THE CONSTANT changes in today's healthcare landscape require nurses to stay current in technology and practice.1 According to the Code of Ethics for Nurses, nurses have a responsibility to "maintain competence, and continue personal/professional growth."2 Continuing education and staff development are fundamental components of being a professional nurse.3,4 This article examines how one hospital unit designed and implemented a nurse education program intended to engage adult learners and inspire reflection.
Value of education
The American Nurses Association created a system to formally measure continuing education credits in 1975.5 Since then, much debate has centered over how much continuing education is needed to maintain competency and the best way to obtain that education. Competency is defined most simply as the application of the skills and knowledge for appropriate nursing practice, but it can also be highly complex, as nurses have diverse educational backgrounds and practice in various settings.6
Most nurses recognize the value of continual professional development.7 One study consisting of focused interviews to determine clinical nurses' perceptions about continuing education found that most interviewees saw continuing education as necessary to provide safe, up-to-date patient care.8 Nurses also cite career advancement and increased self-confidence as reasons for professional development.7
Barriers
Unfortunately, several barriers-both real and perceived-can stand in the way of nurses' involvement in continuing education and professional development. Clinical nurse educators and education committees are challenged to change staff perceptions to view continuing education and professional development in a more positive light.
One of the biggest barriers to learning in the hospital is lack of time.4 While protected education time is invaluable, it's unrealistic to think that this will always be available as healthcare costs continue to rise. Extra paid training time is expensive for health systems, and administrators don't always see it as a worthwhile investment.7 Other barriers to continuing education and professional development are staff shortages, inconvenient places/times, fatigue/inability to concentrate after working, family/personal commitments, lack of interest in topics, past experiences of negative/inadequate programs, lack of program variety, poor planning, inappropriate teachers, and lack of manager/administration support.3-5
Another challenge is the effort and time required to continually update information so it's current.9 Creating and analyzing needs assessments and updating resources are time-consuming activities. Staff may have learning preferences based on generational differences. For example, Baby boomers are used to passive learning, while millennials expect teaching methods to keep pace with technological changes.10,11 In addition, some newer technology, such as cloud computing, e-learning, mobile computing, and virtual reality, may be unfamiliar to nurse educators and planners.
The learning environment itself can impact nurses' development and education.8 In a culture that supports and values learning, continuing education is a priority. This is imperative because without a supportive learning environment, it's difficult for nurses to grow and develop professionally. Factors such as self-directed ability, sense of accountability, motivation to learn, and opportunities for education influence learning.10 Educational planning and instructional design must be approached like the nursing process by assessing needs, diagnosing the issues, planning the appropriate education, implementing it, and, finally, evaluating the results.11
A new type of program
One unit's education committee recognized these challenges to staff development and education and decided to implement a new type of nurse education program. The patient population of this 55-bed unit consisted of trauma/orthopedic patients, stroke/neurosurgical patients, and some general medical-surgical patients. Besides general yearly required education credits, nurses on this unit must earn mandatory trauma and stroke credits because the hospital has both trauma and stroke certifications. The total number of required credits seemed overwhelming to some nurses, so the education team created additional opportunities for staff to complete requirements while also encouraging continuing professional development.
Adult Learning Theory states that adult learners need to be in control of their own learning.10 Optimal learning for this group must be learner-centered and accessible, as well as accommodating to their needs. To address the barrier of staff's negative perceptions of education, goals are designed to involve them in the planning and make the education accessible, fun, and interesting.
By first conducting an educational needs assessment using paper forms and Survey Monkey, the committee determined the areas in which the clinical nurses wished for more education. This needs assessment also asked about their preferred ways to learn.
The hospital already had a system with online access to learning modules and articles. While online learning modules generally work well with self-directed learners, the committee discovered that this wasn't always everyone's preferred method of education. Based on this information, several different methods of education were incorporated into the learning options. For example, staff development sessions were planned and held right on the unit at various times convenient to both day- and night-shift staff. Physicians associated with the unit were invited to present at some of these sessions, which helped strengthen nurse-physician relationships and collaboration. In addition to the live educational sessions, several webinars were made available and viewed by groups of nurses for credits.
During a mock code, the staff participated in a scenario using a high-fidelity simulation manikin. Staff had to demonstrate CPR skills, use of the defibrillator, and team dynamics during the mock code. To add some fun to the offerings, the team also included educational games, such as crossword puzzles and "Stroke Jeopardy!" Some staff even completed adult coloring pages on brain anatomy and functions of the different brain areas. Another idea involved using some of the empty bulletin boards throughout the unit to post topics from current journal articles and other information with quizzes that could be completed for credit. One innovation that proved very successful over the last 2 years was the planning of an Education Week in the beginning of the year to help staff get a jump start on the yearly education requirements.
After any program development, outcomes measurement is essential.9 This involves performing a comprehensive evaluation of the information presented and assessing how it was received, if it was retained, and if it was applicable to current practice.11 Self-reflection and self-assessment are needed to evaluate competency and determine ways to improve.6 Once again, the unit education team utilized paper evaluations as well as Survey Monkey to get staff feedback.
Staff members stated that they really liked the bulletin board quizzes because these were readily accessible and easy to do. They said this activity helped them learn new information while reinforcing previous knowledge. The games were also well received. Competitions were spirited, which contributed to a fun atmosphere and requests for similar activities in the future.
Many staff members joined in education week offerings in varying degrees and stated that they liked the variety of activities. Some requested a longer time frame (such as 2 weeks) in the future to give them additional opportunities to participate. The education team plans to use the feedback to plan future activities.
Planning pays off
Maintaining staff education and professional development is challenging in today's busy healthcare landscape. The first step to building a successful training program is an assessment of staff needs and preferred learning strategies. Using this information, clinical educators and unit education teams can create educational offerings using various delivery methods to try to improve staff participation and satisfaction. While this planning takes some time, the result makes the extra effort worthwhile.
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