Supportive Voice  Vol. 6 No. 4  Fall 2000

by Barbara Anderson Head, RN, CHPN, ACSW

All those involved in end-of-life care, be they patients, families, or health care professionals, recognize that providing hospice and palliative care requires a unique and specialized set of skills, knowledge, and expertise. Therefore it is no surprise that hospice and palliative care nursing has become a recognized nursing specialty with a certification program that recognizes and evaluates the competency of nurses practicing in this area of expertise.

The current process through which the registered nurse becomes certified in hospice and palliative nursing (and can use the CHPN Certified Hospice and Palliative Nurse credential) evolved from the establishment of the National Board for Certification of Hospice Nurses in 1992. For five years, beginning in 1994, hospice nurses were certified by this board as CRNHs (Certified Registered Nurse Hospice). In 1998, the board initiated a role delineation study to validate the responsibilities and skills involved in the actual practice of both hospice and palliative nurses and to ascertain if one certification process could be inclusive of both groups. Four hundred and six nurses participated by completing the job analysis tool. The results provided the basis for the content of the current exam and validated the inclusion of both hospice and palliative nurses in the process. The first inclusive exam was given in 1999; there are currently more than 7,000 nurses certified with either the CRNH or CHPN credential. Certification is for four years. Currently, nurses must retest to maintain their certification.

A candidate must be a licensed registered nurse and must pass a written exam. Although there is no practice requirement, the test is designed to evaluate the knowledge and skills of a hospice/palliative nurse with at least two years of experience in the field. The cost for initial certification is $230 for current members of the Hospice and Palliative Nurses Association ($330 for nonmembers). The exam is administered twice yearly (March and September) by Applied Measurement Professionals, Inc., at various testing centers across the nation. The 150-item test evaluates the nurse’s knowledge of seven major content areas: end-stage disease process in adult patients, pain management, symptom management, care of the patient and family, education and advocacy, interdisciplinary/collaborative practice, and professional issues. More than 6,000 registered nurses have successfully completed the certification process.

Along with the intrinsic rewards of having competency and knowledge validated through preparation and examination, certified nurses have found the process to benefit them in numerous ways, including:

• A comprehensive review of the current body of knowledge related to end-of-life care
• Educational opportunities with and from other nurses in review courses and/or study groups
• Enhancement of skills and knowledge not used daily
• Recommitment to excellence and expertise in hospice/palliative care
• Increased competence and confidence in practice
• Recognition by peers and other health care professionals through credentialing

Improved employment opportunities as certification becomes valued by employers
Many organizations support certification by providing review courses, reimbursement for related fees, promotion, salary incentives, and bonuses for certified nurses. Some organizations use the certification process to validate the competency of the nurse with two years of experience; others require certification after two years of practice or specify that certification is required or preferred when filling certain positions.

Further information regarding certification can be obtained by contacting the Hospice and Palliative Nurses Association, 211 North Whitefield St., Suite 375, Pittsburgh, PA 15206, phone 412-361-2470. A candidate handbook may be secured by calling Applied Measurement Professionals, Inc. at 888-519-9901.

Ms. Head, RN, CHPN, ACSW, is president, National Board for Certification of Hospice and Palliative Nurses. Contact information: Director of Education and Access Alliance of Community Hospices and Palliative Care Services, 3532 Ephraim McDowell Dr., Louisville, KY 40205-3224; 502-456-6200.