Bariatric Nursing
in the Spotlight:

An Interview with ASMBS
Integrated Health CBN Certification Committee Chair Bill Gourash, MSN, CRNP


Published in August 2013 Issue             


One of the biggest achievements in Integrated Health was the creation of the ASMBS Certified Bariatric Nurse (CBN) program, the first certification program for bariatric nurses. Committee Chair William (Bill) Gourash, MSN, CRNP, has been a driving force behind the program, which has certified more than 1,200 nurses since 2007.

connect recently interviewed Bill about how it all got started and how the 27-member committee and certification program continue to represent the best of bariatric nursing.

connect:  What was it like for you to attend the very first certification exam?

It was an awesome feeling. It was in San Diego. More than 300 nurses took the test and I remember looking out at them and thinking how much time and effort it took to get us to this day, but that it was well worth it.  The nurses, the surgeons, the ASMBS Foundation, the Corporate Council and the entire Integrated Health section did everything they were asked to do and more to get us to this day. It was an incredibly important moment for us and our specialty and marked a new chapter in bariatric nursing.

connect:  How did it all start?

The interest in establishing certification for bariatric nursing actually started over 15 years ago. There were a lot of stops and starts for various reasons back then. But in late 2002, there was a renewed effort and commitment to figure out how we could develop a program. We had to do the due diligence. We had to know what was involved. We had to know its professional, legal and financial implications, what it would take to sustain a program, what the program would look like, what would be its policies and procedures, and how we would define the knowledge and skills required to be a bariatric nurse and how we would assess that, among many other things.

We consulted with experts in certification program management and representatives of the American Nurses Association, American Nurses Credentialing Center and American Board of Nursing Specialties so we could establish a model program.

connect:  What were some of the milestones of the program? 

We had to define the field of bariatric nursing and to do that we had to take a scientific, methodical approach. In 2005, under the direction of Professional Examination Services, a certification consultant, the committee conducted a practice analysis study to create an empirically sound foundation for the new nursing specialty certification examination. There were a series of task force meetings, expert interviews and an external review process that were used to define the specialty in terms of four domains of practice, 45 nursing tasks and 54 knowledge areas. The definition encompassed the work of bariatric nurse coordinators, bariatric program directors and floor nurses caring for patients with morbid obesity and bariatric surgical patients. A survey was administered to 1,084 nurses practicing in the specialty to validate these domains, tasks and knowledge. The survey demonstrated that the respondents for all the job roles rated the domains and tasks moderately or highly important in optimizing patient outcomes. In addition, most respondents agreed that the 54 knowledge areas were acquired during the first two years of practice in the specialty. These results guided the development of CBN, as well as education and training initiatives. The practice analysis study was published
in SOARD.

connect: The results also led to the development of the CBN Examination?

The survey results validated the practice analysis and helped guide the development of the CBN Examination, a 175-multiple choice test. The test presents each question with four response choices. Candidates are allowed three hours to complete it. The test covers the four domains of bariatric surgical nursing: clinical management, multidisciplinary team collaboration, outreach and program administration. More information regarding the CBN exam can be found in the candidate handbook. Nurses can obtain a copy of the handbook here in PDF format.

connect: Who is eligible to become a CBN?

Registered Nurses (RNs or equivalent for international nurses) with a valid license who have worked with morbidly obese and bariatric surgery patients for a minimum of 24 months in the preceding four years are eligible to take the CBN Examination. Of the nurses who have taken the program, thus far, about 50 percent are ASMBS members and 50 percent are non-members.

connect: How often is the test updated and what do you have to do to
maintain certification?

The exam is updated each year. We want to make sure the exam is up-to-date on the latest issues in patient care. For example, the exam contains questions on quality improvement strategies, an increasingly important area in all of medicine. We also review scientific literature and published data on bariatric surgical procedures, including recent studies that have helped us to better understand the biological mechanisms of surgery and metabolic responses. Recertification is required every four years either through taking another exam or completion of continuing education.

connect:  What study resources are available to help prepare for the CBN exam?

ASMBS offers a live CBN Review Course presented during the annual conference each year. Registration for this course is available once registration for the annual conference opens. An online version of the course is now available online at: http://cbn-review.asmbs.org/. Additionally, the CBN Candidate Handbook offers resources that may be useful in preparing for the exam.

connect:  What are some of the biggest challenges in bariatric nursing?

The whole field of metabolic and bariatric surgery is facing challenges in terms of patient education and compliance with treatment plans, which remains an important issue in bariatric care. Bariatric nurses often serve as a primary patient educator. Bariatric nurses lead informational classes for surgical patients, host support groups for post-op patients and act as a trust source of information and support. Poor compliance has been shown to be directly related to treatment outcomes. As nurses we have the ability to provide the support needed to work through potential barriers to success for patients struggling in treatment programs.

Coordination among a multidisciplinary treatment team, specifically for surgical patients, can mean managing communication between surgeons, psychologists, nutritionists and several other care specialists. Nurses are involved in every aspect of patient care, making them a central piece to maintaining successful collaboration throughout the treatment process.

connect:  How has the establishment of the CBN program affected
bariatric nursing?  

The CBN program promotes standards of excellence in patient care, so the real beneficiaries of the program are the patients. It also has become increasingly clear that what happens before and after surgery is as important as the surgery itself in terms of patient outcomes. Certification is indication and validation that the bariatric nurse has the specialized skills and knowledge required to deliver quality patient care throughout the entire patient journey. The latest draft of the MBSAQIP standards states, "The optimal care of the metabolic and bariatric surgery patient requires specialized training, education and experience that can include Certified Bariatric Nurses (CBN) certification." This is yet another endorsement of the importance of bariatric nursing to quality care.

connect:  What is the committee currently working on?

We are completing the documentation needed to submit a request for a review of the CBN program by the Accreditation Board for Specialty Nursing Certification (ABSNC). The ABSNC, formerly the ABNS Accreditation Council, is the only accrediting body specifically for nursing certification. ABSNC accreditation is a peer-review mechanism that allows nursing certification organizations to obtain accreditation by demonstrating compliance with the highest quality standards available in the industry.

connect: Where can registered nurses who are interested in exploring certification go to learn more about CBN requirements?

We encourage anyone interested in taking the CBN examination or learning more about the program to visit the Certified Bariatric Nurse (CBN) Program page on the ASMBS website, found here: http://asmbs.org/cbn-program/. We provide information on eligibility requirements, exam registration, administration dates and the process for re-certification.

Bill Gourash, MSN, CRNP, is a Research Coordinator and Nurse Practitioner for minimally invasive bariatric and general surgery at the University of Pittsburgh Medical Center. From 2008 to 2010 he served as the president of the Integrated Health division of ASMBS. Gourash received the 2007 “Circle of Excellence Award” for his work in integrated health, and his current research as a member of the Longitudinal Assessment of Bariatric Surgery (LABS) Consortium in retention strategies for patients participating in observational longitudinal studies after bariatric surgery, which was presented during the 29th annual meeting of the ASMBS and published in SOARD.