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International
ANCC's prestigious recognition programs for healthcare organizations are now accepting international applications.
ANCC's prestigious recognition programs for healthcare organizations are now accepting international applications.
Healthcare organizations around the world are searching for ways to improve patient care and quality. Our organizational accreditation programs for nursing excellence offer proven strategies to reach these goals.
For hospitals located outside of the United States, ANCC offers additional support and resources to assist you in pursuing Pathway designation. For more information, contact pathwayinfo@ana.org
Educational Requirements and Validation of Credentials
International applicants for the Pathway to Excellence Program must meet the CNO eligibility requirements for academic preparation and licensure.
Eligibility Criteria
The following eligibility requirements apply to organizations applying for the Pathway to Excellence Program.
Chief Nursing Officer and Nursing Leadership
The applicant organization must designate one individual as the chief nursing officer (CNO) who is ultimately accountable for the standards of nursing practice throughout the organization.
- The CNO is responsible for all nursing practice; therefore, all areas and campuses under the CNO's accountability where nursing is present must be included in the application, regardless of reporting relationships.
- The CNO, as part of the organization's highest governing, decision- making, and strategic-planning body, advocates for nursing to the Board of Directors.
- The Chief Nursing Officer/Director of Nursing must have a minimum of a baccalaureate degree in nursing.
- If the baccalaureate degree (or higher) in nursing was obtained outside the United States, the Chief Nursing Officer/Director of Nursing does not need to have the degree evaluated for comparability to US degree requirements.
- If the Chief Nursing Officer/Director of Nursing is educated outside the United States and does not hold a baccalaureate (or higher) nursing degree, they must have their credentials evaluated for comparability to US degree standards through Commission on Graduate of Foreign Nursing Schools (CGFNS).
- All requirements must be maintained through the application phase, the review phase, and designation as a Pathway to Excellence organization.
- Appointees as interim CNOs and subsequent CNOs must also comply with all requirements.
Organizational Structure
Individual organizations within the system may apply; however, a multi-facility healthcare system cannot apply as a whole. (For those with campuses, please refer to the campus definition below.)
Compliance
The organization must be compliant with all state and/or federal laws as they relate to registered nurses in the workplace.
Announcement:
Effective 2/1/2021: Commission on Pathway to Excellence has unanimously approved the inclusion of non-RN midwives in the Pathway Nurse Survey phase of the Pathway to Excellence® application.
Definition of Midwife
Completed midwifery education program based on ICM Essential Competencies for Basic Midwifery Practice and framework of ICM Global Standards for Midwifery Education. Click on
https://www.internationalmidwives.org/our-work/policy-and-practice/icm-definitions.html for more information on the Scope and Practice of a Midwife.
Persons not eligible to participate in the Pathway Nurse Survey include Auxiliary Midwife, as defined by the WHO: https://apps.who.int/iris/bitstream/handle/10665/128037/WHO_RHR_14.22_eng.pdf;jsessionid=0865667ABAAAF165C7E35C77CC69ED6C?sequence=1.
Questions?
Contact pathwayinfo@ana.org
Pathway International Liaisons
|
(United Kingdom, New Zealand, Australia, Europe) |
(Middle East, Central, and Southeast Asia, South America) |
| Contact Paulette.Sepe@ana.org | Contact Patience.Harris@ana.org |
Terms Defined
Campus
For Pathway purposes, campuses are remote care sites of an applicant organization. The CNO of the applicant organization is accountable for nursing practice at the remote sites. Campuses typically provide services to augment the full set of services offered at the primary site.
Chief Nursing Officer
The highest-level nurse with ultimate responsibility for all nursing practice within the organization. In long-term care, this role is synonymous with the "Director of Nursing" (DON).
Nurse Manager
A registered nurse responsible for the supervision of registered nurses and other health care providers who deliver nursing care in an inpatient or outpatient area. The nurse manager’s primary domains of activity are planning, organizing, leading, and evaluating. The term “nurse manager” is not synonymous with the chief nursing officer. In long-term care, “nurse manager” may be used interchangeably with “associate director,” “charge nurse,” or “supervisor.”
ANCC has successfully achieved ISO 9001:2015 certification for all of its credentialing programs.
