By Margaret Harrison, MS, CPNP-PC, CAE, and Lori Anne Boocks
Certification for registered nurses (RNs) is voluntary, and not all employers offer financial rewards for staying certified or pay for recertification fees. While new certificant acquisition is a key focus of all boards, the ongoing challenge is retention.
For the past seven years, the renewal rate for RNs holding the Pediatric Nursing Certification Board’s (PNCB's) Certified Pediatric Nurse (CPN) credential has never dropped below 90 percent. In the past three years, the rate has reached 92 percent or above. During informal discussions, other nursing boards report RN renewal rates well below the 90th percentile, usually in the 70 percent range. The following strategies may improve retention rates in any industry’s certification program where a credential is not required for employment.
PNCB is the only nursing certification board to require an annual recertification program for RNs. Certificants recertify any time between Oct. 1 and Jan. 31 every year. This timeline, required since the exam’s inception in 1989, offers many advantages for the board and the certificant. Currently there are more than 25,000 CPNs.
- More affordable cost
- Manageable CE hour requirements
- Reduced paperwork/time burden
- Board benefits
- Current contact information: The first CPN Recert reminder e-blast for 2017 had a 99.3 percent deliverability rate
- Up-to-date demographics, practice settings and work characteristics for internal research
- Less onerous audit process for staff
In a 2017 survey that asked an open-ended question about the value of PNCB certification, staff were surprised that annual recertification emerged as an unprompted theme. Of the 15 CPNs who noted renewal among the 2,121 respondent comments, all feedback was positive and is represented by these comments:
- “It gives me a renewed sense of pride in my career. Every time I recertify, I am reminded of how much I can get out of my profession.”
- “It’s so much simpler to recertify annually instead of keeping track of a five-year Recert.”
- “This certification is more affordable with annual fees.”
Additionally, CPNs can only recertify if they hold an active, unencumbered RN license free of disciplinary incidents. The annual update ensures that attention is paid to current licensure every year.
Through feedback at various touchpoints like phone calls or conferences, staff hear from CPNs that annual recertification is perceived as rigorous and respected—that it holds them to a higher standard. Annual renewal demonstrates knowledge currency for supervisors and families.
Survey Before the Deadline
One week before 2016 recertification was due, PNCB tried a new approach for email reminders: Ask the hard questions now, not after lapsing. This “Two Quick Questions about your CPN Certification” email was sent to 1,763 CPNs who still needed to recertify.
This initiative, repeated for 2017, yields actionable information to help CPNs stay certified. From major life events to lack of access to CE, many CPN respondents described their barriers. PNCB staff were able to reach out and assist before processing lapsed certification notification. In the survey, some respondents shared that they didn’t understand they really needed to take action, thought that they had already completed recertification, or didn’t think they met the renewal requirements. Again, staff were able to contact these CPNs personally and guide them through the process. For many who received the email, this was a wake-up call to meet the deadline or prepare to lapse their credential.
Engaging from the Start
When a nurse passes the CPN exam, a pass packet includes a basic primer on the renewal requirements and an introduction to their optional online recordkeeping tool: the ReCErt Tracker. Here they can pre-load continuing education prior to submitting the renewal application to stay organized and save time on the application. New CPNs also receive a letter in August alerting them to the recertification requirement and deadline.
E-newsletters throughout the year often include renewal FAQs. In addition, CPNs frequently comment that they look forward to PNCB’s postcard announcement each year, which features a child or children, and a caption, often humorous, tied to the Recert concept.
