By Dennis Spence, PhD, MS, CRNA, FAAN, CAPT (ret), NC, USN, National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA), and Janice Moore, SeaCrest Consulting

In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic. The impact of shut downs, travel restrictions and social distancing requirements on the credentialing community included an accelerated adoption of live remote proctoring and rapid transitions from office-based to remote work settings. The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) and SeaCrest Consulting conducted a survey to gather information regarding how certifying organizations in the United States responded to COVID-19 during 2020. The survey was developed with input from ad-hoc volunteer workgroups that provided key feedback regarding survey development and participation in survey pilot testing.

The COVID-19 Impact Credentialing Survey sought to answer the following questions:

• How did organizations respond to the COVID-19 pandemic operationally and programmatically?
• What change implementation occurred to address the needs of staff and other target audiences?
• What future changes are anticipated by certifying organizations?

The final data analysis included information from 75 respondent organizations collected during January 2021. Most respondents were split between stand-alone certifying bodies (47%, N=35) and certification programs within a larger, parent organization (47%, N=35). The majority (57%, N=43) offer one to three programs. Most respondents (57%, N=42) stated that their programs addressed health care. Additional demographic data are included in the full report.

Our interpretations of the results are noted below along with key survey highlights. Click here to view the full report.

Staffing

For most organizations, staff size remained the same and employees successfully shifted to remote work settings.

• More than three-quarters of organizations (78%, N=58) made no changes to their certification department staffing because of the pandemic.
• Forty-two percent (N=31) reported shifting the work setting for all employees from an office setting to a remote setting.
• Most organizations (86%, N=64) indicated they managed the shift to remote work without significant disruption.

Marketing

Many organizations responded with increased resources and customer service support for certificants.

• Most organizations (70%, N=52) developed COVID-19-specific resources and communications for their certificants.
• More than one-third of respondents (34%, N=25) reported increasing the amount of marketing and communications related to the promotion of certification and/or recertification.
• Twenty percent of respondents (N=15) confirmed increasing their customer service capacity to address applicant and certificant questions and concerns.

Meetings and Travel

While the impact of travel restrictions was wide-ranging, volunteers for most organizations remained available to participate.

• Organizations temporarily limited or restricted their employee travel, with restrictions still being imposed (66%, N=49), and reported that their governing board volunteers were unable to travel due to restrictions imposed by their employers (65%, N=48).
• More than half of certifying organizations (53%, N=38) reported that volunteer availability to participate remained the same.

Testing and Other Operations

Test site closures and reduced capacity caused significant disruptions.

• More than half of the programs (55%, N=39) reported that testing sites were temporarily unavailable. Only 4% (N=3) of certification programs had no interruption to testing operations.
• Problems related to test center closures were the most frequently noted contributors to operational interruptions in organizations’ open-ended comments.
• Almost half of respondents (48%, N=32) reported conducting planned examination development activities as scheduled. The most frequently postponed activities included item writing (25%, N=17) and item review (22%, N=15).

Workforce Impact

Practitioner impacts varied, with as many organizations reporting increased demand as reported short-term decreases in demand.

• Impact on the practitioner workforce, including the candidate and certificant population, was evenly split between an overall increase in demand, workload and/or similar factors (39%, N=27) and a short term decrease in demand, including reduced workload, furloughs, layoffs, etc. (39%, N=27).
• Reduced employer support for certification was reported by 20% (N=14).
• An accelerated need to transition more candidates/practitioners into practice (for example, expediting students’ entry into practice or transitioning retired professionals back into the workforce) was reported by 17% (N=12).

Certification Program Policies and Procedures

Most programs adjusted deadlines in response to the pandemic, while many made additional policy changes.

• Most organizations (67%, N=45%) adjusted program deadlines.
• Other policy and procedure changes included changes to examination administration methods (43%, N=29), recertification requirements (30%, N=20), examination development activities (28%, N=19), access to continuing education (28%, N=19) and program fees (25%, N=17).

Examination Administration Methods

One third of respondents added live remote proctoring as a test administration option during 2020.

• Half of the respondents (50%, N=35) reported that their examination continued to be offered when and where feasible without changes to test administration method(s), despite disruptions and delays.
• One third (33%, N=23) reported adding live remote proctoring as an option, in addition to their existing test administration method(s).
• Six programs commented they are planning on adding live remote proctoring.
• Only 9% (N=6) reported the ability to administer their exam as planned and scheduled.

