Self Care and Lifelong Learning Discussion Paper

CONTINUING EDUCATION Professional Development Strategies to Enhance Nurses’ Knowledge and Maintain Safe Practice 1.7 www.aornjournal.org/content/cme SUSAN L. BINDON, DNP, RN-BC, CNE Continuing Education Contact Hours Approvals indicates that continuing education (CE) contact hours are available for this activity. Earn the CE contact hours by reading this article, reviewing the purpose/goal and objectives, and completing the online Examination and Learner Evaluation at http://www.aornjournal.org/content/cme. A score of 70% correct on the examination is required for credit. Participants receive feedback on incorrect answers. Each applicant who successfully completes this program can immediately print a certificate of completion. Event: #17523 Session: #0001 Fee: For current pricing, please go to: http://www.aornjournal .org/content/cme. This program meets criteria for CNOR and CRNFA recertification, as well as other CE requirements. The contact hours for this article expire August 31, 2020. Pricing is subject to change. Purpose/Goal To provide the learner with knowledge of best practices related to engaging in nursing professional development (NPD) activities. AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. Check with your state board of nursing for acceptance of this activity for relicensure. Self Care and Lifelong Learning Discussion Paper

Conflict-of-Interest Disclosures As a coeditor of the Journal for Nurses in Professional Development, Susan L. Bindon, DNP, RN-BC, CNE, has declared an affiliation that could be perceived as posing a potential conflict of interest in the publication of this article. The behavioral objectives for this program were created by Kristi Van Anderson, BSN, RN, CNOR, clinical editor, with consultation from Susan Bakewell, MS, RN-BC, director, Perioperative Education. Ms Van Anderson and Ms Bakewell have no declared affiliations that could be perceived as posing potential conflicts of interest in the publication of this article. Objectives 1. Discuss the importance of engaging in various types of NPD activities. 2. Describe the different requirements for NPD activities. 3. Identify barriers to participating in NPD activities. 4. Identify strategies and resources for engaging in NPD activities. Sponsorship or Commercial Support Accreditation AORN recognizes these activities as CE for RNs. This recognition does not imply that AORN or the American Nurses Credentialing Center approves or endorses products mentioned in the activity. AORN is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. No sponsorship or commercial support was received for this article. Disclaimer http://dx.doi.org/10.1016/j.aorn.2017.06.002 ª AORN, Inc, 2017 www.aornjournal.org AORN Journal j 99 Professional Development Strategies to Enhance Nurses’ Knowledge and Maintain Safe Practice 1.7 www.aornjournal.org/content/cme SUSAN L. BINDON, DNP, RN-BC, CNE ABSTRACT Maintaining competence is a professional responsibility for nurses. Individual nurses are accountable for their practice, as outlined in the American Nurses Association’s Nursing: Scope and Standards of Practice. Nurses across clinical settings face the sometimes daunting challenge of staying abreast of regulatory mandates, practice changes, equipment updates, and other workplace expectations. In the complex, evolving perioperative setting, professional development is a priority, and the need for ongoing education is critical. However, nurses’ efforts to engage in their own development can be hampered by a lack of time, limited access to educational resources, or cost concerns. This article provides an overview of nursing professional development and offers some resources to help individual nurses maintain or enhance their knowledge, skills, and attitudes. AORN J 106 (August 2017) 99-110. ª AORN, Inc, 2017. http://dx.doi.org/10.1016/j.aorn.2017.06.002 Key words: competency, nursing professional development, continuing education, contact hours, lifelong learning. T he American Nurses Association defines the general standards of practice for professional nurses across settings and specialties.1 Multiple nursing specialties also have standards of practice and performance for nurses who work in specific areas or with certain patient populations. These standardsdalong with regulatory changes, advances in clinical practice, technical updates, and organizational expectationsdhelp to determine the competencies nurses need to maintain safe, current practice. Lifelong learning and competency are mainstays of nursing practice. Self Care and Lifelong Learning Discussion Paper

