DO NOT DUPLICATE. Wound prevention and healing are two. Wound Care Organizations, Programs, and Certifications: An Overview FEATURE

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1 FEATURE Wound Care Organizations, Programs, and Certifications: An Overview Laurie M. Rappl, PT, CWS; Cynthia Fleck, MBA, BSN, RN, ET/WOCN, CWS, DNC, DAPWCA, FACCWS; Debbie Hecker, RN, MBA, WCC; Kathleen D. Wright, RN, MS, CWOCN, APRN; Cary Fredericks; and Donald Mrdjenovich, DPM, CWS, FACCWS The number and variety of wound care organizations and certification programs have increased considerably in recent years. Many healthcare professionals interested in pursuing certification, employers who want to hire them, and the public at large are confused about the plethora of certification designations, program names, and requirements. Some of the largest wound care organizations in the US support or develop educational programs and meetings or support credentialing programs. Two of the four largest credentialing organizations are accredited. Information about the effect of credentialing on healthcare provider knowledge and clinical skills is not available and standards are needed to help healthcare providers and employers decide which program best serves their needs. Most importantly, research to ascertain the effects of educational programs and credentialing on patient outcomes must be conducted to help improve the quality of care and substantiate the goals of the credentialing programs. KEYWORDS: education, credentialing, accreditation, wound care Wound prevention and healing are two critical aspects of patient care. Frequently, wounds are symptoms of larger underlying health issues. 1 Holistic patient assessment and treatment are needed to determine the etiology of the various types of wounds and properly implement care. Wounds have become the focus of government regulations for long-term-care, home care, and acute care. They are among the most often-litigated Ostomy Wound Management 2007;53(11):28 39 health issues. The Nursing Home Quality Initiative, 2 a Medicare program designed to help nursing homes improve their quality of care in key areas, lists pressure sores as one of five quality measures for post-acute care; low risk pressure sores, high risk pressure sores, and pressure ulcers short stay are three of the 15 quality measures for chronic care. In home health, 73.1% of patients are reported to have a wound or lesion, 34% have surgical wounds, and 6.8% have pressure ulcers. 3 Ms. Rappl is the Patient Board Member, Association for the Advancement of Wound Care (AAWC) Board of Directors; and Clinical Support Manager, Span-America, Greenville, SC. Ms. Fleck is President, American Academy of Wound Management; Nurse Board Member, AAWC Board of Directors; and Vice President of Clinical Marketing, Medline Industries, Mundelien, Ill. Ms. Hecker is Executive Director, National Alliance of Wound Care. Ms. Wright is President, Wound, Ostomy and Continence Nursing Certification Board.Ms. Fredericks is Administrative Coordinator, Dermatology Nurses Association. Dr. Mrdjenovich is Chair, American College of Certified Wound Specialists. Please address correspondence to: Laurie M. Rappl, PT, CWS, 205 Staffordshire Way, Simpsonville, SC 29681; lrappl@span-america.com. 28 OstomyWound Management

2 Under pay-for-performance in home care, pressure ulcer development will negatively affect an agency s reimbursement. 3 In an August 2007 update to the acute care inpatient prospective payment system, 4 the Centers for Medicare and Medicaid Services (CMS) cite the development of pressure ulcers as one of eight conditions that will be subject to payment reductions as of October 1, The CMS considers the development of a Stage III or Stage IV pressure ulcer to be a preventable event. The update also notes that, compared to many other conditions, a pressure ulcer is a highcost, high-volume condition. In fiscal year 2006, 322,946 Medicare patients with pressure ulcer as a secondary diagnosis were reported and their average hospital stay charge was $40,381. Therefore, healthcare professionals specializing in wound prevention and management have become sought-after employees in all areas of patient care and wound care is becoming recognized as a specialty area of practice. To further their knowledge, skills, and marketability, healthcare professionals at various disciplinary levels seek advanced training specifically related to wound care. Over time, various certifications have become available but people are confused about certification meaning, qualifications, accreditation, and whether a certified employee will meet their needs. In addition, credentialing programs often are confused with membership organizations that do not certify but provide a shared voice and professional development. This article provides an overview of currently available certification programs in order to 1) foster a better understanding of the differences between and benefits of the individual programs and certifications, 2) encourage discussion regarding the role graduates of these programs and the certifications play in the total healthcare picture, 3) assist in the selection of an appropriate program and/or certification, and 4) encourage pursuit of higher education and skill in wound care. The Difference between Accreditation and Certification Accreditation is earned by a certifying or educational program after extensive review by an external, independent accrediting body. The accrediting body determines that the program has met predetermined and standardized criteria. Accreditation reflects the achievement of a level of excellence and distinguishes the program as one of quality according to industry standards. Certifying programs can vary widely in their character, composition, and quality; they seek accreditation as a measure and testament to their worth. The National Organization for Competency Assurance (NOCA) is the national membership organization for professional certification organizations. This organization provides accreditation through its National Commission for Certifying Agencies (NCCA), the international leader in setting quality standards for credentialing organizations. 