Perceived Value of Certification for Nurses and Nurse Managers: Updated 2026 White Paper

Abstract

Introduction:

Since the first orthopaedic nurse certification (ONC) examination in 1988, more than 16,000 nurses have earned the ONC credential, with nearly 5000 currently certified in orthopaedic nursing, advanced practice, or nurse navigation roles. Certification validates expertise in musculoskeletal care and supports improved clinical practice, professional identity, and organizational performance.

Methods:

The Orthopaedic Nurses Certification Board survey included a representative sample of over 300 orthopaedic-certified nurses. Survey items were based on the Perceived Value of Certification Tool, a validated instrument measuring intrinsic and extrinsic value. Data were collected anonymously to ensure unbiased responses and allow comparison between 2020 and 2025 survey responses. Orthopaedic-certified nurses were offered the opportunity to provide personal quotes highlighting their opinions and lived experiences as a specialty-certified nurse. Quotes represent the opinions of those individuals specifically.

Findings:

Survey results consistently demonstrated high perceived value of certification, including increased confidence, enhanced professional identity, greater autonomy, professional growth, lifelong learning, improved competence, commitment to excellence, increased marketability, additional opportunities for career advancement, and improved recognition from peers, leaders, and patients, versus the experiences of respondents before they were certified. The data collected is explained in context, as well as in comparison to the data collected in 2020 using the same survey and tool.

Clinical Outcomes:

Published research was reviewed as a part of this work. Evidence demonstrates that hospitals with higher proportions of certified nurses’ experience lower healthcare-associated infections and patient fall rates, improved patient safety metrics, and reduced mortality and failure-to-rescue rates.

Discussion:

Based on available evidence and data gathered through surveys, the role of the specialty certified nurse is discussed in context and comparison. Certification strengthens competency, accountability, and evidence-based practice adoption. Manager perspectives continue to support certified nurses as preferred hires, and health systems increasingly invest in certification support and incentives.

Conclusion:

Nursing specialty certification delivers measurable benefits to nurses, healthcare organizations, and patients. Continued support for certification advancement promotes excellence in care delivery, workforce expertise, and patient safety.

Purpose

Since the first RNs earned orthopaedic certification in 1988, over 16,000 nurses have proudly held the Orthopedic Nurse Certified (ONC) credential. Today, nearly 5000 orthopaedic-certified nurses, nurse practitioners, and clinical nurse specialists demonstrate excellence in the care of persons with musculoskeletal health concerns. Why did they choose certification? A representative sample of over 300 orthopaedic-certified nurses responded to a survey from the Orthopaedic Nurses Certification Board (ONCB) to confirm why they value their credentials and maintain specialty certification. Their answers offer compelling reasons for nurses to get, and keep, orthopaedic nursing certification. In 2020, the ONCB conducted an anonymous survey to gather this important data, and in 2025 we repeated the survey to reflect any changes in certificant perspectives since the original white paper was published.

Value for the Nurse

Attaining orthopaedic nursing certification has historically and anecdotally been identified by individual nurses as a great source of personal pride. Their answers on the Perceived Value of Certification Tool help us identify the specific reasons certified nurses prize their credentials.

Enhances Feeling of Personal Accomplishment and Confidence in Clinical Abilities

Because change in health care is a constant reality, nurses need to be prepared to contribute to and provide the highest level of care. Nurses responded to survey questions about the value of certification on a personal level, specifically indicating how orthopaedic nursing certification enhances their feelings of accomplishment and personal confidence in clinical abilities.

From the group of over 300 survey respondents, 96% strongly agreed or agreed that certification enhances feelings of personal accomplishment. Additionally, 86% strongly agreed or agreed orthopaedic nursing certification enhances their personal confidence in clinical abilities. Professional growth is seen by many in nursing as a personal responsibility. Nurses are called to prioritize continuous professional development (Mlambo et al., 2021). Achieving certification is an investment in self; studying and preparing for the certification examination offers the opportunity to increase professional knowledge and confidence. Clinical ladders offer nurses in many hospitals and health systems a path to professional advancement. Attaining and maintaining a specialty nursing certification credential, such as ONC, ONP-C, OCNS-C, or ONC-A™, may be built into the clinical ladder structure for healthcare employers. Certification has been cited by many nurses as a path to enhanced professional credibility and feelings of personal accomplishment.