Patients expect professional nurses to be competent in their practice and in the care they provide. Care team members depend on the competence and up-to-date skills of their colleagues. In its 2014 position statement on professional role competence, the American Nurses Association stated that “[a]ssurance of competence is the shared responsibility of the profession, individual nurses, professional organizations, credentialing and certification entities, regulatory agencies, employers, and other key stakeholders.”2 In other words, maintaining nursing competence requires a team effort. To maintain their competency, most nurses rely on some type of continuing education, which can take many forms (eg, clinical updates and competency assessments, e-learning modules, webinars, workshops, conferences, specialty certification). These efforts, in part, constitute nursing professional development (NPD), the outcomes of which are growth, learning, and change.3 Individual nurses have the responsibility to reflect regularly upon their knowledge, skills, and attitudes (KSAs) to identify professional practice gaps. The American Nurses Credentialing http://dx.doi.org/10.1016/j.aorn.2017.06.002 ª AORN, Inc, 2017 100 j AORN Journal www.aornjournal.org August 2017, Vol. 106, No. 2 Center states that these gaps may result from a “change that has been made to a standard of care, a problem that exists in practice, or an opportunity for improvement.”4(p24) Once identified, practice gaps become learning needs. Learning needs can then be categorized, prioritized, and addressed for nurses at all levels to maintain competence and ensure that practice is unaffected. This article offers resources and strategies for supporting nurses’ professional development. NPD OVERVIEW Newly hired perioperative nurses complete orientation to their new organizations, roles, and the units or areas in which they will be working. They learn about their jobs and the expectations that accompany their new positions. They gain knowledge, develop skills, and become socialized into their work teams. The goals of an orientation period are for nurses to demonstrate basic competency and integrate into their new roles and settings. With time, experience, and support, they will become safe, independent nurses practicing in intense, high-stakes specialties. In most instances, hospital-based nurse educators, commonly referred to as NPD educators, facilitate this process.Self Care and Lifelong Learning Discussion Paper

They assess new employees’ KSAs and validate their initial competencies. Together with the employees and their managers, NPD educators identify learning needs and employ strategies to address them. This learning process is ongoing throughout nurses’ careers and reflects their continuous professional development. Nursing professional development is a part of the cumulative learning and growth that takes place during a nurse’s career after passing the National Council Licensure Examination (NCLEX) and securing a nursing license. Lifelong learning and acquisition of knowledge and skills are intentional pursuits throughout a nurse’s career. This active process helps nurses prepare for new or different roles and respond to inevitable changes in the practice environment. Lifelong learning can take place formally or informally, either inside or outside the work setting.5 How nurses view lifelong learning and their own professional development varies significantly. Some nurses seek out opportunities and look forward to the challenge of “what’s next.” These nurses often have plans and strategies that align with their career goals. Others face yearly competency validations and learning events with less enthusiasm. Their development plans may be more along the lines of “checking the boxes.” They may complete what is required to maintain their positions but do not necessarily extend their learning activities beyond the basics. Learning styles, previous learning experiences, comfort with technology, career goals, years of experience, presence of mentoring, and availability of support might www.aornjournal.org Professional Development Strategies influence a nurse’s readiness and willingness to pursue NPD activities. Regardless of a nurse’s perspective or motivation related to NPD, the avenues and resources for addressing learning needs are plentiful. The Association for Nursing Professional Development defines NPD as a specialty area of nursing that facilitates the professional role development and growth of nurses and other health care personnel along the novice-toexpert continuum.Self Care and Lifelong Learning Discussion Paper

5 Nursing professional development educators are experts in the lifelong learning process and can offer ideas and support. The NPD Practice Model5 (Figure 1) describes the NPD process as an input-throughput-output system. The inputs are the learner(s) and the NPD practitioner (ie, educator). The throughputs of the model are the various kinds of learning activities in which nurses can engage, and the outputs are learning, change, and professional growth and competence. The environment for learning can be wherever the learning takes place: at the bedside, in a classroom, via a podcast or online learning module, in a simulation laboratory, or off site at a conference. The NPD model captures the dynamic nature of lifelong learning and continuing professional development. It also highlights the partnership between individual nurses and the NPD educator, who can facilitate and support the NPD process. VARIATION IN REQUIREMENTS Expectations for ongoing education and competency management differ across specialties and organizations, and requirements vary by state. Many state boards of nursing require a certain number of continuing nursing education (CNE) contact hours or professional nursing activities, or both, per RN license renewal cycle. For example, New Jersey requires 30 contact hours every two years and Massachusetts requires 15; however, other states, including Arizona, Colorado, and Maine, do not require any.6 Professional activity requirements also vary but might include precepting, participating in research, obtaining national certification, or engaging in additional academic coursework. Some states are more prescriptive, requiring continuing education on specific topics such as domestic violence, pain management, or medical errors. Some states have employment hour requirements in lieu of or in addition to contact hours. Nurses certified in advanced practice roles typically must fulfill ongoing education requirements to maintain their status, with special emphasis on their area of practice.6 Given the varied settings, roles, organizational cultures, and regulatory requirements that exist concerning continuing education and professional development for nurses, it is AORN Journal j 101 Bindon August 2017, Vol. 106, No. 2 Figure 1. Nursing Professional Development Practice Model. EBP ¼ evidence-based practice; QI ¼ quality improvement. ª 2016 ANPD. Reprinted with permission from the Association for Nursing Professional Development, Chicago, IL. understandable that managing one’s own learning can be a challenge. Finding and navigating the necessary information can be overwhelming and time-, labor-, and cost-intensive. Continuing education terminology also varies and can be confusing for nurses trying to determine appropriate continuing education requirements (Table 1). For assistance with determining specific requirements, nurses may want to consider starting with their state’s board of nursing web site, which will offer information regarding current licensure and renewal requirements. PERIOPERATIVE COMPETENCY IDENTIFICATIONSelf Care and Lifelong Learning Discussion Paper