5 The NCCA has set forth a stringent and comprehensive set of criteria to evaluate certification programs. The 21 criteria are divided into five categories: 1) Purpose, Governance, and Resources, containing five Standards, 2) Responsibilities to Stakeholders, containing four Standards, 3) Assessment Instruments, containing nine Standards, 4) Re-certification, containing two Standards, and 5) Maintaining Accreditation, containing one Standard. The criteria include evaluation of bylaws, policies, and procedures; eligibility requirements; examination development; validity and reliability of the examination; examination administration and scoring; and governance by a board that is independent of education and membership organizations to prevent undue influence. Programs that meet the standards and are granted accreditation are expected to continuously improve and are required to submit an annual update to maintain their accreditation. Ostomy Wound Management 2007;53(11):28 39 KEY POINTS This article was written to help healthcare professionals interested in pursuing wound care information and certification, as well as employers interested in hiring them. The credentialing and accreditation process and the structure and goals of the largest US-based wound care organizations and credentialing organizations are described. November 2007 Vol. 53 Issue 11 29

3 Accreditation demonstrates that the credentials given by an accredited program are based on a valid and reliable testing process that the structures in place to administer the examinations meet and exceed the standards of the certification industry from a legally defensible perspective. The NCCA is to certification organizations what the Joint Commission (JCAHO) is to hospitals. Only two wound care programs are accredited by the NCCA. Certification is bestowed by a certifying program on the person who successfully meets a set of criteria, which may include examination following a course of study or a portfolio that demonstrates advancing levels of specialty practice. Certification focuses specifically on the individual and is an indication of current proficiency in a specialized field. A profession or occupation uses certification to differentiate among its members using standards based on legal and psychometric requirements. Certification bodies are subject to few if any legal restrictions from state or federal agenies. Therefore, nearly any organization can claim to be a credentialing association. The lack of a professional organization for wound care (such as the American Medical Association for physicians or the American Nurse Association for nurses) has led to the rise of various certifications and created confusion in the industry. This poses a risk to both the regulatory agencies and to the public health. Accreditation can help lessen the confusion persons interested in pursuing certification in wound care should investigate whether the credentialing program is accredited and if so, by whom. Certifying Organizations: American Academy of Wound Management (AAWM) 6 The AAWM is a national, voluntary, not-for-profit, multidisciplinary certifying board for healthcare professionals involved in wound care. It operates independent of any membership or education organization. Goal. The purpose of the AAWM is to establish and administer a certification process to elevate the standard of care across the continuum of wound management. The Academy is dedicated to an interdisciplinary approach in promoting prevention, care, and treatment of acute and chronic wounds. History and structure. Established in 1995, the AAWM was founded by experienced wound care practitioners dedicated to helping patients with acute and chronic wounds of various etiologies. The volunteer Board of Directors is an interdisciplinary panel of wound care experts and comprises practitioners, academicians, and researchers. Accreditation and quality testing oversight. The AAWM is accredited by the NCCA and is a full voting member of the NOCA. Credentials offered. Certified Wound Specialist CWS Certified Wound Care Associate CWCA Testing. The CWS and CWCA examinations are administered by the Professional Testing Corporation (PTC, New York, NY). The PTC s psychometricians assist the AAWM with a number of issues that include program development and credentialing feasibility; role delineation studies; test and item development, including conducting question writing workshops; correlation studies; and test validation. Additionally, the PTC oversees examination scoring and results. The AAWM strives to write questions at multiple levels of cognitive domain so the test is not purely recall. Additionally, the AAWM does not endorse any textbooks, journals, or educational materials, nor teach or sanction any course. Certified Wound Specialist CWS. CWS examination