and job analysis research studies, exam blueprint development, item develop-ment/analysis/maintenance, exam structure and standard setting, exam administration and scoring, and score reporting and analysis.
Credential(s) offered (wound and ostomy care).
• Certified Wound, Ostomy, Continence Nurse — CWOCN®
• Certified Wound Care Nurse — CWCN®
• Certified Wound Ostomy Nurse — CWON™
• Certified Wound Ostomy Continence Nurse-Advanced Practice — CWOCN-AP™
• Certified Wound Care Nurse-Advanced Practice — CWCN-AP™
• Certified Wound Ostomy Nurse-Advanced Practice — CWON-AP™
In addition, the WOCNCB® offers credentials in
ostomy care (Certified Ostomy Care Nurse — COCN™), continence care (Certified Continence Care
Nurse — CCCN™), and foot and nail care (Certified
Foot Care Nurse — CFCN™).
The WOCNCB®is currently exploring the
feasibili-ty of offering a new credentialing program for LPNs/LVNs or RNs with an Associate or diploma-level education. Role delineation and job analysis studies are in progress; the title or credential to be offered has not yet been determined.
Eligibility requirements. To be eligible for the
WOCNCB®examination(s), an applicant must be
cur-rently licensed as an RN and hold a baccalaureate degree. In addition, the applicant must fulfill one of the following requirements:
• Accredited Education Program Track — complete a WOC Nursing education program accredited by WOCN
• Graduate Level Track — complete a gradu-ate-level program in nursing with documen-tation of graduate clinical course work equiv-alent to two semester hours in each specialty for which certification is sought
• Experiential Track — have 50 contact hours (CEU) over the last 5 years within
each specialty for which certification is sought; have 1,500 clinical experience hours over the last 5 years within each specialty for which certification is sought. At least 375 of those hours must be completed within the year prior to certification application.
Preparation for certification. Preparatory courses
for the certification exam are offered at nine inde-pendent educational settings across the country. More information on each program can be found on the WOCNCB® website (www.wocncb.org). Programs
include distance learning through home study, online courses, and traditional onsite classroom venues. After completing a minimum of 240 hours of didactic edu-cation in the tri-specialty of wound, ostomy, and con-tinence, students are required to complete a minimum of 160 precepted hours to facilitate application of the newly learned principles in clinical practice. Some programs offer the opportunity to complete the wound care module exclusively in preparation for cer-tification. Graduate or continuing education credits may be available when qualified applicants complete the coursework successfully.
The WOCN Society’s Accreditation Council reviews and accredits specialty education programs throughout the US, promoting high quality and stan-dardization of eligibility requirements, educational content, and preceptorships. Some WOC educational programs publish review books to help students pre-pare for the certification exam. The WOCN Society often offers a certification preparation course associat-ed with their annual conference; CD-ROMs of the conference presentations are available for purchase via the website. The WOCNCB®also offers an online,
self-assessment examination (SAE) that provides practice and preparation for the certification exam.
Examination, certification maintenance, and re-certification. The computer-based certification exam
is offered in quarterly cycles at testing centers across the US. Recently, the exam has been offered in Canada and Korea and requests have been made for addition-al test sites internationaddition-ally.
The multiple-choice exam is based on recall and application of specialty-related practice principles as detailed on the published content outline. The exam outline is based on a role delineation/job analysis that
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is conducted on a regular basis by the testing compa-ny to ensure that questions reflect current, evidence-based practice.
Credentials are awarded for a 5-year period. Nurses can be re-certified via re-examination or the Professional Growth Program, which involves submis-sion of a portfolio with specified specialty-related components of continuing education, programs/proj-ects, research, publication, teaching, professional organization leadership, and/or academic education.
Application fees.
• One specialty — $300 • Two specialties — $350 • Three specialties — $400 • Four specialties — $450.
No annual fees are requested for maintaining certification.
Website. www.wocncb.org.
National Alliance of Wound Care
®(NAWC
®)
9The NAWC®is both a non-profit, national
multidis-ciplinary wound care certification board and a wound care professional membership organization.
