June 18, 2018

Nurses with CHFN Credentials Are Likely to Have Decision-Making in Heart Failure Management Consistent with Evidence-Based Practices

Study examines the value of certification on decision-making

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Nurse certification credentialing formally recognizes a caregivers’ clinical knowledge, judgment and experience in a specific specialty or job role. But what is the true value of certification? When Nancy M. Albert, PhD, CCNS, CHFN, CCRN, NE-BC, FAHA, FCCM, FHFSA, FAAN served as chair of the certification board for the American Association of Heart Failure Nurses (AAHFN), she launched a research study to find out.

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“I started thinking it would be great to have objective evidence of the benefit of being certified,” says Dr. Albert, ACNO of Nursing Research and Innovation at Cleveland Clinic. “The benefit of certification of highest interest was nurses’ ability to make best practice decisions.” She was principal investigator on a cross-sectional study that examined nurses’ decision-making. In the study, decision making was based on nurses’ responses to clinical vignettes. Vignette response options reflected clinical performance and quality of delivery of nursing care.

Study purpose and methods

In a literature review, researchers learned that previous research on nurse certification was based on subjective perceptions or biased by correlations of certification status and global clinical factors. There were no reports in the literature on the value of Certified Heart Failure Nurse (CHFN) status.

Albert’s study was guided by one main research question: Does heart failure decision-making differ among nurses with and without heart failure certification? The study utilized a cross-sectional, descriptive design using clinical vignettes to examine nurses’ decision-making. It was hypothesized that nurses with heart failure certification would be more likely to respond to vignettes by selecting answer options that represented highest evidence-based practice.

Albert and her fellow researchers created the seven clinical vignettes based on the 2013 American Heart Association/American College of Cardiology heart failure management guidelines. Vignettes consisted of scenarios about fictional patients with heart failure and reduced and preserved ejection fraction and involved four domains important to nurses’ decision-making: chronic heart failure medication management, acute care heart failure medication management, self-care education and evaluation of patients’ adherence to self-care behaviors.

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Research was conducted online by clinical nurse members of the American Association of Heart Failure Nurses and nurses from two hospitals in the Midwest and one in the northeast United States who provided direct-care or patient-related heart failure services in any environment of care.

Study results and implications

Of the 605 participants, 29.1 percent had CHFN credentials, 35 percent were certified in areas other than heart failure and 35.9 percent were not certified. After controlling for personal, nursing and work characteristics of participants, CHFN status was associated with clinical decisions that reflected higher quality clinical management of patients with heart failure based on vignette scores.

Certification in heart failure applies to patients treated in multiple settings (hospital or ambulatory care) since core management principles are the same. The focus of this research, and therefore, the clinical vignettes was not on ventricular assist device care or newer methods to assess clinical fluid status. However, regardless of the use of ventricular assist devices or clinical fluid assessment methods, patient management with medications and other strategies in response to assessment findings is important and needs to be based on current evidence.

The results of the study, published online in March in Heart & Lung: The Journal of Acute and Critical Care, have implications on clinical practice.

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“Nurses are constantly making decisions about patients’ current status and change in status. They also assess patients for effectiveness of treatments and readiness to advance therapies,” says Dr. Albert. “Managers and other leaders can have confidence that certified nurses managing patients with heart failure have a stronger knowledge base and are better equipped to make clinical decisions that are impactful and help optimize patient outcomes.”

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