eligibility requirements. To be eligible to sit for the CWS exam, an applicant must 1) possess a Bachelor s degree, 2) hold a license or designation as one of the following: MD, DO, DPM, PA, DMD, or equivalent; VDM or equivalent; RN, PT or OT, and 3) be able to document 3 years of clinical wound care-related experience, including direct patient care. CWS preparation for certification. At this time, the CWS examination requires self-preparation. The AAWM does not produce/provide any seminars or review courses. A number of wound care meetings, seminars, and courses are available to wound care professionals, including those qualified and endorsed by the American College of Certified Wound Specialists (ACCWS ) (see the description of ACCWS to follow). Several current wound management textbooks are recommended for self-study; test questions may 30 OstomyWound Management

4 come from these texts as well as from industry journals. CWS examination, certification maintenance, and re-certification. The National Examination for Board Certification in Wound Management from the AAWM is held every April and October at selected testing centers nationwide. Applicants for certification must achieve a passing score on the 200-question, multiple-choice examination. Multidisciplinary questions cover general knowledge, anatomy, pathophysiology, diagnosis, physiology, therapeutics, and psychosocial topics. A minimum of six contact hours of continuing education in wound management are required each year to remain certified. Re-certification by re-examination takes place every 10 years. CWS fees. $550 first time examination fee $150 yearly maintenance fee $550 re-certification examination fee (every 10 years) Certified Wound Care Associate CWCA. CWCA examination eligibility requirements. To be eligible to sit for the CWCA exam, an applicant must have 3 years of clinical wound care-related experience including direct patient care. Applicants do not have to have a Bachelor s degree. CWCA examination, certification maintenance, and re-certification. The exam is given electronically in August and February during a 2-week period at selected testing centers nationwide. The examination consists of 150 multiple-choice items and covers the following topics: physical assessment, patient preparation, treatment, patient/caregiver education, and administration. All CWCAs are required to re-register and pay applicable fees to the AAWM annually. In addition, all CWCAs must demonstrate a minimum of 6 hours of continuing education per year in the field of wound care. Certification is valid for 10 years, with re-certification by self-assessment examination every 10 years. CWCA fees. $300 first time examination fee $150 yearly maintenance fee November 2007 Vol. 53 Issue 11 31

5 $300 re-certification examination fee (every 10 years) Website. The American College of Certified Wound Specialists (ACCWS) 7 The ACCWS is a membership organization that serves as the educational resource and advocate for Diplomate (CWS ) and Associate (CWCA ) status. Among many member benefits, the ACCWS qualifies, endorses, and offers preparatory courses that can help the candidate prepare for the CWS examination. The organization also serves as a provider and political advocateto promote to the public and wound care community an enhanced awareness and understanding of the potential impact the CWS and the CWCA can have on the general healthcare environment. The College provides education, informational resources, and research avenues to enhance the knowledge, skills, professional performance, and relationships required by health professionals to serve their patients, public, and professionals in the interdisciplinary field of wound management. History and structure. In January 2005, the AAWM Board of Directors sanctioned the foundation of the ACCWS in response to the need for an advocacy, membership, and educational arm for its Diplomates. While the AAWM functions solely as a certifying organization, the ACCWS, as an independent body, serves as the voice for those credentialed by the AAWM. The Board of Directors is wholly independent from the AAWM and any other organization. Credentials offered. Fellow of the American College of Certified Wound Specialists FACCWS Associate of the American College of Certified Wound Specialists AACCWS Honorary Fellow of the American College of Certified Wound Specialists FACCWS Eligibility requirements. Any CWS or CWCA currently credentialed by the AAWM may join to gain Fellow or Associate status within the College. An Honorary Fellow is an individual of national or international stature, selected by the Board of Directors, who has made an outstanding contribution to the interdisciplinary practice of wound management. Membership is available for industrial-level professionals who possess an interest in wound care and in promoting the goals of the College but who do not have a CWS. Fees. $ per year Website. Wound, Ostomy and Continence Nursing Certification Board (WOCNCB ) 8 The WOCNCB is the only organization that offers wound care certification exclusively to nurses. Goal. The goal of the WOCNCB is to set, maintain, and evaluate national standards for certification and re-certification in wound, ostomy and continence care nursing. History and structure. The WOCNCB was established in 1978 to promote excellence in wound, ostomy, and continence nursing through the development, maintenance, and protection of the certification process. The WOCNCB is incorporated as a distinct and