Goal. The NAWC® is dedicated to the
advance-ment and promotion of excellence in wound care through the certification of wound care practition-ers in the US. The NAWC®was created with the
aspi-rations of unifying wound care providers and prac-titioners from different educational backgrounds in an effort to streamline the delivery of quality wound care to more patients.
History and structure. The NAWC® was
estab-lished in 2002 through a grass roots effort led by a group of dedicated wound care professionals in the Midwest. It was incorporated as a non-profit organi-zation for the certification of multidisciplinary wound care practitioners. The voluntary Board of Directors consists of wound care professionals representing the various disciplines of the certificant population. A subcommittee of the Board is dedicated to certifica-tion activities.
Accreditation. The NAWC®is a member of both the
NOCA and the ABNS. The NAWC®believes strongly in
the value of national accreditation and is currently preparing for NCCA and ABNS accreditation.
Application for NCCA accreditation will be submitted on January 31, 2008.
Quality testing oversight. Psychometric services
for the NAWC®-administered Certification
examina-tion are provided by Alpine Testing Corporaexamina-tion (Oren, Utah).
Wound care credential offered. Wound Care
Certified — WCC®.
Eligibility requirements. To be eligible to sit for the
NAWC®Certification Examination, an applicant must
fulfill the following requirements:
• Have an active unrestricted license in one of the following healthcare professions where wound care is within the scope of practice: all levels of nurses including LVN/LPN, RN, APN/NP; therapists including PT, PTA, and OT; and physicians (MD, DO, DPM) and their assistants (PA)
• Prove active involvement as a licensed profes-sional in the care of wound patients, or in management, education, or research directly related to wound care for at least 2 years full-time or 4 years part-full-time and professional wound care experience within the past 5 years • Successfully complete an NAWC®-approved
Wound Management Certification Training Course or
Have current active certification with the WOCNCB®as a CWCN®or CWOCN®or
Have current active certification with the AAWM as a CWS®or a CWCA®.
Preparation for certification. The Wound Care
Education Institute (www.wcei.net) presently is the only provider of a preparatory course for this certifi-cation. The 4-day course is offered by the WCEI at var-ious locations around the US every week. Sample exam questions and a recommended reading list may be found in the NAWC® Candidate Handbook and at
www.nawccb.org.
Examination, certification maintenance, and re-certification. The NAWC® Certification Examination
is offered in a paper-and-pencil format at the conclu-sion of each WCEI course in Skin and Wound Management, as well as at more than 1,000 LaserGrade Computer Testing Centers nationwide. Once awarded, the WCC®credential is good for 5 years
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and may be renewed by re-exam, training, continuing education, or completion of the Continuing Education and Outreach Program (CEOP). Each is described in detail at www.nawccb.org.
Fees.
• Examination fee is $300, plus $30 application fee, rolled into course fee for candidates tak-ing the course (see www.wcei.net for course fees and applicable discounts)
• Re-certification fee $330 (after 5 years).
Website. www.nawccb.org.
The Dermatology Nurses’ Certification
Board (DNCB)
10The DNCB is a certifying organization, inde-pendent of but affiliated with the Dermatology Nurses’ Association (DNA). This certification and association focuses on the practice of dermatology nursing, which encompasses all areas of skin assess-ment and care, including wound manageassess-ment.
History and structure. The DNA was
estab-lished as a non-profit organization in 1981 and serves its members through a national structure, regionally and locally, in the US and abroad. Licensed RNs, LPNs/licensed vocational nurses, and individuals involved or interested in the care of the dermatology patient are eligible for member-ship in the association.
Accreditation. The DNCB is a non-accredited
member of the ABNS.
Credential offered. Dermatology Nurse Certified — DNC.
Eligibility requirements. To earn the DNC
creden-tial, the candidate must hold a current and unrestrict-ed license as an RN in the US or Canada, have a min-imum of 2 years of dermatology nursing experience as an RN, and have a minimum of 2,000 hours of work experience in dermatology nursing within the past 2 years in a general staff, administrative, teaching, or research capacity.
