Perceived Value of Certification Tool (PVCT)
The PVCT is a survey instrument developed by the Competency and Credentialing Institute (CCI), formerly the Certification Board for Perioperative Nursing (CBPN), to determine the perceived value of certification among perioperative nurses. The PVCT is the result of extensive efforts by CCI Research Committee members, staff, and key research experts. The PVCT is a valid, reliable instrument that measures the value of CNOR and CRNFA certification for operating room nurses. The instrument is also valid for use in assessing other nursing certifications. The PVCT has been used extensively with a wide variety of other nursing specialties administering a number of other nursing certifications.
Use of the PVCT is not restricted to perioperative nurses and nurses holding certifications administered by the Competency and Credentialing Institute (CCI). The instrument has been successfully administered to more than 26,000 nurses in a variety of nursing specialties holding a wide variety of nursing certifications. The PVCT may also be administered to individuals who are not certified. Often the PVCT is administered to both certified and non-certified nurses and comparisons are made between the groups.
The PVCT has also been utilized, with modifications, with non-nursing subjects to include safety professionals and administrative assistants. Researchers wishing to use the PVCT with non-nursing subjects and/or those wishing to modify the PVCT instrument in any way cannot use validity and reliability results from previous publications or studies which have used the PVCT.
The Competency and Credentialing Institute encourages the use of the PVCT by researchers of all levels of experience. This instrument is often used by novice researchers either to fulfill the requirements of the ANCC Magnet Program® or as part of their academic studies.
The Development and Revision of the PVCT
A Brief History of 18-Item PVCT Use and Findings
Since its development in 2003, the PVCT has been used in 18 studies, administered to more than 26,000 respondents. Participants have represented a range of nurses including hospital-based perioperative nurses, public health nurses, pediatric nurses, anesthetic nurses, nurses working in infusion centers, hospice and palliative nursing assistants, and administrators in various settings. Generally, results are similar across all types of nursing work. In a recent systematic review of these studies (Van Wicklin, Leveling, & Stobinski, 2020), it was found that nurses (certified, non-certified, and managers) expressed high levels of agreement with most PVCT value statements, especially the Intrinsic value statements of, certification “enhances feeling of personal accomplishment”, “provides personal satisfaction”, and “validates specialized knowledge.” The value statement that nurses most frequently disagreed with was certification “provides evidence of accountability.” When comparing certified and non-certified nurses’ responses across each of the Intrinsic and Extrinsic value statements, certified nurses responded with a higher level of agreement than non-certified nurses by 9.6%, on average.
Factor Structure and Reliability of the 18-Item PVCT
During the initial development of the PVCT (Gaberson et al., 2003), an exploratory factor analysis (EFA) was conducted, which identified a stable factor structure with three factors that were measured by the 18 items in the PVCT. Gaberson et al. labeled these factors, or subscales, Personal Value, Recognition by Others, and Professional Practice, which taken together displayed a high level of reliability (Cronbach’s alpha α = .92). In 2006, Sechrist et al. conducted an EFA on the PVCT and arrived at a simpler two-factor structure with factors labeled Intrinsic and Extrinsic. The 6-item Extrinsic factor was identical to the Recognition by Others factor identified by Gaberson et al. (2003), but the Intrinsic factor combined the remaining 12 items from the Personal Value and Professional Practice factors into a single subscale. This two-factor model exhibited a high level of reliability (Cronbach’s alpha α = .94). Subsequent work has confirmed the validity of this two-factor structure and demonstrated its improved fit over the three-factor structure (Sechrist & Berlin, 2006). The two-factor structure has proven stable across groups of certified nurses, non-certified nurses, and administrators, and has been adopted by researchers and credentialing organizations to evaluate the value of certification in a wide variety of nursing specializations.
