News / Periop Café

CSSM: Certified Surgical Services Management Credential

April 29, 2017


CSSM: Certified Surgical Services Management Credential

A New Way to Recognize and Strengthen Perioperative Leadership

Directors of Surgical Services bring an immensely specialized set of skills to the healthcare setting. In addition to vast clinical knowledge, they must be proficient and current in their knowledge and practice of all aspects of management. Important credentials such as CNOR and CASC reflect and acknowledge the clinical side of perioperative leadership, but until now the management side of the role has not been fully reflected in credentialing or recognition. Directors of Surgical Services bring an immensely specialized set of skills to the healthcare setting. In addition to vast clinical knowledge, they must be proficient and current in their knowledge and practice of all aspects of management. Important credentials such as CNOR and CASC reflect and acknowledge the clinical side of perioperative leadership, but until now the management side of the role has not been fully reflected in credentialing or recognition.

The new Certified Surgical Services Manager (CSSM) credential was created by the Competency & Credentialing Institute (CCI) in 2015 to respond to this gap. The certification program focuses on the specific body of knowledge that leads to delivery of safe patient care through effective direction of staff, programs, and budgets. This validation of managerial skills is intended not only to advance the competency of those who participate in the program, but also to advance the performance and effectiveness of their surgical services departments—a boon to both perioperative leaders and their employers.

The CSSM three-year certification program is aimed at professionals who manage surgical services departments and who oversee personnel and/or a budget, business unit, or service line, no matter what their title may be, as long as they meet eligibility requirements. The credentialing program:

• Validates perioperative leadership competency and professional achievement
• Establishes a standard of excellence for surgical services leaders
• Positions the leader for future development in perioperative administration and leadership
• Strengthens the use of theory in assessing, planning, implementing, and evaluating patient care

James Stobinski, PhD, RN, CNOR, CSSM, CEO of CCI has managed operating rooms since the late 1980s. It became clear to him during the course of his career that a new certification for OR leaders—especially in such a high-risk area—was sorely needed. “We at CCI did a job analysis of the OR director position and came to realize that to legitimize the career path, and provide a certification option, we really needed to focus on surgical services management,” he says.

Marie Paulson, MS, BSN, RN, CNOR, CSSM, Regional Perioperative Director for Kaiser Permanente, is a board member for CCI who helped develop the program. She explains that before the CSSM there was no formal training for managers for the operating room. “There is a deficit across the country in developing perioperative managers, and there was really no formal program to do that,” she says. “There was a great deal of variability in any perioperative management staff on how they were taught. It might have been they were the most technical person, or the most senior person. They might have done what we call ‘see one, do one, teach one.’ They might have been appointed just because they were there. And so that creates all kinds of havoc within an organization when your leaders aren’t trained in all the same standard processes. There needed to be a foundation.”

The CSSM credential provides an avenue for those in the field in many different positions who want to advance in their careers. Marie Paulson explains, “Often clinical specialist or other types of nurses may want to be in management, but they’re not sure what that means. All they can tell is what they see their boss doing—which may or may not be what the job truly is. So CSSM gives them some support. If I’m a lead nurse or a charge nurse and I’d like to be a manager or a director, where do I go? This is one of those stepping points.”

In addition to the focus on management skills, CSSM distinguishes itself from other credentials in several ways. James Stobinski notes that “We set prerequisites for taking the exam that are much more rigorous than many other certification exams—you are required to have a bachelor’s degree and recent college credits, or continuing education in surgical services management-related topics.”

Recognizing the additional need for lifelong learning about management in a fast-changing environment, CCI has built into the program a vital continuing education requirement for recertification. “To recertify the CSSM credential, you have to fulfill a customized learning plan based on your strengths and deficits revealed by the certification exam,” says James. “So if you do poorly on your certification exam, say in financial management, you will have to complete learning activities in financial management in order to keep your certification. And that’s a huge difference.”

“What we’re talking about goes beyond certification,” he says. “It’s really a partnership where we help guide your learning activities into what we hope will make you better at doing your job.”

Tashma Watson, MSN, RN, CSSM, Senior Associate Administrator of Perioperative Services at State University of New York Downstate Medical Center, recently received her certification and recommends it highly for other directors. “It’s an educational opportunity,” she says. “You get to read about what the practices are and what some of the new best practices are when you’re running an operating room. Unlike the clinical side, there isn’t a whole lot of evidence and research about how to do this job. So it does give you validation if you’ve been doing it a long time and guidance if you’re new to it—because there isn’t a whole big orientation you get for how to run an OR.”

“It’s not like the inpatient floor,” says Tashma. “Everything is different about the operating room: what we need, how we work, the mentality. When you move from staff into a leadership role, it’s different too. And the transition is different for us in the perioperative side. I think the CSSM certification can be used to give you a lot of guidance and also be a resource.”


