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Why Should I Take One More Exam? From Larvae to Butterflies

Diabetes educators came into the health professional world just a few decades ago and have developed from larvae into mature and intricate butterflies within the diabetes community.

Marking the 25th year of my diabetes health care career recently provided me an opportunity to reminisce about my professional life and the evolution of my profession. The role of diabetes educator was created to meet the specific need to teach and support people living with diabetes. In the years since, the role has expanded to define independently functioning practitioners who are integral players on the diabetes care team.

In the mid-1970s, "diabetes educator" was a fairly new title for a fairly new specialty. My mentor, Dr. Diana Guthrie, became one of the founding 200 members of the American Association of Diabetes Educators (AADE) in 1973. She served on the AADE national board of directors, and, in 1979, she was recognized with the American Diabetes Association Outstanding Educator in Diabetes Award. I saw her as the model for professional expertise and development in the field.

The certified diabetes educator (CDE) credential became available in 1986, and we all took the exam. This credential verified to the public that we had expertise in the arena of diabetes education. It did not, alas, guarantee any reimbursement for our work. Still, it has since become the gold standard for professionalism in diabetes education and is recognized by employers as a prerequisite for hiring in the field.

Even in the 1970s, group patient education classes were the norm, research and clinical activities were routine, and publications and professional education were commonplace for diabetes educators in our diabetes program in Wichita, Kans. As CDEs found their professional footing, their expertise and value on the diabetes health care team grew.

The Diabetes Control and Complications Trial verified the importance of the team approach and the fact that nurses and dietitians were deeply involved in and crucially important to effective clinical care. This logical but subtle addition of "clinical care" to the original education role of diabetes educators, which had often been viewed as separate from actual patient care, stimulated discussion regarding the need to verify these additional clinical skills.

In addition, diabetes nurses in clinical practice found that they needed national certification of their clinical skills to gain legal recognition as advanced practitioners at the state level. The CDE exam, although widely accepted and recognized, is a multidisciplinary exam. However, the advanced practice requirements of state boards of nursing called for an exam exclusively for nurses.

Because of the large number of nurses in AADE, the development of an advanced practice nursing credential with a specialty in diabetes became an AADE goal. Later, as interdisciplinary team work in diabetes care and education became more evident both in practice and in the literature, AADE’s goal expanded to include the disciplines of nutrition and pharmacy as well as nursing.

Work began with input from all three disciplines to develop a definition and credential for advanced practice in diabetes. The Scope and Standards for Diabetes Nursing, including advanced practice, were developed with AADE’s leadership and published by the American Nurses Association in 1998. Revisions to this document are now underway. Scope and standards documents for advanced diabetes practice in dietetics and pharmacy are now being refined.

As a result of this work, the board certified–advanced diabetes manager (BC-ADM) certification was launched in 2000. So far, more than 250 practitioners have earned certification.

So, Why Take Another Exam?

Nurses
If you are a nurse with an advanced degree, state-level advanced practice recognition is necessary to gain prescriptive authority and insurance reimbursement for services. Earning the BC-ADM credential may meet a state requirement for advanced practice status.

There are separate American Nurses Credentialing Center (ANCC)/AADE exams for clinical nurse specialists and nurse practitioners. These exams cover the domains of clinical practice, collaboration, research, patient and professional education for diabetes, and the co-morbid conditions that accompany diabetes.

The new diabetes exams do not yet have the national acceptance that family nurse practitioner or medical-surgical credentials have gained. However, the development of these individual diabetes exams is a major step in this evolving process.

Dietitians
For dietitians, the new credential is a first opportunity to validate knowledge and skills in advanced practice in diabetes. Role delineation studies involving hundreds of dietitians have verified that clinical practice—not just patient education—is part of the role of advanced practice dietitians who work in the diabetes field. Until this exam was developed, there were no advanced practice certification exams for dietitians working in diabetes care.

Does this credential guarantee reimbursement for dietitian services? Not at this point. It does verify and assure the public that individuals who earn the credential have attained a certain level of specialty and expertise.

Dietitians have been working collaboratively with their colleagues in other disciplines for many years. Cross-training for many education tasks, such as teaching patients to inject insulin or use a blood glucose meter, is now common among diabetes-related disciplines.

Pharmacists
For pharmacists with advanced degrees, the BC-ADM is one of several diabetes certifications available. It is specific to diabetes advanced practice, and its exam is more academically and clinically rigorous than some others.

Does this certification guarantee reimbursement for pharmacists’ services? Not at this point. But as with dietitians, it is a statement to the public and the health care professional community that those who earn the certification have attained a specific level of expertise in diabetes education and clinical practice.

A Team Approach to Advanced Practice

Exams for each discipline—nursing, nutrition, and pharmacy—are available via computer at Sylvan Learning Centers across the country. Although each discipline has its own exam, the BC-ADM certification was developed with the belief that it is important to have equal expectations for all disciplines working in diabetes.

AADE and ANCC are proud to be making history by co-sponsoring the development of this credential with so many prestigious organizations collaborating. The American Dietetic Association, the Commission of Dietetic Registration, and the American Pharmaceutical Association have all been actively involved throughout the process. The American Diabetes Association has also collaborated, with current and past national leaders sitting on the committee for test development, item writing, and development of review materials. The National Certification Board for Diabetes Educators, which oversees CDE credentialing, has been represented at stakeholders’ meetings as a demonstration of collaboration and collegiality. With so many national organizations involved, this effort to certify advanced practice in diabetes will gain broad recognition by the diabetes and general health care professional community.

The BC-ADM credential is a badge of honor proclaiming your diabetes clinical skill and other advanced practice roles to the world. I encourage you to step up to the challenge of verifying your own clinical expertise in addition to your education skills. For more information about the BC-ADM certification, visit www.aadenet.org or www.nursingworld.org.

Footnotes

Debbie Hinnen, MN, ARNP, CDE, BC-ADM, is manager for diabetes services at Via Christi Regional Medical Center in Wichita, Kans. She is an adjunct faculty member for the Graduate Nursing Department of Wichita State University and the School of Pharmacy and School of Medicine, Pediatrics Department, at the University of Kansas School of Medicine in Wichita. An associate editor of Diabetes Spectrum, she is also chair of the AADE/ANCC Test Content Outline Committee, which has been developing the diabetes advanced practice credential.

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