Role Delineation Study of the Infusion Nurse
The purpose of this role delineation study, also known as a practice analysis or job analysis, was to identify the necessary knowledge and tasks involved in infusion nursing practice as a first step in the continuing development of a job-related certification examination. The Infusion Nurses Certification Corporation (INCC) requested the services of Applied Measurement Professionals, Inc. (PSI/AMP) to design and conduct a study that would provide the support necessary to develop specifications upon which content valid certification examination could be built for infusion nurses.
INCC appointed a Role Delineation Advisory Committee (RDAC) to conduct the activities necessary to identify responsibilities of practitioners and develop examination specifications. The diversity of this group was reflective of the practice of infusion nursing throughout the United States, and all RDAC members had demonstrated expertise in their respective areas of specialization.
The study involved development of a web-based role delineation survey, distribution of the survey to target practitioners, and an analysis of their responses. Examination Specifications were derived from the data gathered using the role delineation survey. The Examination Specifications can be described as including a Detailed Content Outline of knowledge and associated tasks, along with requirements related to the number of items to be included on the new Certified Registered Nurse Infusion (CRNI®) examination.
The RDAC met in March 2012 to initiate the following six tasks:
- Develop a sampling plan
- Identify topics and tasks for the survey instrument
- Identify content categories
- Determine the rating scales
- Determine the relevant demographic variables of interest
The primary resource for the RDAC to use to identify topics, tasks, and content categories was the previous role delineation study (RDS). In addition, various publications were considered, including those published by the Infusion Nurses Society, such as Infusion Nursing Standards of Practice, Policies and Procedures for Infusion Nursing, and Infusion Nursing: An Evidence-Based Approach. As with the current examination content outline, nine major domains of practice were identified as the content categories. However, the scope of one of those domains, Pediatrics, was broadened somewhat to be more reflective of current infusion nursing practice. This new domain, called Special Populations, included pediatrics as well as topics related to older adults and pregnancy. Another change made by the RDAC was to collect data that would lead to an outline organized primarily by topics, rather than by tasks, as is the case with the current outline. When identifying topics and tasks, the RDAC considered that any task could potentially be associated with any topic. Finally, the RDAC discussed whether the last domain, Performance Improvement, should remain separate or be integrated within the other domains, and for the purpose of collecting data on the survey, the domain remained separate.
A total of 3,751 invitations containing a link to the online role delineation survey were e-mailed to nurses registered with INCC. After adjusting for undeliverable addresses (n=76) and opt-outs (n=4), it was determined that approximately 21.8% of the sample responded (n=819). Among the total respondent group, 3 cases were excluded because they were duplicate responses from the same individual. Of the remaining 816 potential respondents, 85 were excluded because they did not respond to any knowledge and/or task statements. These adjustments yielded 730 responses and an adjusted, usable response rate of 19.9%. Respondents used all rating scales with an acceptable level of reliability.
During a series of meetings in July 2012, the RDAC reviewed the demographics of the respondent group and concluded that the respondents were consistent with their expectation of the population of infusion nurses. In addition, it was determined that a sufficient number of responses in relevant subgroups were received to facilitate subsequent analyses.
Decision rules were adopted by the RDAC and used to determine which knowledge and tasks were appropriate for assessment and therefore for inclusion in the final Detailed Content Outline (DCO). Decision rules were established to ensure that the resulting content was:
- Part of practice
- Important to practice
- Important throughout the United States
- Important regardless of educational preparation, and
- Important for entry-level practitioners
It was determined that a total of 150 multiple-choice items would be sufficient to assess the knowledge and tasks that are important to infusion nursing practice. The number of items specified for each content category was determined by the RDAC based upon consideration of the breadth and depth of content, using the survey respondents’ judgments regarding the percentage of a CRNI® examination that should be included in each area.
The RDAC also evaluated the cognitive complexity that would likely be associated with the categories on the content outline and determined that 30 items should require recall on the part of the candidate, 90 should require application of knowledge, and 30 should require analysis of an infusion patient situation.
The final Detailed Content Outline was used to build examination forms that were administered beginning in September 2013.
To ensure that the role of the infusion nurse is adequately represented in the CRNI® exam, it is necessary that an RDS be conducted on a routine basis (typically every 4 – 5 years).