Religion has always played a role of the balm for the soul, and regular religious participation is associated with better emotional health outcomes (Kowalczyk et al., 2020, p. 2671).

The conceptualization and measurement of religion and spirituality have new implications for physical and mental health and a higher level of well-being. Typically, scientific measures were confounded with deficiencies such as non-representative samples and directedly related constructs such as religiosity, well-being, civility, pro-sociality, and virtues (Hill & Pargament, 2003). Notably, religion and spirituality have been measured in global indices (e.g., frequency of church attendance and self-related righteousness) that do not specify how or why religion and spirituality affect health. Significantly, oversights have hindered the research on religion and spirituality across racial and ethnic communities that bear a disproportionate burden of chronic disease. An evidence-based practice of how religion and spirituality differ across minority communities may inform novel interventions to reduce health disparities (Park, 2007). 

Historic and Present-Day Definitions of Religion and Spirituality

Historical definitions of spirituality can initially be understood from the earlier writings of Hildegard of Bingen Scivias (Bingen, 1990), a visionary woman of the Western European Middle Ages whose writings focused on bringing together the Divine presence of God, the love of God, and prayer. Her self-awareness of God can be seen throughout her expressions of unique spiritual engagements through her 13 visions and walking through her profound, inspiring thoughts from the depth of her heart. Throughout her lifetime, she captured the essence of what it means to be alive in a particular space and time with a growing spiritual awareness in reaching up to God to bring forth to humankind writings and visions that help readers build a spiritual relationship with God (Bingen). In addition, Jeremy Taylor, a renowned theologian, preacher, and faithful pastor of the Anglican church in Europe circa 1663-1667, wrote down incredible discourses to impact Western Spirituality today. He clearly defines Christian spirituality formed through Scripture and praising God. He proclaimed how God impacted his spiritual worship (Taylor, 1990).

In 2017, Holt posed the most practical definitions of spirituality throughout Christian history. The underlying principle is continually revisited, as spirituality is a critical biblical word in Hebrew and Greek meaning breath, wind, and spirit. He posed a different way of thinking about spirituality across the dimensions of being, relating, and doing.

In being, because God as creator loves and values the result of his work and has made mortal human beings to share the joy of being; in relating because we could not grow up to be human being without the care of many others who make it possible for us to relate; and in doing because people express their being and their relationships and actions. (Holt, 2017, pp. 8-10).

Gilbert (2019) added that “Spiritus,” or breath, is described as the vital principle or animating force traditionally believed to be within the human being. The term vital identifies a spirit as a necessary aspect of the human being's spirit and is also recognized as the essential nature of the person, the soul. “It is clear from its roots that the spirit is at the central core of human existence" (Gilbert, 2019, p. 4).  

Although religion and spirituality are closely linked concepts, they are different. Religious practices can be found within faith-belief systems, whereas spirituality is considered a more general feeling and connectedness to the sacred. And, sacred is more clearly described as a “socially-influenced perception of either a) a divine being or object; or b) a sense of ultimate reality or that truth” (Worthington et al., 2011, p. 205) may be experienced by some people in the context of religion but not everyone. In contrast with the former Christian views on spirituality, Worthington et al. proposed four types of spirituality that include:

religious spirituality - a sense of closeness and connection to the sacred, to a higher power ascribed by a specific religion (Christian, Buddhist, Islam, and Judaism); humanistic spirituality - involves a sense of closeness and connection to humankind with feelings of love, altruism, or reflection; nature spirituality - involves a sense of closeness and connection to the environment or nature; and cosmos spirituality- involves a sense of closeness and connection with the whole of creation. (p. 205)

In essence, developing a broader knowledge of spirituality may widen one’s senses and heighten one’s own spiritual practices, which can impact health (Osorio et al., 2017).   

Research Studies on Religion/Spirituality and Health and Well-Being

Seeman et al. (2003) applied a meta-analysis comprising 51 samples from 46 studies to examine the outcomes of religious accommodative therapies and non-religious spirituality therapies. Patients in Religion/Spirituality (R/S) psychotherapies showed greater improvement than those in alternative secular psychotherapies both on psychological and spiritual outcomes. Religiously accommodated treatments outperformed dismantling-design alternative treatments on spiritual but not on psychological outcomes.  

Osorio et al. (2017) employed a randomized controlled trial consisting of an intervention group (a theoretical-practical course in Spirituality and Health) and a control group that sought to assess whether spirituality and health programs are effective interventions in teaching faster competence changes in healthcare students. A total of 49 students were evaluated in the intervention group who received higher scores on knowledge, felt more comfortable and prepared to talk about religious/spiritual beliefs with patients, more readily recognized the importance of hospital chaplains, and more frequently held the opinion that addressing spirituality is essential. An interesting critical review of the evidence was conducted with a hypothesis that links religiosity/spirituality to physiological processes. More substantial evidence was found linking Judeo-Christian religious practices to blood pressure and immune function. The strongest evidence came from randomized interventional trials supporting the beneficial psychological impact of meditation (primarily Transcendental Meditation). Overall, the hypothesis was supported that religiosity and spirituality are linked to health-related physiological processes, including cardiovascular, neuroendocrine, and immune function (Seeman et al., 2003).   

During the COVID-19 pandemic, Kowalczyk et al. (2020) conducted a study (845,000 cases in 202 countries and territories around the world with more than 41,000 deaths at that time) among 324 Polish nationals. Notably, 50.6 % male and 49.4 % female respondents (21-35 years of age) from March 13 to 16, 2020 were included in the final sample. The tool measured 10 dimensions: sex, age, education, place of residence, faith, the essence of faith in life, the practice of prayer, the importance of faith/spirituality in connection with coronavirus danger, strengthening of the faith/ spirituality in connection with the increasing coronavirus risk, and the belief that faith/spirituality will increase the sensitivity of security in times of the pandemic. The research indicated that women more often than men declared strengthening their faith/spirituality in the face of the coronavirus hazard. In conclusion, the authors hope survival strategies include faith, hope, and a sound sense of security when exposed to a threat. The COVID-19 worldwide situation can bring people together through joint prayer (Kowalczyk et al.).