financially independent entity from the WOCN and from the tri-specialty educational programs. Volunteer board members are elected by WOCNCB certificants. Certification program. The objectives of the WOCNCB certification program are to: Promote the certification program for wound, ostomy, continence, and foot care nursing practice Encourage continued professional growth in these specialized nursing practices Provide formal recognition of individuals who meet the certification requirements Identify nurses who have achieved WOC- NCB certification to employing agencies, the public, and other healthcare professionals. Accreditation. The WOCNCB certification examinations are accredited by the NCCA. The WOCNCB is a full voting member of the NOCA. In addition, the WOCNCB has earned accreditation from the American Board of Nursing Specialties (ABNS), the only accrediting body specifically for nursing certification. The ABNS adheres to a stringent and comprehensive accreditation process; the WOCNCB provided extensive documentation demonstrating that it has met the 18 ABNS standards of quality. 32 OstomyWound Management

6 Quality testing oversight. The WOCNCB contracts with Applied Measurement Professionals (AMP, Olathe, Kan) to ensure the psychometric soundness and legal defensibility of the certification exams via role delineation and job analysis research studies, exam blueprint development, item development/analysis/maintenance, exam structure and standard setting, exam administration and scoring, and score reporting and analysis. Credential(s) offered (wound and ostomy care). Certified Wound, Ostomy, Continence Nurse CWOCN Certified Wound Care Nurse CWCN Certified Wound Ostomy Nurse CWON Certified Wound Ostomy Continence Nurse- Advanced Practice CWOCN-AP Certified Wound Care Nurse-Advanced Practice CWCN-AP Certified Wound Ostomy Nurse-Advanced Practice CWON-AP In addition, the WOCNCB offers credentials in ostomy care (Certified Ostomy Care Nurse COCN ), continence care (Certified Continence Care Nurse CCCN ), and foot and nail care (Certified Foot Care Nurse CFCN ). The WOCNCB is currently exploring the feasibility of offering a new credentialing program for LPNs/LVNs or RNs with an Associate or diploma-level education. Role delineation and job analysis studies are in progress; the title or credential to be offered has not yet been determined. Eligibility requirements. To be eligible for the WOCNCB examination(s), an applicant must be currently licensed as an RN and hold a baccalaureate degree. In addition, the applicant must fulfill one of the following requirements: Accredited Education Program Track complete a WOC Nursing education program accredited by WOCN Graduate Level Track complete a graduate-level program in nursing with documentation of graduate clinical course work equivalent to two semester hours in each specialty for which certification is sought Experiential Track have 50 contact hours (CEU) over the last 5 years within each specialty for which certification is sought; have 1,500 clinical experience hours over the last 5 years within each specialty for which certification is sought. At least 375 of those hours must be completed within the year prior to certification application. Preparation for certification. Preparatory courses for the certification exam are offered at nine independent educational settings across the country. More information on each program can be found on the WOCNCB website ( Programs include distance learning through home study, online courses, and traditional onsite classroom venues. After completing a minimum of 240 hours of didactic education in the tri-specialty of wound, ostomy, and continence, students are required to complete a minimum of 160 precepted hours to facilitate application of the newly learned principles in clinical practice. Some programs offer the opportunity to complete the wound care module exclusively in preparation for certification. Graduate or continuing education credits may be available when qualified applicants complete the coursework successfully. The WOCN Society s Accreditation Council reviews and accredits specialty education programs throughout the US, promoting high quality and standardization of eligibility requirements, educational content, and preceptorships. Some WOC educational programs publish review books to help students prepare for the certification exam. The WOCN Society often offers a certification preparation course associated with their annual conference; CD-ROMs of the conference presentations are available for purchase via the website. The WOCNCB also offers an online, selfassessment examination (SAE) that provides practice and preparation for the certification exam. Examination, certification maintenance, and recertification. The computer-based certification exam is offered in quarterly cycles at testing centers across the US. Recently, the exam has been offered in Canada and Korea and requests have been made for additional test sites internationally. The multiple-choice exam is based on recall and application of specialty-related practice principles as detailed on the published content outline. The exam outline is based on a role delineation/job analysis that November 2007 Vol. 53 Issue 11 33

