摘要：Objectives. I explored the underutilization of the community/public health nursing (C/PHN) credential by examining the individual characteristics of public health nurses, the value these nurses perceive for certification, the barriers they perceive to obtaining or maintaining a C/PHN credential, and their credential status. Methods. I surveyed a national sample of 655 public health nurses regarding this more than 20-year-old credential. I analyzed variables related to perceived value, barriers, and characteristics of public health nurses. Results. The perceived value of credentialing did not differ among public health nurses relative to whether they had ever had a C/PHN credential. The C/PHN credential, however, was obtained significantly more often by public health nurses in academic settings than by those working in practice settings. Conclusions. The C/PHN credential appears to be disproportionately underutilized and unknown to public health nurses in the practice community. Findings suggest, however, that utilization could be improved by increasing the credential's visibility outside of academic environments and by establishing system-level changes that provide external recognition, such as salary increases and career advancement, for specialty credentials. Several public health disciplines have developed certification or registration programs during the past century. These include the Registered Environmental Health Specialist or Registered Sanitarian (REHS/RS) credential in 1937, the Community Health Education Specialist (CHES) certification in 1989, the Public Health and General Preventive Medicine certification (for physicians) in 1983, and certification for public health nursing in the early 1980s. In recent years, discussion has increased regarding the potential benefits of a system for credentialing the general public health workforce, and indeed, the first public health credentialing exam was given in August 2008. 1 At the same time, a lack of empirical research has left the public health community divided on the perceived value, benefits, and barriers related to credentialing as an appropriate measure for ensuring a competent workforce. 2 – 5 Researchers and public health leaders involved in establishing the broader public health research agenda recognize that little substantive research has been conducted regarding the benefits of a credentialed workforce and the structures most effective for supporting the process. 3 , 6 , 7 As a result, research regarding credentialing has been made a national agenda item. 8 The limited empirical evidence regarding credentialing is largely positive, and published commentaries overwhelmingly describe it as a constructive investment. Commentaries regarding health profession–related credentialing frequently cite personal benefits for the credentialed professional such as increased job satisfaction, challenge, and personal achievement. 9 , 10 The actual research studies related to empirically measuring this, however, have been varied and inconclusive. 11 – 15 Whereas little conclusive research evidence exists regarding the value of credentialing, even less research has been conducted regarding the barriers to obtaining or maintaining a credential. Published commentaries indicate that specific barriers to credentialing include challenges related to cost, agreement on standards, workforce acceptance, and workforce diversity. 3 , 16 Only limited and inconclusive research has been conducted on these issues. 17 Several studies have profiled credentialed specialty groups 12 , 18 , 19 and have examined differences between credentialed and noncredentialed professionals. 9 , 12 – 15 , 19 , 20 None of these studies examined public health nurses, but their findings suggest the potential for relations to exist between individual characteristics of nurses or public health workers, how they perceive the value of and barriers to credentialing, and whether they are credentialed. The research literature suggests that workplace role (as a frontline staff nurse), 12 race and ethnicity (as a nonminority), 21 geographical setting (in a nonrural area), 22 age (as an older professional), 9 , 21 and education (having less-advanced education) 19 can positively affect how nurses value credentialing and might have significant positive relations with credential status. 22 As discussions related to the credentialing of public health nurses and the broader public health workforce widen, it has become even more critical to understand the perceived value of credentialing to public health workers and the factors related to what supports or hampers the utilization of specialty credentials in public health. Public health nurses have had access to a specialty credential for more than 20 years. In 2005, however, nurses recognized for their specialization in public health through credentialing faced the potential discontinuation of their credentialing process because of low participation rates. 23 No one knows exactly why this public health nursing credential has been underutilized and what this could mean for efforts to credential the broader public health workforce. To date, the Community/Public Health Nursing (C/PHN) credential has largely survived its 2005 threat of discontinuation but has not seemingly achieved its full potential for acceptance among a broad constituency of nurses in our public health workforce. Nurses make up the largest single discipline in public health, 24 and lessons can be learned from them regarding the implementation of a broader public health worker credential. Based on a review of the literature and ongoing national discussions, I designed a survey and used cross-sectional research methods to examine relations between the individual characteristics of public health nurses, the value they perceive for certification in general, the barriers they perceive to obtaining or maintaining a C/PHN credential, and their credential status. I expected that identifying apparent differences between those who obtained the credential and those who did not would help to explain some of the underutilization of this established credential.