In a study on stress, spirituality, and health (SSSH), the psychometric evaluation and initial validation of the SSSH Baseline Spirituality Survey demonstrated that the Spirituality Survey (SS-1) exhibited adequate-to-strong psychometric properties of construct and predictive validity (Warner et al., 2021). The 82 religion and spirituality (R/S) items assessed the following areas: religious activities, closeness to God, religious coping (both positive and negative religious coping), spiritual struggles, gratitude, and nontheistic daily spiritual experiences. Overall, the correlational findings provide solid evidence that the SS-1 scales are associated with a wide range of relative R/S attitudes, mental health, and, to a lesser degree, physical health. The tool will most likely be used in future research studies on religion/spirituality.

In another venue, Laird et al. (2017) conducted a phenomenological study that yielded 13 qualitative interviews with mothers in the Greater Boston, MA region between October 2014 and May 2015. At this time, the participants fell below the federal poverty line and met the criteria for Social Security income. The participants were asked questions about spirituality regarding motherhood, stress, or depression and about spiritual and religious practices for coping. Notably, the participants spoke about the relationships with the spirits of dead relatives and friends or with ghosts. They talked about seeing lights and having premonitions about the death of others and that relating to spirits was a part of how these participants grieve and maintain a sense of community amidst the persistent loss of loved ones (Laird et al., 2017).

Though the quality of research studies has improved in the last several years, different methodologies must be explored to capture evidence on the effects of spirituality and health. Additionally, a clearer understanding of religion and spirituality is increasingly essential to delineate the multiple pathways for evidence-based psychological and physiological health interventions that spirituality may influence. 

Propose Spirituality Self-help Strategies for Nurses

Goma Kumari, a nurse from Nepal, works in an intensive care unit. Finding hope and comfort in her religious belief and spirituality, she stated,

“I fear for my patients. I hope Krishna hears me today, for I will take care of a child, and I wish for love, peace, and joy to surround this patient and the family that provides care; yes, I truly believe that this guidance will help me to be confident and have a clear mind to do my job, to help my patient feel safe. In my nursing work, I wish to follow his (Krishna’s) path shown in Bhagavat Geeta, the path of peace and love” (Goma Kumari Bhusal Pudasaini, personal communication, October 5, 2023).

Malgorzata (Margaret) is a nurse educator with many years of teaching expertise; including a hospital-wide Resuscitation education program. She stated,

I believe in the power of prayer and miracles, but I still feel anxious that the participants will not be receptive. I fear that their response to a real-life situation may not succeed, so I pray; I pray to Divine Mercy for guidance and direction so that I can teach confidently and effectively and that my students will learn so that their patients can benefit (Malgorzata Ryndak, personal communication, November 2, 2023).

Nurses face challenges in the discharge of patient care. Spiritual Intelligence (SI) and its aspects of general thinking and doctrinal dimensions, the ability to deal with and interact with problems, self-awareness, and moral issues are emerging components of nursing intervention (Mehralian et al., 2023). To better support nurses in their total well-being, it is beneficial to provide regular training courses from experienced instructors and use various methods to incorporate SI and its role in interpersonal communication. Maslow’s hierarchy of needs indicates that this essential aspect of human nature is partly met through the practice of praying, which nurses bring to the bedside (Babula, 2023). The need to communicate one’s spirituality must be addressed. Spiritual intelligence can bring about a positive change in nursing through communication skills that establish effective relationships with supervisors, colleagues, hospital visitors, and patients. Notably, when nurses stay in touch with their spirituality, their care can immeasurably facilitate the spiritual connectedness of patients and their families, especially when patients are more acutely aware of their vulnerability.

Also, highlighted in the 2023 American Nurses Practice Issues Conference on Self-Care, nurses spent a day learning about how important it is to engage in self-care both at work and home (https://www.ana-illinois.org/events/professional-issues-conference/). Self-care involves choosing behaviors to count emotional and physical stress. The American Nurses Association Code of Ethics (American Nurses Association, 2015) indicates, “It is unethical not to attend to your self-care as a practitioner because sufficient self-care prevents harming those we serve” (Provision 5). Concerning spiritual wellness, Gilbert (2019) posed, “Only when the nurse is willing to confront his or her own spiritual issues will he or she be fully available to the patients under his or her care (p. 5). The ANA Code of Ethics Provision 5 and Gilbert’s position have a common theme relating to the care of nurses. Nurses must be able to ensure their wellness in all three facets-physical, mental, and spiritual- to provide the best evidence-based care they can provide for the ever-evolving healthcare system.

The post-COVID-19 pandemic is opening new horizons for innovative models of patient-centered care. The three million+ licensed nurses who comprise the largest segment of the healthcare workforce in the United States will rise to the challenge of securing the future of nursing and its nurses. “The Future of Nursing 2020-2030" initiative explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by healthcare reform and to advance improvements in America's increasingly complex health system (National Academies of Sciences, Engineering, and Medicine, 2021).

Author Note:
Correspondence concerning this article should be addressed to lisa.riecke@purdueglobal.edu

Abstract
The NCLEX examination serves as the defining entry point to practice for every registered nurse. The history and evolution of this exam has been influenced by historical events as well as reflecting changes in the healthcare system and the role and function of registered nurses. This is the first in a 4-part series; Pulling Back the Curtain on the NCLEX, that covers the NCLEX exam from inception to its current, Next Generation form, including the driving need to close the gap between nursing theory and practice, current state including the most recent data from NCLEX pass rates, and, finally, the implications for the future of nursing education and practice.

Next Generation NCLEX: Pulling Back the Curtain: A Year in Review
It has been over a year now since the National Council of State Boards of Nursing (NCSBN) launched the Next Generation National Council Licensure Examination (NG NCLEX) with a vision to evaluate not just nursing knowledge, but clinical judgment in the application of entry-level nursing concepts, and the results have been impressive. According to the NCSBN (2024b), as of June 2024, the total first-time NCLEX RN pass rate for U.S.-educated test takers is 93.35%, a significant increase from 79.90% in 2022. This jump raises questions about possible contributors, and in order to provide context, it’s important to consider trends over the last several years: 86.57% in 2020, a dip to 82.48% in 2021, followed by a further decline in 2022 and a rebound to 88.56% in 2023. Between 2015 and 2019, pass rates were fairly stable, ranging from a low of 84.53% in 2015 to a high of 88.29% in 2019. In addition to test format changes, there are some additional influences on pass rates that need to be considered.

