To Certify or Not to Certify? That Is The Question

  As wound care takes center stage with regard to public awareness, government regulations, reimbursement issues, and patient need, perception, and interest in wound care education, preparation and certification has grown. As a result, healthcare professionals who specialize 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. Healthcare professionals in various disciplines are seeking advanced training, specifically related to wound management, to further their knowledge, skills, and marketability. Nurses, physicians, and other allied professionals involved in wound care are frequently interested and yet often confused about the certification process.

  When clinicians apply for jobs in the wound care arena, they often find the words, ‘board certification required’ or ‘board certification highly desirable’ in the ad or career offering, and wonder what does this mean? Are they qualified? Is there special training required? Which exam is appropriate for their situation? What credentials are accredited? The same uncertainty can be said for employers, other clinical providers, and the public. This article will provide those interested in wound care education and certification further information on the currently available accredited and non-accredited exams, the organizations that administer these credentials and the benefits of becoming certified. Keep in mind that anyone can develop a test that offers a credential and promote it as wound care certification.

Does Certification Matter?

  To some, certification is essential and a requirement from their employer. For others it is a matter of pride and a boost to their identity within their specialty and/or their practice.

  Surprisingly, some individuals want to challenge their knowledge for professional reasons.

  The question remains, are credentialed individuals better suited to care for patients with wounds? In their research, Zulkowski, Ayello, and Wexler determined significant differences between nurses certified as wound specialists by the Wound Ostomy Continence Nursing Certification Board (WOCNCB) and the American Academy of Wound Management (AAWM) and nurses not certified in wound care or any nursing specialty.¹ This substantiates former research by Ayello et al that provides evidence that those nurses certified by an accredited provider, perform at a higher level than those who are not.

What’s the Difference Between Certification and Accreditation?

  Certification is granted to individuals who successfully go through a set of standards, which might include a written, practical, and/or oral exam following a course of study or a portfolio that shows a higher degree of specialty practice. Certification concentrates particularly on the person taking the exam and is a mark of existing knowledge in a specialized field. Keep in mind however, the available tests and credentials do not measure competency, only knowledge.

  Accreditation is achieved once a certifying or educational program encompassing widespread assessment and evaluation by a separate and external objective review method has successfully taken place. Accreditation reflects the attainment of an echelon of superiority and deems the program as one that possesses quality in accordance with industry standards. Institutions of learning and educational curriculum can differ broadly in their nature, arrangement, and properties and strive to attain accreditation as a gauge, and evidence of their program's value, certifying programs are similar.

  Be aware of any program or credential that is not accredited and has simply ‘applied for accreditation’ or is a ‘member’ of an accrediting body. Accreditation is earned by a certifying or educational program after extensive review by an external review process and approval by an independent accrediting organization. This organization assists the candidate in ensuring that the program meets a set of high standards and the credentials earned from this program have the backing and the strength of this approval³. Accreditation reflects the achievement of a level of excellence, and marks the program as one of superiority according to industry standards³. Accreditation shows that the credentials given by a qualified program are based on a valid and reliable testing process.³ It means that the structures in place to administer the examinations meet—even exceed the standards of the certification industry from an unbiased and legally defensible perspective protecting the student and ultimately public health³. Only two wound care credentials are currently accredited and widely accepted within the industry.

  When seeking a legitimate wound care credential, it is crucial to be conscious of programs and exams that claim a ‘high pass rate.’ An elevated degree of passing scores can potentially cause concern among psychometricians (test development experts) as to the capacity of the exam actually measuring the expertise of the individual and to the validity of the exam. Psychometrics is the science and technology of mental measurement, which includes psychology, behavioral science, education, statistics, and information technology⁴. With regard to test design, psychometrics is used to measure knowledge, abilities, and the capacity of the exam to justly assess the examinees competencies. This routine therefore increases the passing rate, but does not necessarily equate to a superior exam or process. In addition, any programs that ‘teach to an exam’—a practice that is not synonymous with psychometrics—is considered a conflict of interest.

  The following represent the two accredited certifying boards for wound management: American Academy of Wound Management (AAWM) www.aawm.org.