Interpretation of Terms:
Library of Pathway Associated Concepts
Notes on Selected Research Studies Relevant to Pathway to Excellence® Standards
The tables below list selected research studies that found a favorable association between a variable we interpret to be consistent with a Pathway to Excellence characteristic and patient, nurse, or organizational outcomes. This is not an exhaustive representation of the current literature on these subjects.
| Standard 1. Shared Decision-Making | ||
| Study: | Pathway-relevant measure(s): | Associated outcome(s): |
|
Laschinger & Leiter (2006) |
higher nurse participation in hospital affairs |
lower nurse-reported adverse events |
|
Clarke (2007) |
higher nurse participation in hospital affairs |
lower needle or sharps injuries |
|
Gregory et al. (2010) |
higher control/empowerment and input into decision-making |
higher nurse perceptions of quality of care, standards of care, and safety issues |
|
Hanrahan, Aiken, et al. (2010) |
higher nurse participation in hospital affairs |
lower emotional exhaustion |
|
Flynn et al. (2012) |
higher nurse participation in hospital affairs |
higher error interception practices, which linked to lower medication errors |
|
Friese & Himes-Ferris (2013) |
higher nurse participation in practice affairs |
higher intent to stay |
|
Leineweber, Chungkham, et al. (2014) |
higher nurse participation in hospital affairs |
lower work-family conflict |
|
Nowrouzi et al. (2015) |
higher involvement in decision making |
higher intent to stay in current position for next 5 years |
|
Papastavrou et al. (2015) |
higher control over practice |
higher nurse perceptions of individualized care successfully provided to patients in latest shift |
|
Zaheer et al. (2015) |
higher levels of participative leadership |
stronger frontline staff perceptions of patient safety climate (senior and supervisory leadership support for patient safety) |
|
Kutney-Lee et al. (2016) |
higher engagement in shared governance |
lower nurse reports of
higher patient reports of
|
|
Cox Sullivan et al. (2017) |
higher engagement in shared governance at unit level |
increased nurse empowerment, self-management, engagement, and satisfaction |
|
Underwood et al. (2017) |
system-level shared governance |
higher empowerment in nurses |
|
Orchard et al. (2017) |
promotion of a culture of interprofessional decision-making |
increased capacity to influence integration of interprofessional collaborative practice with other health professionals within their leadership areas |
|
Chisengantambu-Winters et al. (2019) |
interprofessional decision making processes |
increased awareness of the governance system |
|
Kaddourah et al. (2020) |
nurses involved in shared governance |
increased professional development |
|
Bagot et al. (2020) |
interprofessional decision-making process to select new technology |
improved rates in:
|
| Standard 2. Leadership | ||
| Study: | Pathway-relevant measure(s): | Associated outcome(s): |
|
Sawatzky & Enns (2012) |
higher perceptions of nursing management |
|
|
Van Bogaert et al. (2013) |
higher perceptions of nurse management at the unit level |
|
|
Leineweber, Westerlund, et al. (2014) |
better leadership and support for RNs |
reduced risk of
|
|
Roche et al. (2015) |
higher perceptions of nurse unit manager leadership skills |
lower intent to leave within 12 months |
|
Spano-Szekely et al. (2016) |
better access to the nurse manager |
|
|
Roche et al. (2016) |
positive practice environment perception, higher retention |
|
|
Duffield et al (2019) |
higher involvement of direct care nurses in cost management discussions |
|
|
Moeta et al (2019) |
better role orientation for NM |
|
|
Keutchafo et al. (2019) |
role orientation for NM and leadership development |
|
|
Frasier (2019) |
leadership development |
|
| Standard 3. Safety | ||
| Study: | Pathway-relevant measure(s): | Associated outcome(s): |
|
Rosen et al. (2010) |
higher overall emphasis on safety |
lower rates of
|
|
Chang & Mark (2011) |
stronger learning climate (communication and thinking about errors) |
lower medication errors |
|
Houser et al. (2012) |
higher RN involvement in planning for staffing |
higher unit-level indicators of patient satisfaction with nursing care |
|
Tvedt et al. (2012) |
higher patient safety management |
nurse-reported:
|
|
Steyrer et al. (2013) |
more positive safety climate (management commitment to patient safety, organizational learning, communication and cooperation, and attitude toward safety management) |
lower rates of medical errors |
|
Zaheer et al. (2015) |
higher ease for reporting events |
stronger frontline staff perceptions of patient safety climate (senior and supervisory leadership support for patient safety) |
|
Richter et al. (2016) — 237,409 clinical staff in 1,046 hospitals |
higher perceptions of management support for safety |
higher perceptions of successful handoffs |
|
Quillivan et al. (2016) |
positive practice environment and higher perception of safety |
|
|
Trahan & Bishop (2016) |
better organization safeguards nurses from verbal or physical abuse directed at nurses from patients and families |
|
|
Bambi et al. (2017) |