7 is conducted on a regular basis by the testing company to ensure that questions reflect current, evidencebased practice. Credentials are awarded for a 5-year period. Nurses can be re-certified via re-examination or the Professional Growth Program, which involves submission of a portfolio with specified specialty-related components of continuing education, programs/projects, research, publication, teaching, professional organization leadership, and/or academic education. Application fees. One specialty $300 Two specialties $350 Three specialties $400 Four specialties $450. No annual fees are requested for maintaining certification. Website. National Alliance of Wound Care (NAWC ) 9 The NAWC is both a non-profit, national multidisciplinary wound care certification board and a wound care professional membership organization. Goal. The NAWC is dedicated to the advancement and promotion of excellence in wound care through the certification of wound care practitioners in the US. The NAWC was created with the aspirations of unifying wound care providers and practitioners from different educational backgrounds in an effort to streamline the delivery of quality wound care to more patients. History and structure. The NAWC was established in 2002 through a grass roots effort led by a group of dedicated wound care professionals in the Midwest. It was incorporated as a non-profit organization for the certification of multidisciplinary wound care practitioners. The voluntary Board of Directors consists of wound care professionals representing the various disciplines of the certificant population. A subcommittee of the Board is dedicated to certification activities. Accreditation. The NAWC is a member of both the NOCA and the ABNS. The NAWC believes strongly in the value of national accreditation and is currently preparing for NCCA and ABNS accreditation. Application for NCCA accreditation will be submitted on January 31, Quality testing oversight. Psychometric services for the NAWC -administered Certification examination are provided by Alpine Testing Corporation (Oren, Utah). Wound care credential offered. Wound Care Certified WCC. Eligibility requirements. To be eligible to sit for the NAWC Certification Examination, an applicant must fulfill the following requirements: Have an active unrestricted license in one of the following healthcare professions where wound care is within the scope of practice: all levels of nurses including LVN/LPN, RN, APN/NP; therapists including PT, PTA, and OT; and physicians (MD, DO, DPM) and their assistants (PA) Prove active involvement as a licensed professional in the care of wound patients, or in management, education, or research directly related to wound care for at least 2 years fulltime or 4 years part-time and professional wound care experience within the past 5 years Successfully complete an NAWC -approved Wound Management Certification Training Course or Have current active certification with the WOCNCB as a CWCN or CWOCN or Have current active certification with the AAWM as a CWS or a CWCA. Preparation for certification. The Wound Care Education Institute ( presently is the only provider of a preparatory course for this certification. The 4-day course is offered by the WCEI at various locations around the US every week. Sample exam questions and a recommended reading list may be found in the NAWC Candidate Handbook and at Examination, certification maintenance, and recertification. The NAWC Certification Examination is offered in a paper-and-pencil format at the conclusion of each WCEI course in Skin and Wound Management, as well as at more than 1,000 LaserGrade Computer Testing Centers nationwide. Once awarded, the WCC credential is good for 5 years 34 OstomyWound Management

8 and may be renewed by re-exam, training, continuing education, or completion of the Continuing Education and Outreach Program (CEOP). Each is described in detail at Fees. Examination fee is $300, plus $30 application fee, rolled into course fee for candidates taking the course (see for course fees and applicable discounts) Re-certification fee $330 (after 5 years). Website. The Dermatology Nurses Certification Board (DNCB) 10 The DNCB is a certifying organization, independent of but affiliated with the Dermatology Nurses Association (DNA). This certification and association focuses on the practice of dermatology nursing, which encompasses all areas of skin assessment and care, including wound management. History and structure. The DNA was established as a non-profit organization in 1981 and serves its members through a national structure, regionally and locally, in the US and abroad. Licensed RNs, LPNs/licensed vocational nurses, and individuals involved or interested in the care of the dermatology patient are eligible for membership in the association. Accreditation. The DNCB is a non-accredited member of the ABNS. Credential offered. Dermatology Nurse Certified DNC. Eligibility requirements. To earn the DNC credential, the candidate must hold a current and unrestricted license as an RN in the US or Canada, have a minimum of 2 years of dermatology nursing experience as an RN, and have a minimum of 2,000 hours of work experience in dermatology nursing within the past 2 years in a general staff, administrative, teaching, or research capacity. Preparation for certification. The DNA offers a variety of study tools to help nurses prepare for the exam, including a core curriculum textbook, computer software, self-assessment tools, and full-day course and symposiums, including one held at the DNA s annual conference. Examination, certification maintenance, and recertification. The certification process involves meeting the eligibility criteria and passing a multiplechoice written examination consisting of 200 