Factors Impacting NCLEX Pass Rates

Impact of COVID-19 Pandemic
The year 2020 brought the beginning of the COVID-19 pandemic, which changed the healthcare landscape in many ways, including presenting significant challenges to nursing education. Nursing programs were suddenly tasked with maintaining quality instruction in an environment where much of the traditional in-person learning was shifted to online formats. In addition to the fact that virtual simulations cannot fully replicate the experience of fieldwork, increased burdens were placed on faculty and students to quickly adapt to new technologies, not to mention the stress and anxiety created by the impact of COVID-19 on family, friends, and healthcare as a whole. Overall, the pandemic had a negative effect on nursing student learning and, ultimately, on NCLEX pass rates compared to pre-pandemic levels (Austin, 2023).

Impact of NG NCLEX Format Change
The increase in the NCLEX-RN pass rates has been attributed to many factors. Primarily, the NCSBN has updated its format with the NG NCLEX model. While the traditional multiple-choice questions remain, NCSBN introduced the NCSBN Clinical Judgment Measurement Model (NCJMM) as a framework to measure clinical judgment and high-level decision-making (National Council of State Boards of Nursing, Inc. [NCSBN], 2024a). The NCJMM questions are in an unfolding case study format and emphasize the assessment of critical thinking and clinical judgment. These questions are designed to evaluate a test-takers ability to apply knowledge in a complex, real-world scenario, which is crucial for safe and effective nursing practice (NCSBN, 2024a). According to Boev (2022), who completed an analysis on some of the new question types of the NG NCLEX, the hot spot or highlighting types of questions allow for the use of cognitive skills and clinical judgment. Additionally, the case study style questions allow for partial credit for situations when students only select a portion of the correct options. NCSBN also outlines the partial credit scoring policy and gives examples of potential scoring (NCSBN, 2021).

Early notice of the upcoming NG NCLEX is another factor. NCSBN gave schools of nursing and other stakeholders early notice of these changes. In the Fall of 2017, almost six years before the release of the NG NCLEX, NCSBN released a publication, Next Generation NCLEX News, that would be published quarterly. NCSBN outlined the upcoming NG NCLEX changes and stated there would be other announcements and releases regarding the changes (NCSBN, 2017). This early communication allowed not only schools of nursing to anticipate the changes but also publishers of nursing textbooks and other nursing school content.

Impact of Curriculum Changes
This early release of the new style of questions allowed nursing schools to adjust their curriculum. Nursing education has evolved its methodologies by increasing evidence-based practice and in-person simulation-based learning. For quite some time, simulation has been identified as a method to provide nursing students with opportunities with realistic clinical scenarios that are designed to enhance critical thinking, clinical skills, and decision-making by following the CJMM. Simulations provide situations where students can encounter a clinical situation without risk to a live client and develop their clinical judgment. Nursing faculty can assess students' clinical judgment and give timely feedback (Ironside, et al., 2009).

Individual student coaching/mentoring is another factor that has been found to increase student success on the NG NCLEX. Thompson et al. (2023) found that faculty coaching for students who demonstrated a risk of failing the NCLEX helped improve student confidence as they prepared to take the NCLEX exam. Many strategies can be included in the coaching/mentoring of students, such as review of content, ways to reduce test anxiety, test-taking skills, and NCLEX test prep sessions (Thompson et al., 2023).

Conclusion
While no one factor is solely responsible for the increase in NCLEX scores, it is important to consider that some of this may be attributed to a predictable rebound from the COVID-19 decline. Additionally, early notice from the NCSBN of the NG NCLEX changes had a significant impact. It provided nursing schools with the necessary lead time to adapt to the anticipated changes and incorporate the clinical judgment measurement model into the curriculum. This new format allows NCLEX test-takers to better demonstrate critical thinking and practice readiness through application-based questions. In the next and final article in this series, we will discuss what the NG NCLEX means for the future of nursing and nursing education.

MANTENO – The Illinois Society for Advanced Practice Nursing announced the election results during the association’s 2024 annual meeting during the APRN Midwest Conference held on October 19th.

The new leadership includes advanced practice registered nurse leaders from across the state and from a variety of backgrounds.

About ISAPN:  Formed in 2002, the Illinois Society for Advanced Practice Nursing is a powerful network of advanced practice registered nurses who are committed to advancing the profession through education and political action. ISAPN is the leading voice of the approximately 14,000 advanced practice registered nurses in Illinois. To become a member of the Illinois Society for Advanced Practice Nursing, visit www.isapn.org.

I recently had the honor of representing AMSN Chicago Chapter #317 on the Q&A panel at SNAI's 75th Annual State Convention, centered around 'Igniting Your Passion in Nursing.' The topic resonated deeply as I’m currently on my own journey to reignite my passion for this field. Students shared that clinical experiences often leave them feeling overlooked by nurses, which is disheartening when they hoped these would ignite their passion. We discussed the profound impact of 2020 on our profession and how the aftermath has contributed to widespread burnout. However, I reminded them of the honor and pride that comes with being the bridge between our patients and the world. I'm grateful to have shared AMSN's insight and connected with these passionate future nurses.

Nursing continues to be a trusted profession. It is no surprise because we see nurses in different collaborative roles that effectively solidify teamwork and tirelessly promote lifelong learning. Over the years, nurses have entered uncharted workforce regions: advanced nurse practice, informatics, leadership, politics, and forensics, among others. Indeed, nursing can open a myriad of career opportunities, one of which is through specialty nursing practice. Specialty nursing carries an added responsibility and the privilege of being known as an expert in a particular nursing field. What does it take to be a board-certified operating room nurse? Or professional development practitioner? Or nurse executive?

