When Kathy Apple graduated from nursing school four decades ago, she couldn’t find the kind of job she had hoped to get: a position as a staff nurse in a large hospital. She expanded her search, and found a job as a psychiatric nurse in an outpatient mental health clinic. She was grateful for the job, but knew from the start she wasn’t prepared to do it well.
So, Apple enrolled in a master’s program in psychiatric mental health and later earned a second master’s degree in counseling psychology. Since then, she has participated in numerous shorter-term opportunities to advance her education. “We all have a duty to recognize what we know and what we don’t know,” says Apple, MS, RN, who plans to step down this month as CEO of the National Council of State Boards of Nursing (NCSBN). “As professional nurses, we are legally bound to provide safe and competent care.”
Continuing education is one key way to do that, she says. That’s why she advanced her own education and participated in so many other opportunities—both formal and informal—to stay abreast of current nursing knowledge. And it’s why many state boards of nursing, which are responsible for administering and renewing nurse licenses, require nurses to take a minimum number of continuing education courses at regular intervals in order to renew their licenses.
It’s also why the American Nurses Credentialing Center (ANCC) puts a premium on continuing education. In addition to accrediting organizations that offer continuing education programs and certifying nurses who demonstrate specialty expertise, ANCC oversees a prestigious Magnet Recognition Program to recognize health care organizations with excellent nursing environments and quality patient outcomes. To obtain Magnet status, applicant organizations must demonstrate how they support continuous professional development and national certifications for staff. The Magnet Recognition Program® also requires organizations to submit an action plan that includes a target and demonstrates evidence of progress toward 80 percent of registered nurses obtaining a baccalaureate or graduate degree in nursing by 2020.
Nurses, like all other health professionals, graduate with a certain standard of information,” said Linda Lewis, MSN, RN, NEA-BC, chief ANCC officer and director of ANCC’s Magnet program. “As professionals, the public expects us to practice using the most current, evidence-based protocols... This commitment requires lifelong learning.
Nurses have long been expected to continue their education, and the ANCC has been accrediting providers and accreditors of continuing education programs for four decades. But there is a debate over whether even more needs to be done at this time when technology and the science of nursing and medicine are undergoing rapid change.
In 2009, an Institute of Medicine (IOM) report found “major flaws in the way [continuing education in the health professions] is conducted, financed, regulated, and evaluated” and called the evidence base underlying continuing education programs “fragmented and undeveloped.” It called for continuous professional development that ensures that “all health professionals engage in a process of lifelong learning aimed squarely at improving patient care and population health.” One year later, in its 2010 report on the future of nursing, the IOM called on health care organizations to create workplace cultures that foster continuing education.
Nevertheless, debate continues over how best to do that, Apple said. “To my knowledge, no one has adequately answered the question about what a practitioner needs to do to demonstrate ongoing competency throughout the lifetime of his or her career,” she said, adding that many stakeholders—individual nurses, employers, and licensing boards—play a role in answering that question. “Each of these stakeholders has a part to play in ultimately saying to the public that nurses are able to provide safe and competent care.”
Suzanne Prevost, PhD, RN, FAAN, dean of nursing at the University of Alabama and an alumna of the RWJF Executive Nurse Fellows program, says there is “wide variability” in continuing education programs and providers. Continuing education requirements for nurse licensure, she notes, “vary widely between states and across specialties.” Hospital support for continuing education, she added, also “varies widely” and tends to be more prevalent in states that require continuing education for licensure and Magnet-designated hospitals.
The good news is that more stakeholders are paying attention to continuing education in nursing, Lewis added. The Magnet Recognition Program is growing, as more health care organizations seek the prestigious distinction to attract consumers. Currently, 419 organizations have earned Magnet status worldwide, and many more are “on the journey,” Lewis said. Consumers, she added, use nationally recognized data sources to make decisions about where to seek care. One of those sources is U.S. News and World Report’s annual list of best hospitals, which includes Magnet status in its list of criteria.
In addition, more health care organizations are requiring nurses to continue their education as a condition of employment, according to a multi-year study of nurse leaders, published in the Journal of Nursing Administration. It found that 30 percent of health care organizations required additional education and/or certification in 2013, up from 23 percent in 2011. “Our findings suggest that health care organizations are changing and working to put in place key nursing reforms,” said Patricia Pittman, PhD, one of the authors and an associate professor of health policy at the Milken Institute School of Public Health at the George Washington University, in a news release.