case-scenario questions. Certification is valid for 3 years. Nurses may be re-certified through continuing education credit contact hours or by examination. Fees. $175 for DNA members $250 for non-members Website. Membership Associations Although not specifically educational or certification organizations, the following membership associations are excellent resources for clinical information and networking in the wound care arena. American Professional Wound Care Association (APWCA) The APWCA is a membership organization incorporating the various medical specialties involved in treating complex wounds. The mission of the Association is to help decrease the rate of complications from all wounds, including acute, chronic, postsurgical, post-radiation, reconstructive, and other problematic wounds. The Association s goal is to accelerate wound healing and preserve and/or enhance the quality of life for these patients. The APWCA hosts a yearly conference in the Spring and endorses the journal, Advances in Skin and Wound Care. Association for the Advancement of Wound Care (AAWC) Headquartered in the US, the AAWC is a non-profit, international multidisciplinary organization for wound care. This organization is open to everyone involved in wound care, including clinicians, patients and their lay caregivers, facilities, industry, students, retirees, and others interested in the care of wounds. The AAWC was founded in 1995 to spread wound awareness by promoting excellence in education, clinical practice, public policy, and research. Originated by HMP Communications, the AAWC is now an independent, freestanding organization with a volunteer Board elected by the membership. The yearly meeting of the AAWC is the Symposium on Advanced Wound Care (SAWC), held in the Spring. Ostomy Wound Management and WOUNDS are the official journals of the AAWC. November 2007 Vol. 53 Issue 11 35

9 TABLE 1 CONTINUING EDUCATION PROGRAMS AND WOUND CARE SYMPOSIUMS Symposium on Advanced Wound Care: WOCN Annual Conference: Clinical Symposium on Advances in Skin and Wound Care: The Wound Healing Society Annual Educational Symposium and Exhibition: The American Professional Wound Care Association (APWCA) Annual National Symposium: The Annual Wound Care Congress: Wild on Wounds (WOW) Symposium: National Alliance of Wound Care (NAWC ) In January 2007, the NAWC launched its membership organization to provide educational, research, and advocacy opportunities to members. The Alliance is open to WCC certificants and to all other wound care professionals and corporations doing business in the field of wound care. The NAWC endorses Advances in Skin and Wound Care. Wound Ostomy Continence Nurses (WOCN) The WOCN is a professional, international nursing society of more than 4,000 nurse professionals who are experts in the care of patients with wound, ostomy, and continence problems. Membership also is open to students, corporate colleagues, and all individuals who share the mission and goals of the Society. Founded in 1968, the WOCN supports its members by promoting educational, clinical, and research opportunities to advance the practice and guide the delivery of expert healthcare to individuals with wounds, ostomies, and incontinence. The WOCN hosts its yearly national conference in June, with regional conferences throughout the year. The WOCN publishes the Journal of Wound Ostomy Continence Nursing. Dermatology Nurses Association (DNA) The DNA is a professional nursing organization comprised of a diverse group of individuals committed to quality care through sharing knowledge and expertise. The core purpose of the DNA is to promote excellence in dermatologic care. Membership is comprised of RNs, NPs, LPN/LVNs, medical assistants, and other associate members. Categories of membership include Nurse Member, Associate Member, Senior Member, Honorary, Lifetime, and Corporate. The DNA hosts a yearly conference and offers many member benefits, including its official journal, Dermatology Nursing. Continuing Education Programs Various continuing education (CE) programs covering an array of wound management topics are offered throughout North America. Some are offered onsite at particular facilities or hospitals or offsite as partial-day, full-day, or week-long seminars. Other CE offerings are virtual and/or accessible online. Wound care meetings and educational symposia scheduled around the country and throughout the year provide opportunities to learn the latest techniques, stay abreast of the state of the science, and see new wound-related products. Some of the better-known programs are listed in Table 1. Discussion Each of the certification programs discussed fulfills a need in the wound care arena. All certifications are highly valued but, considering differences in the level of preparation and knowledge/experience required, instruction, and program accreditation and structure, these programs are not equivalent (see Table 2). Accreditation. The accreditation process is lengthy and expensive for the applicant organization. Adhering to the accreditation process is meant to reflect that a credential meets specific, standardized, necessary, unbiased, and legally defensible criteria. 11 A program written, organized, and continuously updated by experienced and knowledgeable professionals may produce knowledgeable certificants who may or may not be certified according to accredited standards. Also, a program can be a member of NOCA without being accredited the majority of NOCA 36 OstomyWound Management

