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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
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.
| Standard 1. Shared Decision-Making | ||
| Study: | Pathway-relevant measure(s): | Associated outcome(s): |
| Clarke (2007) — 11,512 nurses in 188 hospitals in Pennsylvania |
higher nurse participation in hospital affairs | lower needle or sharps injuries |
| Flynn et al. (2012) — 686 RNs in 82 medical-surgical units in 14 hospitals in New Jersey |
higher nurse participation in hospital affairs | higher error interception practices, which linked to lower medication errors |
| Friese & Himes-Ferris (2013) — 242 outpatient oncology nurses in a large southeastern state |
higher nurse participation in practice affairs | higher intent to stay |
| Gregory et al. (2010) — 548 acute care nurses in Canada |
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) — 353 direct inpatient care psychiatric nurses in 67 hospitals in Pennsylvania |
higher nurse participation in hospital affairs | lower emotional exhaustion |
| Kutney-Lee et al. (2016) — 20,674 RNs in 425 hospitals in California, New Jersey, Pennsylvania, and Florida |
higher engagement in shared governance | lower nurse reports of
|
| Laschinger (2008) — 234 nurses in tertiary care hospitals in Ontario |
higher nurse participation in hospital affairs |
|
| Laschinger et al. (2009) — 247 new graduate nurses from hospital inpatient units in Ontario |
higher nurse participation in hospital affairs | lower emotional exhaustion |
| Laschinger & Leiter (2006) — 8,597 acute care nurses in Ontario and Alberta |
higher nurse participation in hospital affairs | lower nurse-reported adverse events |
| Leineweber, Chungkham, et al. (2014) — 8,948 medical/surgical RNs in 53 hospitals in Sweden |
higher nurse participation in hospital affairs | lower work-family conflict |
| Leiter & Laschinger (2006) — 8,597 nurses in acute care hospitals in Ontario and Alberta |
higher nurse participation in hospital affairs | lower burnout |
| Nowrouzi et al. (2015) — 506 registered practical nurses in Ontario, Canada |
higher involvement in decision making | higher intent to stay in current position for next 5 years |
| Papastavrou et al. (2015) — 1,163 RNs and LPNs in 91 wards in 34 hospitals in Cyprus, Finland, Greece, Portugal, Sweden, Turkey, and the state of Kansas |
higher control over practice | higher nurse perceptions of individualized care successfully provided to patients in latest shift |
| Zaheer et al. (2015) — 2,495 nurses (81%), physicians (13%), and pharmacists (6%) in 13 hospitals in Ontario, Canada |
higher levels of participative leadership | stronger frontline staff perceptions of patient safety climate (senior and supervisory leadership support for patient safety) |
| Standard 2. Leadership | ||
| Study: | Pathway-relevant measure(s): | Associated outcome(s): |
| Boev (2012) — 671 nurses and 1,532 discharged patients from 4 critical care units in a New York hospital |
higher perceptions of nurse manager ability, leadership, and support | higher patient reports of satisfaction with nursing care |
| Carter & Tourangeau (2012) — 17,707 RNs and midwives at 147 acute and 20 specialist hospitals in England |
better relationships with and support from manager | less intention to leave |
| Duffield et al. (2010) — 1,559 nurses in 91 wards in 21 public hospitals in 2 Australian states |
higher perceptions of
|
higher job satisfaction |
| Flynn et al. (2012) — 686 RNs in 82 medical-surgical units in 14 hospitals in New Jersey |
higher perceptions of nurse manager ability, leadership, and support | higher error interception practices, which linked to lower medication errors |
| Friese (2005) — 1,956 nurses in 22 hospitals |
higher perceptions of nurse manager ability, leadership, and support |
|
| Hanrahan, Aiken, et al. (2010) — 353 direct inpatient care psychiatric nurses in 67 hospitals in Pennsylvania |
higher perceptions of nurse manager ability, leadership, and support | lower nurse reports of
|
| Hanrahan, Kumar, et al. — 353 direct inpatient care psychiatric nurses in 67 hospitals in Pennsylvania |
higher perceptions of nurse manager ability, leadership, and support | lower nurse-reported frequency of
|
| Jourdain & Chenevert (2010) — 1,636 RNs working in hospitals in Canada |
higher support from supervisor | lower depersonalization of patients, which in turn related to higher professional commitment and lower intent to leave the profession |
