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 Tool 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 successfully been administered to in excess of 25,000 subjects in a variety of nursing specialties holding a wide variety of nursing certifications. The PVCT may also be administered to subjects who are not certified. Often the PVCT is administered to both certified and non-certified subjects and comparisons are made between the groups.
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.
Use of the PVCT with Non-Nursing Subjects
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.
PVCT 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.
Once permission to use the PVCT is granted materials and forms will be sent via e-mail attachment to the researcher. The researcher will receive:
- The PVCT 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 instrument which may also 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.
Background on Statistics and History of Use of the PVCT
Psychometric Characteristics of the PVCT
The PVCT has been used in 17 studies since 2003, with a total of more than 25,000 respondents. Participants have included hospital-based perioperative nurses, public health nurses, pediatric nurses, nurses working in infusion centers, hospice and palliative nursing assistants, and administrators in various settings. Results are generally consistent across all types of nursing work, with nurses’ perception that certification increases salary being the least-endorsed item. In most cases nursing administrators and nurses in direct patient care appear to perceive the benefits of certification similarly (Bekemeier, 2007; Byrne, Valentine, & Carter, 2004; Sechrist, Valentine, & Berlin, 2006), but there is some evidence that supervisors see credentialing as carrying external recognition (Bekemeier, 2007).
Factor Structure and Reliability
Three psychometric studies of the PVCT have identified a stable factor structure. Gaberson et al. (2003) identified three factors, which they labeled personal value, recognition by others, and professional practice, together accounting for 61.1% of the total variance in the measure. Factor loadings ranged from .51 to .82, with relatively high inter-correlation among the factors leading to an overall Cronbach’s alpha of .92 for the 18-item measure taken as a whole (all 3 subscales together). Sechrist et al. (2006) found a simpler two-factor structure that still explained 59.2% of the total variance, with subscales labeled intrinsic and extrinsic. Sechrist et al.’s 6-item extrinsic factor was identical to the recognition by others factor in the Gaberson et al. study, while the intrinsic factor combined the remaining 12 items into a single subscale. Again Cronbach’s alpha was .94 for the measure as a whole, suggesting high inter-correlation between the subscales. A third psychometric study by Sechrist and Berlin (2006) directly compared the 3-factor and 2-factor solutions and arrived at a final solution with intrinsic and extrinsic factors identical to those in Sechrist et al. (2006), with a factor structure that was stable across groups of certified nurses, non-certified nurses, and administrators. Sechrest et al. also applied confirmatory factor analysis (CFA) to the total sample and found that the two-factor model provided an acceptable fit for the data, RMSEA = .057, CFI = .97, AGFI = .98.
Based on these psychometric results, the PVCT can be meaningfully evaluated as a total score. Alternately, two subscales can be created and interpreted separately:
- Intrinsic Subscale (12 items): Average of items 1, 2, 3, 4, 9, 10, 11, 12, 13, 14, 15, and 16
- Extrinsic Subscale (6 items): Average of items 5, 6, 7, 8, 17, and 18
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: SD = 1, D = 2, A = 3, SA = 4, with “no opinion” scores treated as missing data, which must be imputed or pro-rated before calculating a total. PVCT items are so highly inter-correlated, prorating is not expected to bias results, and averaging across completed items is a meaningful alternative method. However, most prior research has used addition to calculate totals.
Discriminant validity of the instrument is supported by its ability to detect an expected difference in the perceived value of certification between certified and non-certified nurses (Bekemeier, 2007; Weis, 2012). Predictive validity is supported by the PVCT’s ability to differentiate between nurses at Magnet and non-Magnet facilities (Swartwout, 2012), and by significant correlations of certification with factors such as job satisfaction, team spirit, and relationships with supervisors (Head, 2010).