“My orthopedic nurse certification demonstrates my passion to provide specialized care of our orthopedic patients. It reflects my commitment to providing safe, evidence-based, and high-quality care that improves patients’ outcomes.”—Angie LeMarr, BSN, RN, ONC

Provides Professional Challenge

Since the launch of the ONC credential more than 35 years ago, many nurses have provided insights into the intrinsic value they receive from orthopaedic nursing certification. On the 2025 ONCB survey, more than 65% of respondents indicated they strongly agree or agree that certification provides a professional challenge. Although achieving certification represents the first challenge, the certified nurse embraces continued opportunities by serving as a professional role model and valuable resource for colleagues. Certification maintenance through continued education and recertification reflects a commitment to lifelong learning that further contributes to increased confidence and personal satisfaction.

“Being a certified Orthopedic nurse has given me greater confidence within my specialty role of Orthopedic N\urse Navigation. I will be re-certifying in 2026 to continue gaining knowledge within this specialty and providing enhanced care to my orthopedic patients. It is a distinct honor to have ONC attached to my credentials that I wear proudly on my badge.”—Jessica Hughes, BSN, RN, MEDSURG-BC, ONC

Indicates Professional Growth

Nearly 300 nurses (97.3%) who completed the 2025 survey indicated they strongly agree or agree that certification indicates professional growth. Attainment of certification represents a fulfillment of professional accomplishment as nurses continue to excel in their practice. Professional growth requires a commitment to lifelong learning, including continuing education and self-study, networking with professional colleagues, professional reading, achieving specialty certification, and seeking advanced degrees (American Nurses Association, 2025b). Nurses who pursue specialty certification in orthopaedics epitomize a dedication to professional growth.

“I obtained my initial certification in 1991. It was a catalyst to lifelong learning and professional growth in orthopaedic nursing.”—Charla Johnson, DNP, RN, ONC

Enhances Professional Autonomy

In the 2020 ONCB survey, 89% of respondents indicated they strongly agree or agree that certification enhances their professional autonomy. This was true not just for advanced practice nurses, many of whom may already have autonomous practice authority, but also for registered nurses working in a wide range of practice settings. In the 2025 survey, 49% of respondents indicated that they strongly agree or agree with the statement. Autonomy does not refer only to unsupervised or independent practice; autonomy can also be realized as confidence to make decisions in practice. Certified orthopaedic nurses gain autonomy through experience, dedication, and a penchant for lifelong learning. Nurses with more experience are more likely to become certified in their specialty (Dierkes et al., 2021).

In addition to enhanced autonomy, orthopaedic nursing certification increases a sense of accountability in credential holders. Nearly 78% of survey respondents answered they strongly agree or agree that certification provides evidence of accountability in their knowledge and practice. The American Nurses Association (2025a) has identified accountability as essential for educational progression and lifelong learning, both of which are key components in nursing scope and standards of practice. Orthopaedic nursing certification helps nurses attain and maintain these important elements of nursing practice.

“The leader of our special unit was so enthusiastic, motivating and encouraging our unit to become 100% ONCs. The benefits for our patients were immeasurable … the most knowledgeable team of orthopaedic nurses caring for orthopaedic patients. The credential has given me self-confidence when interfacing with patients and their families.”—Diane Jeselskis, BSN, RN, ONC

Provides Evidence of Professional Commitment

Over 98% of nurses who responded to the 2025 ONCB survey indicated they strongly agree or agree that certification provides evidence of professional commitment. This finding is consistent with results over time from other nursing certification bodies (Pediatric Nursing Certification Board [PNCB], 2007). For example, a 2024 study into the value of certification for holistic health nurses found 96% of certified nurses believe their credentials represented evidence of professional commitment (Vital et al., 2026). Participating in a 2024 study, 107 nurses at an Orthopedic Hospital reported higher levels of certification in those with higher education and more nursing experience (Bell et al., 2024).

Finally, clinical expertise, knowledge, skill, mastery of professional issues, and competence are hallmark features of a nurse specialty certification (Coles et al., 2023). Many healthcare employers, including those that have pursued MagnetTM designation for their nursing services, also recognize the professional commitment exemplified by certified nurses. “We find that most nurses who participate in ONCB’s Retest for Success program continue to have their certification fees covered by their employers. This indicates that employers not only acknowledge the expertise that certified nurses bring to their organizations but support their nurses’ journey to elevate patient care and professional growth.”—R. Kalinga, ONCB Staff

Eligibility requirements from any certifying body typically specify a number of worked hours or years as a registered nurse in the specialty. Examination candidates or employers pay for the testing opportunity, and candidates also must dedicate time to prepare for the test. These actions represent substantial professional commitment. Examinees may not be required to have specialty nursing certification, so their voluntary action is even more commendable.

