GUEST EDITORIAL
Credentialing for
Perioperative Nurse
Leaders
JAMES X. STOBINSKI, PhD, RN, CNOR, CSSM
I n the October 2015 issue of the AORN Journal, I wrote a
Guest Editorial about emerging trends affecting nursing
professional development and about the importance of
“. . . developing new skills and areas of expertise that were not
covered in prelicensure education. . . .”1(p325) One of those
trends is a shift to greater individual responsibility for a
nurse regarding lifelong learning. Nurses, including those in
leadership and management roles, are faced with the need
for ongoing professional development during the courses of
their careers.
The need to develop new skills is of particular importance for
perioperative nurse leaders in a time of rapid change. A key
message from the Institute of Medicine (IOM) report The
Future of Nursing: Leading Change, Advancing Health echoes
the importance of ongoing education and lifelong learning:
“The nursing profession must adopt a framework of
continuous lifelong learning that includes basic education,
academic progression, and continuing competencies.”2(p213)
Recognizing this need, AORN has dedicated this issue of
the AORN Journal to providing content on a variety of
management- and leadership-oriented topics that are of
interest to a wide range of perioperative nurses, including
perioperative nurse leaders.
EDUCATION PROGRAMS FOR
PERIOPERATIVE NURSE LEADERS
Since 2009, the Competency & Credentialing Institute (CCI)
has offered continuing education (CE) and a certificate of
mastery program (Surgical Services Management) centered on
management and leadership in the perioperative setting; they
are available in the form of self-paced individualized learning
combined with live presentations by subject matter experts.
94 j AORN Journal
This content was built on the foundation of a job analysis
(ie, role delineation study) of the work performed by periop-
erative nursing leaders. A job analysis is “. . . designed to
obtain descriptive information about the tasks performed in a
job and the knowledge needed to adequately perform those
tasks.”3(p7) The purpose of the job analysis, which was
sponsored by CCI, was to “. . . develop and validate the
listing of the tasks and knowledge related to work performed
by professionals in the field of surgical services management”
and to “. . . develop a body of knowledge for the Surgical
Services Management education program.”3(p7)
The same rigorous process of job analysis supports certification
examinations such as the CNOR credential, which is also
administered by CCI. The certificate of mastery program in-
cludes a pretest to guide learning and a posttest to measure
participant’s knowledge of the content taught in the course.
These assessments are critical elements of the program. The
assessment component and the job analysis foundation
distinguish a certificate program from traditional CE activities.
Through the job analysis, CCI monitors the nature of peri-
operative nurse leaders’ work and stays current with changes in
that role.
In frequent interactions with the perioperative leadership
community and through the job analysis findings, CCI
learned that certificate of mastery programs are important and
valued, particularly by those who are new to or aspiring to
perioperative management. However, we also discovered un-
met needs for the community of perioperative nurse leaders.
Those needs were for additional formalized education and a
certification examination based on the body of knowledge
delineated in the job analysis. There is no standardized
http://dx.doi.org/10.1016/j.aorn.2016.06.016
ª AORN, Inc, 2016
www.aornjournal.org
August 2016, Vol. 104, No. 2
educational program for perioperative nurse leaders working
in the challenging OR setting. There is also a wide variety
of educational and training processes used on entry into this
role. The diversity of approaches contributes to a lack of
consistency and leaves much room for improvement. Many
perioperative nurse leaders develop a level of competency
without a formalized course of instruction tailored to the
unique demands of the field. This is often attained through an
arduous process of “learning on the job,” a difficult method
of competency attainment that may lead to a frustrating, error-
prone career development process. A far more desirable option
to learning on the job would be a well-structured program,
perhaps augmented by additional academic coursework.
However, these ideal types of learning paths are infrequent for
perioperative nurse leaders and are typically found only in
larger facilities and health systems.
These unmet needs led CCI to develop the Certified Surgical
Services Manager (CSSM) certification program in 2015.
The CSSM credential and its recertification mechanism
address the identified gaps in the career paths for nurse leaders
working in the OR setting. In addition, the CSSM credential
further substantiates one of the career paths available to peri-
operative nurses.