| Laschinger (2008) — 234 nurses in tertiary care hospitals in Ontario |
higher perceptions of nurse manager ability, leadership, and support |
|
| Laschinger et al. (2009) — 247 new graduate nurses from hospital inpatient units in Ontario |
higher perceptions of nurse manager ability, leadership, and support | lower emotional exhaustion |
| Laschinger & Leiter (2006) — 8,597 acute care nurses in Ontario and Alberta |
higher perceptions of nurse manager ability, leadership, and support | lower nurse-reported adverse events |
| Leineweber, Westerlund, et al. (2014) — 8,620 RNs in 53 hospitals in Sweden |
better leadership and support for RNs | reduced risk of
|
| Leiter & Laschinger (2006) — 8,597 nurses in acute care hospitals in Ontario and Alberta |
higher perceptions of nurse manager ability, leadership, and support | lower burnout |
| Roche et al. (2015) — 1,673 nurses in 62 wards in 11 hospitals in 3 states in Australia |
higher perceptions of nurse unit manager leadership skills | lower intent to leave within 12 months |
| Sawatzky & Enns (2012) — 261 RNs in adult emergency departments in Manitoba, Canada |
higher perceptions of nursing management | higher engagement, which in turn related to lower intent to leave current position |
| Van Bogaert et al. (2013) — 1,201 RNs in 116 units in 8 hospitals in Belgium |
higher perceptions of nurse management at the unit level |
|
| Standard 3. Safety | ||
| Study: | Pathway-relevant measure(s): | Associated outcome(s): |
| Chang & Mark (2011) — 4,954 medical-surgical RNs in 286 units in 146 US hospitals |
stronger learning climate (communication and thinking about errors) | lower medication errors |
| Houser et al. (2012) — 420 nurses in 54 units in 9 hospitals in Colorado |
higher RN involvement in planning for staffing | higher unit-level indicators of patient satisfaction with nursing care |
| Mark et al. (2007) — approx. 4,000 nurses in 143 hospitals |
stronger safety climate | fewer back injuries |
| Richter et al. (2016) — 237,409 clinical staff in 1,046 hospitals |
higher perceptions of management support for safety | higher perceptions of successful handoffs |
| Rosen et al. (2010) — 4,581 VA hospital workers in 29 hospitals |
higher overall emphasis on safety | lower rates of
|
| Steyrer et al. (2013) — 549 nurses, 185 physicians, and ICU 378 patients in 57 hospitals in Austria, Germany, and Switzerland |
more positive safety climate (management commitment to patient safety, organizational learning, communication and cooperation, and attitude toward safety management) | lower rates of medical errors |
| Tvedt et al. (2012) — 3,618 nurses in surgical and medical wards in 35 hospitals in Norway |
higher patient safety management | nurse-reported:
|
| Vaughn et al. (2004) — 1,454 healthcare workers (1,047 RNs) in 84 Iowa hospitals |
higher management support for safety | more consistent adherence to safe needle precautions |
| Zaheer et al. (2015) — 2,495 nurses (81%), physicians (13%), and pharmacists (6%) in 13 hospitals in Ontario, Canada |
higher ease for reporting events | stronger frontline staff perceptions of patient safety climate (senior and supervisory leadership support for patient safety) |
| Standard 4. Quality | ||
| Study: | Pathway-relevant measure(s): | Associated outcome(s): |
| Brooks et al. (2009) — 1,578 patients in 12 Midwest acute care hospitals |
intervention of evidence-based pain management practices | lower total cost per inpatient stay, cost per day, and length of stay |
| Doran et al. (2014) — 338 nurses and 939 clients from 13 home care offices in Ontario, Canada |
higher number of nursing sensitive EBP interventions documented in client records | improvements in
|
| Gittell et al. (2000) — 338 care providers (nurses and physicians) from 9 hospitals, 878 orthopedic patients |
higher mutual respect, shared goals, and frequency of communication (dimensions of “relational coordination”) |
|
| Gregory et al. (2010) — 548 acute care nurses in Canada |
higher satisfaction with managerial and interdisciplinary relations | higher nurse perceptions of quality of care, standards of care, and safety issues |
| Hickey et al. (2013) — 3,413 pediatric critical nurses with 26,158 congenital heart disease patients in 38 children’s hospitals |
participation in national quality metric benchmarking | lower odds of in-hospital mortality |