Increases Marketability

Nurses who achieve certification historically report their credentials make them more attractive to employers, patients, and clients. Leaders at an orthopaedic hospital in an academic health system surveyed post-anesthesia care unit nurses to ascertain their awareness of specialty nursing certification, identify any barriers to their becoming certified, and determine their perceived value of certification. Authors noted, “specialty nursing certification enhances professional development, improves marketability, and promotes growth for health care organizations” (Epstein et al., 2025). This position is consistent with responses to the 2025 ONCB survey, of which more than 69% of nurses indicated they strongly agreed or agreed that certification increases marketability. See “Manager Survey” for additional insights from nurse managers on the question of marketability.

The National Association of Orthopaedic Nursing has solidified its stance regarding orthopaedic nursing certification through a recently revised position statement. In the release of the position statement, Satusky (2019) noted, “Certified nurses enjoy enhanced professional credibility, increased job satisfaction and marketability” (p. 301). As part of the competency assessment in its disease-specific program, The Joint Commission (2020) also recognized the importance of certification. Part of the site visit includes a facilitated review of “relevant education, experience and training or certification” (p. 29). Because of this, many healthcare administrators actively chose to include the use of certified nurses who are experts in their field as part of their marketing endeavors. “There is a continued trend in certification verification requests. Each year, recertifying orthopaedic nurses continue to communicate to ONCB the need for immediate proof of their maintenance of certification for their employers. There has been an increase in requests directly from employers for ONCB to provide official letters of certification verification.”—R. Kalinga, ONCB Staff

More facility leaders now recognize the value of specialty nursing certification and often link it to continued employment in identified roles, receipt of a bonus, or consideration for promotion.

“I have maintained my certification over the years and it has never been a job requirement, but I do feel it has helped me stand out against my other orthopedic peers when I have applied for different nursing positions … People look up to me as an expert.”—Robin Olmstead, RN, ONC

Increases Salary

Along with marketability, salary may be an extrinsic motivator for nurses to certify and maintain certification. Results on the ONCB survey indicated that 48% of respondents indicating they strongly agreed or agreed that certification contributes to increased salary. Anecdotally, however, certified nurses have described a trend that includes increased salary or hourly differentials related to their certification. Bonuses also could be offered in the form of a one-time payment for earning certification or an annual bonus for continuing to maintain certification. Certified nurses also may be able to negotiate increased pay with a prospective employer. Based on a 2024 Nurse Salary and Work-Life Report, their base salaries are often greater than those of noncertified nurses (Nurse.com, 2024). Specifically, 36% of certified respondents said it led to higher salaries. In fact, RNs reported a $10,000 increase after earning a certification (Nurse.com, 2024).

Validates Specialized Knowledge

Of the over 300 nurses who responded to this item on the ONCB survey, 71% agreed or strongly agreed that certification validates specialized knowledge. These results are consistent with the findings of other specialty nursing certification bodies. Nursing specialty certification is “the criterion standard of professional practice, distinguishing excellence in nursing care, mastery of knowledge, skills, and abilities beyond the scope of professional licensure” (Benike & Wozniak, 2022). Certification programs such as those maintained by ONCB help to promote the highest standards of nursing practice for optimal patient care. Passing the ONC or ONP-C examination ensures the nurse has knowledge in the specialty practice of orthopaedic nursing.

“Since becoming certified, I’ve noticed greater credibility among peers, being awarded opportunities such as a travel grant to attend the NAON Annual Congress and the leadership role of chairing our Nursing Practice Council, and a renewed sense of pride in representing and uplifting fellow nurses in orthopedic care.”—Jessa Duque, RN, ONC

Indicates Level of Clinical Competence

Competency assessment is dynamic and reflects new research in the field, new equipment, and changes in practice or procedures (Mlambo et al., 2021). Nurses who choose to pursue certification not only spend time studying for an examination but also devote themselves to continued education for maintenance of certification to ensure their practice knowledge remains current. In some states, certification by a national crediting body is one way to demonstrate competence when renewing a nursing license. Of more than 300 respondents to the ONCB survey, 79% agreed or strongly agreed that certification indicates a level of clinical competence. The Accreditation Board for Specialty Nursing Certification (ABSNC, 2022) defined continuing competence as “The ongoing commitment of a registered nurse to integrate and apply the knowledge, skills, and judgement with the attitudes, values, and beliefs required to practice safely, effectively, and ethically in a designated role, patient population and/or setting” (Standard 13, Rationale). This is reflected not only in attainment of certification, but also in maintenance of certification. Recertifying nurses continue to meet requirements related to professional practice hours and continuing education as ways to demonstrate their ongoing competence.

