Hospice and palliative nurses care for some of the most complex patients and their families during a time when they are at their most vulnerable. Because of the multifaceted nature of their medical conditions, these patients depend on the clinical knowledge and skills of their nurses. But “the premier national credentialing organization” that certifies these nurses aims to prioritize identity politics over merit with a new strategy.
The Hospice and Palliative Care Credentialing Center (HPCC), which offers specialty certification exams for advanced practice nurses, registered nurses, pediatric hospice and palliative nurses, licensed practical/vocational nurses, and nursing assistants, prides itself on “advancing expert care in serious illness through state-of-the art certification procedures. HPCC recently announced its “Multiyear Diversity, Equity, Inclusion, and Belonging (DEIB) Strategic Initiatives,” which aims to enshrine DEIB within its organization by “identifying internal and external barriers to achieving certification and providing opportunities to alleviate disparities and remove systematic biases.”
Those initiatives included the formation of a DEIB task force in 2023, made up of individuals “passionate about a culture and processes prioritizing DEIB.” In a recent letter to certification holders, HPCC board president Larry Fabrey, PhD wrote, “The [DEIB] task force is making recommendations to the board that will impact the appropriateness of all aspects of HPCC certification, from initial contact with prospective applicants through recertification.”
The inspiration for this initiative came from a 2022 article in Nursing Outlook, which hypothesizes standardized testing historically impeded education and career attainment for members of underrepresented minority groups. They specifically looked at the National Council Licensure Exam (NCLEX) – an exam all new graduates in the United States must take to determine if they are deemed safe to practice as a nursing professional. The article indicates nursing organizations have not published data needed to “evaluate/refine the NCLEX-RN from a DEI perspective.” “Preliminary nursing studies and data from other professions indicated disparities in testing outcomes,” the authors lament. Noticeably missing is a concern for a merit-based licensure process.
In response, HPCC launched a performance analysis of its certification exams with a review of disparities in pass rates based on race, ethnicity, and gender over a 3-year period. To date, the full report of these findings is not available. However, HPCC asserts their initial findings indicate a racial, gender, and ethnic gap in exam pass rates, with a commitment to reduce pass rate disparities among these groups.
The HPCC outlined other strategies in their notice to certificate holders and members, including:
- Performing a differential item functioning (DIF) analysis of its Certified Hospice and Palliative Nurse (CHPN®) program, which is its largest certification exam. The aim is to identify bias in exam questions and how different demographic groups answer exam questions correctly.
- Increase diversity in HPCC committees with member and certificate holder volunteers. Applicants are considered based on their demographic and geographic background, with the goal to reach “underrepresented” certification holders.
- A review of current exams, by the HPCC Examination Development Committees (EDCs), to “ensure they are free from stereotypes, overt and subtle discrimination, and negative messages.”
- Creation of a “DEIB Style Guide” to ensure exam questions are written with “inclusive language and are culturally aware”, including “avoiding the use of gender-specific pronouns and other non-inclusive language.”
The hospice and palliative nursing certifications are some of the most challenging and rigorous credentialing exams in the profession. They require knowledge of multiple disease states, extensive pathophysiology, and caring for a patient at the end of life. It has traditionally been a prestigious, merit-based certification that palliative and hospice nurses are proud to display. The initiatives proposed by HPCC beg the question: How will they ensure excellence remains the top priority in the certification process?
This is a disheartening trend among nursing organizations that prioritizes DEI over merit, activism over healing, and appeasement over fidelity to the profession. For current HPN certification holders, it is insulting to realize that the work done to reach this accomplishment is minimized by ideologically motivated initiatives that have no credible evidence to support them. Even worse, it is heartbreaking for patients and families, who need the best, most qualified nurses at the most vulnerable times of their lives. Nurses – who are repeatedly ranked as members of the most trusted profession in the country – must act to return their professional organizations to its main purpose: Providing the best possible care to all patients.
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