Certification is a process by which agencies certify an individual licensed to practice a profession, like nursing, has met specific predetermined standards specified by that profession, including examination formulated by subject matter experts (Marfell et al., 2021). Certification positively affects patient care quality; for example, recent studies have shown significant associations between higher unit-level rates of specialty certification and lower rates of hospital-acquired infections, central-line-associated bloodstream infections, and ventilator-associated pneumonia (Smith et al., 2021).

The following board-certified nurses have shared some insights into their specialties. Their contributions inspire others to continue advancing the nursing profession. One such specialty and certification, the esteemed Nurse Executive (NE), is a testament to the dedication and expertise of those who hold it.

To earn the Nurse Executive (NE/NEA-BC) certification, one must have a Bachelor in Nursing (BSN) or a higher graduate degree. Verification of educational level must be submitted to the American Nurses Credentialing Center (ANCC) when first applying by sending copies of academic transcripts. The nurse must be an active and licensed registered nurse (RN) with at least 2000 hours of leadership, management, or administrative positions. Those positions must be of primary responsibility for the RN. The RN also must have at least 30 hours of continuing education (CE) credits in those areas within the former three years (Competency & Credentialing Institute, 2024a).

After paying the application fee and providing the evidence described above, the RN would take a certification exam for initial certification. For maintenance and recertification, the RN would have to apply, provide evidence of meeting requirements for recertification, and pay the fee. The NE/NEA-BC certification must be renewed every five years. The ANCC has a website where proof of meeting the maintenance requirements (i.e., CE hours, academic credits, publishing, presentations, preceptorships, and professional roles) is recorded. To renew, one must prove all the information listed for initial certification but have at least 75 hours of CE credits. There are eight other categories for renewal, and the RN must meet at least one of them. There are initial certification and renewal fees. The original application fee is $395 for non-American Nurses Association (ANA) members and $295 for ANA members. The renewal fee is $350 for non-ANA members and $250 for ANA members (Competency & Credentialing Institute, 2024a).

The Nurse Executive (NE) and Nurse Executive/ Nurse Executive NE/NEA-BC certification can work anywhere a position in nursing administration or nursing education is available. Generally, the nurse would be in an administrative position.

The NE-BC has allowed me to work in nursing and nursing education positions. It has not increased my salary per se. Still, it has allowed me to work in roles such as the interim Master of Science in Nursing (MSN) chair, program lead, course lead, and graduate nursing faculty in the Executive Leadership track.  

I would say that the NE/NEA-BC certification is not one that most non-nursing health positions recognize as readily as having a Master in Business Administration (MBA). Still, part of that relies on the RN educating others as to the importance of this certification. It was worth the time and cost when I first sat for the exam after meeting the qualifications with my BSN. It gives one confidence that they have taken a competency-based exam verifying their knowledge and skills in leadership and management roles. It strengthens our profession as well. (Deborah Adelman, personal communication, September 2024)

Another nurse specialty/certification is the Certified Nurse in the Operating Room (CNOR). Eligibility requirements to sit for the CNOR certification include holding a current, unrestricted RN license; having a part-time or full-time job in perioperative nursing, administration, education, or research; having a minimum of two years and 2,400 hours of experience in perioperative nursing, with a minimum of 1,200 hours in the intraoperative setting within the past five years; and paying the initial cost of the certification exam of $445 (Competency & Credentialing Institute, 2024b). 

The initial certification is valid for five years. After five years, the nurse must apply for renewal. One must complete 300 professional development activity points within the past five years to maintain certification. Some activities include academic study/teaching, continuing education, publishing, precepting/mentoring, participating in professional organization activities, and performing case studies. Other recertification eligibility requirements, in addition to having an active CNOR credential and current, unrestricted RN license, include working full—or part-time in perioperative nursing clinical practice, nursing education, administration, or research and have worked a minimum of 500 hours in perioperative nursing within the accrual period. Of those 500 hours, 250 must be in research, clinical practice education, or administration that impacts intraoperative patient care (Competency & Credentialing Institute, 2024b). 

I have held the CNOR certification since 2005. This certification is held by over 40,000 nurses internationally. The nurse who obtains this certification demonstrates an ongoing commitment to the care of the surgical patient and dedication to perioperative excellence. The RN who holds a CNOR can work in any perioperative setting. This can be in hospital operating rooms, ambulatory surgery centers, sterile processing services (SPS), surgical clinics, or perioperative education. I have over 25 years of operating room experience and now have a role in providing professional development to operating room staff as a Nursing Professional Development Specialist.

There are many benefits to obtaining your CNOR certification. This strengthened my dedication and passion by validating my knowledge and skills while gaining well-deserved recognition for achieving nursing excellence in patient safety. Some studies identified a direct impact on patient care. There is a direct relationship between higher rates of nursing specialty certification and lower rates of hospital-acquired pressure injuries (HAPIs), patient falls, hospital-acquired infections (HAIs), and patient mortality (Boyle et al., 2014; Boyle, 2017). In addition, my related experiences opened doors for leadership opportunities. I am the current president of the Association of Perioperative Nurses (AORN) Graue Valley Chapter and a current member of the Chicago Association for Nursing Professional Development.

One of my proudest moments as a perioperative nurse was when I was awarded my certification. I had tangible validation of all my hard work in providing the best and safest care to my patients. My certification granted me the respect of my peers with the title of “role model.” It identified me as a resource person who wants to share knowledge, support team members, and drive to be a transformational leader. Be prideful in demonstrating your knowledge. This is a tangible way to demonstrate what a wonderful nurse you are! (Arlene Miranda, personal communication, September 2024)

            Nurses can also specialize in working with patients with a physical disability or chronic illness—Rehabilitation Nursing certification (CRRN).  If you are a nurse working with individuals with physical disability or chronic illnesses toward restoring, maintaining, and promoting optimal health, you are a rehabilitation nurse.

Eligibility for the initial CRRN exam includes a current, unrestricted US, US territories, or Canadian RN license and completion of at least one of the following at the time of application: two years of practice as an RN in rehabilitation nursing within the last five years; or one year of practice as an RN in rehabilitation nursing and one year of advanced study (beyond baccalaureate) in nursing within the last five years.

The exam is offered twice a year, during June and December. To register for the exam, you must submit a complete application with payment by the deadline on the website www.rehabnurse.org. The exam costs $300 for Association of Rehabilitation Nurses (ARN) members and $460 for nonmembers. Once you have passed the CRRN exam, the certification is valid for five years (Association of Rehab Nursing, 2024a).