Indicates Attainment of a Practice Standard

The American Board of Nursing Specialties (n.d.) has declared, “Specialty nursing certification is THE standard by which the public recognizes quality nursing care” (“Vision”). The value placed on certification as a mark of excellence was reflected in responses to the ONCB survey. Over 85% of nurses indicated they strongly agreed or agreed that certification gives them more confidence in their abilities than noncertified practitioners. “Ultimately, certification exams are pivotal in evaluating nurses’ competencies in vital aspects of clinical practice, facilitated by ongoing partnerships between nurses and certifying bodies” (Myers et al., 2024).

Enhances Professional Credibility

Nearly 80% of nurses responding to the 2025 ONCB survey indicated they strongly agreed or agreed that certification enhances professional credibility. Maintenance of certification validates credential holders’ expertise and enables them to maintain an innovative edge in their practice. Earning specialty nursing certification can boost confidence and allow nurses to present themselves with even more confidence in what they can bring to a care setting. The American Nurses Association (2025) noted that nurses continue to be rated #1 in honesty and ethical standards on annual Gallup polls, but employers still need evidence of their ability to perform as qualified professionals. Having specialty certification increases the credibility of nurses who have gone beyond basic education to gain advanced knowledge so they can provide high-quality care.

Promotes Recognition From Peers

A majority of over 72% of respondents to the ONCB survey indicated they strongly agreed or agreed that certification promotes peer recognition. Certified nurses are respected as experts and become mentors for their co-workers. Certified nurses can also assist other nurses on their journey to become certified. Becoming certified helped me to be more confident in my profession.

“I am very passionate about continuing my education and keeping my education up, and to help my co-workers to become certified. I loved being an orthopaedic-certified nurse!”—Jody Pearcy, RN, ONC

Promotes Recognition From Other Health Care Professionals

Over 91% of the nurses surveyed strongly agreed or agreed that certification promotes recognition from other healthcare professionals. This is done in part through enhanced collaboration with interprofessional team members in the healthcare setting. Certified nurses are seen as having increased collaboration with the healthcare team and improved nurse–physician communication. Certification, which is well understood by medical colleagues, contributes to the recognition of nurses’ practice expertise.

“I believe it is essential to have this additional knowledge to provide better care for my patients and serve as a resource for my coworkers. As nurses, we know that our practice is ever-changing, and recertifying helps me stay up to date. Knowledge is power after all!”—Nicole Onken, RN, ONC

Promotes Recognition From Employers

More than 68% of survey respondents indicated they strongly agreed or agreed that certification is preferred by their employers. Anecdotally, certified nurses have reported employer recognition through financial rewards, banners, bulletin board postings, hospital newsletters, personal notes from the chief nursing officer, and wall plaques. A frequent recognition strategy among healthcare facilities is the establishment of a “Wall of Honor” for display of certified nurses’ photographs or certificates. In addition, certification is often included in clinical ladders to allow nurses an additional benefit. These efforts honor certified nurses’ dedication, expertise, and dedication to continuing competence.

Manager Survey

The American Board of Nursing Specialties surveyed a convenience sample of 139 attendees at a nursing management conference in 2002 (Stromborg et al., 2005). ONCB replicated this survey in September 2019 to determine if nurse managers’ perceptions of specialty nursing certification had changed in the following 17 years. For the ONCB survey, nurse manager was operationally defined as one who “oversees patient care, makes management and budgetary decisions, sets work schedules, coordinates meetings and makes personnel decisions (e.g., hiring).” A convenience sample of potential nurse managers in the database of the National Association of Orthopaedic Nurses received the survey, with 82 responding (Roberts et al., 2020). Aligning with trends from the Niebuhr and Biel’s (2007) findings, areas of continued agreement in this updated survey included the manager’s recognition of certification demonstrating “proven knowledge” and “experience in a given specialty” and “proven commitment to lifelong learning” (Roberts et al., 2020).

“For the past eight years I have served as an Orthopedic Care Coordinator, supporting and providing education to patients through their orthopedic journeys, while facilitating communications between the patient and the healthcare team. Maintaining my ONC has provided me advanced, ongoing knowledge that allows me to stay current, confident, and effective in my role.”—Sarah Brenly, MSN, RN, ONC

Notably, both manager surveys (2005 and 2019) requested a response to the following: “Assuming all other qualifications were equal, I would prefer to hire a certified nurse.” On the ABNS survey, 85% of respondents indicated they would hire a certified nurse if all other qualifications were equal (Stromborg et al., 2005). On the ONCB survey, the average score for this statement was 4.5 on a 5-point scale, indicating a high level of agreement (Roberts et al., 2020). Responses to the ONCB survey confirmed that nurse managers clearly valued specialty certification by their registered nurse staff, and certification does play a part in hiring.