THE CSSM CREDENTIAL
The certificate of mastery program in Surgical Services
Management represented an ambitious but early attempt to
meet the need for additional quality education and training for
the perioperative community. With the CSSM certification
examination, there now exists a standardized test of the
knowledge needed to lead and manage an OR. Although the
test itself is a significant accomplishment, the strength of the
credential and its value to the profession lie in the recertifi-
cation mechanism.
The CSSM certification and recertification process is funda-
mentally different from the processes for other perioperative
nursing certifications.4 First, a nurse wishing to take the
certification examination must substantiate recent learning
activity (eg, CE or academic coursework on the subject
matter covered on the test). This education must have been
completed within the two-year period immediately before
the nurse registers for the certification examination. This
requirement substantiates recent learning in the field and
some degree of current knowledge of the material that will
be on the test.
Second, all nurses wishing to take the CSSM certification
examination must have a minimum of baccalaureate-level
www.aornjournal.org
Guest Editorial
Table 1. Certified Surgical Services Manager
Certification ExaminationdMajor Topic Areas
Communication and Relationship Management
Operational Management
Leadership
Financial Management
Professionalism
Strategic Management
Human Resource Management
education. This requirement establishes a common knowl-
edge base for all test takers and reflects a known characteristic
of the nursing communitydthat nearly 50% of nurses have
graduate-level education.5 This eligibility requirement is also
consistent with the positions stated in the IOM Future of
Nursing report regarding the need for additional academic
preparation for nurse leaders.2 The CCI fully supports this
recommendation; the eligibility criteria for the CSSM
credential and the recertification processes serve to support
nurses who further their formalized academic education.
On passing the CSSM certification examination, each nurse
receives a detailed score report relative to his or her perfor-
mance on each of the seven major subject areas covered on the
exam (Table 1) and a tailored professional development plan.
Nurses who wish to maintain their CSSM certification have
two options. They may retake and pass the certification
examination or fulfill that professional development plan,
which addresses deficits relative to the major subject areas
found on the certification examination.
Figure 1 shows this CSSM recertification pathway in graphic
form. To fulfill that customized plan, those holding CSSM
certification must have access to quality CE materials aligned
with their learning needs. This special edition of the AORN
Journal can meet at least part of that need with content
covering several of the domains found on the CSSM exam.
The CE activities in this issue may also be used to meet the
education requirements for CSSM eligibility.
Continuous Professional Development
The CSSM certification examination and the information
presented in the Surgical Services Management materials pro-
vide both the content to support lifelong learning and a
mechanism by which to engage in ongoing professional devel-
opment relevant to the role. In addition, these materials change
the paradigm of learning for the nurse from a passive, directed
AORN Journal j 95
Stobinski
Figure 1. The Certified Surgical Services Manager (CSSM) recertification pathway.
model of learning to a proactive model of planned professional
development requiring active participation by the candidate.
Nurses holding the CSSM certification will be at the
forefront of the latest trends in professional credentialing.
As the first candidates for this credential, they will experi-
ence a far more personalized and directed professional
development path than those holding other nursing certi-
fications. These perioperative nurse leaders will be well
positioned to assist their staff members, who almost
certainly will experience a similar certification process in the
near future. Accreditation agencies for certification organi-
zations are now examining fundamental issues such as the
link between certification processes and competency. The
guidance of these accreditation groups will compel organi-
zations like CCI to make these changes to a more robust
and personalized professional development plan in the cer-
tification mechanism.
THE LARGER PICTURE IN HEALTH CARE
In the larger context of US health care, the discussion
regarding career paths and professional development for
perioperative nurse leaders is similar to discussions occurring
for other groups in nursing and other health care professions.
Two recent publications reinforce the rationale underlying
the CSSM credential. The first publication is from the IOM
and the second is from the American Board of Medical
Specialties (ABMS).
The Future of Credentialing in Nursing
In 2015, the IOM published a summary of a series of work-
shops on the subject of nursing certification research titled
Future Directions of Credentialing Research in Nursing:
Workshop Summary.6 The report provided the latest thoughts
96 j AORN Journal
August 2016, Vol. 104, No. 2
on certification against which the CSSM credential could be
benchmarked. A review of that summary demonstrates that
the CSSM credential represents a progressive program that is
well positioned for the future.