To renew CRRN certification, you must meet the following requirements at the time of application: have a current, unrestricted RN license, complete 1000 hours of rehabilitation nursing experience within the five-year certification period, complete at least 60 points of credit that meet the published criteria within your five-year certification period (points of credit MUST be completed within the five-year certification period, not after selected for audit). There is a fee for CRRN renewal. Applications may be submitted beginning six months before the expiration date. The application deadline is the last day of the month, three months before expiration. Applications are accepted during the final three months, with a late fee (Association of Rehab Nursing, 2024c).

When you apply for certification, you will be asked to provide contact information from two professional colleagues who can verify your rehabilitation nursing experience. One must be your immediate supervisor or another CRRN. The second can be any other colleague, such as a nurse, physician, therapist, or social worker (Association of Rehab Nursing, 2024b).

CRRN nurses generally work in a general hospital with an acute rehabilitation unit, a long-term care facility, a home health agency, an insurance company, an outpatient clinic, an educational institution, a freestanding rehabilitation facility, or a private company.

I have determined that CRRN certification has many benefits. It demonstrates my knowledge and commitment to excellence in patient care and has helped me improve patient outcomes and satisfaction. In addition, my certification, and that of others, is a factor in the accreditation criteria by agencies and distinction by the ANCC Magnet Recognition Program, and it provides me with more excellent career opportunities.

I advise other nurses who are preparing for the CRRN to look at the test blueprint online. In addition to patient care, the test includes questions on legislation affecting rehabilitation and disability, reimbursement, ethics, case management, nursing theory, and nursing research. If you do not pass the first time, take the test at the next opportunity.  (Jolene M. Simon, personal communication, September 2024)

Nursing Professional Development is yet another nursing specialty that offers certification. The Certified Nursing Professional Development Specialist (NPD-BC) works anywhere in the healthcare setting where staff education happens. This includes hospitals, clinics, long-term care facilities, nursing schools, government agencies, and public health offices, and research facilities. Nursing Professional Development Practitioners (NPDP) can be generalists (non-NPD-board certified) or specialists (NPD-BC). There is also advanced nursing professional practice certification (NPDA) (Harper et al., 2023).

To qualify for the NPD-BC certification exam, the nurse must hold a current, active RN license in a state or territory of the US or hold the professional, legally recognized equivalent in another country, hold a bachelor’s or higher degree in nursing (educational verification documents needed), have practiced the equivalent of two years full-time as a registered nurse, have a minimum of 2,000 hours of clinical practice in nursing professional development within the last three years, and have completed 30 hours of CE in nursing professional development within the last three years. The NPD-BC is active for five years when the nurse applies for renewal, meeting all the renewal requirements.

Earning the NPD-BC has many benefits for nurses. Being certified helped me improve my knowledge base and mastery of educational principles, increase my recognition and credibility by the system, leaders, and peers, and improve patient care.

Certification adds to knowledge and dedication to the profession and improves recognition and confidence. Note that the Competency & Credentialing Institute (CCI) offers a separate certification to advanced-practice NPD-BC nurses. (Beena Vallikalam, personal communication, September 2024)

The Certified Flexible Endoscope Reprocessor (CFER) is a nursing specialty that also offers certification. CFER-certified nurses work in hospitals, ambulatory surgery centers, clinics, medical device companies, and endoscopy offices. This certification is for the proper and safe processing and reprocessing of flexible endoscopes. This certification's requirements include completing 12 months of full-time employment or equivalent part-time hours processing flexible endoscopes. A manager must verify and sign this certification, and the signed document will be presented along with the examination application. This requirement can also be satisfied by completion of an Endoscopy Technician course with a minimum of eight hours and a grade of 70 percent or higher verified and signed by the instructor, and the signed document will be presented along with the examination application. If an applicant does not have any experience but working as a Sales Representative for GI/Endoscopy for at least 12 months, a verification of employment as such must be signed by the manager, and the signed document will be presented along with the examination application. The certification application fee is $128.00, valid for five years. A renewal fee of $125.00 is required, including 100 units of CE, which is comprised of college courses, chairing or serving on committees, or local and/or national level endoscopy organizations, certification test question reviewing, departmental in-service development and implementation, publishing endoscopic articles, and presentation of flexible endoscopic reprocessing educational programs. 

One significant benefit of certification is the recognition of meeting measurable competency-based standards of the profession. It also ensures safe and effective levels of practice to protect the public. It also encourages continuing education and research for the specialty, promotes accountability, and upholds identified standards in this specialty. In addition, it enhances professional credibility, validates specialized knowledge, and signifies a commitment to lifelong learning. The CFER does not require a nursing board certification. However, my Operating Room (OR) experience and my other specialty certification (CNOR) have equipped me with the knowledge and confidence to do my job better and inspire others as they continue to excel in their OR skills. (Geri Weissmann, personal communication, September 2024)

There are many other nursing specialties and certifications. This article introduces the reader to some nursing specialties and initial and renewal certification requirements. When nurses possess self-confidence because of validated expertise, it manifests in clinical judgment that leads to quicker execution of critical thinking abilities, ultimately resulting in safe patient care. Board-certified nurses reported feeling more empowered and in control of their practice. While it entails extra hard work and sacrifice, obtaining a specialty certification is well worth the effort for safe patient care and continuing professional development.

