Unit tackles barriers and increases number of PCCNs
When Alexander Nydza, BSN, RN, PCCN served as the chair of his unit-based Shared Governance Committee in 2017, he noticed a trend on the cardiovascular surgical step-down unit at Cleveland Clinic’s main campus. “We were seeing a lot of nurses interested in taking the two-day, enterprise-wide PCCN review session, but never following up, taking the exam and achieving certification,” says Nydza, now nurse manager of cardiovascular surgical step-down. “We wanted to investigate that and discover why it was happening.”
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His interest led to a survey to identify barriers to specialty certification, a continuous improvement project to overcome those barriers and ultimately an increase in the number of clinical nurses on the unit becoming Progressive Care Certified Nurses (PCCN).
Nydza received support from nursing leadership and Jennifer Colwill, DNP, APRN, CCNS, PCCN, a clinical nurse specialist with the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute, to pursue the topic. “As an organization, Cleveland Clinic encourages specialty certification because there is evidence in the literature that shows that nurse certification is associated with improved patient outcomes,” says Colwill.
Nydza and one of his peers created a short survey asking nurses who had taken the two-day educational session, but did not register for the PCCN exam, what prevented them from following through. Most of the barriers related to time, money, support and resources. “Nurses felt they didn’t have the time to study, and they were unsure of the nuts-and-bolts of how to sign up,” says Colwill. “They really needed local support to take this through to certification.”
The next step involved finding a solution. “We took feedback from the nurses and used the continuous improvement model to design countermeasures to overcome some of those barriers,” says Nydza. He developed, and now spearheads, study sessions for nurses on the cardiovascular surgical step-down unit along with two clinical nurses: Aimee Smith, BSN, RN, PCCN, and Rachel Lipnicki, BSN, RN, PCCN.
Nurses are allotted time during their work week for the class, which is offered in two four-hour interactive sessions. Curriculum includes clinical lectures led by PCCNs on the unit, practice questions and exams, and information on test-taking strategies. Some of the clinical content covered relates to topics that nurses are familiar with, but don’t experience routinely on the cardiovascular surgical step-down unit, such as arterial blood gas interpretation and 12-lead electrocardiogram interpretation. At the end of the study sessions, the registration process is thoroughly explained, and the nurses receive vouchers to sign up for free within 90 days.
After the study sessions, participants continue to receive support from peers who lead the sessions. “They touch base weekly, sending out 10 practice questions and reminding nurses to keep up with their studying,” says Nydza. “It helps keep people engaged and make sure they are staying on track.” As nurse manager, Nydza also follows up individually with nurses to check if they’ve scheduled an exam date and have any questions.
The cardiovascular surgical step-down unit offers the study sessions twice a year. During the first two years, 56 clinical nurses attended the workshop and registered for the exam, with an average certification pass rate of 79.2%. In 2019, approximately 40% of nurses on the unit had earned their PCCN compared to 8% prior to implementation of the interactive study sessions.
Nydza attributes much of the success to the peer-led strategy. “It means more to our nurses to be encouraged by their peers – to see someone they work with at the bedside every single day, who is well-versed and skilled as a result of the certification,” says Nydza. “It’s empowering and they think, ‘If Rachel can do this, I can do it, too.’”
The initiative is also effective because the team continually refines the study sessions as the certification exam evolves. For example, the nurse leaders recently added content on electrolyte imbalances and the AACN Synergy Model for Patient Care. The sessions now also include discussion of the exam experience – where the exam is held, who will welcome the nurses upon arrival, what to expect and so on.
Colwill concludes that the program works for three primary reasons: peer empowerment, organizational support and key leaders who shepherd the initiative. The success of the study sessions and an increase in certified nurses benefits patients, individual nurses and the profession as a whole.
“It’s all about promoting professionalism in nursing,” says Nydza. “We are increasing the standard of what we are truly capable of.”
With plans to offer another review course before the end of 2020, Nydza says the team is looking at options to modify the content and make it a virtual course due to the COVID-19 pandemic.
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