Perioperative Leadership: A Distinct Skillset Gained from CSSM Credential
In 2015, there were two viable credentials in perioperative nursing: the CNOR and CRNFA. But when the Competency and Credentialing Institute (CCI) surveyed nurses on whether another certification was needed, one skill got the most votes: management.
“The way management was done for decades—really since perioperative nursing was declared a specialty—was you took the most experienced clinicians and tried to make them into managers and leaders,” says James X. Stobinski, former CEO of CCI. “When we did the job analysis study for CSSM, we found out, without a doubt, they are two totally different skill sets, period.”
At the time, this was groundbreaking. It was a formal acknowledgment that a perioperative leadership role is distinct. In addition, as CCI was building out the credential, there was a realization that more robust eligibility requirements were necessary. So, to take the CSSM, a nurse leader must have a baccalaureate level of education or higher. According to an OR Manager leadership survey, 93% of the people that responded say they have a BSN or higher.
In addition to a higher level of formal education, a CSSM candidate must supervise people, a program, or a budget, plus have recent coursework or professional development activities in management and leadership.
“All of this was brand new at the time,” Stobinski says. “People would come to our tradeshow booths, pound their fists on the table and say, ‘You disrespect me because I do a great job and I have an associate’s degree/diploma of nursing.’ We took a lot of heat for it.”
Benefits of the CSSM
The official birthdate of the CSSM is 2016, and as of January 2023, 300 leaders have the credential. Why should perioperative leaders get this certification?
“If you’re certified, you are essentially compelled to stay current in your field to maintain it,” Stobinski says. “You can talk about how you do a great job, and everyone loves you, but you don’t have objective data. If you pass the CSSM—which isn’t easy to pass—you have an objective, psychometrically sound measurement that you possess the knowledge to manage and lead an operating room.”
It’s also a rigorous professional development system. Three subjects (strategic management, operational management, and financial management) make up a large portion of the content covered on the CSSM certification exam. These areas cover supply chain management, reimbursement mechanisms, and contracts).
Voluntarily opting into a CSSM is an undertaking; you’ve separated yourself from your peers, taking the extra coursework, passing it, and renewing it every three years. But this is not a passive renewal; to keep the credential current (and to get your initial certification), you must submit a reflective learning exercise and lay out a professional development path.
“At the end of the three years, you will document how well you did and then lay out the plan for the next three years,” Stobinski says. “This is one of the most progressive and innovative methods for certification there is for nursing.”
Impact on Salaries
There is a nationwide shortage of nurses and nurse leaders in perioperative. This trend is not new, as a mass of retirements was already expected; over half of RNs are over 50. But the pandemic acted as an accelerator, speeding the clock to a crisis.
If organizations are desperate for nurses, is it worth getting the credential?
Stobinski says he doesn’t know exactly how much of an edge it gives, but there is some data to support that it probably does. According to AORN Journal 2022 Annual Salary Survey, many facilities, either directly or indirectly, will pay more if you’re certified.
“That may come in the form of a career path where you can’t advance beyond a certain level unless you’re certified,” Stobinski says. “Or if you hold the credential, you get paid 50 cents to $1 more. All else being equal—and we’re in a competitive job market—you would get paid more.”
How Has OR Leadership Changed Over the Years
When Stobinski started his career in perioperative services 40 years ago, volume was inextricably tied to revenue. Surgeons were effectively sovereign, and any discourteous behavior was largely tolerated because they generated volume. Similarly, Stobinski says the OR had its “own little kingdom” for the same reason: they helped usher in a significant portion of hospital revenue.
But then reimbursement methods began to change and put more emphasis on value. Providers are giving set amounts for reimbursement or stating they’ll only pay for a total joint on a healthy adult if it’s an outpatient procedure. If the quality isn’t there, facilities won’t get paid.
“If you have high surgical site infections, your surgeons have a higher-than-average number of errors, it’ll hurt you financially,” Stobinski says. “With all the pressure to keep costs down and increase revenue, you must be efficient to survive. It’s changed the skill set for leaders. Now you have to talk to pre-op, post-op, pharmacy, the patient, and the discharge manager. You can’t have that autocratic approach we had 40 years ago. If you’re going to be successful as a perioperative leader, you need good communication skills, teamwork, a certain level of business acumen, but also, be willing to adapt if you need to.”