Preparation for certification. The DNA offers a
variety of study tools to help nurses prepare for the exam, including a core curriculum textbook, comput-er software, self-assessment tools, and full-day course and symposiums, including one held at the DNA’s annual conference.
Examination, certification maintenance, and re-certification. The certification process involves
meet-ing the eligibility criteria and passmeet-ing a multiple-choice written examination consisting of 200 case-sce-nario questions. Certification is valid for 3 years. Nurses may be re-certified through continuing educa-tion credit contact hours or by examinaeduca-tion.
Fees.
• $175 for DNA members • $250 for non-members
Website. www.dnanurse.org.
Membership Associations
Although not specifically “educational” or certifica-tion organizacertifica-tions, the following membership associ-ations are excellent resources for clinical information and networking in the wound care arena.
American Professional Wound Care Association (APWCA) — www.apwca.org. The APWCA is a
mem-bership organization incorporating the various medical specialties involved in treating complex wounds. The mission of the Association is to help decrease the rate of complications from all wounds, including acute, chron-ic, postsurgical, post-radiation, reconstructive, and other problematic wounds. The Association’s goal is to accelerate wound healing and preserve and/or enhance the quality of life for these patients. The APWCA hosts a yearly conference in the Spring and endorses the jour-nal, Advances in Skin and Wound Care.
Association for the Advancement of Wound Care (AAWC) — www.aawconline.org. Headquartered in
the US, the AAWC is a non-profit, international multi-disciplinary organization for wound care. This organi-zation is open to everyone involved in wound care, including clinicians, patients and their lay caregivers, facilities, industry, students, retirees, and others inter-ested in the care of wounds. The AAWC was founded in 1995 to spread wound awareness by promoting excellence in education, clinical practice, public policy, and research. Originated by HMP Communications, the AAWC is now an independent, freestanding organ-ization with a volunteer Board elected by the member-ship. The yearly meeting of the AAWC is the Symposium on Advanced Wound Care (SAWC), held in the Spring. Ostomy Wound Management and
WOUNDS are the official journals of the AAWC.
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National Alliance of Wound Care®(NAWC®) —
www.nawccb.org. In January 2007, the NAWC®
launched its membership organization to provide educational, research, and advocacy opportunities to members. The Alliance is open to WCC®
certifi-cants and to all other wound care professionals and corporations doing business in the field of wound care. The NAWC® endorses Advances in Skin and
Wound Care.
Wound Ostomy Continence Nurses (WOCN) — www.wocn.org. The WOCN is a professional,
interna-tional nursing society of more than 4,000 nurse pro-fessionals who are experts in the care of patients with wound, ostomy, and continence problems. Membership also is open to students, corporate col-leagues, and all individuals who share the mission and goals of the Society. Founded in 1968, the WOCN sup-ports its members by promoting educational, clinical, and research opportunities to advance the practice and guide the delivery of expert healthcare to individ-uals with wounds, ostomies, and incontinence. The WOCN hosts its yearly national conference in June, with regional conferences throughout the year. The WOCN publishes the Journal of Wound Ostomy
Continence Nursing.
Dermatology Nurses’ Association (DNA) — www.dnanurse.org. The DNA is a professional
nurs-ing organization comprised of a diverse group of indi-viduals committed to quality care through sharing knowledge and expertise. The core purpose of the DNA is to promote excellence in dermatologic care. Membership is comprised of RNs, NPs, LPN/LVNs, medical assistants, and other associate members. Categories of membership include Nurse Member, Associate Member, Senior Member, Honorary, Lifetime, and Corporate. The DNA hosts a yearly con-ference and offers many member benefits, including its official journal, Dermatology Nursing.
Continuing Education Programs
Various continuing education (CE) programs cov-ering an array of wound management topics are offered throughout North America. Some are offered onsite at particular facilities or hospitals or offsite as partial-day, full-day, or week-long seminars. Other CE offerings are virtual and/or accessible online. Wound care meetings and educational symposia scheduled around the country and throughout the year provide opportunities to learn the latest techniques, stay abreast of the “state of the science,” and see new wound-related products. Some of the better-known programs are listed in Table 1.
