Pros and Cons of Mandatory Continuing Nursing Education

Mandatory Continuing Nursing Education

There is a rapid expansion of techniques and knowledge in the field of health. Researchers James Morrison, James Kelly and Carl Lindsay have approximated that the half-life of knowledge gotten in school of medicine is about 5 years. Thus, in just 5 years 50% of what a physician learns in a medical school will be irrelevant. With such a huge increase in knowledge base, it is important that clinical professionals, such as nurses, dentists and physicians constantly update or enhance their skills. For nursing practitioners, constantly improving education is important for proper and effective nursing care. The quantity of knowledge / information required to care for patients who are critically ill can't be simply gained through experience in the ward or at the patient's bedside. The current stress on competency in healthcare means that experience alone is no longer enough. The current environment requires a constant emphasis for a nursing practitioner to constantly improve their education. Nursing practitioners have a legal and professional duty to update their skills and knowledge and to apply that knowledge at their workplace (Dickerson, 2010).

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Pros and Cons of Continuing Nursing Education

Pros

Mandates Education: Health technology and nursing practices are always changing. Almost every other day there are new healthcare innovations, medical breakthroughs, and threats of emerging illnesses. For the purpose of keeping up with the new trends in the field of medicine, continuing education is important for a nursing practitioner. Competence will help a nursing practitioner keep abreast with the new trends. Patients will be poorly served if nurses weren't required to further their studies. Thus, it is rational that continuing education be required.

Enhances Patient Outcomes: Through continuing education either via clinical trials, videos, webinars, or reading journals, nursing practitioners are able to enhance patient outcomes, which is their ultimate objective.

It Shows Professionalism: As nursing practitioners, work is ever changing. Putting these changes to the best use can only be done through dedication to learning.

It Enhances Networking: By attending seminars or reviewing journals, nurses are able to interact with other healthcare professionals. This interaction improves their knowledge and experience, and through this, they are able to enhance, shape and guide their practice.

Cons

Cost: Continuing with education can be expensive. For example, it is expensive to pay for staff to attend a nursing conference or seminar and for them to be away from the patients' side. Moreover, subscribing to journals and purchasing teaching videos requires a lot of money. Finally, incorporating a change, either new innovation or a way of doing things, can be expensive, since it might require the purchase of new equipment or re-training of personnel.

Time: Incorporating a change requires a lot of time, as does continuing education. Continuing education means that nurses have to spend a lot of time away from patients to complete their credit hours, and in most cases, this is frowned upon.

Learning and education are always important. However, since one is learning through continuing education, this doesn't necessarily mean that there will be an improvement in practice. Some opponents of continuing education might opine that more knowledge/learning doesn't equate to better services/practices. Arguing the validity of continuing education credit hours taking a lot of time and is often intense. The pros and cons presented above are only examples of the kind of arguments that can be brought forth to debate the validity of continuing education. Without a doubt, continuing education can enhance patient outcomes. However, it is rational for one to challenge the idea that continuing learning in the field of nursing is a must for continued licensure (Ward, 2013).

Impact on Competency

As a nursing practitioner, one can only guarantee better patient outcomes through commitment to continuing education and the application of new knowledge and techniques gained through such education. Nurses who take care of critically ill patients ought to be competent to carry out tasks and make tough choices that could mean either life or death for the patients they are caring for (Krugman M., 2008). The demand for safe practice and competence forces individuals in the nursing profession to meet the goals of high quality care with programs in continuing education. It is obvious that nursing practitioners can't afford to continue practicing only with their basic education. Neither can they depend on obsolete policies gained from educators who insist on using outdated principles and "facts" from the twentieth century. Additionally, gaining experience at the patient's bedside on a day-to-day basis doesn't necessarily mean that a nurse is current. On the contrary, it has been revealed that incorporation of new knowledge into nursing practice can take as much as seventeen years in certain circumstances (Balas & Boren, 2000). The time taken in integrating new knowledge into practice is scary. Another argument that has been put forth to support continuing education is that continued learning has in fact been listed on a report by the Pew Commission as one of the twenty-one competencies for current health care professionals (Bellack & O'Neill, 2000). All nursing practitioners who have specialty certification ought to show evidence of participating or attending continuing education programs, if they want to renew their certifications/licensing. Therefore, continuing education is evidence of specialization in nursing practice (Skees J., 2010).