Engagement can be a tough hurdle for certification boards that exist independent of membership organizations. After the honeymoon period of passing the exam subsides, one way to avoid the perception that a board only exists to earn renewal revenue is to develop initiatives that give back such as:
- A Certificant Appreciation Week with CE discounts and prizes
- Robust recognition of certificants, like PNCB’s Faces of Certification web feature, interviews and hospital stories
- Free materials to celebrate certification, like PNCB’s Wall of Distinction poster
- Thought leader committees like PNCB’s Institute of Pediatric Nursing to support the profession
Invoice the Employers
PNCB offers a risk-free testing program called No Pass, No Pay for employers. The employer is only billed for the exam fee when a nurse passes the CPN exam. However, if the nurse fails, he or she is permitted a second attempt, and the employer is not invoiced for any failed exam attempt. Database programming for exam billing has been adapted to include renewal billing for employers who pay for recertification too. This employer support, coupled with no out-of-pocket cost for the CPN to renew, ensures strong renewal rates. A total of 11 hospitals participated in the renewal add-on for their No Pass, No Pay contract for 2017, and 14 have submitted contracts thus far for 2018.
Mobilize the Influencers
Because the No Pass, No Pay program needs on-site facilitation by a hospital/ organization staff member at each location, PNCB stays in close contact with these nurse leaders as the recertification deadline approaches. Informing these facilitators that a certain percentage of CPNs has yet to renew 45 days prior to the deadline is a call to action. Though PNCB does not release the names of CPNs still needing to recertify, facilitators are encouraged to make announcements on their intranet, via email and at unit meetings.
PNCB’s Champion program consists of CPN ambassadors who are well acquainted with getting RNs excited about testing, but in recent years, staff added a focus on retention in communications with these highly engaged nurses. Extra copies of the popular recertification postcard were offered to Champions with hundreds of requests. These were handed out by Champions at work or posted on bulletin boards in staff lounges. In 2016, there were 175 Champions, and 97 percent reported that they spoke to RNs informally about CPN certification and renewal. Champions also have access to a private listserv to ask PNCB staff questions or discuss engagement strategies for their nurses.
Let the Data Speak
PNCB also looks for any patterns seen in the aggregate data before sharing numbers with No Pass, No Pay facilitators. For example, are a large percentage of a site’s nonrenewed CPNs new to the process? If this is a CPN’s first year to renew, he or she may want to talk with an established CPN mentor about how to meet requirements or with PNCB staff for in-depth guidance. Did a percentage of CPNs go on to graduate school and obtain PNCB’s nurse practitioner certification? Chances are they won’t renew, and this is considered normal attrition. Sharing these trends gives facilitators insight into their site’s evolving workforce and support for strengthening renewal communications.
SWOT for the Future
For many boards in a variety of industries, looming retirements, employer culture and budget cuts will impact retention rates. Staying in close contact with influencers and ambassadors helps PNCB understand the landscape within employer systems.
Listening to stakeholders and using short surveys routinely is essential. Ask certificants how they want to receive communications, and how often. For example, PNCB now asks on each recertification application if CPNs want to receive text messages. So far, the majority has responded no, but should their needs change, staff will be ready to make text reminders happen. Periodically ask employers if they are aware of your ambassador program to support credential retention and if they pay certificant renewal fees.
Besides a strong acquisition plan to offset retiree impact, how will your organization ensure that your value proposition continues to resonate with those nearing retirement age? Have a plan for analyzing retention drifts among all generations and other demographic characteristics.
Watching for trends and inviting feedback from key stakeholders can ensure that certificant renewal is just as valued as the thrill of opening that pass packet. What strategies can your certification organization consider today to ensure stability for tomorrow?
Margaret Harrison, MS, CPNP-PC, CAE, has served as PNCB’s chief executive officer since 2011 and previously served as PNCB’s executive vice president for general practice exam development from 2006 to 2011. She is a graduate of the Walter Reed Army Institute of Nursing, received her bachelor of science in nursing degree from the University of Maryland and her master’s in nursing degree from the University of Arizona. She has more than 30 years of military and civilian pediatric nursing experience as a nurse practitioner and nurse manager.
Lori Anne Boocks has served as PNCB’s director of marketing and communications since 2006. Her focus is to create and implement certificant-centric strategies that result in growth, such as the influential No Pass, No Pay testing program. Additional experience includes development of the Campaign for Pediatric Nursing to encourage students to choose a pediatric nursing career and increase gender and cultural diversity in the profession.