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East Dane Designer Men's Fashion. Shopbop Designer Fashion Brands. Specialty certified nurses expect higher levels of autonomy and decision-making Boyle et al. Therefore, a plausible explanation of our finding of a small—as opposed to a moderate or strong—inverse association between unit level changes over time in RN national nursing specialty certification rates and unit level changes over time in total fall rates may be an unfavorable invisible infrastructure.

Future research guided by the Expanded Conceptual Model is needed. In future research, linking patient safety and quality to specific national nursing specialty certifications which test plans include general patient safety content about risk assessment, prevention protocols, monitoring unit level patient safety data, quality improvement methods, and diffusion of innovation methods in their certifying examinations may provide more fruitful results. NDNQI hospitals electively pay to join the database and are a select sample.

NDNQI is underrepresentative of small facilities. Although about half of U. Therefore, the results are not representative of all units in U. Only critical care, step-down, medical, surgical, medical-surgical combined, and rehabilitation units were included in our study. Results may not be generalizable to other unit types. Our study is unique in examining time trend — associations between unit level RN national nursing specialty certification rates and total patient fall rates.

We found a small, statistically significant relationship that may suggest that increases in RN national nursing specialty certification rates are associated with improvements in total fall rates in acute care settings. Our finding—along with the findings of Kendall-Gallagher and Blegen , Lange et al. Supplemental digital content is available for this article.


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The work cannot be changed in any way or used commercially. The authors declare no conflicts of interest. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the funders.

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National Center for Biotechnology Information , U. Published online May 1. Accepted Apr 9. This article has been cited by other articles in PMC. Abstract Background Researchers have studied inpatient falls in relation to aspects of nurse staffing, focusing primarily on staffing levels and proportion of nursing care hours provided by registered nurses RNs.

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Objective The aim of the study was to examine the relationship over time between changes in RN national nursing specialty certification rates and changes in total patient fall rates at the patient care unit level. Methods We used longitudinal data with standardized variable definitions across sites from the National Database of Nursing Quality Indicators. Results The model indices indicated a good fit of the data to the model.


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  • Discussion Our findings may be supportive of promoting national nursing specialty certification as a means of improving patient safety. Open in a separate window. Sample Patient care units were the main units of analysis—not the individual patient or nurse.

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    RN national specialty certification rate by unit type for — Latent Growth Curve Modeling The overall model indices indicated a good fit of the data to the model: Discussion We found a small, statistically significant inverse association between unit level changes in RN national nursing specialty certification rates and unit level changes in total fall rates during — Conclusions Our study is unique in examining time trend — associations between unit level RN national nursing specialty certification rates and total patient fall rates.

    Footnotes Supplemental digital content is available for this article. Preventing falls in hospitals: A toolkit for improving quality of care. Medical-surgical nursing board certification examination test content outline. Gerontological nursing board certification examination test content outline. CRRN examination content outline.

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    Patient safety in medical-surgical units: Can nurse certification make a difference? Medsurg Nursing , 22 , 26— 32, Falls among adult patients hospitalized in the United States: Journal of Patient Safety , 9 , 13— The relationship between direct-care RN specialty certification and surgical patient outcomes.

    AORN Journal , , — The Journal of Nursing Administration , 42 , — A year cohort study of the burden and risk of in-hospital falls and fractures using routinely collected hospital data. Interventions for preventing falls in older people in care facilities and hospitals. NDNQI nursing care hours indicator. Western Journal of Nursing Research , 36 , — Interventions for preventing falls in acute- and chronic-care hospitals: A systematic review and meta-analysis.

    Journal of the American Geriatrics Society , 56 , 29— The quality of care: How can it be assessed? JAMA , , — The relationship of nursing workforce characteristics to patient outcomes. The Online Journal of Issues in Nursing , 12 , 1— Western Journal of Nursing Research Advance online publication. Unit-level time trends in inpatient fall rates of US hospitals. Medical Care , 50 , — A systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatrics Society , 61 , — The need for a national research agenda.

    Nursing Outlook , 62 , — Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling , 6 , 1— To err is human: Building a safer health system. Institute of Medicine The future of nursing: Leading change, advancing health. Future directions of credentialing research in nursing: Competence and certification of registered nurses and safety of patients in intensive care units.

    American Journal of Critical Care , 18 , — Reliability of the nursing care hour measure: International Journal of Nursing Studies , 50 , — Association with hospital Magnet status and nursing unit staffing. Effect of an acute care geriatric educational program on fall rates and nurse work satisfaction. Journal of Continuing Education in Nursing , 40 , — A measure of expertise. Nursing Management , 39 , 10— National Quality Forum Author; Retrieved from www.

    Do falls and falls—injuries in hospital indicate negligent care—and how big is the risk? A retrospective analysis of the NHS Litigation Authority Database of clinical negligence claims, resulting from falls in hospitals in England to Agreement of fall classifications among staff in U.

    Nursing Research , 62 , 74—

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