• Illinois Licensed Practical Nurse (LPN) license renewal begins in November 2024 and will go through through January 31, 2025 (https://idfpr.illinois.gov/profs/nursing.html). After renewal and payment of fee, the LPN receives an email receipt which includes a request for the licensee to participate in the workforce supply survey. We estimate it takes only five minutes to complete the survey, with the data being reported in the aggregate for use in determining nursing workforce projections and needs in Illinois. Individual responses will remain anonymous and confidential. Please share with the LPNs you work with this opportunity to participate.
• In July, IDFPR introduced virtual licensing appointments for licensure applicants seeking assistance with their applications. The Division of Professional Regulation requests that individuals seeking updates on licensure applications make virtual appointments on Wednesdays instead of visiting the Department’s Springfield office. This request is so staff are adequately prepared to address your concerns, while also ensuring the public has equitable access to appointments. Virtual licensing appointments may be scheduled via this online calendar: https://outlook.office365.com/book/FPRMBLicensingAppointments@illinois.gov/s/o7Ar2jtMUUyFCyDO8gaXsA2. Appointments are available in 30-minute intervals starting at 9am each Wednesday and ending at 4pm. Two individuals can sign up for appointments during each time slot. Appointments can be made as soon as 14 days prior to the appointment date, but cannot be made less than 48 business hours before the appointment date.
• Nurses: this webpage is for individuals who need to reactivate their license. If you need to reactivate your Illinois nurse license, please use the chart on this page to identify what fee amount is owed and which application to use. Submit the required form along with the required fee: https://idfpr.illinois.gov/dpr/license-renewal-info.html. The last step will be to print the application and instructions to complete and send along with the fee - to the Department.
• Nurses: this webpage is available for professionals looking to reinstate or restore Illinois professional licenses that expired or were placed in inactive status by the licensees: https://idfpr.illinois.gov/dpr/reactivate-your-license.html. Any other inquiries submitted via this page will NOT receive a response. The request is submitted online, with a reinstatement packet then provided for licenses which expired or went inactive less than five years ago. If you have questions, please call 1-800-560-6420.
• Please utilize the License Lookup tool (https://online-dfpr.micropact.com/lookup/licenselookup.aspx) if you do not remember your license number. Be sure to enter your type of license (“Nursing Board”), then include your first name, last name, state (Illinois) and “captcha” to find your Illinois license number.
• To print your license or download an electronic copy to your phone, just head to the IDFPR website: https://idfpr.illinois.gov/fpr-applications/getmylicense/loginprof.html.
• For U.S. residents with an Illinois nurses license seeking to change their email address, U.S. mailing address or phone number, please click on this link to update the information: https://idfpr.illinois.gov/fpr-applications/licensereprint.html. This form is not for international residents, who must download a paper form found on that same page.
• Military families: Members and Spouses who are an active duty member or whose active duty service concluded within the preceding two years before application. In addition, the Department’s dedicated Military Liaison will work with you and your military installation’s military and family support center to help you through the licensing process. Licenses issued via the Military Portability Method will only be valid while the service member is on Active-Duty, stationed in Illinois, and through the date of expiration on the license received. Learn more here: https://idfpr.illinois.gov/military.html. You may also email the Military Liaison using this email address: fpr.militarylicense@illinois.gov.
• The IDFPR “Requirements of an Internationally Educated Nurse” document is available online here: https://idfpr.illinois.gov/content/dam/soi/en/web/idfpr/renewals/apply/forms/cgfns-02.pdf. Resources include the names of Board of Nursing approved vendors for items required to apply for an Illinois nurse license.
  o Information includes that endorsing an active license from another state requires an application by Endorsement.
  o If the state of original licensure required a Credential Evaluation Service (CES) report at the time of original licensure, a CES report is not required for the Illinois licensure endorsement process.
  o An English equivalency test is not required as long as the nurse applying for Illinois endorsement took and passed the NCLEX® national licensure examination.
• An application on the overview of the nurse testing application process. Applying to sit for an exam is a dual process. Applicants apply to Continental Testing Services (CTS) and Pearson Vue to sit for the State Board Exam. Note: this is ONLY for the application for the exam and NOT for the licesure application with IDFPR. https://idfpr.illinois.gov/content/dam/soi/en/web/idfpr/forms/dpr/testing-flyer.pdf
• On the IDFPR Nurses webpage, there is a list of all 138 Illinois Board of Nursing approved RN/Registered Nurse and LPN/Licensed Practical Nurse pre-licensure nursing education programs: https://idfpr.illinois.gov/content/dam/soi/en/web/idfpr/forms/dpr/nurseschools.pdf.
• A complete copy of the Illinois Nurse Practice Act and the Rules may be found on the Division of Professional Regulation’s Nurses webpage (https://idfpr.illinois.gov/profs/nursing.html).
  or on the Illinois Nursing Workforce Center’s website (https://nursing.illinois.gov/nursing-licensure/nursing-act-rules.html).
• Applications for Full Practice Authority APRN (277) and Full Practice Authority APRN Controlled Substance (377) licenses may now be completed online. Create an account on IDFPR’s online portal (https://online-dfpr.micropact.com), select the applications, and complete and submit them to IDFPR. Find helpful checklists for completing your application here: https://idfpr.illinois.gov/dpr/professional-licensing-illinois.html.
• Complaints against any individual or entity regulated by the Division of Professional Regulation may be filed by following the instructions here: https://idfpr.illinois.gov/admin/dpr/dprcomplaint.html. For a complete list of professions licensed by DPR, please click here: https://idfpr.illinois.gov/Forms/Brochures/DPR.pdf.
• Please note: Pursuant to Illinois law (20 ILCS 2105/2105-117), all information collected by the Department during an examination or investigation of a licensee, registrant, or applicant is confidential and cannot be publicly disclosed. This includes complaints and any information collected during an investigation. Exceptions to this law exist only for law enforcement, other regulatory agencies with appropriate regulatory interest, or a party presenting a lawful subpoena. The Division of Professional Regulation online complaint form may be found here: https://idfpr.illinois.gov/admin/dpr/complaint.html.
• The purpose of the Illinois Nursing Workforce Center (INWC) is to address issues of supply and demand in the nursing profession, including issues of recruitment, retention, and utilization of nurse manpower resources. The INWC has sections with links to all levels Illinois nursing education from pre-licensure to APRN specialization, links to continuing education requirements for license renewal, links to annual IBHE and ISAC scholarships and applications during application windows, and there are reports created with data collected with past license renewal. Find those resources and more at https://nursing.illinois.gov

Per- and Polyfluoroalkyl Substances (PFAS), commonly known as "forever chemicals," are a class of over 12,000 synthetic compounds used in a variety of industrial and consumer products, including non-stick cookware, stain-resistant fabrics, firefighting foams, and food packaging. Due to their chemical structure, PFAS are resistant to breaking down in the environment, leading to widespread contamination in soil, water, and air.