The 2025 updated survey statement read: “Employers tend to favor hiring certified practitioners in the profession over non-certified practitioners.” Responses yielded 69% agree or strongly agreed. This may indicate a growing discrepancy between nurse and manager perceptions.

“After over a decade of orthopedic nursing, my ONC has helped me to be recognized as more credible when I speak to patients and coworkers as an experienced nurse. It’s helped me advocate for patients with their families and with the doctors using evidence-based practice as examples. My ONC pin and badge buddy identify me as a trusted source of information for my patients and their families … Each time I renew my ONC I renew my commitment to my growth, specialty, and the nursing profession.”—Susan Ruocco, RN, ONC

While research demonstrates the intrinsic benefits of nursing certification and improved patient outcomes, extrinsic value was experienced less frequently by survey respondents. For example, in 2019, slightly more than 86% of survey respondents indicated they strongly agreed or agreed that certification promotes recognition from employers. Only 43% of respondents indicated they strongly agreed or agreed that certification contributes to increased salary. In 2025, the statement “Certified practitioners in the profession generally make more money than non-certified practitioners” had a similar 48% favorable rating. Certified nurses clearly value their credentials as part of their professional development.

Nurse managers indicated certification does play a part in their hiring practices, reflecting their perception over time of certified nurses as valued members of the healthcare team. Anecdotal reports of practice changes, including financial assistance with maintenance of certification as well as provision of a bonus or differential, suggest healthcare leaders’ growing desire to recognize and reward practice excellence through specialty nursing certification.

Improves Clinical Outcomes

Several studies have shown a positive relationship between nurse satisfaction and certification and improved quality outcomes. Hospital units with higher proportions of certified nurses demonstrated lower rates of healthcare-associated infections and fall rates (Coelho, 2020). Combined with other measures of nurse satisfaction, higher percentages of registered nurses with national specialty certification are associated with lower central line associated blood stream infection rates (Wei et al., 2023).

Further supported by a systematic literature review, there is an inverse relationship between high RN certification and reduction in complications, failure to rescue, and mortality (Coelho, 2020; Halm, 2021).

Increases Consumer Confidence

More than 78% of respondents to the ONCB survey indicated they strongly agreed or agreed that certification increases consumer confidence in their health care. “The data suggest that patients who are cared for by certified nurses have better outcomes than patients who are cared for by nurses who are not certified. Hospitals with certified nurses are better able to provide a higher quality of care and demonstrate their commitment to do just that” (Kaplow, 2022).

“Obtaining the ONP-C credential has been one of the most meaningful milestones in my career. This certification not only validated my advanced knowledge and skills, but also gave me great confidence in providing specialized, high-quality patient care. I’m proud to hold this credential because it strengthens clinical expertise, builds confidence, and demonstrates a true commitment to excellence in patient care.”—Jessica Pelkowski, DNP, APRN, ONP-C, FAANP, FNAON

About the Perceived Value of Certification Tool (PCVT)

ONCB used the PVCT as its survey tool. This tool is a nurse-reported rating of how certification benefits nurses. The instrument has a 2-factor structure consisting of intrinsic and extrinsic value subscales based on both exploratory (Gaberson et al., 2003; Sechrist et al., 2006) and confirmatory factor analysis (Sechrist et al., 2006). Reliability of the PVCT is demonstrated by a stable factor structure across samples of certified nurses, noncertified nurses, and administrators (Sechrist et al., 2006). The PVCT can also be evaluated as a total score with high internal consistency reliability, Cronbach’s alpha = 0.92–0.94. In studies with diverse groups of nurses, the PVCT has demonstrated both discriminant and predictive validity (Bekemeier, 2007; Ward et al., 2019).

ACKNOWLEDGMENTS

With gratitude to the original ONCB White Paper Board Members: Dottie Roberts, EdD, MSN, MACI, RN, OCNS-C®, CMSRN, CNE, Dorothy Pietrowski, MSN, RN, ONC®, ONP-C®, Pam DeGeorge, MSN, RN-BC, ONC®, Matt Price, MSN, RN, CNP, ONP-C®, RNFA, Diane Ryzner, RN, APN, CNS, OCNS-C®, Margaret Hanes, BSN, RN-BC, ONC®, Barbara Larsen, BSN, RN, ONC®.