Refining the PVCT: From the 18-item PVCT to the PVCT-12
In a recent systematic review (Van Wicklin, Leveling, & Stobinski, 2020), the authors noted that several studies have reported striking majorities of participants either agreeing or strongly agreeing with the PVCT items and very little disagreeing with the items. When the items do not capture the full spectrum of responses from strongly disagree to strongly agree, there is a greater opportunity for measurement error that could make participants seem more agreeable than they actually are. Therefore, the ease at which participants agree with PVCT items threatens the validity of their responses and the accuracy of comparisons made between groups of nurses using 18-item PVCT results.
In reaction to this matter, CCI launched a nationwide study to examine the psychometric properties of the original 18-item PVCT in comparison to its revision, known as the PVCT-12 (Leveling, 2020). The functioning of the PVCT-12 was found to be an improvement over the original PVCT, as it yielded a measurement model with better fit (see table below), while increasing the variation of responses. These results suggest that the PVCT-12 has a higher level of construct validity as well. Additionally, the PVCT-12 displayed an acceptable level of reliability and a stable factor structure across nine nursing certification organizations (Intrinsic range of reliability α = .74 – .83; Extrinsic range of reliability α = .83 – .86), providing evidence of its concurrent validity and support for its use for research examining the perceived value of certification among various groups of nurses.
The PVCT-12 improves upon the original PVCT with 12 newly drafted items that capture a broader range of respondents’ opinions, as they relate to their perceptions of certification. The PVCT-12 omits the no opinion option (which was included in the 18-item PVCT) from the response categories, yielding a 4-point response scale ranging from strongly disagree to strongly agree. Similar to the 18-item PVCT, the PVCT-12 embodies a two-factor structure, with 6 items measuring the Intrinsic factor and 6 items measuring the Extrinsic factor.
Scoring the PVCT-12
The PVCT-12 can be meaningfully evaluated as a total score by summing each of the 12 items together. Alternately, items can be sorted into Intrinsic and Extrinsic factors, summed, then interpreted separately:
- Intrinsic total score (6 items) = item 1 + item 2 + item 6 + item 7 + item 8 + item 12
(24 points possible)
- Extrinsic total score (6 items) = item 3 + item 4 + item 5 + item 9 + item 10 + item 11
(24 points possible)
Individual PVCT items have been evaluated in some studies as percent agreement (nominal-level) by collapsing the agree and strongly agree categories. In many studies, however, PVCT subscales have also been treated as interval-level data on a 4-point Likert-type scale. For this option, the following scoring is recommended: strongly disagree = 1, disagree = 2, agree = 3, strongly agree = 4.
PVCT-12 Permission Request
CCI will provide permission for individuals and organizations to use the tool for their research. All requests for permission much include:
- An abstract of your proposed research
- A statement that you will provide CCI with any validity and reliability data you derive from the PVCT based on your sample
- Agreement that you will use the instrument without modification and that the copyright statement will appear at the bottom of all photocopies
- Confirmation that the instrument will be duplicated only for the purposes of your research
Learn more and request information at firstname.lastname@example.org.
What to Expect When Given the Tool
Once permission to use the PVCT-12 is granted, materials and forms will be sent via e-mail attachment to the researcher. The researcher will receive:
- The PVCT-12 instrument as a PDF scan document
- A summary table of results from previous studies utilizing the PVCT instrument
- An MS Word document – Background on Statistics and History of Use of the PVCT which contains information regarding statistical tests and scoring methods to be used with the PVCT. This document also contains language needed for the IRB approval process.
The PVCT has also been uploaded as an internet-based survey which may be utilized by researchers. CCI will provide results and descriptive statistics to researchers wishing to use this method of administration. Further details regarding the use of the internet-based survey are available by emailing the customer service department.
As a condition of permission for use researchers, upon completion of their study, are required to submit a copy of their results to the Competency and Credentialing Institute. If the research results are published, the Competency and Credentialing Institute requires a final copy of the article. The Competency and Credentialing Institute does not require approval of manuscripts submitted for publication but does require a copyright statement at the bottom of all photocopies of the instrument.