organizational promotion of a culture free from 1) incivility, 2) bullying, 3) and workplace violence among the healthcare provider team, including nurse-to-nurse, include methods to track and address trends |
the implementation of zero tolerance policies and passive dissemination of information about these phenomena showed to be clearly ineffective |
|
M Clark et al. (2018) |
organizational commitment to safe working environment |
improved trust among coworkers, colleagues, or work group help improve self-awareness, give, and receive constructive feedback form the basis for continuing strengths and addressing areas for improvement |
|
In-Young Jeong & Ji-Soo Kim (2018) |
higher organizational safeguards to protect nurses from abuse |
|
|
Shi-Hong Zhao et al. (2018) |
Increased awareness of verbal or physical abuse directed at nurses from patients and families |
|
|
Xin Zhang et al. (2019) |
higher perception of positive practice environment and safety |
reduced second victim-related distress |
|
Saville et al. (2019) |
higher involvement of direct care nurses in staffing plans |
Improved skill mix, nursing work other than direct patient care, quantifying risks, and benefits of staffing below or above a target level, and validating staffing methods in a range of hospitals |
|
Wen Qi Mok 1 et al. (2020) |
strong organizational support to a positive practice environment and higher perception of safety |
|
|
Howard et al. (2020) |
organizational promotion of a culture free from 1) incivility, 2) bullying, 3) and workplace violence among the healthcare provider team, including nurse-to-nurse, include methods to track and address trends |
educational activities raise awareness of these issues and can improve the ability to reduce the frequency and overall impact of incivility |
| Standard 4. Quality | ||
| Study: | Pathway-relevant measure(s): | Associated outcome(s): |
|
Gittell et al. (2000) |
higher mutual respect, shared goals, and frequency of communication (dimensions of “relational coordination”) |
|
|
Brooks et al. (2009) |
intervention of evidence-based pain management practices |
lower total cost per inpatient stay, cost per day, and length of stay |
|
Gregory et al. (2010) |
higher satisfaction with managerial and interdisciplinary relations |
higher nurse perceptions of quality of care, standards of care, and safety issues |
|
Hickey et al. (2013) |
participation in national quality metric benchmarking |
lower odds of in-hospital mortality |
|
Melnyk et al. (2014) |
more educational opportunities provided by the organization for direct care nurses regarding application of evidence-based practice |
higher quality, reliability, and consistency of healthcare as well as reduce costs |
|
Lee Khuan et al. (2017) |
organizational promotion of a culture of person-and-family centered care. |
|
|
Melnyk et al. (2018) |
more educational opportunities provided by the organization for direct care nurses regarding application of evidence-based practice |
improved competency in EBP ensure the highest quality of care and best population health outcomes |
|
Asmirajanti et al. (2018) |
organizational promotion of interprofessional collaboration to meet wide quality initiatives |
|
|
Berit Misund Dahl (2018) |
organizational approach to improving population health |
increased population-based interventions |
|
Malfait et al. (2019) |
organizational promotion of a culture of person-and-family centered care |
put patient participation on the agenda and negative effects are absent |
|
Saunders et al. (2019) |
more educational opportunities provided by the organization for direct care nurses regarding application of evidence-based practice |
international quality standardize path for nurses to aspire to and attain on EBP and provide guidance for nurses in integrating best evidence into their daily practice, facilitating broad-based, consistent implementation of EBP worldwide |
|
Myers(2020) |
organizational approach to improving population health |
Nurses need to actively embrace strategies to improve population health outcomes and reduce health and other disparities. |
|
Lasater et al. (2020) |
organizational approach to improving population health |
|
| Standard 5. Well-Being | ||
| Study: | Pathway-relevant measure(s): | Associated outcome(s): |
|
Tourangeau & Cranley (2006) |
higher satisfaction with praise and recognition |
higher intention to remain employed in current hospital |
|
Duffield et al. (2010) |
|
higher job satisfaction |
|
Estryn-Behar et al. (2010) |
work schedule difficulties |
exited organization in past year |
|
Carter & Tourangeau (2012) |
better ability to achieve good work-life balance |
lower intention to leave |
|
Leineweber et al. (2016) |
higher satisfaction with scheduling flexibility |
less likely to
|
|
Nantsupawat et al. (2016) |
better integration of employee well-being and resilience into strategic planning |
|
|
Brennan (2017) |
better integration of employee well-being and resilience into strategic planning |
|
|
Labrague et al. (2017) |
better integration of employee well-being and resilience into strategic planning |
perceived organizational politics predicted nurses' stress and burnout levels, turnover intention and job satisfaction |