Among the sections of that report germane to the issue of how
to address the knowledge gaps of nurses were the comments of
Patricia Flatley Brennan, RN, PhD, FACMI, an associate
professor of nursing at Case Western Reserve University,
Cleveland, Ohio, who said, “Some certification requirements
may not adequately reflect the changing knowledge and skill
sets required to practice in today’s health care environ-
ment.”6(p8) She also stated that emerging technologies in
health care have the potential to fundamentally change the
practice of nursing. Based on this statement, we can see the
potential for the development of a gap between prelicensure
education and the real-life needs of the changing work-
place. This gap, when we consider the lack of standardized
educational preparation, is especially noteworthy for peri-
operative nurse leaders. Certification programs like the CSSM
program, if properly configured, could be part of the solution
to addressing this knowledge and skills gap.
Also in the report, Robin Newhouse, PhD, RN, NEA-BC,
FAAN, dean and professor of the Indiana University School
of Nursing, Indianapolis, suggested that “credentialing pro-
grams could be used to standardize and validate specific
knowledge sets and encourage nurses to develop advanced
leadership skills.”6(p9) Her rationale was that the certification
mechanism could be constructed to require knowledge of
current standards of care but also mandate that candidates
“continually demonstrate appropriate knowledge, skill, and
competency to meet credentialing requirements.”6(p9) The
net result would be to validate knowledge sets and skills,
perhaps necessitated by rapid changes in job requirements.
www.aornjournal.org
August 2016, Vol. 104, No. 2 Guest Editorial

Table 2. The August 2016 AORN Journal Continuing Education Articles and the Corresponding Domains of the
Certified Surgical Services Manager Certification Examination
Article Author(s) Domain
Perioperative Nurse Leaders and Dawn Whiteside, MSN, RN, CNOR Professionalism
Professionalism
Effective Perioperative Communication J. Hudson Garrett, Jr, PhD, MSN, MPH, Communication and Relationship
to Enhance Patient Care FNP-BC, CSRN, PLNC, VA-BC, IP-BC, Management
CDONA, FACDONA
Strategies for Successful Perioperative Joseph K. Mollohan, MSN, RN, CNOR, Human Resource Management
Orientation CSSM; Maria Morales, MSN, RN, CPAN
Improving OR Efficiency Patricia Vassell, DNP, MBA, BSN, RN, CNOR Operational Management
Leadership and Management Roles: Joyce A. Cox, MBA, MSN, CNP, CNOR, Leadership
Challenges and Success Strategies CRNFA, OCN, CHPN

The need to develop new skill sets is exemplified by the
changes coming from the implementation of the Centers
for Medicare & Medicaid Services Hospital Value-Based
Purchasing Program. This transition to value-based care
versus volume-centered care has required nurses to master
new skills and build their knowledge in new areas.
One key recommendation from the IOM Future of Nursing
report states that “nurses should be full partners, with
physicians and other health professionals, in redesigning
health care in the United States.”2(p29) Should such
partnership opportunities arise, nursing leaders must be
ready to actively participate. These opportunities may be
presented in the near future, and the CSSM credentialing
process can facilitate nurses being better prepared to meet
these challenges.
The Future of Practice
The ABMS is a nonprofit organization that “serves the public
and the medical profession by improving the quality of health
care through setting professional and educational standards
for medical specialty practice.”7 This organization is addressing
the question of how physicians in various specialties can
maintain competency in the face of rapid change in
US health care. The following quote is from the ABMS
web site:
With more options for patients to receive care and more va-
rieties of medicines, devices, and procedures which physicians
can choose from in providing care, it is important that phy-
sicians remain knowledgeable and skillful in their disciplines
and are attentive about providing safe, evidence-based, and
compassionate care to patients.8
The ABMS released a special report in 2015 titled The Future
of Practice: Transformation to Patient-Centered Systems; Insights
and Opportunities.9 In the report, the ABMS authors also
speak to the evolving physician view of professionalism and
how it can be developed during a career.9(p8) The work CCI
has done on the CSSM certification examination is entirely
consistent with the perspective presented in the ABMS
paper. In addition, the report highlights the need to develop
new skills for the transition to value-based care. These
skill sets, which are not major components of current
medical training, include strategic management, leadership,
professionalism, and financial management. It should be noted
that these areas, which ABMS maintains will be integral for
health care leaders, comprise four of the seven major subject
areas from the surgical services manager job analysis.
