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...factors, colleague relationships and benefits, will predict job satisfaction, lob satisfaction was represented by four factors: autonomy, professional status, professional growth, and time efficiency. Participants included MS nurses certified for months or more practicing mostly in three countries (Canada, Great Britain, and the United States) who anonymously completed the Misener Nurse Practitioner lob Satisfaction Scale, an overall job satisfaction rating, and demographic information. Findings indicate that colleague relationships and benefits significantly estimated organization structure and that autonomy, professional status, professional growth, and time efficiency significantly estimated job satisfaction; furthermore, organization factors such as colleague relationships and benefits significantly predict job satisfaction. Among the countries, several statistically significant differences were observed between job satisfaction factors as well as items in both organization and job satisfaction subscales. Average factor scores among the countries were mostly rated satisfactory. The International Organization of Multiple Sclerosis Nurses Executive Board plans to use the study findings to see how it needs to focus efforts as an organization toward enhancing and standardizing MS care and develop MS nurse professionalism worldwide.
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Certification for nurses is one measure of competence in specialty areas of practice (Smolenski, 2000). Nurse certification is available to registered nurses through examination within the United States (Smolenski) and in countries outside the United States (Daly & Carnwell, 2003). Certification promotes quality and effective patient care through expert knowledge and clinical skills as well as role satisfaction. Recently, certification has become available to nurses who provide specialized care to persons with multiple sclerosis (MS) and their families through the Multiple Sclerosis Nurses International Certification Board (MSNICB). MSNICB certification is highly valued by both employers and MS patients and provides formal recognition of basic MS nursing knowledge (MSNICB, 2005).
Although numerous studies document high levels of job satisfaction among certified nurses, no published study has examined job satisfaction among MS certified nurses (MSCNs) and factors that influence job satisfaction as an MSCN. MS nursing includes concepts underlying clinical practice that incorporate assessment, interventions, advocacy, education, and research. Practice settings may include rehabilitation centers, hospitals, MS centers or clinics, home or community care settings, nursing homes, pharmaceutical or other commercial facilities, and educational and research facilities (MSNICB, 2005).
Certification in a specialized area of nursing supports one's knowledge base and reflects competence, professional commitment to lifelong learning through required continuing education and recertification, and documented experience in a given specialty (Stromborg et al., 2005). Certified nurses possess increased knowledge and technical skills and feel more confident in their ability to detect and initiate early and prompt interventions when signs and symptoms of complications appear in their patients, leading to enhanced patient outcomes, health, and satisfaction. A study conducted by the Nursing Credentialing Research Coalition in North America indicated that certified nurses reported fewer adverse events and errors in patient care than before they were certified (Henley, 2000). In a systematic review of randomized clinical trials and observational studies of primary patient care, certified nurses, compared to physicians, were rated better on communication skills, completeness of the medical record, and advice on self-management (Horrocks, Anderson, & Salisbury, 2002). Continence nurse specialists practicing in Great Britain, who had received a 3-month training program on assessment procedures and evidence-based practice protocols, were rated by their patients as having excellent interpersonal skills (friendly, respectful, sensitive, trusting), technical-care skills (competent, thorough), and information-giving skills (Shaw, Williams, & Assassa, 2000). Certified nurses reported more personal growth and job satisfaction, increased consultation within their organization, higher participation in leadership activities, and greater financial benefits (Henley, 2000). MS certification provides a standard of knowledge that assists the employer, public, and members of the health professions in the assessment of nurses involved in MS care (MSNICB, 2005). Certification is an attempt to unite MS nurses worldwide through standard practices (Uccelli, Fraser, Battaglia, Maloni, & Wollin, 2004). MS nurses face similar issues when assisting people with MS in terms of treatments aimed at modifying the disease course, treating exacerbations, and managing symptoms. This leads to the rationale for establishing an internationally relevant and recognized standard of MS care through Internet resources, publications, and on-site programs.
The goal of this study was to determine the extent to which certification for MS nurses increased one's overall job satisfaction and to identify specific areas of satisfaction. Stromborg and colleagues (2005) reported that specialty certification among nurses enhanced job satisfaction and is associated with increased knowledge and skills, autonomy, sense of accomplishment, and collegiality (Tri, 1991). Increased job satisfaction resulted in improved patient perceptions of quality of care (Atkins, Marshall, & Javalgi, 1996).
Background Literature
To date, no studies have evaluated MSCN job satisfaction and factors that influence it. Studies are available that examine job satisfaction and influencing factors among other certified nursing specialty areas and advanced practice nurses (APNs). Studies that examined predictors of nurse job satisfaction frequently include noncertified nurses, certified nurses, and APNs but failed to report specific differences between these groups in terms of job satisfaction (American Board of Nursing Specialties [ABNS], 2006; Kovner, Brewer, Wu, Cheng, & Suzuki, 2006). Thus, there is a need to determine if job satisfaction of nurses holding a single license or certification differs from that of those who hold multiple certifications and/or licenses.
Distinctions Between Certified Nurses and Advanced Practice Nurses
According to the American Nurses Credentialing Center (2006), certification is based on formal educational preparation and experience in a specialty area that recognizes nurses' knowledge, skills, and abilities or competence. Eligibility requirements for MS nurse certification include a recommendation that candidates have at least 2 years of experience in MS nursing and current registered nurse (RN) licensure or the equivalent from other countries (MSNICB, 2005). MS nursing may cover clinical practice, concepts underlying clinical practice, assessment and interventions in clinical practice, advocacy, and education and research in diverse practice settings, such as rehabilitation, MS centers and clinics, hospitals, and home or community care (MSNICB, 2005).
Advanced practice nurse is a term given to a registered nurse who has met advanced educational and clinical practice requirements beyond the 2-4 years of basic nursing education. It includes nurse practitioners (NPs), clinical nurse specialists (CNSs), certified registered nurse anesthetists (CRNAs), and certified nurse midwives (CNMs; American Nurses Association [ANA], 2006). NPs and CNSs have formal clinical preparation leading to a master's degree; both CRNAs and CNMs fulfill educational preparation through post-RN certificate programs that may occur through a master's degree program (ANA). Nursing roles for APNs generally include clinical care, counseling, and patient education in their respective clinical specialties and populations. In addition, APNs may or may not prescribe medication; other roles may also include administration, research, and policymaking (ANA).
Many certified nurses hold certification in more than one area and may also hold APN licensure....
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