Certified Emergency Nurse Program Overview

40 Years of Excellence: The Certified Emergency Nurse (CEN)

Originally Published July 2020

Download the Program Overview PDF

Large blue quotation mark symbol on a transparent background.

For the sick, it is important to have the best.

– Florence Nightingale

In July 2020, as BCEN celebrates the 40th birthday of the Certified Emergency Nurse (CEN®) — the world’s first1 and most widely held2 emergency nursing professional credential — today’s nearly 40,000 CENs are excelling in their careers and workplaces and delivering the highest quality patient care, around the clock and around the world, in healthcare’s most demanding, dynamic and often unforgiving environments.

The Consequential Role of Emergency RNs

Nowhere are specialized knowledge and skills, critical thinking, and self-efficacy needed more than in high-risk, high-volume and unpredictable emergency care settings.

Today’s 210,000-strong emergency trauma RN nurse workforce3 partners with over 42,000 emergency medicine physicians4 to spearhead care for 139.0 million annual emergency department (ED) visits.5 Further, about 70% of hospital admissions are processed through the ED.6 As such, the ED’s consequential role includes serving as every hospital’s front door and gatekeeper to inpatient services, and RNs’ consequential role includes providing the lion’s share of patient care and contact, from triage to ED discharge or hospital admission.

Emergency RNs rapidly and accurately assess patients, analyze data, monitor for changes and recognize when interventions are needed. They also anticipate patient and physician needs while simultaneously coordinating and documenting care and communicating with patients and their families. Mastery of the now well-defined body of emergency nursing knowledge, which spans every patient population and clinical category plus a wide range of professional issues, is essential for effective, efficient and frequently needed lifesaving care.

CEN’s Prehistory – Vision & Persistence

The CEN came to fruition thanks to the remarkable persistence of the visionary nurses who conceived of a certification program for emergency nurses in the mid-1970s, just as emergency medicine was emerging as a discrete medical specialty. The leaders and members of the Emergency Department Nurses Association (today’s ENA) overcame various setbacks in this journey. In 1977, through their steadfast commitment, they were finally able to overcome funding challenges by earmarking 7% of member dues to finance the exam’s development.7,8

Through the dedication and diligence of successive certification subcommittees, a certification philosophy was formulated, the emergency nursing body of knowledge was assembled, and a professional testing agency was hired. The final push took place over 10 months starting in late summer 1979. The herculean efforts of the certification committee turned certification board was aided by dozens of designated item writers who created the first exam item bank, which included test question suggestions submitted by nurses across the nation. In every way, it was a professional effort of, by and for the emergency nursing profession.9

1980s – Advent & Independence

The July 1980 introduction of the CEN by the Board of Certification for Emergency Nursing (BCEN®) marked not only the advent of emergency nursing specialty certification but also the start of BCEN’s leadership role in advancing the practice of emergency nursing and supporting the success of certified emergency nurses.

The nurses who passed the first CEN certification examination were enthusiastically feted at the 1980 EDNA Scientific Assembly in Atlanta and honored by name in the Journal of Emergency Nursing, which heralded their historic achievement:

Large blue quotation mark symbol on a transparent background.

“Congratulations to the 1,274 nurses who passed the July 19, 1980 Certification Examination!

They will now be seen in hospitals, universities, and industry — nurses who have proved their attainment of a defined body of knowledge and are now entitled to the CEN designation as part of their professional recognition.”10

In fact, 1980 was also the first year emergency care physicians could become board certified, with emergency medicine having just been officially recognized as the 23rd medical specialty by the American Board of Medical Specialties in September 1979.11 While specialty certification for physicians, which began in 1917, was already well-established, the CEN was among the first dozen or so specialty certifications for RNs. As word of the first emergency nursing certification spread, and despite there being only two CEN exam dates per year, the number of CENs grew to nearly 6,000 by July 1982 and topped 7,800 going into 1984.

Thanks to the wisdom and foresight of ENA’s first Blue Ribbon Commission, it was determined that the certifi- cation board should be separated from the professional membership association, a decision that would later prove critical to the accreditation of the CEN certifica-tion program.12 As a result, on January 1, 1986, BCEN became an independent, not-for-profit corporation.

1990s – Development & Expansion

With steadily growing interest from nurses and advances in computer technology, the CEN exam progressed apace. The 250-question, four-hour, paper-and-pencil exam initially offered in just 30 states evolved into an equally robust, 150-question computerized exam offered in every state and, eventually, to nurses outside America. In 1997, for instance, the CEN was first offered in Australia. During the 90s, the exam construction and review process matured, regular role delineation studies continued to ensure the clinical currency of the exam, and new recertification options were explored. By 1999, testing was offered monthly and test takers could finally learn their certification exam scores immediately.

2000s – Accreditation & Magnet Status

In 2000, BCEN transitioned to offering CEN renewal by retesting or accruing 100 contact hours of relevant continuing education. This choice remains in place today. But perhaps what most distinguishes the post-millennial decade is accreditation. National accreditation is the gold standard for certification programs. Because accreditation standards require a certifying organization to be autonomous from a related member organization, ENA’s decision for BCEN to separate proved prescient.

In February 2002, the CEN certification program earned initial accreditation from the American Board of Nursing Specialties’ Accreditation Council (today’s Accreditation Board of Specialty Nursing Certification). This rigorous, comprehensive, data-intensive process constituted an impartial, third-party validation that the CEN certification program complied with recognized national industry standards. Accreditation and reaccreditation remain the crown jewels of achievement for BCEN’s CEN certification program. As the 2000s concluded, BCEN’s first article on the value of certification13 published and the CEN earned Magnet®-approved status.