Choosing the Correct Statistical Test
If individual PVCT items are interpreted using a “percent agreement” approach, the data should be treated as nominal-level data and appropriate nonparametric statistical tests should be used for any comparisons between groups (e.g., chi-square, Fisher’s exact test, and Kruskall Wallis test). If the items are treated as a Likert scale and responses are scored (1 to 4), the data can be treated as interval-level data and parametric tests (e.g., t-test, ANOVA, regression) can be used for comparisons between groups.
Statistical Assumptions to Consider
When treating the PVCT items as interval-level data, it is important to check a few statistical assumptions before conducting a parametric test:
- Normality – Parametric tests require that the data are approximately normally distributed. The distribution of the data can be visualized by generating a histogram, boxplot, or a QQ plot. Statistical tests can be used to test the normality of the data as well.
- Homogeneity of Variance/Homoskedasticity – Parametric tests assume that all comparison groups, or levels of the independent variable, have similar variances. If this assumption is violated, appropriate corrections should be used.
- Independence – Investigators should check the intra-class correlations among data points from nurses in the same work environment (e.g., unit or hospital). If there are significant dependencies among data points, standard parametric methods are inappropriate. This is a common problem in health systems research and has been observed in studies using the PVCT. In this situation, more advanced statistical methods that evaluate the effect of clustering variables, such as multilevel modeling/hierarchical linear modeling, must be used instead of standard regression or ANOVA approaches.
An Example Description of the PVCT-12: For Use in the Methods/Measures Section of a Research Paper
The 12-item Perceived Value of Certification Tool (PVCT-12; Leveling, 2020) is a self-report instrument in which nurses are asked the degree to which they agree with statements about how certification benefits nurses. Responses are aggregated across the 12 items to reveal nurses’ perceptions of the value of being certified. Participants respond to each statement on a 4-point Likert scale, ranging from strongly disagree (1) to strongly agree (4). The PVCT-12 can be divided into two subscales: Intrinsic value (6 items) and Extrinsic value (6 items). Intrinsic value statements include statements such as “nurses that have obtained certification feel a strong sense of accomplishment”, whereas Extrinsic value statements include statements such as “certified nurses generally make more money than non-certified nurses”. The PVCT-12 exhibits a stable factor structure, measurement model fit, and adequate reliability (Intrinsic α = .74 – .83; Extrinsic α = .83 – .86) across a variety of nursing credentialing organizations, certified nurses, and non-certified nurses, evidencing its construct and concurrent validity (Leveling, 2020).
Selected Articles Regarding the PVCT
Gaberson, K. B., Schroeter, K., Killen, A. R., & Valentine, W. A. (2003). The perceived value of certification by certified perioperative nurses. Nursing Outlook, 51(6), 272-276.
We conducted this study to determine the perceived value of certification in perioperative nursing. Following development and pilot-testing, we mailed the 18-item Likert-type instrument, the Perceived Value of Certification Tool (PVCT), to a sample of 2750 perioperative nurses who had earned the CNOR or CRNFA credential or both. A total of 1398 surveys were returned (50.8% response rate). Factor analysis extracted three factors, accounting for 61% of variance: personal value, recognition by others, and professional practice. Internal consistency reliability testing (Cronbach’s alpha) identified a standardized alpha of .924. Over 90% of respondents agreed or strongly agreed with statements about the value of certification related to feelings of personal accomplishment and satisfaction, validating specialized knowledge, indicating professional growth, attainment of a practice standard, personal challenge, and professional commitment, challenge, and credibility. These results are consistent with previously published literature on specialty certification in nursing.
Byrne, M., Valentine, W., & Carter, S. (2004). The value of certification – A research journey. AORN Journal, 79(4), 825-835.
