Nursing Wiki

Nursing Specialties

A nursing specialty is a defined area of practice with its own body of knowledge, its own professional association, and usually its own certification. There are more than eighty recognized in the United States, ranging from the very large — critical care, emergency, perioperative, medical-surgical — to the genuinely small, such as hyperbaric and flight nursing.

The list is not fixed and no authority maintains a definitive version. Specialties form, merge, and occasionally disappear as practice changes.

How a specialty comes into being

The pattern is consistent enough to describe. A group of nurses doing similar work in a distinct setting begins meeting and publishing. A professional association forms. The association articulates a scope and standards statement for the specialty, describing what practice in it involves. A certification examination follows, administered either by the association's own credentialing arm or by one of the large general certifying bodies. Finally the certifying body seeks accreditation, which signals that the examination is psychometrically sound rather than a membership perk.

Specialties tend to appear when a technology or a care setting creates a distinct knowledge base — the intensive care unit produced critical care nursing, dialysis produced nephrology nursing, transplantation and hyperbaric medicine each produced their own. Some are defined by population instead of setting, such as pediatric or gerontological nursing, and some by function rather than either, such as informatics, case management, legal nurse consulting, and nursing professional development.

Specialties also close. Certifications in home health nursing, faith community nursing, community health nursing, and advanced public health nursing are now maintained for renewal only, and the nursing case management credential is being wound down. A credential a colleague holds may no longer be available to sit.

Certification is not licensure

This distinction is the single most misunderstood thing about specialties, and it matters legally.

A licence is state authority to practise nursing at all. It is compulsory, it is granted by a board of nursing under a practice act, and losing it ends your career. See nurse practice acts and boards of nursing.

Certification is voluntary recognition by a private body that a nurse has met a standard beyond licensure in a defined specialty. It is not granted by the state, it does not expand scope of practice, and in most cases nothing in law requires it. A nurse without a specialty certification is not practising illegally in that specialty.

The exception is the advanced practice tier, where certification has been pulled into the regulatory structure. Under the Consensus Model, an advanced practice nurse's licence, certification, and education must match on both role and population focus, which makes national certification a de facto condition of licensure rather than a voluntary credential. See levels of nursing.

Who issues and who accredits

Certifications come from a mix of bodies. A few large ones cover many specialties: the American Nurses Credentialing Center, the credentialing arm of the American Nurses Association, offers certifications across a wide range. The American Association of Critical-Care Nurses certifies in critical and progressive care. Others are single-specialty organizations — oncology, perioperative, obstetric and neonatal, emergency, wound and ostomy, nephrology, and so on each have their own.

Two organizations are frequently confused because their names are nearly identical. The American Board of Nursing Specialties is a membership organization of certifying bodies. The Accreditation Board for Specialty Nursing Certification is the accrediting body — the only one specific to nursing certification — which reviews certification programmes against quality standards and grants accreditation for five-year terms. When a certification is described as accredited, that is usually what is meant, though some nursing certifications are instead accredited by the general credentialing accreditor used across professions.

Accreditation is worth checking. Because certification is a private market, nothing prevents an organization from selling a credential with no defensible examination behind it. Wound care and legal nurse consulting are the two areas where this happens most. See wound, ostomy, and continence nursing and legal nurse consulting.

What certification is associated with

The evidence for certification improving patient outcomes is weaker and more contested than the profession's rhetoric implies, largely because the studies cannot separate certification from the characteristics of nurses who pursue it. Certification does appear consistently in another context: the proportion of certified nurses on a unit is one of the structural measures collected as a nursing-sensitive indicator, alongside staffing levels, skill mix, and educational preparation. See nurse staffing and patient outcomes.

The specialties

By acuity and setting

By body system or condition

By population

By setting outside the hospital

By function rather than clinical area

Advanced practice is organized separately, by role and population focus rather than by specialty. See nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists, and nurse midwifery.

Sources

In this section

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