In the face of increasing health care complexities, it’s more important than ever before for nurses to have advanced skills and to be able to easily demonstrate to patients, families and other health care professionals that they have the knowledge and abilities to rise to the challenge. One way that nurses can show their commitment to best practices, patient safety and ongoing education is by becoming board-certified in a specialty area. The designation RN-BC refers to board certification and indicates that the nurse has met the standards of excellence established by the certification organization.

Becoming a Board-Certified Nurse

The typical career path for a nurse begins by completing a two- or four-year program of study that leads to an associate degree, nursing diploma or bachelor’s degree. Upon finishing their education, prospective nurses must pass the NCLEX-RN, a standardized examination used nationwide, to become licensed as a registered nurse and become legally authorized to practice nursing. At this point, an RN can work in any health care facility, including hospitals, outpatient centers, doctors' offices, schools, public health programs, correctional facilities or in the military.

After you earn your RN license, you are on track to become board-certified. The RN-BC designation is primarily used by the American Nurses Credentialing Center (ANCC) and can refer to one of many specialty certifications. The ANCC board certification program offers more than 20 specialty credentials for nurse practitioners, clinical nurse specialists and specialty nurses. The specific requirements regarding coursework for board certification varies according to specialty, but all include experience, education and examination requirements.

For example, to earn the Adult-Gerontology Acute Care Nurse Practitioner Certification (AGACNP-BC), you must be a licensed RN, hold a master’s or doctoral degree from an adult-gerontology acute care nurse practitioner program that includes at least 500 hours of supervised clinical experience and advanced courses in physiology/pathophysiology, health assessment and pharmacology, and pass a computerized exam. To earn board certification in medical-surgical nursing and the designation of RN-BC, you need an active RN license, two years of experience as a registered nurse, at least 2,000 hours of clinical practice in medical-surgical nursing in the last three years, at least 30 hours of continuing education in medical-surgical nursing in that same period, and you must pass the examination. In all cases, candidates are required to submit transcripts and pay a fee, which as of 2018, ranges from $270 to $395, depending on your membership in the American Nurses Association.

Some nursing professional and specialty organizations offer their own specific board certifications. For example, to become a certified nurse midwife, you must be a registered nurse and pass the American Midwifery Certification Board examination, while nurse anesthetists can only become certified by passing an exam administered by the National Board of Certification and Recertification for Nurse Anesthetists.

Board Certification vs. Advanced Practice and BSN

Although every state requires nurses to be licensed, there is no requirement for board certification. Some employers prefer to hire board-certified nurses, even requiring certification for certain specialties, but certification is not mandatory to work as a nurse. In some cases, board certification is confused with advanced practice, but they are not the same thing. Advanced practice nurses perform many of the same functions as a doctor, often serving as primary care providers and diagnosing and treating illnesses, managing chronic conditions and providing preventive care. An advanced practice nurse, or APRN, must hold a master’s or doctoral degree in addition to meeting the requirements to be licensed as an RN, as well as being board-certified in their area of specialization.

Board certification is also not to be confused with earning a Bachelor of Science in nursing (BSN). Provided you meet the licensing, experience and continuing education credit requirements, you can be board-certified in a nursing specialty with only a two-year nursing degree. However, there is an increased push for nurses to earn four-year degrees, with the Institutes of Medicine calling for 80 percent of nurses to have a bachelor’s degree by 2020, and some states, including New York, passing legislation requiring all new nurses to earn a four-year degree within 10 years of earning their initial RN credential. Research indicates that patient safety and outcomes are improved when nurses hold a BSN or higher, and many health care facilities prefer candidates to have an advanced degree. Board certification is not a replacement for this education, but the education you undertake to achieve and maintain certification could potentially count toward an advanced nursing degree.

Renewing Your Certification

In most cases, certifications are valid for five years, at which point you must renew your credential. If your certification has not expired, you can apply for renewal at any time in the 12 months preceding expiration.