One measure of nursing excellence is achieving specialty certification, which denotes a more advanced level of knowledge and practice. The Certification Board Perioperative Nursing (CBPN) provides specialty certification for perioperative nurses. The organization’s mission is to be the leader in competency credentialing and education that promotes safe, quality patient care in the perioperative arena. This article presents study findings regarding the perceived value of and barriers to obtaining certification.
Sechrist, K. R., Valentine, W., & Berlin, L. E. (2006). Perceived value of certification among certified, noncertified and administrative perioperative nurses. Journal of Professional Nursing, 22(4), 242-247.
The 18-item Perceived Value of Certification Tool (PVCT) was developed to support a multi-phased research initiative related to assessing certification value among perioperative nurses. This article addresses the reliability and validity evaluation of the PVCT in a study of three samples of perioperative nurses: certificants (n = 954), non-certificants (n = 675), and administrators (n = 694). Factor analysis identified two-factor solutions for non-certificants and certificants. A three-factor solution for administrators was not clear; a two-factor solution was more interpretable. Explained variance ranged between 56.1% and 60.8% for the two factors of intrinsic and extrinsic value of certification. Confirmatory factor analysis model fit statistics for the two-factor model showed an acceptable fit of the data to the model. Internal consistency reliability (coefficient alpha) for the total PVCT ranged between .93 and .95 for the three samples. The coefficient alpha’s ranged between .94 and .92 for the intrinsic value and from .86 to .84 for the extrinsic value among samples. Responses to the PVCT were also shown to adequately and correctly classify 76.9% of certificants and 48.2% of non-certificants. Overall, the PVCT is a valid and reliable tool to measure perceived value of certification.
Sechrist, K. R., & Berlin, L. E. (2006). Psychometric analysis of the perceived value of certification tool. J Prof Nurs, 22(4), 248-252.
The 18-item Perceived Value of Certification Tool (PVCT) was developed to support a multiphased research initiative related to assessing certification value among perioperative nurses. This article addresses the reliability and validity evaluation of the PVCT in a study of three samples of perioperative nurses: certificants (n = 954), non-certificants (n = 675), and administrators (n = 694). Factor analysis identified two-factor solutions for non-certificants and certificants. A three-factor solution for administrators was not clear; a two-factor solution was more interpretable. Explained variance ranged between 56.1% and 60.8% for the two factors of intrinsic and extrinsic value of certification. Confirmatory factor analysis model fit statistics for the two-factor model showed an acceptable fit of the data to the model. Internal consistency reliability (coefficient alpha) for the total PVCT ranged between .93 and .95 for the three samples. The coefficient alpha’s ranged between .94 and .92 for the intrinsic value and from .86 to .84 for the extrinsic value among samples. Responses to the PVCT were also shown to adequately and correctly classify 76.9% of certificants and 48.2% of non-certificants. Overall, the PVCT is a valid and reliable tool to measure perceived value of certification.
American Board of Nursing Specialties. (2006). Specialty nursing certification: nurses’ perceptions, values and behaviors.
In 2003, after completing a process that identified research priorities among organizational members, the ABNS Research Committee chose to undertake a study that would validate nurses’ perceptions, values and behaviors related to certification. This national study broke new ground by surveying a sample of certified nurses, noncertified nurses and a sub-sample of nurse managers across 20 different specialty nursing certification organizations using a web-based survey that included the 18-item PVCT – Perceived Value of Certification Tool©. The study also sought to address a variety of ABNS member-generated research priorities by exploring nurse managers’ perceptions of the value of certification, challenges and barriers to certification, benefits and rewards to nurses who are certified, the impact of certification on lost workdays, and the impact of certification on nurse retention. From a sample of 94,768 nurses, 11,427 responses were obtained from the on-line survey for a return rate of 12.1%. Of the respondents, 8, 615 (75%) identified themselves as certified nurses, and 2,812 (25%) were noncertified nurses. A total of 1,608 respondents (14%) held the position of Nurse Manager. Of the nurse manager respondents, 77.3% (N=1,243) were certified. This white paper will focus specifically on the value of specialty nursing certification, beginning with a brief overview of the literature on this topic. A snapshot of the study sample is given with specific demographic data highlighted. Nurse and nurse manager perceptions of the value of certification are shared. With an understanding that there is value to nursing specialty certification, incentives and barriers to certification will be examined. Finally, conclusions are drawn and suggestions are made for future activities that support enhancing the value of certification.