  Established in 1995, the AAWM is a not-for-profit, national, multidisciplinary certifying board for healthcare professionals involved in wound management. The AAWM is independent from any membership or educational organization and accredited by the National Commission for Certifying Agencies (NCCA), which is the accreditation body of the National Organization for Competency Assurance (NOCA). The AAWM is a full voting member of the NOCA. The AAWM strives to write questions at multiple levels of cognitive domain so that the test is not just pure recall. Additionally, the board does not endorse any textbooks, journals, educational materials, or teach or sanction any course that teaches to the test.

  In order to be eligible to take the CWS® exam, the applicant must:
    • Possess a minimum of a bachelor’s degree.
    • Hold the license or designation as one of the following: MD, DO, DPM, PA, DMD, or equivalent, VDM or equivalent, RN, PT or OT.
    • Document three years of clinical wound care related experience including direct patient care.

  The CWS exam requires self-preparation. The AAWM does not generate or endorse any educational programs, seminars or review courses. Several wound care conferences, seminars, and courses are available to the wound care professional, including those qualified and endorsed by the American College of Certified Wound Specialists (ACCWS). The ACCWS is a membership organization that functions as the educational resource and advocate for those who have achieved the CWS and the CWCA. Among its numerous member benefits, the ACCWS qualifies and endorses preparatory courses that can assist the examination candidate in preparation for the CWS examination and offers educational programming. Additionally, several current wound management textbooks are recommended for self-study and test questions may come from these texts as well as industry journals and literature. A blueprint of the exam subject materials can be found in the AAWM Candidate Handbook online.

  The AAWM’s National Examination for Board Certification in Wound Management is computer-based and held each April and October at testing centers nationwide. Applicants for certification must achieve a passing score on the 200-question, multiple-choice examination. Multidisciplinary questions cover general knowledge, anatomy, pathophysiology, diagnosis, physiology, therapeutics, and psychosocial topics. A minimum of 6 contact hours of continuing education in wound management are required each year to remain certified. Re-certification must be accomplished every 10 years.

  Wound, Ostomy and Continence Nursing Certification Board (WOCNCB) www.wocncb.org

  Established in 1978, The Wound, Ostomy and Continence Nursing Certification Board (WOCNCB) sets, maintains, and evaluates national standards for certification and re-certification in wound, ostomy and continence care nursing. The WOCNCB is a distinct and financially independent organization from the WOCN Society and from any of the specialty educational programs. The following certifications are available for registered professional nurses only.

  Wound Care Certifications Offered by the WOCNCB include:
    • CWOCN® - Certified Wound, Ostomy, Continence Nurse
    • CWCN® - Certified Wound Care Nurse
    • CWON™ - Certified Wound Ostomy Nurse
    • CWOCN-AP™- Certified Wound Ostomy Continence Nurse Advanced Practice
    • CWCN-AP™ - Certified Wound Care Nurse - Advanced Practice
    • CWON-AP™ - Certified Wound Ostomy Nurse - Advanced Practice

  Similar to the AAWM, the WOCNCB certification examinations are all accredited by the National Commission for Certifying Agencies, which is the accreditation body of the National Organization for Competency Assurance (NOCA). The WOCNCB is a full voting member of the NOCA. In addition, the WOCNCB has established accreditation status from the American Board of Nursing Specialties (ABNS). The ABNS is the exclusive accrediting source specifically for nursing certification.

  To be eligible to take the WOCNCB® examination(s) an applicant must accomplish the following requirements:

  Current licensure as a Registered Nurse (RN), and
    1. Hold a bachelor’s degree, and
    2. Fulfill one of the following requirements:
      a. Accredited Education Program Track—Complete a WOC Nursing Education Program that is accredited by WOCN.
      b. Graduate Level Track—Complete a graduate-level program in nursing with documentation of graduate clinical course work equivalent to 2 semester hours in each specialty for which certification is sought.
      c. 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 five 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.

  Training courses for the certification exam(s) are offered at nine educational programs throughout the United States. Further details on these curriculums can be found at Wocncb.org. Some programs present the opportunity to participate solely in the wound care specialty track individually in preparation for certification.

  A number of the Wound, Ostomy, and Continence educational programs publish review books in preparation for the certification exam. The WOCN Society often offers a certification preparation course associated with their annual conference. The WOCNCB also offers an online self-assessment examination (SAE), which provides practice and preparation for the certification exam.

