The relationship between direct-care RN specialty certification and surgical patient outcomes

AORN J. 2014 Nov;100(5):511-28. doi: 10.1016/j.aorn.2014.04.018. Epub 2014 Oct 25.


Specialty certification enhances patient safety in health care by validating that practice is consistent with standards of excellence. The purpose of this research was to explore the relationship between direct-care, specialty-certified nurses employed in perioperative units, surgical intensive care units (SICUs), and surgical units and nursing-sensitive patient outcomes in SICUs and surgical units. Lower rates of central-line-associated bloodstream infections in SICUs were significantly associated with higher rates of CPAN (certified postanesthesia nurse) (β = -0.09, P = .05) and CNOR/CRNFA (certified nurse operating room/certified RN first assistant) (β = -0.17, P = .00) certifications in perioperative units. Unexpectedly, higher rates of CNOR/CRNFA certification in perioperative units were associated with higher rates of hospital-acquired pressure ulcers (β = 0.08, P = .03) and unit-acquired pressure ulcers (β = 0.13, P = .00), possibly because of a higher risk of pressure ulcers in the patient population. Additional research is needed to clarify this relationship. Our findings lend credence to perioperative, SICU, and surgical nurses participating in lifelong learning and continuous professional development, including achievement of specialty certification.

Keywords: CAPA; CNOR; CPAN; CRNFA; certified ambulatory perianesthesia nurse; certified nurse operating room; certified postanesthesia nurse; certified registered nurse first assistant; patient outcomes; specialty nursing certification.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Certification*
  • Humans
  • Retrospective Studies
  • Specialties, Nursing*
  • Surgical Procedures, Operative*
  • Treatment Outcome*