Hanson, H. M., & Doering, J. J. Perceived value of certification of graduate students.
Description of a Poster.
Background and Significance: Healthcare culture continues to insist upon superior quality care by its payers and consumers. Achieving and maintaining a high level of competence is essential in providing high quality nursing care. Literature reveals that certified nurses bring a mark of excellence to healthcare systems. Certified nurses are deemed to be abreast of current changes within a specialty, competent in their fields, consistent with national standards, and dedicated to their profession. Although current literature has examined the value of certification within different nursing specialties, nurses who are pursuing a master’s degree have not been studied. Purpose: The purpose of this study was to describe graduate nursing students’ perceived value of certification. Theoretical Framework: Donabedian’s conceptualization of quality health care. Sample Description/Population: A convenience sample of 41 Marquette University licensed nurses pursuing a master’s degree in nursing voluntarily participated (88% response rate). Results: Over 95% of the respondents indicated agreement about the value of certification related to professional credibility and professional challenge
Niebuhr, B., & Biel, M. (2007). The value of specialty nursing certification. Nurs Outlook, 55(4), 176-181.
The American Board of Nursing Specialties (ABNS) undertook a national study to validate nurses’ perceptions, values, and behaviors related to certification. A Web-based survey was developed and disseminated to certified nurses, noncertified nurses, and nurse managers. Of the 11,427 respondents, 8,615 (75%) identified themselves as certified nurses, and 2,812 (25%) were noncertified nurses. Of these, 1,608 respondents (14%) held the position of Nurse Manager. Using the Perceived Value of Certification Tool (PVCT), certified and noncertified nurses showed a high level of agreement with the value statements on certified practice. Nurse Managers bolstered these perceptions with their correspondingly high rate of agreement on the certification value statements. Additionally, the study examined barriers and challenges to certification, incentives to certification, the impact of certification on lost workdays and nurse retention. This study took an important step in furthering understanding of nursing certification and the implications for health care organizations, nursing certification boards, and certified and noncertified nurses.
Prowant, B. F., Niebuhr, B., & Biel, M. (2007). Perceived value of nursing certification – Summary of a national survey. Nephrology Nursing Journal, 34(4).
The American Board of Nursing Specialties (ABNS) conducted a survey to determine the value professional nurses place on nursing certification as well as barriers to certification. This article presents an overview of the survey results in general and specifically the views of nephrology nurse participants.
Bekemeier, B. (2007). Credentialing for public health nurses: personally valued … But not well recognized. Public Health Nurs, 24(5), 439-48.
This study examined the extent to which public health nurses (PHNs) see value in credentialing and perceive specific barriers related to a community/public health nursing (C/PHN) credential. A cross-sectional exploratory survey was used to examine the perceived value of credentialing for PHNs and the perceived barriers to obtaining or maintaining the C/PHN credential as the primary variables of interest. Data were collected from 655 PHN members of national public health nursing organizations who participated in an online survey. Responses related to the perceived value of credentialing were analyzed using factor analysis and descriptive statistics. Data regarding perceived barriers to the C/PHN credential were analyzed through descriptive statistics and through the Borda Count Method for analysis of ranked data (Tannenbaum, 1995). Similar to nurses in other specialties, study participants perceived that credentialing has a high personal value for PHNs, but that certification provides less value in terms of extrinsic recognition. Respondents identified issues related to the lack of external recognition as particular barriers to the C/PHN credential. These findings provide guidance to public health nursing leaders and inform discussions regarding the development of credentialing systems within the field of public health.