Knowledge of these subjects is both taught in the Surgical
Services Management materials and tested on the CSSM
certification examination.
Amid the transition in US health care described in the
ABMS report, nurses are well positioned to add value to the
greater health care system. This added value is predicated on
nurse leaders learning the skills needed to function in a
value-based system. Perioperative nurse leaders have a long
history of coordinating the various elements of perioperative
care. As health care roles and responsibilities evolve, nurses
may be able to increase their power and influence in
leveraging their areas of strength. In doing so, they can
gracefully and skillfully alter long-standing power gradients in
the perioperative setting and perhaps improve the nursing
work environment for perioperative nurses. But new
knowledge and skills will be needed to make this transition.
These attributes, such as communication and relationship

www.aornjournal.org AORN Journal j 97

Stobinski
skills, are subject areas delineated in the surgical services
manager job analysis.
IN THIS THEMED ISSUE
I am pleased to point out the features of this special issue on
the CSSM certification. First, you should note that these pages
contain 8.2 CE opportunities. The issue was built on the
premise that the topics covered would meet education re-
quirements central to the CSSM certification but also be of
interest to a variety of nurses working in the perioperative
setting. It should be noted that the CE opportunities
found in this issue may also be used by those holding the
CNOR and CRNFA credentials to meet those recertification
education requirements. Drawing on the knowledge of
subject matter experts in perioperative nursing leadership
and management, we have assembled a diverse selection of
articles that address some of the major subject areas of the
CSSM certification examination. Each of the CE articles
link to one or more subject areas of the CSSM certification
examination (Table 2).
CONCLUSION
One of the goals of the issue was to present materials useful to
perioperative nurses involved in patient care as well as current
and aspiring nurse leaders. The CCI asserts that maintaining
and enhancing professional competency fulfills an ethical
obligation to our patients to consistently provide high-quality
care. The educational materials contained in this issue afford
one method to enhance the knowledge of perioperative nurses
in the area of surgical services management. In this time of
increasing complexity in US health care, we see materials such


as these as integral to the continuous professional development
of perioperative nurses.
Editor’s note: CNOR, CSSM, and CRNFA are registered trade-
marks of the Competency & Credentialing Institute, Denver, CO.
98 j AORN Journal
August 2016, Vol. 104, No. 2
References
1. Stobinski JX. Nursing’s invisible architecture: individual re-
sponsibility for professional development. AORN J. 2015;102(4):
324-328.
2. Committee on the Robert Wood Johnson Foundation Initiative on the
Future of Nursing, at the Institute of Medicine. The Future of
Nursing: Leading Change, Advancing Health. Washington, DC:
National Academies Press; 2011.
3. Prometric. Job Analysis of Surgical Services Manager [research
report]. Baltimore, MD: Prometric; 2013.
4. CSSM Handbook. Competency & Credentialing Institute. http://
www.cc-institute.org/docs/default-source/cssm/cssm_candidate_
handbook_2015.pdf?sfvrsn¼2. Accessed June 6, 2016.
5. Stable benefits but lower salaries noted in annual survey. OR
Manager. http://www.ormanager.com/stable-benefits-lower-salaries
-noted-annual-survey. Published September 22, 2015. Accessed
June 6, 2016.
6. Institute of Medicine. Future Directions of Credentialing Research in
Nursing: Workshop Summary. Washington, DC: National Academies
Press; 2015.
7. Frequently asked questions. American Board of Medical Specialties.
http://www.abms.org/about-abms/faqs/. Accessed June 29, 2016.
8. ABMS history of improving quality care. American Board of Medical
Specialties. http://www.abms.org/about-abms/history. Accessed
June 6, 2016.
9. 2015 National Policy Forum, American Board of Medical Specialties.
The Future of Practice: Transformation to Patient-Centered Systems;
Insights & Opportunities [special report]. American Board of Medical
Specialties. http://www.abms.org/media/93958/2015npfinsightsopps
digital.pdf. Accessed June 6, 2016.
James X. Stobinski, PhD, RN, CNOR, CSSM, is
the director of credentialing and education at the
Competency & Credentialing Institute, Denver, CO.
As director of credentialing and education at the
Competency & Credentialing Institute, Dr Stobinski
has declared an affiliation that could be perceived as
posing a potential conflict of interest in the publication
of this article.
www.aornjournal.org