Accreditation

Allowances made by all accrediting bodies during 2020 for programs to seek approval of live remote proctored test administration likely allowed programs to continue operations without risking their accreditation status.

• Most (58%, N=42) accredited programs reported no expected changes to accreditation status because of COVID-19 program impacts.
• Four percent (N=3) reported that changes made during 2020 may risk their existing accreditation.
• Fourteen percent (N=10) reported delaying an initial accreditation application.

Employee Work Setting

Plans to return to an in-office work setting are wide-ranging, with uncertainty remaining for many programs. With a shift to remote work, organizations made adjustments to promote team building, communications and productivity by leveraging technology.

• Prior to the onset of the pandemic, 41% (N=30) of organizations’ employees worked entirely from an office setting and 42% (N=31) reported that employees worked in an office setting with some employees working remotely. Only 9% (N=7) of employees worked mostly remotely and 8% (N=6) reported no central office location with all employees working remotely.
• Thirty-three percent (N=24) reported that returning to an office setting is currently optional with each staff member given the option to decide. Thirty-one percent (N=22) plan to keep virtual/remote work in place with no planned return to the office and 22% (N=16) plan to return to the office setting on a rotating and/or part-time basis to allow for increased distancing.
• Optional comments indicated ongoing uncertainty about when and how staff will return to the office.
• Regularly scheduled video conference staff check-ins were the most common tactic to promote team building, communication and productivity (82%, N=59). Other frequently used approaches included scheduled social times using a video conferencing platform (53% N=38), increased or expanded use of existing tools/technology for collaboration (53%, N=38) and the addition of new technology tools to facilitate communication (39%, N=28).

Looking Ahead

Continued use of remote work and remote proctoring are planned for the next two to three years. Several organizations commented that they remain uncertain about, or are still developing, their future plans.

• When asked about strategic changes planned for the next two to three years, organizations reported plans for continued use of virtual/remote meetings for governance and committee work (56%, N=40) and for other volunteers that cannot, or do not want to travel (53%, N=38), along with reduction in staff and volunteer travel (43%, N=31).
• Continued use of remote proctoring is anticipated by 43% (N=31) of programs.
• When asked about the continued economic impact of the pandemic, 39% (N=28) of programs anticipate some improvement for projected revenue in 2021 while 38% (N=27) are uncertain. Only 4% (N=3) expect significant improvement.

Lessons Learned

Programs shifted to provide additional support, understanding and flexibility for their certificants, including increased communication and information resources, free and/or easier to access continued education options and waived or lowered fees.

Organizations were asked to share their lessons learned related to their COVID-19 response in open-ended comments. In general, respondents recommended:

• Frequent and clear communication with a focus on empathy, flexibility and value
• An increased use of paperless and automated processes
•  A willingness to make adjustments to policies and procedures without sacrificing key standards
• Embracing new technology tools and providing training to support their use
• Patience, careful planning and coordinated vendor communications for the transition to live remote proctoring
• Collaborative relationships and information sharing

Some of the unanticipated opportunities noted by respondents included adoption of new technologies sooner than would have otherwise been planned, benefits from increased communication and expense savings from reduced travel.

Volunteer engagement experiences ranged widely with the shift to virtual meetings. Respondents advised patience and understanding for volunteers balancing increased work demands, additional planning for recruitment, shorter meeting times and formats suitable for a virtual environment and finding ways to recognize and appreciate volunteer contributions.

Based on the survey results, most certifying organizations successfully shifted operations to remote work with few, if any, changes to staffing. Organizations reported providing increased customer service and communications.

Closures and reduced capacity at test centers caused the most significant operational disruptions. While half of the responding organizations adjusted to disruptions without changing their test administration methods, a third of organizations added live remote proctoring to increase testing availability. Programmatically, certifying organizations displayed responsiveness to applicant and certificant needs by adjusting deadlines and implementing temporary policy changes.

Looking ahead, uncertainly remains for plans to return to in-office work settings. Continued use of remote work and remote proctoring strategies seem likely. In the long term, organizations will benefit from the adoption of new technology, increases in automation and improved communication channels. These rapid reactions to the pandemic provide increased flexibility for responding to future crisis events.