To keep your board certification in good standing, you must apply for renewal, pay the fee ($175 as of 2018), and submit evidence that you have completed the requirements. The ANCC requires nurses to have a nursing license and have completed at least 75 credit hours of continuing education in their specialty in the previous five years. Also, nurses must complete at least one of several categories for recertification within that period. These categories include:

• Academic credits (five semester credits or six quarter credits)
  
• Presentations totaling at least five hours
  
• An evidence-based practice, quality improvement project, research or publication
• 120 hours as a preceptor or clinical supervisor
• Two years of professional volunteer service
• A minimum of 1,000 practice hours in your specialty within the five years before applying for certification
• Passing an exam or portfolio assessment when available. 

Advanced practice nurses must include at least 25 credit hours in pharmacotherapeutics as part of their 75 hours for recertification.

If your board certification has expired, you must complete all of the above requirements and pay an additional $125 reactivation fee. If it’s been more than two years, you have to complete the 75 hours of continuing education and the exam or portfolio to reinstate your certification. If there is no assessment option available for your specialty at that time, you cannot renew your certification.

Why Become Certified

Earning the board-certified credential is an investment in your career. An increasing number of nurses are seeking the credential every year. Between 2015 and 2016 alone, the number of nurses with the BC credential increased by 7 percent or 51,000 nurses. That brought the total of board-certified nurses to 750,000 in the U.S. with about 80,500 achieving RN-BC status through ANCC, and the numbers keep climbing.

Why is the credential so in demand? For starters, it opens the door to more career opportunities, and board-certified nurses earn more than those who aren’t certified. Also, the RN-BC designation not only translates to more job offers, but it also expands your opportunities within an organization. Employers value certifications and are likely to promote certified nurses faster and more often than others.

From a personal development standpoint, because maintaining board certification requires continuing education, you are consistently learning and growing in your profession and helping to advance the nursing profession. Being board-certified requires proficiency in your specialty and tells your employer, co-workers and patients that you are committed to providing the best possible care. Putting in the extra time and work to build your expertise in your specialty means that you are better prepared to take on complex cases and elevate the quality of care provided by your employer. A study by the American Association of Critical Care Nurses indicated that 73 percent of Americans would prefer hospitals that have a higher percentage of board-certified nurses.

The preference of patients to work with certified nurses is supported by evidence that patient outcomes improve when nurses are board-certified in their specialties. A 2011 study in the "Journal of Nursing Scholarship" revealed that when a hospital increases the number of board-certified nurses by 10 percent, the 30-day mortality rates of patients decreased by 2 percent. For this reason, many employers are not only looking to increase the number of certified nurses that they hire, but they are also supporting the efforts of their nurses to achieve board certification. Many hospitals offer tuition reimbursement for continuing education and cover some or all of the fees for certification. Others offer bonuses to nurses who pass their exams.

Overcoming Barriers

Some nurses are apprehensive about seeking board certification because of the time and the cost involved. Many employers offer a wide array of incentive programs and other support for nurses who want to seek certification, including bonuses and tuition assistance. Many certified nurses note that the exam, while challenging, focuses largely on skills and information that nurses use every day. Reviewing the test materials and putting in the time to prepare for the exam is usually adequate for success. The vast majority (about 86 percent) of test-takers pass on the first try.

Salary and Job Outlook

According to the U.S. Bureau of Labor Statistics, registered nurses earn a median annual salary of $70,000. This means that 50 percent of nurses earn more, and 50 percent earn less than this figure. On the low end, registered nurses in the bottom 10 percent of earners brought home a salary of less than $48,690, while the top 10 percent of earners took home more than $104,100. Earnings potential is closely tied to specialty, education level, certifications and geographic location. The BLS reports that nurses who have a bachelor’s degree and certification have better job prospects than those who do not.

In recent years, there has been a great deal of discussion of a nursing shortage, and a significant number of new nurses have entered the labor market. Still, the BLS projects a 15 percent increase in new job growth in nursing by 2026, which is well above average. The aging population in the U.S. is a major driver of this growth, as not only will there be increased demand for health care services, but also an increased need for nurses to care for patients with chronic conditions such as Alzheimer’s, dementia, diabetes and obesity. Long-term care and rehabilitation centers will have plenty of opportunities for nurses in the coming years as more patients are discharged to these facilities. Home health is another fast-growing segment for nurses, as more people want to age in place and receive care at home. Regardless of where they work, though, nurses with a specialty credential are always in demand and have an advantage over the competition.