  The computer-based certification exam is offered in quarterly cycles at testing centers across the US. The test consists of multiple-choice questions and is based on recall and application of specialty-related practice principles, as outlined on the published content outline. The exam outline is based on a role delineation/job analysis which is conducted on a regular basis by the testing company to assure that current, evidence–based practice is reflected by test questions.

  The earned WOCNCB credentials are awarded for a 5-year period. Candidates may recertify via one of two methods, re-examination or the Professional Growth Program that includes submission of a portfolio with specific specialty-related pieces of continuing education, programs/projects, research, publication, teaching, professional organization leadership, and/or academic education.

A Note About Physician Only Wound Care Certification

  Although the American Academy of Wound Management’s (AAWM) Certified Wound Specialist (CWS) exam is a multidisciplinary accredited exam that is available for physicians (including surgeons and podiatrists), nurses, therapists, and other allied health professionals with a minimum of a Bachelor’s degree, interest in the expansion of a physicians only exam is being developed and pursued (www.aawm.org). In addition, the American Professional Wound Care Association (APWCA) (www.apwca.org) is also producing a physician specific exam and recently conducted their pilot test. The development of these physician exams is a first step toward the long-term goal of achieving specialty recognition of wound care by the American Board of Medical Specialties, American Osteopathic Association, and the Council of Podiatric Medical Education. Visit their respective websites for more information.

Wound Care Certification for Those Who Do Not Possess a Bachelor’s Degree

  There are two organizations that offer certification, although neither has attained accreditation), for those possessing less than a Bachelor’s degree. One is the American Academy of Wound Management’s (AAWM) (www.aawm.org) Certified Wound Care Associate (CWCA) exam and credential. This is the same organization that offers the CWS, the only accredited multidisciplinary certification in wound care. The National Association of Wound Care (NAWC) (www.nawccb.org) also offers an exam for individuals who do not possess a Bachelor’s degree, in their Wound Care Certified (WCC) credential.

  For the purposes of this article, only the accredited programs, those offered by the American Academy of Wound Management (AAWM) and the Wound, Ostomy, and Continence Nurses Society Certification Board (WOCNCB) are covered in detail. Information about the non-accredited exams many be accessed online at the previously mentioned websites.

Certification or Bust

  If you are considering certification, your first steps include investigating the requirements of each credential and the process to become certified. Explore the respective websites, sign up and embark on your course of study. Becoming certified by an accredited wound management organization is not necessarily easy, but what endeavor that enriches your career and self-satisfaction is?

  Since a non-accredited program may not meet minimum professional requirements, Bachelor’s prepared clinicians who are interested in pursuing board certification in wound management have two accredited certification options, the Certified Wound Specialist (CWS) exam, administered by the American Academy of Wound Management and given to multidisciplinary clinicians and the Wound, Ostomy, and Continence Nurses Society’s six certified designations, for registered nurses only. Why not get started today on a journey that can last a lifetime?

  Cynthia A. Fleck, RN, BSN, MBA, ET/WOCN, CWS, DNC, DAPWCA, FACCWS is a certified wound specialist and dermatology advanced practice nurse, writer, speaker, President and Chairman of the Board of the American Academy of Wound Management (AAWM), Member of the Board of Directors of the Association for the Advancement of Wound Care (AAWC), and Vice President, Clinical Marketing for Medline Industries, Inc. Advanced Skin and Wound Care Division. She can be reached at cfleck@medline.com.

References

1. Zulkowski K, Ayello EA, Wexler S. Certification and education: do the affect pressure ulcer knowledge in nursing? Adv Skin and Wound Care, 2007;20(1):34-38.

2. Ayello EA, Baranoski S, Salati DS. A survey of nurses’ wound care knowledge. Adv Skin Wound Care. 2005;18(5 Part 1):268-278.

3. Rappl LM, Fleck CA, Hecker D, Wright KD, Fredericks C, Mrdjenovich D. Wound care organizations, programs and certifications, an overview. Ostomy Wound Manage. 2007;53(11):28-39.

4. The NOCA’s Basic Guide to Credentialing Terminology, October 2006. www.noca.org accessed October 8, 2007.