| Titler et al. (2009) — 669 hospitalized older adults in 12 Midwest acute care hospitals |
intervention of evidence-based pain management practices | lower mean pain intensity |
| Standard 5. Well-Being | ||
| Study: | Pathway-relevant measure(s): | Associated outcome(s): |
| Carter & Tourangeau (2012) — 17,707 RNs and midwives at 140 acute and 20 specialist hospitals in England |
better ability to achieve good work-life balance | lower intention to leave |
| Duffield et al. (2010) — 1,559 nurses in 91 wards in 21 public hospitals in 2 Australian states |
|
higher job satisfaction |
| Estryn-Behar et al. (2010) — 866 nurses in Belgium, Germany, Finland, France, Italy, the Netherlands, Poland, and Slovakia |
work schedule difficulties | exited organization in past year |
| Leineweber et al. (2016) — 23,076 RNs Belgium, England, Finland, Germany, Greece, Ireland, the Netherlands, Norway, Poland, Spain, Sweden, and Switzerland |
higher satisfaction with scheduling flexibility | less likely to
|
| Penz et al. (2008) — 944 RNs in rural hospitals in Canada |
higher satisfaction with scheduling and shifts | higher job satisfaction |
| Tourangeau & Cranley (2006) — 6,856 RNs and 1,325 RPNs in Ontario, Canada |
higher satisfaction with praise and recognition | higher intention to remain employed in current hospital |
| Standard 6. Professional Development | ||
| Study: | Pathway-relevant measure(s): | Associated outcome(s): |
| Boyle et al. (2016) — 5,144 patient care units in 857 hospitals |
higher unit-level rates of specialty certification | better quality on a composite index of pressure ulcer and fall rates |
| Boltz et al. (2013) — 44 medical and medical-surgical units serving older adults in 25 hospitals |
higher percent unit RNs certified in any specialty | lower fall rates |
| Carter & Tourangeau (2012) — 17,707 RNs and midwives at 140 acute and 20 specialist hospitals in England |
more perceived developmental opportunities | lower intention to leave |
| Covell & Sidani (2013) — 91 units in 6 hospitals in Ontario and Quebec |
higher unit-level proportion of RNs with specialty certification |
|
| Estryn-Behar et al. (2010) — 866 nurses in Belgium, Germany, Finland, France, Italy, The Netherlands, Poland, and Slovakia |
dissatisfied with development opportunities | exited organization in past year |
| Flinkman et al. (2008) — 147 nurses in 6 hospital districts in Finland |
lower rating of development opportunities | more frequent thoughts of leaving nursing in the last 12 months |
| Kendall-Gallagher & Blegen (2009) — 48 ICUs in 29 hospitals |
higher proportion of certified staff RNs in unit | lower annualized rate of falls |
| Rondeau et al. (2009) — 680 CNOs and others responsible for nursing function at 232 hospitals and 473 long-term care facilities in Canada |
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) |
| Rush et al. (2015) — 245 new graduate nurses in acute care settings in British Columbia |
participation in formal new graduate transition program | higher scores on transition experience (workplace integration) |
| Spector et al. (2015) — 486 new graduate nurses in 51 hospitals in Illinois, North Carolina, and Ohio |
participation in established (vs. limited) onboarding/transition program | nurse self-reports of:
|
| Trinchero et al. (2013) — 827 nurses in 6 public and private hospitals in Italy |
higher satisfaction with training and development provided by the hospital | higher employee engagement |
| Unruh & Zhang, 2014a — 533 newly licensed RNs in Florida |
higher perceptions of having a good orientation | lower turnover (nurse reports of leaving a job within 1.5-2.5 years of graduating) |
| Unruh & Zhang, 2014b — 414 newly licensed RNs in Florida |
more positive orientation experience | higher job satisfaction |
| Vander Elst et al. (2016) — 633 nurses from a large home healthcare organization in Belgium |
more opportunities provided in the job situation to learn and to develop |
|
| Warshawsky et al. (2016) — 348 nurse managers working in 9 healthcare systems |
organizational support for ongoing development of nursing leaders (culture of generativity) |
|
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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.
Pathway to Excellence Application Resources Guide for VHA
Click here to download the Pathway to Excellence Application Resources Guide for VHA
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