Exposure to PFAS is a growing public health concern, as these chemicals accumulate in the human body over time, contributing to a range of serious health conditions. Research has linked PFAS exposure to health effects including (National Academies of Sciences, Engineering, and Medicine, 2022):

• Increased risk of kidney and testicular cancer
• Liver damage and elevated cholesterol levels
• Thyroid disease and hormonal imbalances
• Decreased vaccine response in children
• Hypertension and preeclampsia in pregnant individuals
• Impaired immune function and developmental issues

The widespread contamination of drinking water systems, agricultural areas, and consumer products has made it increasingly important for healthcare professionals to understand how to assess, manage, and educate patients on PFAS exposure. To address this need, the Alliance of Nurses for Healthy Environments (ANHE) has developed a PFAS Guidance for Clinicians Toolkit specifically designed to guide clinicians in recognizing and responding to PFAS exposure in their patients. The toolkit offers evidence-based clinical guidance and resources to support healthcare professionals in managing PFAS-related health risks.

Key Features of the PFAS Toolkit:

1. PFAS Exposure Assessment Questionnaire: A comprehensive questionnaire to help clinicians assess a patient's risk of PFAS exposure based on occupation, geographic location, and consumption of potentially contaminated food or water. This tool is critical for identifying individuals who are at the highest risk and need further testing or monitoring.
2. Clinical Testing Recommendations: PFAS testing is currently limited to a select number of chemicals, and the toolkit provides guidance on which PFAS blood tests are available and how to interpret the results. It includes a list of laboratories that can process these tests, including Eurofins, AXYS Analytical, and Quest Diagnostics, which offer reliable methods for PFAS detection. While testing helps determine the body burden of PFAS, it does not predict future health outcomes, so the toolkit also advises on how to communicate test results effectively to patients.
3. Follow-Up Care and Monitoring: The toolkit outlines recommendations for follow-up care based on PFAS exposure levels, including:

• Regular screenings for testicular and breast cancers.
• Liver function tests for patients with elevated PFAS levels due to their association with liver damage.
• Blood pressure monitoring for pregnant patients, as PFAS exposure is linked to preeclampsia.
• Lipid panels for monitoring cholesterol levels, especially in pediatric patients exposed to high PFAS levels.

1. Patient Education and Risk Reduction Strategies: Educating patients on how to reduce their exposure to PFAS is essential. The toolkit provides resources on:

• Filtering drinking water with NSF-certified filters designed to remove PFAS.
• Avoiding consumer products known to contain PFAS, such as non-stick cookware and grease-resistant food packaging.
• Understanding local advisories on the consumption of fish and wildlife from contaminated areas.

1. Advocacy and Policy Recommendations: The PFAS Toolkit also highlights the importance of advocacy in protecting public health from PFAS. It encourages healthcare providers to stay informed about regulatory developments, including the EPA's proposed regulations (2024) for setting maximum contaminant levels for PFAS in drinking water, which will be enforceable starting in 2025. Nurses and other healthcare professionals are urged to advocate for stronger protections and to support community efforts to reduce PFAS exposure.

Call to Action for Clinicians

As nurses and healthcare providers, we are on the frontlines of addressing the health impacts of environmental toxins like PFAS. By utilizing the PFAS Toolkit, clinicians can better assess patient exposure risks, provide tailored guidance, and advocate for stronger environmental health protections. Whether you work in primary care, public health, or specialty practices, understanding PFAS exposure is critical for protecting the health of our communities.

To access the ANHE PFAS Toolkit and integrate its clinical guidance into your practice, visit: https://bit.ly/4eH1FVr.

The history of nursing education is a rich tapestry that reflects the evolving societal and healthcare landscape. The roots of formal nursing education can be traced back to the early Christian era when religious orders played a pivotal role in caring for the sick and infirm. These religious communities established infirmaries and hospices where individuals, often women, received rudimentary training in nursing care.

The modern era of nursing education began in the 19th century with Florence Nightingale's pioneering efforts. Nightingale emphasized the importance of education and training for nurses. Her establishment of the first secular nursing school at St. Thomas' Hospital in London in 1860 marked a significant milestone in the formalization of nursing education (Hunt et al., 2017).

During the late 19th and early 20th centuries, nursing education underwent further transformation with the establishment of nursing schools and programs across the United States and Europe. These institutions sought to professionalize nursing by providing structured education in both theoretical knowledge and practical skills. The curricula encompassed subjects such as anatomy, physiology, hygiene, and bedside care, laying the groundwork for a comprehensive approach to nursing education (Davis, 1991). 

The early to mid-20th century saw the development of accredited nursing education programs and the standardization of nursing curricula (Hunt et al., 2017). In the latter half of the 20th century, the landscape of nursing education expanded to encompass a broader range of educational pathways, including nursing diplomas, nursing associate degrees, and nursing bachelor's degree programs. This diversification aims to meet the growing demand for well-educated nurses and to provide opportunities for career advancement within the nursing profession.

Nursing education continues to evolve in response to advancements in healthcare, technology, and patient care. There is a growing emphasis on evidence-based practice, interprofessional education, and integrating leadership and management skills into nursing curricula. Additionally, the increasing focus on lifelong learning and continuing education underscores the ongoing commitment to enhancing the knowledge and competencies of the nursing workforce.

Furthermore, nursing students acquire invaluable clinical experience through immersive training in hospitals, clinics, simulation labs, and allied healthcare facilities. This amalgamation of theoretical education and hands-on application gives nurses the expertise to administer high-caliber patient care.

In recent years, there has been a discernible shift towards elevating the educational threshold for entry into the nursing profession. The debate over the minimum education required for a professional registered nurse has been ongoing for many years. With the introduction of Magnet, a recognition of nursing excellence, many healthcare organizations and academic institutions advocate for a bachelor's degree as the minimum educational prerequisite for registered nurses. This transition reflects the mounting intricacy of healthcare provision and nurses' need to possess a profound comprehension of medical science, critical thinking insight, and leadership proficiencies.