Discussion
Each of the certification programs discussed fulfills a need in the wound care arena. All certifications are highly valued but, considering differences in the level of preparation and knowledge/experience required, instruction, and program accreditation and structure, these programs are not equivalent (see Table 2).
Accreditation. The accreditation process is lengthy
and expensive for the applicant organization. Adhering to the accreditation process is meant to reflect that a credential meets specific, standardized, necessary, unbiased, and legally defensible criteria.11A
program written, organized, and continuously updat-ed by experiencupdat-ed and knowlupdat-edgeable professionals may produce knowledgeable certificants who may or may not be certified according to accredited stan-dards. Also, a program can be a member of NOCA without being accredited — the majority of NOCA
TABLE 1
CONTINUING EDUCATION PROGRAMS AND
WOUND CARE SYMPOSIUMS
Symposium on Advanced Wound Care:
www.woundcaresymposium.com
WOCN Annual Conference: www.wocn.org
Clinical Symposium on Advances in Skin and
Wound Care: www.symposiumonwoundcare.com
The Wound Healing Society Annual Educational
Symposium and Exhibition: www.woundheal.com
The American Professional Wound Care Association (APWCA) Annual National Symposium:
www.apwca.org
The Annual Wound Care Congress:
www.woundcarecongress.com
Wild on Wounds (WOW) Symposium:
www.woundseminar.com
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TABLE 2
COMP
ARISON OF CREDENTIALING PR
OGRAMS FOR
W
OUND CARE
Credential(s) offered in w ound careExamination qualifications Accreditation Primar
y method of examination preparation Length of cer tification Re-cer tification requirements
Examination fees Established Board of directors independ- ent from membership
W
OCNCB
®: W
ound
Ostomy
Continence Nursing Cer
tification Board CW OCN ®, CWCN ®, CW ON, ®plus ad
vanced Practice
creden-tialing Bachelor’ s prepared nurses w ho ha ve successfully com-pleted a W OCN appro ved educational prog ram,
includ-ing 160 precepted clinical hours; alter
nate means of
qualification described in text American Board of Nursing Specialties (ABNS) National Commission of Cer
tifying Ag
encies
(NCCA)
Completion of one of nine prog
rams appro ved b y W OCN 5 y ears
Re-examination or professional gro
wth prog ram $300 per cer tification (ostomy , w ound, continence) 1978 Yes
AAWM: American Academy
of W ound Manag ement CWS ®– Cer tified W ound Specialist CWCA ®– Cer tified W ound Care Associate CWS: ®Bachelor’ s deg ree or higher in
a life sciences related field (MD
,DO , DPM, RN, PA, PT ,O T, DMD ,VMD) and >3 y
ears documented clinical
w
ound care experience
CWCA ®: no Bachelor’ s deg ree required; must ha ve >3 y ears docu-mented clinical w
ound care
experi-ence
National Commission of Cer
tifying
Ag
encies (NCCA)
Self-preparation: AA
CWS-recommend-ed resources or attendance at endorsed independent education prog
rams
10 y
ears
Examination CWS: $550 initial exam fee,
$150
annual fee to maintain cer
tification
CWCA: $300 initial fee,
$150 annual
fee to maintain cer
tification 1995 Yes NAWC: National Alliance of W ound Care WCC ®– W
ound Care Cer
tified RN, LPN/L VN, PT ,PT A, O T, NP ,MD ,P A Successful completion of a NA WC-appro ved w ound manag ement cer
tifi-cation training course; cur
rent W OCNB credential (CWCN, ® CW OCN ®), or cur rent AA WM creden-tial (CWS ®,CWCA ®); 2 y ears full-time or 4 y ears par t time w ound care experience in past 5 y ears Not y et accredited Attendance at WCEI course 5 y ears
Examination or Continuing Education and Outreach Prog
ram
$330 exam fee included in
WCEI
course fee of up to $2,797 2002 Subcommittee of membership board
DNCB: Der matological Nursing Cer tification Board DNC – Der matolog y Nurse Cer tified
RNs from the US or Canada Not accredited Variety of tools offered — cur
riculum textbook, computer software, self-assessment tools, full-da y course,
and symposiums 3 years Exam or contact hours of continuing education credit $175 if DNA member $250 non-DNA member 1981 Yes
DO
NOT
members have not achieved accreditation. A concise discussion on credentialing terms and concepts can be found on the NOCA website in a resource document entitled, “The NOCA Guide to Understanding Credentialing Concepts.”11
While lack of accreditation does not necessarily mean that a program is without quality or merit, accredited programs are considered to be of higher value and quality than non-accredited programs. External review and approval by an independent accrediting organization helps protect the public as well as student participants by ensuring that a pro-gram meets a high set of standards and that the cre-dentials earned from this program are sound. The fact that a minority of NOCA members have achieved accreditation speaks to the difficulty of the process, the need for quality to meet high standards, and the respect accorded accreditation.
