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The value of certification in kidney care
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The definition of certification is publicly attesting that a specified quality or standard has been achieved or exceeded. Certification can also be a formal process to identify and acknowledge individuals who have met a recognized standard. The Conditions for Coverage, published by CMS in 2008, established the standards for dialysis certification with the underlying goal of improving care and outcomes in dialysis. That included mandating national certification for all patient care technicians working in a dialysis clinic in the United States. Data to determine if 10 years of mandated certification of dialysis technicians have improved care and outcomes have yet to be formally studied but, there are values to being certified.
To each individual dialysis technician, one of the values of certification is undeniably that of having the ability to work in dialysis. Their job is dependent on maintaining certification. Working in dialysis is more than a job; it is a profession and a calling. The greater value of certification is that it allows the individual, the community, the governing bodies and agencies to support and allow the transformation from the job mentality to the professional mentality. National meetings, providers, testing agencies, educators, managers, CEOs and vendors have embraced the further education of dialysis technicians.
When I started as a dialysis technician in 1975, I sometimes heard the jest, “A hamburger flipper 1 week and a dialysis technician the next.” On-the-job training, “see one do one,” achieved the purpose of knowing how to do dialysis. Content of the training was inconsistent and continuing education to promote enhancement of skill and knowledge was typically the responsibility of the individual. With mandatory certification, not only are technicians taught how to do dialysis, but there is now an emphasis on educating technicians to understand cause and effect, background information, rationale, anticipate potential issues, perform functions beyond put-on and take-off dialysis, psychosocial understanding, team dynamics, infection control, water treatment, vascular access and more.
The dialysis technician’s progression and the contribution to the interdisciplinary team has had a great impact on their role in the renal community. Opportunities that may not have existed in the facility or in the industry are now being populated by dialysis technicians. Industry roles such as vendor representatives, technical consultants, trainers, agency staff and company executives have been filled by individuals who started as technicians. Facilities have developed career or advancement ladders that recognize a technician’s skill and knowledge; they are assigned positions such as vascular access coordinator or preceptor and are assigned tasks with quality assurance and performance improvement or CROWNWeb. One certification testing organization has supported this progression by psychometrically developing an advanced exam for the clinical hemodialysis technician.
Does every technician function at the highest level? Of course not. We all have our individual ability to learn, adapt and perform. However, certification has created the opportunities, the community support and the tools in which each dialysis technician can have the means to achieve the skill and knowledge necessary to improve care and to improve outcomes.
Achieving contact hours is sometimes a challenge for technicians for a variety of reasons. However, without educational contact hours to renew their certification, the lapse of the certification would not allow technicians to provide direct patient care to the patient with end-stage renal disease. Suspension, termination or a reassignment to a non-direct patient care function would be a consequence of a lapsed certification.
There are currently three national certification agencies approved by CMS: Board of Nephrology Examiners Nurses and Technician, Nephrology Nursing Certification Commission and National Nephrology Certification Organization. Each organization has its criteria for recertification and it is imperative that the specific criteria for each certification organization are followed, including the amount of contact hours required, the type of topics and sources accepted and the deadline for recertification application.
Ultimately, the value given to the certification is the exam’s credibility and integrity and meets psychometric standards for exam development. The proof of its value is demonstrated by the thousands of treatments performed each day by certified dialysis technicians.
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- Danilo B. Concepcion, CBNT, CCHT-A, FNKF, is operations manager for Renal Services at St. Joseph’s Hospital Renal Center in Orange, California. He is also a member of the Nephrology News & Issues’ Editorial Advisory Board. Disclosure: Concepcion reports no relevant financial disclosures.