Nurse certification, like licensure for RNs, involves individual testing, in this case testifying to status achieved by a nurse in some given specialty. If licensure has its eye on minimal performance, certification is oriented toward the other end of the spectrum, testifying to the nurse's achievement of a special competence. Most certification programs are limited to nurses but there are some certification programs open to health or human services professionals from diverse fields.

Almost all graduates of nursing master's specialty programs (especially practitioner programs), want the status afforded by certification. However, unlike licensure, it is up to the individual to decide whether or not to take a certification exam. Although many jobs may only be open to nurses holding desired certifications, the certification process is voluntary.

Certification programs in nursing have grown like Topsy, (I count over 30 of them without even working at it), mostly through individual specialty organizations but now through ANA and the American Nurses Credentialing Center as well. Many, but not all, of the certification programs are designed for nurse practitioners; some are open to clinical nurse specialists as well. Many certifications involve "broad" specialties, in areas such as midwifery, anesthesia, orthopaedics, and oncology. Other certificate programs are very narrow, such as those in areas of enterostomal care and intravenous therapy.

For a long time, this country ignored the British system, which relied heavily on the certification process. Of course the British system often used certification in lieu of academic credentials, and our system has not gone that direction.

The certificate has become very important but it is more likely to be combined with higher education than substituted for the lack thereof. Most major certification programs today require graduation from a related academic program (usually master's level) before allowing the candidate to sit for the certification examination.

There are, however exceptions to this rule. Narrow certifications, like intravenous therapy, obviously don't comprise the core of specialty master's programs. Some few certification programs prefer to employ the principle of testing only for knowledge acquired. These programs measure what the candidate knows rather than where and how the knowledge was acquired.

We are in the throes of a love affair with certification in this country, and virtually every RN has a string of (possibly) inexplicable certification initials following her signature. As specialty nursing has replaced general nursing, certification has become a powerful card in the competition for jobs.

Issues in certification chiefly involve quality control and who has the right to certify in a given area. In some cases, nurses may choose among certifying agencies. More interesting is the overall question of when will it all stop? How many specialties will emerge? How many will the market support? Should there be any overall policy regulating certification? At present, certification serves as a good check on the quality of nurse practitioner programs, among which there is still much (if unacknowledged) quality differential.