Impact on Knowledge and Attitudes

The IOM (Institute of medicine) in a 2010 report that reviewed available literature looked at the impact of continuing education on clinical outcomes. Even though there were challenges in assessing outcomes, the report revealed that continuing education can enhance clinical outcomes, change attitudes and behaviors, and improve knowledge base. Continuing education has also been proved to enhance the professional conduct of nurses and also to increase their knowledge in patient management and their overall nursing practice (Gallagher, 2006). According to Florence Nightingale, nurses should always learn constantly, not just through experience and observation, but also through seeking new evidence and knowledge (Nightingale, 1859). Florence had recognized that the then accepted way of nursing conduct was not the best and she worked hard to come up with new ways of creating better nursing environments. This is similar to the current situation. Commitment to continuing education is a professional duty that nurses have to fulfill in order to ensure enhanced patient outcomes (Witt, 2011).

Relationship to Professional Certification

States are turning to certification as an indicator of entry level competence as they control advanced nursing practice. Certification in such instances is thus not a voluntary procedure, however, it is composed of a regulatory requirement to guarantee public safety and enhance public health. As an outcome, certifying bodies are expected to show that their previous certification exams truly display entry level skills and that their recertification procedures display constant competence.

Ever since the late 1970's, the primary assumptions concerning the utilization of certification to guarantee competence and its inherent value have been increasingly questioned. There is a shortage of empirical data from nursing and other related fields that validate the predictive power of certification as well as recertification examinations that has resulted to the assertion that certification does not possess an impact on patient outcomes. Nonetheless, ANCC's (American Nurses Credentialing Centre's) Institute for Research, Education and Consultation (IREC) lately completed the initial phase of a 3-part certification research effort, which picks out various promising results associated with the patient outcomes. A study was conducted on a randomized sample of more than forty thousand certified nurses in Canada and the U.S. whereby nineteen thousand responded. Upon the completion of the study, the nurses compared their pre-certification and post certification practice. In the description of their post certification practice: fifty one percent revealed more confidence in their practice; thirty five percent reported more confidence in their decision making capabilities; twenty eight percent revealed greater confidence in their complication identification capabilities; twenty three percent revealed greater effective communication as well as cooperation with other healthcare practitioners; and six percent reported less adverse errors and events in patient management than prior to their certification. Ann Cary, a PHD registered nurse, the principal investigator of the survey, mentioned that the data from this survey is paramount to an initial comprehension of the nature of quality outcomes and patient safety factors, which might be optimized via certification (Trossman, 2000).

Relationship to ANA Scope and Standards of Practice

Various methods of ensuring competence have been discussed by ANA through its expert panel and recommendations made. Founded on the premise that the huge majority of the nation's 2.6 million registered nurses are practicing in a competent way, the Expert Panel, engaged during the year 1999, came up with the subsequent presuppositions related to "continuing competence:"

1. The aim of guaranteeing continuing competence is the protection of the public and improvement of the profession via the professional development of nurses.

1. The public possesses a right to anticipate competence throughout the careers of nurses.

1. Any procedure of competency assurance ought to be shaped and guided by the nursing profession.

1. Assurance of continuing competence is simply the shared responsibility of the regulatory bodies', profession, individual nurses and workplaces/organizations.

1. Nurses are personally accountable for maintaining continuing competence.

1. The responsibility of the employer is to offer an environment favorable to competent practice.

1. Continuing competence is both definable as well as measurable and could be assessed.

1. Competence is regarded within the backdrop of level expertise, responsibility and domains of practice (ANA, 2000).

In March 2000, the work of the Expert Panel was approved by the ANA board of directors. The next step was the review of the work by the Expert Panel by nursing professionals. After the reviews and comments are obtained and assessed, the program shall undergo an evaluation and refining pilot phase, which entails a sample of volunteer registered and advanced practice registered nurses (Whittaker, Smolenski, & Carson, 2000).

Relationship to ANA Code of Ethics

Provision Five

The nurse owes similar duties to self as to others, with the inclusion of the responsibility to maintain safety and integrity, to preserve competence, and to continue both professional and personal development.