Biel, M. (2007). Infusion nursing certification: Identification of stakeholders and demonstration of the value of certification. Journal of Infusion Nursing, 30(6), 332 – 338.
Nursing certification acknowledges professional achievement and competent practice. To establish the importance of certification, it is necessary to determine the value that primary and secondary stakeholders place on certification. The Infusion Nurses Certification Corporation (INCC) participated in a national study on the Value of Specialty Nursing Certification. As a function of describing INCC’s stakeholders, demographic characteristics of infusion nurses were examined. Using the Perceived Value of Certification Tool (PVCT), certified and noncertified nurses and managers were surveyed. The study clearly showed that CRNI(R) certification is a valued credential.
Wilkerson, B. L. (2011). Specialty nurse certification effects patient outcomes. Plastic Surgical Nursing, 31(2), 57 – 59.
This article reports on studies that have shown specialty nurses with certification contribute to quality patient outcomes and satisfaction. In addition, nurses who have achieved their specialty certification have perceived intrinsic value, empowerment and heighten collaboration with the health care team.
Messmer, P. R., Hill-Rodriguez, D., Williams, A. R., Ernst, M. E., & Tahmooressi, J.J. (2011). Perceived value of national certification for pediatric nurses. Contin Educ Nurs., 42(9), 421-432.
This study evaluated whether pediatric nurses who were certified valued national certifications to a greater degree than those who were not certified. The Gaberson, Schroeter, Killen, and Valentine (2003) Perceived Value of Certification Tool (PVCT) was used to measure nurses’ perceptions of certification. The PVCT includes 18 certification-related value statements, using a five-point Likert scale response ranging from strongly agree to strongly disagree. A principal factor analysis was performed to identify clusters of related variables. Certified pediatric nurses valued national certifications to a greater degree than those who were not certified. More favorable views of certification were moderately associated with favorable views of the effects of certification on salary. The PVCT was found to have one factor, not two, as previously reported in the literature. Lower perceived relationships were reported between certification and salary, clinical competence, and consumer confidence compared with feelings of professionalism and personal satisfaction. Efforts to improve the relationship between certification and its perceived value at one institution were addressed. More attention may be needed to strengthen relationships, perceived or otherwise, between certification and competency skills, public awareness, and compensation of nurses for holding national certification.
Van Wicklin, S. A., Leveling, M. E., & Stobinski, J. X. (2020). What is the perceived value of certification among registered nurses? A Systematic review. Journal of Nursing Scholarship, 1-8. doi:10.1111/jnu.12579.
Purpose: To explore how registered nurses (certified, noncertified, and managers) value certification as determined by the Perceived Value of Certification Tool, review the psychometric properties of the instrument, and ascertain the benefits and barriers to nursing specialty certification. Design: Systematic review (without meta-analysis) of 18 studies representing 26,534 registered nurses. Methods: Rigorous processes were used to minimize bias; to identify, appraise, and synthesize studies to explore how registered nurses value certification; and to ascertain the benefits and barriers to nursing specialty certification. Psychometric properties of the Perceived Value of Certification Tool were also reviewed and evaluated. Methods and results are presented in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Conclusions: The vigorous statistical work completed on the developmental study for the instrument conducted in 2003 has yet to be duplicated in the multiple studies published subsequently. The chiefly descriptive studies detailed in this systematic review are of limited usefulness in guiding future research. The Perceived Value of Certification Tool has proven useful in stimulating interest; however, a revision of the instrument is now required to promote research and patient outcome studies regarding the self-perceived value of certification in nursing specialties. Clinical Relevance: This report systematically reviews 18 studies that have used the Perceived Value of Certification Tool, a tool that has been widely used since 2003, to measure the perceptions of registered nurses regarding specialty certification. This review provides evidence that the instrument has potential for expanded use in patient outcomes studies and should be revised to better serve the needs of researchers.