The current litigious atmosphere in healthcare demands that the effect of accreditation on legal matters must be considered. NOCA, through the NCCA, is the only independent organization that accredits wound care certification programs for nurses and other healthcare professionals (the ABNS accredits only nursing programs). Therefore, NOCA could be considered as having set the indus-try standard for wound care. A program not accred-ited by NOCA might be thought to lack the mini-mum professional requirements. If credentials are examined during a legal matter or an employment situation, the backing of accreditation might be important to the clinician's credibility, especially when two programs are accredited.12However, these
statements are speculative — many factors impact any legal investigation.
Examination. Each of the four certification
pro-grams presented includes an examination. A key part of the standards to obtain accreditation involves can-didate testing. Psychometrics (defined as the science and technology of mental measurement, including psychology, behavioral science, education, statistics, and information technology13) is applied to the
devel-opment of the qualification exam to ensure not only that the test is a valid measurement of the candidate’s knowledge and skill, but also that the test fairly assess-es thassess-ese competenciassess-es.
Several steps are involved in the psychometric analysis of test design. To simplify: A job/practice analysis report determines the performance domains and associated knowledge or skills for the profession. Assessment instruments (the examination questions) are derived from the job practice analysis. The cut score, or the threshold for pass/fail, then is deter-mined. Each step requires statistical analysis to progress to the next step.
The cut score must be consistent with the purpose of the credential and the job practice analysis. If the cut score analysis report is performed correctly according to statistics and psychometrics, the cut score is consid-ered to verify the minimum competency. A cut score can be too high, indicated by a low pass rate, or too low, indicated by a high pass rate.14A high pass rate would
raise psychometric concern regarding the test’s ability to rigorously evaluate the competency of the individual; hence, the validity of the results of such an exam might raise the question of whether the preparatory program “teaches to the test.” However, it is not the intent of the article, nor are there any data, to rate the programs, the reasons certification candidates select them, or the clin-ical competence of the program participants.
Programs. The WOCNCB®, the oldest of the
cer-tifying programs, is accredited by two respected organizations, the American Board of Nursing and NOCA through NCCA. Preparation for certifica-tion is significant and only RNs with a bachelor’s degree or higher qualify for these programs. Based on the amount of coursework and the requirement of precepted experience to reinforce learned princi-ples, the WOCN nurse is the highest trained certifi-cant among all of these programs.
Initiated in 1995, the AAWM achieved accredita-tion in 2007. Certificaaccredita-tion applicants must self-pre-pare; the Association recommends resources and preparation methods on its website. Diplomates of the AAWM who hold a CWS® and Associate
mem-bers with CWCAs may join the ACCWS™, which also
can assist in certification preparation by recom-mending independent educational programs that meet its criteria. Although it is difficult to compare self-preparation to the WOCNCB®program, the fact
that accreditation has been earned attests to the quality of the AAWM program. The test is known to
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NOT
be rigorous, so self-preparation must be thorough. Certifications are available to multidisciplinary practitioners of every level. The AAWM Board of Directors is wholly independent from ACCWS™ and from any membership organization.