In addition, the most recent nursing shortage has led to a breadth of programs demonstrating variations in “entry-into-practice” programs. Nursing entry-into-practice programs, also known as pre-licensure nursing programs, are designed to prepare individuals for entry-level positions in nursing. These programs are essential for individuals seeking to become registered nurses (RNs) and have historically been offered with associate and bachelor's degrees.

Associate Degree in Nursing (ADN) programs typically span two to three years and provide students with a foundational understanding of nursing principles and clinical skills (Nursing License Map, 2024). These programs often focus on preparing students for direct patient care in various healthcare settings. Upon completion, graduates are eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN) to obtain their RN licensure.

Bachelor of Science in Nursing (BSN) programs offer a more comprehensive education encompassing a broader range of subjects, including nursing research, leadership, and community health. BSN programs typically span four years and are designed to equip students with a deeper understanding of nursing theory, evidence-based practice, and critical thinking skills. Graduates of BSN programs also qualify to take the same NCLEX-RN for licensure.

Master of Science in Nursing (MSN) entry-into-practice programs, also known as direct entry or entry-level MSN programs, are designed for individuals who hold a non-nursing bachelor's degree and seek to transition into the nursing profession at an advanced level. These programs provide a streamlined pathway for career changers to obtain a master's degree in nursing and prepare for licensure as a registered nurse (RN), without first earning the BSN.

The requirements for MSN entry-into-practice programs typically include a bachelor's degree in a non-nursing field from an accredited institution. While specific academic prerequisites may vary by program, candidates are generally expected to have completed coursework in areas such as anatomy, physiology, microbiology, and statistics. Some programs may also require applicants to have completed specific prerequisite courses in natural and social sciences to ensure a strong foundation for nursing studies. Additionally, many MSN entry-into-practice programs require applicants to meet specific GPA requirements, often with a minimum GPA of 3.0 or higher. Some programs may also consider relevant work experience, volunteer activities, or personal statements as part of the application process. Letters of recommendation from academic or professional references may also be required to assess the applicant's potential for success in a rigorous nursing program. Moreover, prospective students are typically required to take the Graduate Record Examination (GRE) or other standardized tests as part of the application process. The applicant's GRE scores, academic record, letters of recommendation, and personal statement help the admissions committee evaluate the candidate's readiness for graduate-level nursing education.

Clinical experience or exposure to the healthcare field may also be advantageous for applicants to MSN entry-into-practice programs. However, it is not usually a requirement, as it demonstrates a commitment to and understanding of the nursing profession. While prior nursing experience is not a prerequisite for entry, programs may value applicants who have gained insights into the healthcare system and patient care through volunteer work, internships, or other relevant experiences. Overall, MSN entry-into-practice programs tend to be quite competitive in admission and seek candidates with a solid academic background, a genuine interest in nursing, and the potential to thrive in a rigorous graduate nursing curriculum. By meeting the program's requirements and demonstrating a commitment to the nursing profession, individuals can embark on a rewarding educational journey that will prepare them for a successful career as an advanced practice nurse. A common focus for these MSN programs is in Nursing Leadership. Most of these programs do not prepare students for advanced practice in nursing, such as the nurse practitioner or clinical nurse specialist. Graduates of these MSN entry-into-practice programs usually meet the requirements to sit for the NCLEX-RN and the Nurse Leader nursing certification.

Furthermore, accelerated nursing programs cater to individuals who hold a bachelor's degree in a non-nursing field and wish to pursue a career in nursing. These programs offer an expedited pathway to earning a Bachelor of Science in Nursing (BSN) or Master of Science in Nursing (MSN). Depending on the student’s completed prerequisites, students can complete accelerated programs in three to four semesters over a 12 to 18-month period of time.

There has been some debate over the multiple paths to becoming a professional registered nurse. However, all graduates from entry-into-practice, pre-licensure programs are prepared to sit for the same NCLEX-RN exam. Proponents of maintaining multiple entry points stress the importance of preserving opportunities for individuals to enter the nursing profession and pursue further education while working as practicing nurses. As the debate continues, healthcare, education, and policy-making stakeholders continue to explore ways to balance the need for a well-educated nursing workforce with considerations of accessibility, affordability, and diversity (AACN, 2024). Ultimately, the ongoing dialogue surrounding entry into nursing practice reflects a commitment to ensuring that all individuals entering the nursing profession are equipped to provide safe, competent, and compassionate care to patients.

In conclusion, the history of nursing education is a testament to the resilience and adaptability of the nursing profession. From its humble beginnings rooted in religious care to the development of rigorous academic programs, nursing education has continually evolved to meet the changing needs of healthcare and society. The legacy of nursing education serves as a testament to the enduring dedication of nurses to provide high-quality and compassionate care to those in need.

In late September 2024, two vibrant painting events celebrated the power of art and community in Chicago. These collaborative events, sponsored by the Academy of Medical-Surgical Nurses (AMSN) Chicago Chapter #317 and Hektoen Nurses and the Humanities, took place at the International Museum of Surgical Science, providing a therapeutic space for creativity. The "Neurographic Mocktail Sip & Paint," held on September 26th, invited participants to explore emotions and celebrate the essence of togetherness through neurographic painting under the guidance of artist Terrance Jones, who combines his creative talents with his role at Northwestern Medicine. The evening was enriched by the magical performances of Luis Carreon, a two-time award winner, who captivated attendees and enhanced the atmosphere of connection. With twelve participants creating their interpretations of bonding, the event highlighted art's ability to foster relaxation and self-expression.

The following Saturday, September 28th, the "Little Artists & Summer Colors Art Bash" welcomed over 14 young artists to a painting workshop, again led by Terrance Jones. Luis Carreon returned to delight participants, while harp music from Janelle Jansen Lake Harp School added to the joyful ambiance. Both events underscored the significance of artistic expression in building community bonds and promoting healing, leaving participants with beautiful artworks and a shared sense of unity.

Funds raised from these gatherings will benefit the Covid Memorial Fund, encouraging ongoing support in our upcoming activities. A heartfelt thank you to everyone who participated! Interested in joining us or staying tuned for future events? Reach out to Cora Palmer, MSN, CMSRN, at cjpalmer17@icloud.com to join the mailing list!