10 Credential(s) offered in wound care Examination qualifications Accreditation Primary method of examination preparation Length of certification Re-certification requirements Examination fees Established Board of directors independent from membership TABLE 2 COMPARISON OF CREDENTIALING PROGRAMS FOR WOUND CARE WOCNCB : Wound Ostomy Continence Nursing Certification Board CWOCN, CWCN, CWON, plus advanced Practice credentialing Bachelor s prepared nurses who have successfully completed a WOCN approved educational program, including 160 precepted clinical hours; alternate means of qualification described in text American Board of Nursing Specialties (ABNS) National Commission of Certifying Agencies (NCCA) Completion of one of nine programs approved by WOCN 5 years Re-examination or professional growth program $300 per certification (ostomy, wound, continence) 1978 Yes AAWM: American Academy of Wound Management CWS Certified Wound Specialist CWCA Certified Wound Care Associate CWS: Bachelor s degree or higher in a life sciences related field (MD, DO, DPM, RN, PA, PT, OT, DMD, VMD) and >3 years documented clinical wound care experience CWCA : no Bachelor s degree required; must have >3 years documented clinical wound care experience National Commission of Certifying Agencies (NCCA) Self-preparation: AACWS-recommended resources or attendance at endorsed independent education programs 10 years Examination CWS: $550 initial exam fee, $150 annual fee to maintain certification CWCA: $300 initial fee, $150 annual fee to maintain certification 1995 Yes NAWC: National Alliance of Wound Care WCC Wound Care Certified RN, LPN/LVN, PT, PTA, OT, NP, MD, PA Successful completion of a NAWCapproved wound management certification training course; current WOCNB credential (CWCN, CWOCN ), or current AAWM credential (CWS, CWCA ); 2 years full-time or 4 years part time wound care experience in past 5 years Not yet accredited Attendance at WCEI course 5 years Examination or Continuing Education and Outreach Program $330 exam fee included in WCEI course fee of up to $2, Subcommittee of membership board DNCB: Dermatological Nursing Certification Board DNC Dermatology Nurse Certified RNs from the US or Canada Not accredited Variety of tools offered curriculum textbook, computer software, selfassessment tools, full-day course, and symposiums 3 years Exam or contact hours of continuing education credit $175 if DNA member $250 non-dna member 1981 Yes November 2007 Vol. 53 Issue 11 37

11 members have not achieved accreditation. A concise discussion on credentialing terms and concepts can be found on the NOCA website in a resource document entitled, The NOCA Guide to Understanding Credentialing Concepts. 11 While lack of accreditation does not necessarily mean that a program is without quality or merit, accredited programs are considered to be of higher value and quality than non-accredited programs. External review and approval by an independent accrediting organization helps protect the public as well as student participants by ensuring that a program meets a high set of standards and that the credentials earned from this program are sound. The fact that a minority of NOCA members have achieved accreditation speaks to the difficulty of the process, the need for quality to meet high standards, and the respect accorded accreditation. The current litigious atmosphere in healthcare demands that the effect of accreditation on legal matters must be considered. NOCA, through the NCCA, is the only independent organization that accredits wound care certification programs for nurses and other healthcare professionals (the ABNS accredits only nursing programs). Therefore, NOCA could be considered as having set the industry standard for wound care. A program not accredited by NOCA might be thought to lack the minimum professional requirements. If credentials are examined during a legal matter or an employment situation, the backing of accreditation might be important to the clinician's credibility, especially when two programs are accredited. 12 However, these statements are speculative many factors impact any legal investigation. Examination. Each of the four certification programs presented includes an examination. A key part of the standards to obtain accreditation involves candidate testing. Psychometrics (defined as the science and technology of mental measurement, including psychology, behavioral science, education, statistics, and information technology 13 ) is applied to the development of the qualification exam to ensure not only that the test is a valid measurement of the candidate s knowledge and skill, but also that the test fairly assesses these competencies. Several steps are involved in the psychometric analysis of test design. To simplify: A job/practice analysis report determines the performance domains and associated knowledge or skills for the profession. Assessment instruments (the examination questions) are derived from the job practice analysis. The cut score, or the threshold for pass/fail, then is determined. Each step requires statistical analysis to progress to the next step. The cut score must be consistent with the purpose of the credential and the job practice analysis. If the cut score analysis report is performed correctly according to statistics and psychometrics, the cut score is considered to verify the minimum competency. A cut score can be too high, indicated by a low pass rate, or too low, indicated by a high pass rate. 14 A high pass rate would raise