Suggested Short Version for Manuscripts (suitable for inclusion in Methods/Measures section)
The Perceived Value of Certification Tool (PVCT) 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; Sechrest et al., 2006) and confirmatory factor analysis (Sechrist & Berlin, 2006). Reliability of the PVCT is demonstrated by a stable factor structure across samples of certified nurses, non-certified nurses, and administrators (Sechrist & Berlin, 2006). The PVCT can also be evaluated as a total score with high internal consistency reliability, Cronbach’s = .92-.94. In studies with diverse groups of nurses, the PVCT has demonstrated both discriminant (Bekemeier, 2007; Weis, 2012) and predictive validity (Swartwout, 2012; Head, 2010).
Meeting Statistical Assumptions when using the PVCT
Sampling is a property of design rather than statistics, but prior studies show high response rates to the PVCT. Assuming an appropriate study design, minimal sampling bias is anticipated.
Level of Measurement
If individual PVCT items are interpreted using a “percent agreement” approach, the data should be treated as nominal-level and appropriate nonparametric statistical tests should be used for any comparisons between groups (e.g., chi-square or Fisher’s exact test).
As described above, PVCT subscales can be handled as interval-level measures based on prior research, and parametric tests may be appropriate. Subscale scores were approximately normally distributed in past studies of both certified and non-certified nurses and administrators (e.g., Sechrist & Berlin, 2006), but investigators should always check for violations of normality in their individual research samples and use appropriate corrections or data transformations if needed.
Homogeneity of Variance / Homoskedasticity
In studies comparing certified and non-certified nurses (e.g., Sechrist et al., 2006; Sechrist & Berlin, 2006), certified nurses have not only higher means but also larger standard deviations on subscale scores. This is a typical finding but may suggest violation of the homogeneity of variance assumption when comparing groups via t-test or ANOVA, or violation of the homoscedasticity assumption when using regression. Investigators should check for violation of these assumptions and use appropriate corrections if needed.
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.
Selected Articles Regarding the PVCT
The Perceived Value of Certification by Certified Perioperative Nurses
Gaberson K B, Schroeter K, Killen A R & Valentine W A
Nursing Outlook, Volume 51, Number 6 (November/December 2003) 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. The Value of Certification – A Research Journey
Byrne M, Valentine W & Carter S
AORN Journal 79 (April 2004) 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. Perceived Value of Certification among Certified, Noncertified and Administrative Perioperative Nurses
Sechrist K R, Valentine W & Berlin L E
Journal of Professional Nursing, Volume 22, Number 4 (2006) 242-7.
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. Psychometric Analysis of the Perceived Value of Certification Tool
Sechrist K R, & Berlin L E
J Prof Nurs. 2006 Jul-Aug;22(4):248-52.
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. Specialty Nursing Certification: Nurses’ Perceptions, Values and Behaviors
American Board of Nursing Specialties
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. Perceived Value of Certification of Graduate Students
Hanson H M & Doering J J
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. The Value of Specialty Nursing Certification
Niebuhr B, & Biel M
Nurs Outlook. 2007 Jul-Aug; 55(4):176-81.
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. Perceived Value of Nursing Certification – Summary of a National Survey
Prowant B F, Niebuhr B & Biel M
Nephrology Nursing Journal, July-August 2007, Vol. 34, No. 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. Credentialing for public health nurses: personally valued … But not well recognized
Public Health Nurs. 2007 Sep-Oct;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. Infusion Nursing Certification: Identification of Stakeholders and Demonstration of the Value of Certification
Journal of Infusion Nursing, November/December 2007, Volume 30 Number 6, Pages 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. Specialty Nurse Certification Effects Patient Outcomes
Wilkerson B L
Plastic Surgical Nursing, June 2011, Volume 31, Number 2. pp. Pages 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. Perceived value of national certification for pediatric nurses
Messmer P R, Hill-Rodriguez D, Williams, A R, Ernst M E & Tahmooressi J
J Contin Educ Nurs. 2011 Sep;42(9):421-32.
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.