The newest of the programs, the NAWC®was
estab-lished in 2002 and has grown rapidly to more than 4,000 certificants nationwide. The organization pro-vides a way for licensed clinicians at all educational levels to gain more education and to become certified in wound care. The NAWC®is the only program that
offers the same WCC® credential to all certificants,
regardless of degree. The NAWC® contracts with the
WCEI to provide their 4-day course for its certifica-tion candidates. It is difficult to compare the material in this 4-day class with the material in the other two programs. WCEI was started by two nurses who were originally certified by the WOCNCB®.
The DNCB was established in 1981. This certifica-tion is not as recognized in wound care as the other programs — possibly because dermatology is com-monly (but in fact, mistakenly) considered more skin-than wound-related. The DNCB is accredited by ABNS and has various tools available to assist the applicant in preparation for certification.
Research to assess the effects of certification on healthcare professional knowledge and competence has not been conducted and data comparing the com-petence of practitioners graduating from the different programs have yet to be obtained. Most importantly, studies to ascertain the effect of certification on patient outcomes should be undertaken. The wide variations in curricula and certification passing rates makes it difficult to compare programs but competen-cy differences between program graduates from each program could potentially impact care.
Conclusion
Clinicians of all levels interested in pursuing certifi-cation in wound care now have a wide variety of options requiring varying levels of commitment. It is hoped that this article provides information to allow the potential certificant to make an informed decision on the program that best suits his/her present and future needs. Both accredited and non-accredited pro-grams serve an important purpose for dedicated wound
care professionals — it is up to the participant to deter-mine which program provides the rigor, training, and status required to achieve individual goals. - OWM
References
1. Sussman C, Bates-JensenB. Wound Care: A
Collaborative Practice Manual for Physical Therapists and Nurses, 2nd editon. Gaithersburg,
Md: Aspen Publications;2001.
2. Nursing home enhanced quality measures. Available at: http://www.qsource.org/NHQI/index.htm. Accessed October 9, 2007.
3. 2007 Home Health Line’s PPS Benchmarks Handbook, 6th Edition. Rockville, Md;2007.
4. Centers for Medicare and Medicaid Services. Available at: http://www.cms.hhs.gov/quarter-lyproviderupdates/downloads/cms1533fc.pdf. Accessed August 20, 2007.
5. National Commission for Certifying Agencies: Standards for the Accreditation of Certification Programs, 2004. Available at: www.noca.org. Accessed August 20, 2007.
6. American Academy of Wound Management. Available at: www.aawm.org. Accessed September 30, 2007. 7. American College of Certified Wound Specialists. 8. Wound, Ostomy, Continence Nursing Certification
Board. Available at: www.wocncb.org. Accessed September 30, 2007.
9. National Alliance of Wound Care. Available at: www.nawccborg. Accessed September 30, 2007. 10. Dermatology Nurses Certifcation Board. Available
at: www.dnanurse.org. Accessed September 30, 2007. 11. Durley C. The NOCA Guide to Understanding
Credentialing Concepts. The National Organization
for Competency Assurance. Available at: www.noca.org. Accessed October 28, 2007.
12. Correspondence with Richard Russell, Esq, Legal Counsel for Tennessee Health Care Association, August 20, 2007.
13. NOCA’s Basic Guide to Credentialing Terminology. October 2006. Available at: www.noca.org. Accessed October 8, 2007.
14. Conversation with Jim Kendzel, MPH, SPHR, Executive Director, National Organization for Competency Assurance. September 25, 2007.
Additional Resource
Milne C, Corbett L. Certification in wound, ostomy, or continence specialties. In: Milne C, Corbett L, Dubuc D (eds). Wound, Ostomy, and Continence Nursing
Secrets: Wound, Ostomy, and Continence Secrets.
Philadelphia, PA: Hanley & Belfus, Inc., 2002:10–14.
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