Professional Growth and Maintenance of Competence

Although it has repercussions for others, sustenance of competence and continuing professional growth entails the regulation of one's own conduct in a manner that is basically self-regarding. Competence imparts one's self-esteem, self-respect, significance of work and professional status. In every nursing role, assessment of one's own performance, accompanied with peer review is a way through which nursing practice could be held to the highest standards. Every nurse is accountable for taking part in the development of criteria for assessment of practice and for utilizing those criteria in self and peer evaluation. Continuing professional development, especially in skill and knowledge, needs dedication to lifelong learning. Such learning entails, but is not restricted to, networking with professional colleagues, continuing education, certification, seeking advanced degrees, professional reading and self-study. Nurses are needed to possess knowledge significant to the current standards of nursing practice, controversies, changing issues, concerns and ethics. Where the care needed is outside the competencies of the individual nurse, patients should be referred to other or consultations sought for suitable care (ANA, 2011).

Should Continuing Nursing Education be Mandatory for all Nurses?

There is no doubt that for the public to obtain the best quality of care, healthcare professionals ought to continue learning. However, according to Houle, taking part in organized activities is just one of the means of continuing learning and is not particularly the most suitable or effective means of continuing learning (Darkenwald & Merriam, 1981). The ideal situation, according to Merriam and Darkenwald, would be mandating competence performance via periodic assessments and to refute relicensing to those that fail to display continued proficiency. Periodic assessments might be more effective than mandatory continuing education programs; however, healthcare professionals are right to vigorously oppose them. Mandating continuing education is a reasonable alternative being relatively simple to administer and acceptable by most professionals. The arguments in support of present mandatory continuing education is founded on the assumption that healthcare professionals ought to carry on with their education so as to be competent; the healthcare that the public obtains is in risk, if the healthcare professionals do not stay in their current field; healthcare providers could increase their competence via education; most healthcare professionals would not take part in informal learning within their own discipline, unless needed to do so; and increased knowledge shall result in better performance of healthcare professionals (Partland).

Houle, maintains that it is the inherent responsibility of every professional to stay current (Houle, 1980), and similarly, Cross believes that even if voluntary education is preferable, required learning is a better alternative (Cross, 1981). The majority of the healthcare professionals would not voluntarily attend continuing education programs with regards to the registration lists from approximately 120 SMAHEC educational offerings; hardly ever did individuals not needing CPE for relicensure attend these workshops. Hence regulations are necessary so as to ensure that healthcare professionals update their skills. Authors like Rockhill (1981) and Day (1980) are against mandating continuing learning on the basis that it restricts freedom and learning. The society, however, has a history of restricting individuals for the good of the public.

For instance, restricting the utilization of certain drugs or limiting the speed at which one can drive a car are very good examples of this. Obviously, protecting the public from the harm brought about by incompetent / unknowledgeable nursing practitioners and medical doctors is a must for the greater good. Moreover, as researcher Mattran (1981) argues, when an individual opts to get into a career in a profession that conventionally entails licensure, he or she has also opted to adhere to the rules or canons of that chosen profession — and continuing learning is not necessarily a violation of individual freedom. Mattran further argues that since professions, such as nursing are dynamic and not static, the practitioners can't maintain their integrity if they remain static. Mattran opines that the real issue is the way in which continuing education, if mandatory, can become integrated and sustained. He thinks that if a country, in reaction to the proposals from a professional organization that seeks to enhance, via continuing education, the services that its members offer to the public, decides to use authority of licensure to incorporate into its legislations, the proposals by the professional organization, the state's authority is legitimate.

As of now, the mandates and standards for continuing education are set by healthcare professionals who enjoy and get various benefits from being involved in continuing education activities. For instance, in a research done to evaluate the need of continuing education for health professionals, it was revealed that over ninety-eight percent of medical doctors surveyed, stated that continuing education was professionally significant to them (Krugman, Tabak, & Freyer, 1982, p. 57). Continuing education programs can not only activate, but also enhance the skills and capabilities of healthcare professionals. Continuing education programs also offer an opportunity for healthcare professionals to get away from conventional routines / practices and to get exposure to new ideas. Continuing education programs have also been proved to prevent burn-out, allowing professionals to network. The argument by Rockhill that there is not enough effort made to create an exciting and challenging educational experience for professionals is not the case in healthcare professional CE (Rockhill, 1981, p. 64).