2010s – Research, Resources & Advancing the Emergency Specialty

In 2011, BCEN embarked on an ambitious project to advocate for the acceptance of specialty certification to meet CE requirements for RN licensure renewals.14 The success of this initiative has had a positive and lasting impact for certification programs across all specialties.

In the mid-2010s, BCEN began developing what would become the largest emergency nursing certification study in history. Nearly 10,000 emergency nurses and super-visors participated in BCEN’s landmark Value of CEN Certification Research Study. The 2017 study found that CEN certification was positively linked with greater emergency nursing expertise, self-efficacy, and career success and satisfaction, as well as superior technical performance, accuracy and ethics.15

Recognizing the need to understand the broader emergency nursing professional context that today’s nearly 40,000 CENs must navigate, BCEN initiated another landmark research project by enlisting the partnership of the three major emergency nursing specialty professional membership associations — ASTNA, ENA and STN. Under the aegis of the MedEvac Foundation International, the first comprehensive study of the emergency nursing workforce took place in early 2019. The expansive findings of the Emergency/Trauma/ Transport Nursing Workforce Survey were published in an award-winning 2019 Nursing Management original research article.2

In the late 2010s, in support of CENs and nurses holding or pursuing any of BCEN’s now five credentials, BCEN introduced what has become an industry-leading portfolio of (mostly free) certification resources for nurses, nurse leaders, educators, and ED administrators. In 2016, BCEN introduced a discount exam voucher program for employers. In 2018 and 2019, BCEN published its first two white papers, a nurse recognition toolkit, toolkits to support nurses’ certification journeys, test anxiety resources, and full-length practice exams.

2020s – Building Towards the Future

Just months before celebrating the CEN’s 40th birthday, BCEN introduced the BCEN EDvantage certificate program. BCEN EDvantage was designed to help prepare nursing students and new graduates for a career in emergency nursing, and more specifically, their first job in the ED. The program can be a valuable precursor to CEN certification, and also creates a bridge to emergency nursing for RNs practicing in other specialties.

As we look forward to the next 40 years of CEN-certified nursing, we know this much to be true: Emergency specialty certification helps ensure emergency nurses practice at the top of their specialty. As our healthcare system — and more specifically emergency care — is faced with new and increasingly complex challenges, preparing emergency nurses to be at the top of their game through CEN certification is one of the best things we can do.

References

  1. American Board of Nursing Specialties (ABNS). (2020). ABNS 2019 Annual Member Survey and in-house data. Birmingham, Alabama: ABNS. 
  2. Schumaker, J., Taylor, W., & McGonigle, T. (2019). The emergency/trauma/transport nursing workforce: Highlights of a benchmark 2019 survey. Nurs Manag, 50(12), 20-32. DOI: https://doi.org/10.1097/01.NUMA.0000605152.42445.4b
  3. U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration, National Center for Health Workforce Analysis. (2020). Characteristics of the U.S. Nursing Workforce with Patient Care Responsibilities: Resources for Epidemic and Pandemic Response from the 2018 National Sample Survey of Registered Nurses. Rockville, Maryland: HHS. Retrieved from https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/nssrn-pandemic-response-report.pdf
  4. Association of American Medical Colleges. (2020). Active Physicians in the Largest Specialties, 2017. Retrieved from https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-largest-specialties-2017
  5. Rui, P., & Kang, K. (2020). National Hospital Ambulatory Medical Care Survey: 2017 emergency department summary tables. National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/data/nhamcs/web_tables/2017_ed_web_tables-508.pdf
  6. Augustine, J. (2019, December 20). Latest Data Reveal the ED’s Role as Hospital Admission Gatekeeper. Retrieved from https://www.acepnow.com/article/latest-data-reveal-the-eds-role-as-hospital-admission-gatekeeper
  7. Spinella, J., & Estrada, E. (1980). Certification: A measure of professional accountability. J Emerg Nurs, 6(1), 17-19.
  8. Spinella, J., Tone, B.W., Manton, A., Rhoads, J. & Kidd, P. (1990). A historical look at the CEN certification program. J Emerg Nurs, 16(1), 26A-33A.
  9. Certified emergency nurses. (1980). J Emerg Nurs, 6(6), 35. 
  10. Weldon, B. & Parrish, N. (1984). Certification update: A retrospective review. J Emerg Nurs, 10(1), 34A-35A.
  11. American Board of Emergency Medicine (ABEM). (2020). ABEM History [ABEM Web site]. Retrieved from  https://www.abem.org/public/about-abem/abem-history
  12. Thompson, J. (1983). Blue ribbon commission task force preliminary report: An overview. J Emerg Nurs, 9(6), 21A-31A.
  13. Grief, C.L. (2007). The perceived value of BCEN certification. J Emerg Nurs, 33(3), 214-16.
  14. Grief, C.L. (2013). Advocating for registered nurse specialty certification. J Emerg Nurs, 39(3), 248-49.
  15. Medsker, G.J., & Cogswell, S. (2017). Value of CEN® certification research study. Naperville, Illinois: Human Resources Research Organization. Retrieved from https://bcen.org/wp-content/uploads/2018/09/2017-BCEN-Value-of-Certification-Study-PPT.pdf

Authors

Janie Schumaker, MBA, BSN, RN, CEN, CENP, CPHQ, FABC, Executive Director, Board of Certification for Emergency Nursing (BCEN), and President, American Board of Nursing Specialties (ABNS), and Darleen A. Williams, DNP, APRN-CNS, CEN, CCNS, CNS-BC, EMT-P, Clinical Nurse Specialist for Emergency Services, Center for Nursing Research, Orlando Regional Medical Center, and 2010-2011 BCEN Board Chairperson.