To create an examination process that precisely reflects the work of Directors of Surgical Services, CCI developed an in-depth job analysis of current tasks and knowledge important to their work. They identified continuing education needs and anticipated changes in the role. This resulted in the seven subject areas covering many aspects of the Director role that frame the CSSM examination. They cover fine-tuned sets of knowledge and skills that will be immediately recognizable to Directors of Surgical Services, who should have a strong foundation in these skills through work experience and educational programs. Just a few examples of the content covered in the seven subject areas:

Communication & Relationship Management

Team-building strategies, techniques for negotiation and conflict resolution, effective and timely feedback

Strategic Management

Accreditation requirements, elements of a strategic plan, project management techniques

Financial Management

Indicators to measure fiscal performance, productivity, benchmarks and key performance indicators

Human Resource Management

Concepts of staffing models and their evaluation, scheduling, union environments

Operational Management

Use of data, infection prevention, standards and practices, emergency plans


Appropriate delegation, change management techniques, group dynamics


Application of evidence-based practice, knowledge and use of professional guidelines and codes of ethics and practices, professional organizations

The online application for the 180-question test is available on the CCI website, and testing is scheduled locally year-round, with a three-month window after application to take the test.

Tashma Watson developed a great appreciation for the test and its preparation. “The test looked at things from a different perspective, which I thought was really interesting. It focused more on a lot of what we really do in a director-level position in an operating room, like when you’re forced to look at the budget. And that’s important in this economy, where we have so many different financial responsibilities, and we’re looking at different ways to cut costs but maintain efficiency and keep staff happy, keep docs happy. So it pulled a lot of those different components into the exam and into the certification as well,” she says.


CCI considers two to three months before testing to be ideal for study and retention. To support applicants for CSSM certification, CCI offers a formal, fee-based preparation method—which is not a requirement for the certification—in addition to home-based, self-structured study. The formal course of study is based on intensive, live, interactive webinars, which cover all seven subject areas in six two-hour sessions. CCI also offers onsite prep courses as well, when the need arises. Applicants for CSSM who participate in the virtual or onsite prep courses and complete the work successfully will be eligible for continuing education credit.


James Stobinski is confident that the CSSM certification will become widely used. “It’s just common sense that someone who is engaging in a professional development plan that is scientifically valid will stay current in their profession and be better prepared for all the challenges that American healthcare has in front of it,” he says. “Through the certification, we essentially research and screen candidates for employers. And, if they hire someone that’s certified, they have an objective measure that their candidate has at least a baseline knowledge of what it takes to run an OR. I can guarantee their knowledge level. And that’s legally defensible.”

Marie Paulson believes that CSSM will become a necessary tool for Directors of Surgical Services. “I’ve been in perioperative nursing since about 1978. And I wish that when I started moving toward management I had something as focused as this to help me not only be knowledgeable about certification, but to understand the components that it takes to become a perioperative manager. And this is the only thing that I’ve ever seen that does that. Previously, no one taught you financial budgeting. No one really taught you strategic management or HR, key things that you deal with on a day-to-day basis. Now CSSM is the support for that. And CCI is the support group for perioperative nurses and perioperative management. I want them to feel free and, in fact, engaged to call CCI for that kind of support and help. I wish I’d had it instead of learning as I went, which is a hard thing to do.”


More information about CSSM certification is available on the CCI website at The candidate handbook, with complete instructions, eligibility requirements, and policies, may be downloaded from that site. It is our hope that Directors of Surgical Services will take this opportunity to hone their professional knowledge, plan for lifelong learning, and receive recognition for their accomplishments through the CSSM certification.


Competency & Credentialing Institute (CCI) is a leader in credentialing, nursing competency assessment and education for the perioperative nursing community. For more than 38 years, CCI has administered the CNOR credentialing program, and also administers the CSSM, CRNFA, and CNS-CP credentialing programs. The company currently certifies more than 37,000 nurses.

CCI supports credentialing programs with a suite of exam preparation resources and is committed to upholding standards of excellence that guarantee extraordinary and safe care for all surgical patients.

Special Thanks

James Stobinski

James earned a diploma of nursing from the Toledo Hospital School of Nursing and a BSN and MSN from East Carolina University. He earned his PhD in International Health Research from Touro University International. He has 18 years of management experience in perioperative nursing and has published and presented extensively at the national level on perioperative management- related topics. Since 2011, he has been employed at the Competency & Credentialing Institute in Denver, Colorado, where he serves as CEO.

Marie Paulson

Marie Paulson, MS, BSN, RN, CNOR, CSSM, CPPS, is Regional Director of Perioperative Services for the Southern California Region of Kaiser Permanente in Pasadena, California. Marie has over 39 years of nursing experiences, 35 of which are in perioperative nursing. She has a certification in Health Science Education as a teacher for California community colleges where she has taught Perioperative Nursing for over 16 years. Marie is on the Board of Directors for CCI and was instrumental in establishing the Surgical Services Management credential.

Brandon Bennett

Brandon is an experienced healthcare leader with expertise in operations, executive leadership, and cultural transformation. He graduated from Rhode Island
College (BS), Rush University (MSN), and Simmons College (DNP), where his doctoral research focused on implementation of evidence-based practice in the perioperative setting. He has worked in perioperative nursing for over 25 years in positions that range from Staff Nurse to Vice President of Nursing. He also has executive nursing leadership experience as Interim Chief Nursing Executive and Chief Operating Officer.