Owing to the fact that competition for continuing education students is often keen, the organizers have a motivation to make their continuing education programs attractive. Moreover, under current requirements, healthcare practitioners have an extremely broad range of continuing education arrangements from which they can choose. Nursing practitioners can choose from workshops, online studies, and seminars to home study arrangements to update and enhance their education. Thus, the healthcare practitioners can meet the set standards / requirements with very little effort. Owing to the fact that there is a lot of educational offerings and flexibility, nurses can choose the programs most appealing to them and also the educational arrangements or settings, which best suit their personal preferences. Lastly, continuing education courses can also act as a catalyst for more formal courses. For instance, courses sponsored by the Boston School University of social work, stimulated such interest that it resulted in the course being turned into a M.S.W graduate satellite course. Another example is the family beginnings program that was initiated and offered at St. Anne's Hospital in Massachusetts that was met with so much enthusiasm by pediatricians and social workers that it started discussions for the start of a pediatric mental health residency course (Partland, n.d).

References

ANA. (2000). Continuing Competence: Nursing's Agenda for the 21st Century. Washington, D.C: American Nurses Association.

ANA. (2011). Provision 5 — Code of Ethics for Nurses With Interpretive Statements. Retrieved from American Nurses Association: http://www.nursingworld.org/provision-5

Balas, E., & Boren, S. (2000). Managing Clinical Knowledge for Healthcare Improvements. Stuttgart, Germany: Schattauer Publishing.

Bellack, P., & O'Neill, E. (2000). Recreating nursing practice for a new century: recommendations and implications of the Pew Health Professions Commission's final report. Nurse Health Care Perspect, 21, 14-21.

Cross, P. (1981). Adults as Learners.

Darkenwald, G., & Merriam, S. (1981). Adult Education: Foundations of Practice . Ty Crowell Co.

Day. (1980). On Behalf of Voluntary Adult Education. In T. Heaney (Ed.), Task Force on Voluntary Education.

Dickerson, P. (2010). Continuing nursing education: enhancing professional development. J Contin educ Nurs, 41, 100-101.

Gallagher, L. (2006). Continuing education in nursing: a concept analysis. Nurse Educ Today, 27, 466-473.

Houle, C. (1980). Continuing Learning in the Professions.

Institute of Medicine. (2010). Redesigning continuing education in the health professions. Retrieved January 8, 2016, from http://www.nap.edu/openbook.php?record_id=12704

Krugman, M. (2008). Continuing nursing education accreditation: what you need to know. Colo Nurse, 108(9).

Krugman, Tabak, & Freyer. (1982). Effectiveness of the AHEC Concept in Colorado. J. MED. EDUCATION, 87.

Mattran. (1981). Mandatory Education Increases Professional Competence. In B. W. Kreitlow (Ed.), Examining Controversies in Adult Education.

Nightingale, F. (1859). Notes On Nursing: What it Is And What it Is Not. London: Harrison. Retrieved from http://www.nursingplanet.com/Nightingale/conclusion_appendix.html.

Partland, P. A. (n.d.). Mandatory Continuing Education: Does it Really Protect Society from Incompetent Health Professionals? In A. f. Arts, Legal, Ethical, and Professional Issues in Psychoanalysis and Psychotherapy. Academy for the Study of the Psychoanalytic Arts .

Rockhill. (1981). Professional Education Should Not Be Mandatory. In B. Kreitlow (Ed.), Examining Controversies in Adult Education (p. 62).

Skees, J. (2010). Continuing Education: A Bridge to Excellence in Critical Care Nursing. Critical Care Nursing Quarterly, 104-116.

Trossman, S. (2000). Certified nurses report fewer adverse events: Survey links certification with improved health care. The American Nurse, 1-9.

Ward, J. (2013, January 23). The Pros and Cons of Getting Nursing CEUs. Retrieved from Nursing Together: http://www.nursetogether.com/pros-and-cons-getting-nursing-ceus

Whittaker, S., Smolenski, M., & Carson, W. (2000). Assuring Continued Competence – Policy Questions and Approaches: How Should the Profession Respond? Online Journal of Issues in Nursing, 5(3). Retrieved from www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume52000/No3Sept00/ArticlePreviousTopic/ContinuedCompetence.aspx

Witt, C. L. (2011). Continuing Education: A Personal Responsibility. Advances in Neonatal Care, 227-228.

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Pros and Cons of Mandatory Continuing Nursing Education