psychometric concern regarding the test s ability to rigorously evaluate the competency of the individual; hence, the validity of the results of such an exam might raise the question of whether the preparatory program teaches to the test. However, it is not the intent of the article, nor are there any data, to rate the programs, the reasons certification candidates select them, or the clinical competence of the program participants. Programs. The WOCNCB, the oldest of the certifying programs, is accredited by two respected organizations, the American Board of Nursing and NOCA through NCCA. Preparation for certification is significant and only RNs with a bachelor s degree or higher qualify for these programs. Based on the amount of coursework and the requirement of precepted experience to reinforce learned principles, the WOCN nurse is the highest trained certificant among all of these programs. Initiated in 1995, the AAWM achieved accreditation in Certification applicants must self-prepare; the Association recommends resources and preparation methods on its website. Diplomates of the AAWM who hold a CWS and Associate members with CWCAs may join the ACCWS, which also can assist in certification preparation by recommending independent educational programs that meet its criteria. Although it is difficult to compare self-preparation to the WOCNCB program, the fact that accreditation has been earned attests to the quality of the AAWM program. The test is known to 38 OstomyWound Management

12 be rigorous, so self-preparation must be thorough. Certifications are available to multidisciplinary practitioners of every level. The AAWM Board of Directors is wholly independent from ACCWS and from any membership organization. The newest of the programs, the NAWC was established in 2002 and has grown rapidly to more than 4,000 certificants nationwide. The organization provides a way for licensed clinicians at all educational levels to gain more education and to become certified in wound care. The NAWC is the only program that offers the same WCC credential to all certificants, regardless of degree. The NAWC contracts with the WCEI to provide their 4-day course for its certification candidates. It is difficult to compare the material in this 4-day class with the material in the other two programs. WCEI was started by two nurses who were originally certified by the WOCNCB. The DNCB was established in This certification is not as recognized in wound care as the other programs possibly because dermatology is commonly (but in fact, mistakenly) considered more skinthan wound-related. The DNCB is accredited by ABNS and has various tools available to assist the applicant in preparation for certification. Research to assess the effects of certification on healthcare professional knowledge and competence has not been conducted and data comparing the competence of practitioners graduating from the different programs have yet to be obtained. Most importantly, studies to ascertain the effect of certification on patient outcomes should be undertaken. The wide variations in curricula and certification passing rates makes it difficult to compare programs but competency differences between program graduates from each program could potentially impact care. Conclusion Clinicians of all levels interested in pursuing certification in wound care now have a wide variety of options requiring varying levels of commitment. It is hoped that this article provides information to allow the potential certificant to make an informed decision on the program that best suits his/her present and future needs. Both accredited and non-accredited programs serve an important purpose for dedicated wound care professionals it is up to the participant to determine which program provides the rigor, training, and status required to achieve individual goals. - OWM References 1. Sussman C, Bates-JensenB. Wound Care: A Collaborative Practice Manual for Physical Therapists and Nurses, 2nd editon. Gaithersburg, Md: Aspen Publications; Nursing home enhanced quality measures. Available at: Accessed October 9, Home Health Line s PPS Benchmarks Handbook, 6th Edition. Rockville, Md; Centers for Medicare and Medicaid Services. Available at: Accessed August 20, National Commission for Certifying Agencies: Standards for the Accreditation of Certification Programs, Available at: Accessed August 20, American Academy of Wound Management. Available at: Accessed September 30, American College of Certified Wound Specialists. 8. Wound, Ostomy, Continence Nursing Certification Board. Available at: Accessed September 30, National Alliance of Wound Care. Available at: Accessed September 30, Dermatology Nurses Certifcation Board. Available at: Accessed September 30, Durley C. The NOCA Guide to Understanding Credentialing Concepts. The National Organization for Competency Assurance. Available at: Accessed October 28, Correspondence with Richard Russell, Esq, Legal Counsel for Tennessee Health Care Association, August 20, NOCA s Basic Guide to Credentialing Terminology. October Available at: Accessed October 8, Conversation with Jim Kendzel, MPH, SPHR, Executive Director, National Organization for Competency Assurance. September 25, Additional Resource Milne C, Corbett L. Certification in wound, ostomy, or continence specialties. In: Milne C, Corbett L, Dubuc D (eds). Wound, Ostomy, and Continence Nursing Secrets: Wound, Ostomy, and Continence Secrets. Philadelphia, PA: Hanley & Belfus, Inc., 2002: November 2007 Vol. 53 Issue 11 39