A large component of our leadership role as nursing professional development (NPD) practitioners involves planning and designing educational activities to meet the needs of the organization including regulatory and accreditation requirements, strategic initiatives, and competency validation. Many of the standards in the 2016 Nursing Professional Development: Scope and Standards of Practice (Harper & Maloney, 2016) include these elements. Sometimes the demands are overwhelming, and there is just not enough time or resources. When you find yourself throwing your hands in the air and wanting to scream for help, take a step back, take a deep breath, and prioritize. Investigate all those requirements and requests, and identify the legitimate educational issues and the inappropriate requests for education that will not address the problem. Critical skills for accomplishing this task include assessing and using data to identify learning gaps and appropriate interventions, mentoring and consulting with others to explore alternatives to education when education is not the answer, and interpreting regulation and standards for required education.

Assessing and gathering data is critical for evaluating the presence of a knowledge or skill gap. Data are an essential tool, as long as the results are measurable and quantifiable. Anecdotal data may be exaggerated to justify an educational request. Collecting data or observing a process provides valuable information regarding the extent of a performance issue and provides clues to determine if education is the answer or if addressing system or process issues is the answer. Gathering data by reviewing the source documents for required education from regulations and standards also provides updated information regarding what is required and how often. Setting aside time on a regular basis for investigating and scanning for changes will save you time by eliminating wasted efforts with educational activities when education is not the answer.

So, the next time you receive that e-mail or phone call or attend a meeting in which another educational request is made, ask the following questions:

1. Can you tell me what the issue is and why an educational activity is needed?

2. How were you made aware of this need?

3. How many times has the issue occurred and how has the issue been measured? Or what is the frequency of education required by the new regulation or standard? Please share your data or the source document.

4. How many employees are involved in the performance problem or need to be aware of the new product, regulation, or standard?

5. What previous training or education has been provided? Do the employees know how to do this process or do they have a knowledge or skill gap?

6. What attempts have been made to correct the problem/issue and what were the results? If education has been provided at least once, then an alternative to education needs to be selected and implemented.

7. Are there written procedures, protocols, or guidelines for this process? How do these need to be updated to encourage compliance with the process?

8. What other interventions can improve performance other than education such as a change in the process, the forms, or available equipment? How can we make it easier for employees to perform as expected or meet requirements?

NPD practitioners are the experts in assessing educational needs and designing educational activities to meet identified educational needs. NPD practitioners often need to assume the role of consultant in order to mentor others to help them identify the best response to a performance issue when education is not the answer. In Out of Crisis, W.E. Deming explored the root causes of performance issues and found that staff knowledge and skill issues were the problem in only 10% of the cases. This means education would only be an effective change strategy for 10% of performance issues. Five percent of the time, staff had the knowledge and skills but chose not to comply with performance expectations. The remaining 85% of root causes were due to system issues such as inadequate staffing or resources, poor workflow, or equipment malfunction (Deming, 2000). Education is not an effective tool for solving system issues. In the list below, appropriate interventions for system deficiencies, knowledge or skill deficiencies, and behavior deficiencies are identified. This list can be used to consult with those with educational requests to assist in selecting appropriate interventions to meet the performance issue.

For System Issues or Deficiencies: (85%)

Change the communication channels

Add or revise policies and procedures

Revise job descriptions or assignments

Establish new positions

Hire new staff or increase staffing

Use consulting services (internal or external)

Reallocate resources

Purchase new equipment or alter the use of current equipment

Change the organizational structure or reporting relationships

Revise forms and/or computer entry requirements

Create a flow chart and identify duplications and omissions

Revise the flow of work

Rearrange the work environment to decrease distractions or increase efficiency

Clarify roles and expectations and work assignments

For Staff Knowledge or Skill Deficiencies: (10%)

Provide focused continuing education

Provide case studies or scenarios with policies and procedures

Post an article and current policies and procedures

Provide additional reference resources

Modify orientation procedures

Print reminders and post in most frequently used area

For Behavior or Performance Deficiencies: (5%)

Provide specific performance data to individuals

Provide informal or formal counseling

Issue a verbal/written warning

Change job assignments

Revise individual's job description

Issue a monetary fine or incentive

Impose proctoring or disciplinary sanctions

Place individual on probation, according to organizational policies

Transfer individual to another department

Suspend or revoke privileges and staff appointments

The final element for prioritizing educational activities relates to that long, ever growing list of annual mandatory education. This list needs to be evaluated and reduced annually to allow for new products, equipment, and strategic initiatives. For each item on the mandatory education list, identify which organization or regulatory body includes this required education in their regulations, standards, or guidelines. For example, Occupational Safety and Health Administration (OSHA) requires annual blood-borne pathogen training, and the regulation includes 14 elements that must be addressed. A new Joint Commission standard as of January 1, 2016, requires education of staff and licensed independent practitioners about the purpose and proper operation of alarm systems for which they are responsible in the National Patient Safety goal for clinical alarm systems. Other agencies that require annual education include state licensure regulations, Medicare Conditions of Participation or Coverage, and the National Fire Protection Association Life Safety Code, just to name a few. Review the source of each required educational activity on a regular basis to ensure that current education is still required and that the education meets the requirements in the standard or regulation.

In order to ensure that time and resources are allocated in the most efficient manner, a skilled NPD practitioner will

1. investigate every request for educational activities or required/mandatory education element to determine the need for education;

2. determine the anticipated outcome(s) of any intervention;

3. provide education only when indicated; and

4. offer consultation when education is not the answer for the performance issue.

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