Table 2.

The overall nurse certification evidence matrix.

Themes	Meaning	Selected supportive narrative examples
Sharing resources	Resources refer to healthcare professionals with specialized knowledge, certification study guides, and co-worker study groups.	• “We can all be resources to each other. When we share resources, we can help one another and can all be [certified].” • “What I would tell them is the benefits of being certified … [Through the certification processes, events, and activities], we can create relationships, build friendships, talk to others, and say, hey, how did this work for you? How did it work for your unit or organization? So that we can bring the information back to our unit. If it worked there, then we can make it work.” • “Collaboration is a way to share knowledge as a resource.” • “As a team, we share resources. If nurses want to be certified, we [the leaders] provide them with resources, such as books, materials, and study groups. The other thing is [that] we encourage it [getting certified]. For those that get certified, we praise them and recognize them. We also advocate that, hey, [a nurse’s name] is a certified nurse now. They are a resource and can be your go-to person.” • “Our unit has a folder with resources to share if someone wants to be certified. We have the review materials saved on a G drive, like our common drive, a certification folder with all the resources nurses need to study for the exam.” • “As a nurse leader [on my unit], I believe sharing is caring and always try to create a welcoming environment for all nurses, including those who were pulled to work here.” • “As a nursing development director [in my organization], I collaborate with other hospital directors, and we share resources [at the organizational level]. If one of us finds an online session for a certain certification, we always share and communicate with our staff about upcoming study events they can attend. We also let them [nursing staff] know about the organizational offerings.”
A culture of ownership and a sense of belonging	Encouraging nurses to obtain their certification can help nurses develop an ownership mentality and a sense of belonging.	• “[As a certified nurse], I receive emails [from the certification organization] and am informed about events. I join some events and feel connected.” • “I would say peer support makes me feel a sense of belonging. So, I want to do things to help others have the same feeling too.” • “I am not certified yet, but I want to [become certified]. I want to be like my colleagues [who are certified] to belong to a professional group.” • “I want to be involved [in organizational groups]. One example is shared governance, and if I become a subject matter expert there, I can help plan the educational curriculum and teach. But, if I am not certified in that area, I cannot be part of that.” • “The organizational culture plays a big role [in promoting nurse specialty certification]. I don’t want to be the only one in the group without my [certification] badge.” • “It’s kind of going back to the [organizational] support, which can encourage me to look at my professional growth and evaluate where I am and where I want to go. Achieving certification is a good way to get to where I want.”
Mentorship and role modeling	Mentorship and role modeling are fundamental in guiding and supporting others to achieve nurse specialty certification.	• “What makes me want to be certified is to be considered a mentor in my specialty. I like to go to colleagues who are certified for advice, and I want to be a mentor for others. If others see that I am certified and engaged [at work], then that’s the opportunity for others to reach out to me for advice or help.” • “Role modeling is powerful. It’s like if others can do it, I can do it; If I do it, then others may follow too.” • “When we [nurses certified] are engaged at work, those that are not certified may reach out to us for help. One time, I had someone who came to me for advice. I shared my study materials and my experience. I also shared what the organization pays and supports, which they may not know. Sometimes, I reach out to the nurses who are not certified and ask whether they want to study together. It’s kind of walk the talk.” • “A nurse leader is a role model, a mentor, a guide, and a support person. As a leader, I need to be certified. If I encourage others to pursue certification, I’ve got to do it first. I’ve got to talk the talk and also walk the walk.” • “It is imperative for nurse leaders to have their certifications. It’s hard to be a motivator or tell somebody to get certified if they are not themselves, and there's no way around it.” • “As a unit manager, I try to get new nurses to look towards certification and to show them that, since they love this specialty, they may consider getting the certification.” • “I think my instructor in the perioperative course influenced me. She said you’ve got to get your certification. She was very nice and kind, and I wanted to be like her.”
Recognizing nurses’ efforts and accomplishments	Recognition is essential in motivating and inspiring nurses to obtain specialty certifications.	• “My organization makes it a big to-do about certified nurses. The organizational leaders understand the importance of being certified and recognize the hard work that nurses put in to be certified. They celebrate with certified nurses and set up a culture of recognition. When the nurses not certified see the celebration and the value of being certified, they want to do it too.” • “When someone’s certified, everyone on the unit will know. The nurses get certified and will have a name badge showing they are certified. The unit will celebrate with balloons and hang a plaque with their names on the wall. The nurses’ names will also appear in the organization’s Facebook group and the health system’s weekly newsletter. So, it’s a big thing to do because they want to honor and praise the nurses for their hard work to be certified.” • “My unit has a certified nurses’ wall, where all the certified nurses have a picture and a plaque. People want to be recognized and are motivated to be certified.” • “I work in a small community hospital, and the hospital didn’t promote it. Maybe it’s too inexpensive to do, and I don’t know. It would be nice if the organization could promote it and gain recognition.” • “I felt good [to be certified]. I am proud to wear that pin and badge to show everybody and tell them that I got my certification. So, I felt good, and I got to put another credential after my name, yeah.” • “The recognition makes me feel proud, empowered, and more confident. I feel empowered and self-confident to do more.” • “My organization has a professional development ladder. People can earn points by doing certain things to be promoted to a higher rank.” • “In some hospitals, individuals with certifications ranked higher, an incentive to achieve more. Some organizations reward their staff for doing above and beyond. My hospital does not do that, which may be something to look for in the future.”
Cultivating a sense of meaning, purpose, and support	Organizations can promote nurses’ inspiration for specialty certification by cultivating and co-creating purpose and meaning with their nurses. The incentives could be the necessity for professional growth, clinical ladder, clinical expertise, or financial support and incentives, such as paying for the exam, renewing certificates, and wage increases.	• “My organization pays for nurses to take review courses and certification exams to encourage nurses to be certified.” • “I think that extra incentive pay helps motivate many nurses. Like when I worked at one facility, they gave me an extra paycheck to be certified, which was nice. My current job doesn’t do anything, so I’m the only certified nurse there and can’t talk others into getting certified because they don’t see any incentives. So, I think that incentives, which can be little, might help.” • “However, not all organizations provide incentives, which differ from organization to organization.” • “For me, at this stage of my nursing career, if it does not benefit me, knowledge-wise or financially, then I don’t want to do it because there’s no value in it because it’s not worth the time to do it for me.” • “Some hospitals will do reimbursement if you pass, but you have to pay for it upfront and then take it. So, you know it’s a few hundred dollars to take the certification exam. With everyone’s personal family/life situations, some may not afford the $400 to take their certification.” • “So, without a meaningful purpose, nurses may say, well, why would I want to be certified? To be certified, I have to spend extra time studying, a few hundred dollars to get my certification, and more money to obtain extra continued education credits and renew it every few years. I can see how some people would not think that that is worth it.” • “Our organization offers vouchers for certain certifications. They have partnered with different certifying bodies and paid for everything, and the staff doesn’t have to pay anything out of pocket and just go to take that certification exam. So, removing that financial barrier is an organizational strategy.” • “Having the support of your direct leader is even more vital than having the support of, like, the whole organization because having that encouragement and recognition from your direct leader, you know, that’s the fact that nurses see every day when they come to the unit.”