|
Kelly et al. (2017) |
meaningful recognition |
|
|
Kelly et al. (2017) |
meaningful recognition |
|
|
Jakimowicz et al. (2017) |
implemented organizational strategies to address compassion fatigue |
|
|
Alharbi et al. (2019) |
implemented organizational strategies to address compassion fatigue |
provision of education to nurses to assist with the development of coping strategies to avoid compassion fatigue |
|
Salmond et al. (2019) |
implemented organizational strategies to address compassion fatigue |
|
|
Moloney et al. (2020) |
better integration of employee well-being and resilience into strategic planning |
promotes the development of management approaches that enable their nurses to thrive |
|
Salvant et al. (2020) |
meaningful recognition |
promotes age recognitions (preference for monetary rewards stems from the younger generations' focus on work-life balance) |
| Standard 6. Professional Development | ||
| Study: | Pathway-relevant measure(s): | Associated outcome(s): |
|
Boyle et al. (2016) |
higher unit-level rates of specialty certification |
better quality on a composite index of pressure ulcer and fall rates |
|
Rondeau et al. (2009) |
higher intensity of staff training and development across 10 broad areas (e.g., workplace safety, clinical skills, quality improvement, and team effectiveness) |
lower turnover (percentage of RNs that voluntarily left the organization in the past year) |
|
Carter & Tourangeau (2012) |
more perceived developmental opportunities |
lower intention to leave |
|
Boltz et al. (2013) |
higher percent unit RNs certified in any specialty |
lower fall rates |
|
Covell & Sidani (2013) |
higher unit-level proportion of RNs with specialty certification |
|
|
Trinchero et al. (2013) |
higher satisfaction with training and development provided by the hospital |
higher employee engagement |
|
Unruh & Zhang, 2014a |
higher perceptions of having a good orientation |
|
|
Unruh & Zhang, 2014b |
more positive orientation experience |
higher job satisfaction |
|
Rush et al. (2015) |
participation in formal new graduate transition program |
higher scores on transition experience (workplace integration) |
|
Spector et al. (2015) |
participation in established (vs. limited) onboarding/transition program |
nurse self-reports of:
|
|
Vander Elst et al. (2016) |
more opportunities provided in the job situation to learn and to develop |
|
|
Warshawsky et al. (2016) |
organizational support for ongoing development of nursing leaders (culture of generativity) |
|
|
Phillips et al. (2018) |
organizational succession planning for a nursing leadership role |
effectively reduces replacement costs and time to transition into the new role |
|
Cziraki et al. (2018) |
organizational succession planning for a nursing leadership role |
leadership self-efficacy increases motivation and intention to pursue a leadership careers |
|
Gomes Nogueira et al. (2019) |
organizational succession planning for a nursing leadership role |
Promotes the diagnosis of the leadership profile in the institution that favor the development of succession planning |
|
Tucker (2020) |
organizational succession planning for a nursing leadership role |
a formal succession plan gives purposeful direction in identifying and developing emerging leaders and is especially useful for individuals who are new to a major leadership role |
Download as PDF
Pathway Marketing Toolkit
The Marketing Toolkit contains program logos and trademark use guidelines, as well as sample press releases. To access the Online Marketing Tool Kit, please visit the Pathway Learning Community.
Pathway Learning Community
The Pathway Learning Community™ (PLC) is an exclusive online community for nurses committed to creating positive practice environments and promoting excellence in nursing practice. The PLC provides an opportunity for nurses to connect and share best practices, resources, research, experiences, and strategies that have led to positive practice environments, quality patient care, and excellence in professional nursing practice.
The Pathway Learning Community features:
- Pathway to Excellence Orientation modules and webinars
- Networking opportunities with Pathway Designated and Applicant CNOs & PPCs
- A discussion board where you can ask questions, share best practices with other Pathway organizations and get questions answered to assist you on your Pathway journey
- Get the latest news and information from the Pathway program
- Find information about upcoming events related to ANCC & Pathway
The Pathway Learning Community is available to all Pathway Designated and Pathway Applicant organizations. If you would like to learn more about the community, please fill out the PLC Contact Form or email pathwaycommunity@ana.org.
ANCC Pathway to Excellence® Program Included in the Leapfrog Hospital Survey
Hospitals participating in the Leapfrog Hospital Survey that indicate a current Pathway to Excellence designation as determined by ANCC under the 2020 Pathway to Excellence Application Manual, will earn full credit for the National Quality Forum-endorsed Safe Practice #9 - Nursing Workforce. Questions? Email pathwayinfo@ana.org