I recently came across a spiral-bound notebook filled with nursing care plans that I'd written not during nursing school, when such plans were required, but during my first five years of practice. The notebook contained "mini-reviews" I'd compiled to help me learn about common diagnoses on the medical-surgical units where I worked. Clearly I had been fearful-of missing an important symptom, overlooking an adverse effect of a new drug, or forgetting the procedure for an indicated nursing intervention. My references were the Beeson and McDermott Textbook of Medicine (a graduation present to myself), issues of AJN, and textbooks I'd collected during nursing school.
The entries tapered off as I became more confident and competent. As I read through my notebook now, I think about how much information nurses must retain, process, and use during nearly every moment of their clinical practices. How do they do it?
Basic nursing education programs prepare you only for the beginning of the lifelong learning process that is modern nursing. Of course, a certain amount of continuing education (CE) is necessary in most states to maintain your license, but that's only one reason to increase your base of knowledge. No one makes the transition from student nurse to competent clinician easily, but a commitment to learning is crucial to success. It's also an exciting part of our careers, and today there are more accessible learning opportunities than ever.
MAINSTAY RESOURCES
Books and peer-reviewed professional journals are the tried-and-true sources of literature pertinent to nursing practice, but nurses often lose easy access to a medical library when they graduate. Health care institutions and other employers often provide nurses with access to print and electronic journals, along with an expectation that such resources will be used to enhance patient care. If employers don't provide these resources, nurses can subscribe on their own to journals that offer CE features, or look online for opportunities. For example, Contemporary Forums (http://www.contemporaryforums.com) provides self-study and conference programming on a wide variety of topics. Journals such as AJN and Nursing Spectrum also regularly include CE articles.
The value of a nursing mentor who facilitates learning cannot be overstated. Informal mentoring can occur when you ask a colleague about an unfamiliar procedure or a patient care issue. Formal mentoring-preceptorships or internships-can be beneficial if you're newly graduated, returning to work, or entering a new clinical field.
Professional organizations play vital roles in providing educational opportunities. Member benefits often include subscriptions to professional journals and print and electronic newsletters, electronic chat rooms, listservs, and discounts on publications, conference registrations, and certification fees. A significant benefit of membership in a specialty nursing organization is networking with colleagues. There are some 70 national specialty nursing organizations; at least one will match your interests and educational needs. (See "Nursing Specialty Organizations," page 66, for a list of national nursing organizations.)
Continuing education courses offered by colleges and universities, nursing organizations, health care institutions, and governmental and nongovernmental agencies provide much of the continuing professional education for nurses. Most states require that nurses document CE hours for license renewal. If your employer offers educational leave, it's a benefit that shouldn't be squandered.
You'll need to devote time to finding and scheduling learning opportunities that suit your needs while also meeting CE requirements to maintain your license. Most states accept CE hours from providers accredited by the American Nurses Credentialing Center. Regulations governing the types of offerings that are acceptable-such as home study, online courses, or conferences-vary by state; accreditation statements on program announcements should provide the eligibility details.
To make the best use of your time, first verify that the course objectives and goals are consistent with your needs. If possible, ask colleagues who have heard any scheduled speakers about their credibility and effectiveness.
Governmental and nongovernmental organizations. The National Institutes of Health (NIH) provides a wealth of health-related information on its Web site (http://www.health.nih.gov). Topics are arranged by body locations, body systems, diseases and conditions, and health and wellness categories. They link to resources such as newsletters, video lectures, "podcasts," and online chat groups. The NIH's PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez) provides direct and free access to Medline, a database of citations and abstracts maintained by the National Library of Medicine. Web sites for nongovernmental organizations that focus on a particular disease-such as the American Cancer Society (http://www.cancer.org), the American Heart Association (http://www.americanheart.org), and the American Diabetes Association (http://www.diabetes.org)-generally feature excellent information, crafted especially for health care professionals. Making a telephone call or searching any of these Web sites can quickly get you information about educational offerings from these groups at their various regional or national locations.
SEPARATING GOOD FROM BAD
The ease of finding information online can be a double-edged sword: it's easy to find, but is it accurate? Professional literature that is "peer-reviewed" remains the hallmark of credibility. Print and electronic publications using a peer-review process recruit experts on a particular topic as reviewers. They read and critique manuscripts according to the publications' stated criteria.
You can find out if a journal is peer-reviewed by reading its editorial information, generally found near the table of contents. Publications that aren't peer-reviewed still have a place as resources. Many provide timely discussions, creative ideas, anecdotal information, and thoughtful opinions that in turn may generate a more scientific exploration.
Anyone can create a Web site and post information. There is no single test for quality and truthfulness. The most dependable method of finding reliable information is to start with the sites developed and hosted by respected entities, such as the NIH, prominent nongovernmental organizations, or research universities. For example, Johns Hopkins University's Welch Medical Library (http://www.welch.jhu.edu/internet/nursing.html) provides access to a wide variety of nursing resources, including tutorials, online research instruments, tools, calculators, drug information, evidence-based nursing processes, and patient education resources. Links established from sites of this caliber are generally considered trustworthy.
You can also trace information to its origins to determine its credibility. Using a search engine such as Medline or Google, type in any identifying information, such as the publication's title, date, and author. Reprints of original articles are generally identified as "complete" or "full" reprints, with original dates and places of publication listed. You may find condensed versions of articles; these might be informative but may also misinterpret important points or omit information altogether.
When an original source cannot be located, the information is probably questionable at best, and is unlikely to be useful.
IF YOU CAN'T FIND IT, CREATE IT
If you can't find the educational experience you're looking for, create it. Chances are that the topic will be of interest to others, too.
Develop your idea to the extent that you can: Can you estimate the level of interest in the subject among your colleagues? Can you suggest speakers? Is there a nongovernmental organization that can work with you? Are you aware of funding to support such a program? What form should this educational offering take-one-day conference, in-service training program, online self-study course?
Take your idea and all supporting information to the person or group responsible for planning educational offerings at your workplace; your local, state, or national nursing organization; or a local division of a specialty organization. Offer to be part of the planning. Participating in nursing CE can be tremendously satisfying and can also proactively address your own learning needs.