One way to view competencies is by the type of skills needed to achieve them: technical skills, interpersonal skills, or skills related to critical thinking.7 Another simple way to diagnose or triage learning needs is to decide whether an identified gap is best considered as a knowledge, skill, or attitude need. This identification can help educators align the learner with the most appropriate learning resource. Sometimes there is overlap, and competency needs can fall into more than one category or dimension. For example, learning to use a new electronic 102 j AORN Journal documentation system may include elements of all three learning categories: knowledge about the system’s functionality, data-entry skills, and an open-minded attitude toward new technology and processes. In addition to general continuing education requirements and expectations, nurses in the perioperative setting must consider the KSAs specific to their specialties. More than a decade ago, researchers identified nine major perioperative practice areas or domains for perioperative nursing. These practice areas include patient assessment and diagnosis; identification of expected outcomes and plan of care; intraoperative activities; communication; discharge planning; cleaning, disinfecting, packaging, and sterilizing; emergency situations; management of personnel; and professional accountability.8 Since that time, these domains have provided a foundation for competency assessment. These specialty-specific work www.aornjournal.org August 2017, Vol. 106, No. 2 Professional Development Strategies Table 1. Comparison of Continuing Education Terms Term Abbreviation Definition Comments Continuing education CE A general term for professional adult education undertaken to improve KSAs and to help meet career goals. Applies to all disciplines. Contact hour1 N/A A unit of measure that describes 60 min of an organized learning activity. 1 contact hr ¼ 60 min. Usually refers to nursing activities, CNE. Continuing nursing education1 CNE “Learning activities intended to build upon Often required for ongoing licensure the educational and experiential bases and certification. of the professional RN for enhancement Varies across states and specialties. of practice, education, administration, research, or theory development, to the end of improving the health of the public and RNs’ pursuit of their professional career goals.”1(p23) Credit hour2 N/A Refers to 60 min of organized learning activity that is formally approved for a specific educational program. 1 credit hr ¼ 60 min. Usually refers to medical education activities, CME. Continuing medical education3 CME “[E]ducational activities that serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships a physician uses to provide services for patients, the public, or the profession.”3(p4) Often required for ongoing licensure and certification.Self Care and Lifelong Learning Discussion Paper

Varies across states and specialties. Continuing education unit2 CEU A specific designation of learning time or course time where 1 hr ¼ 0.1 CEU and 10 hr ¼ 1.0 CEU. Often misused or confused with other terms. Usually refers to academic settings or all continuing education activities. ANCC does not use this term.1 Interprofessional continuing education4 ICE Education that occurs when members from 2 or more professions learn with, from, and about each other to enable effective collaboration and improve health outcomes. Relatively new term as interprofessional education efforts gain momentum. KSA ¼ knowledge, skills, attitudes; N/A ¼ not applicable. References 1. American Nurses Credentialing Center. 2015 ANCC Primary Accreditation Provider Application Manual. Silver Spring, MD: American Nurses Credentialing Center; 2015. 2. Continuing education help. Joint Commission Resources. http://www.jcrinc.com/cehelp/#1570. Accessed April 28, 2017. 3. Accreditation Council for Continuing Medical Education (ACCME) and American Medical Association (AMA) Glossary of Terms and Definitions. http://www.accme.org/sites/default/files/011_20170421_Glossary_of_Terms_3.pdf. Published April 2017. Accessed April 28, 2017. 4. Joint Accreditation: interprofessional continuing education. http://www.jointaccreditation.org. Accessed April 28, 2017. categories may help nurses and nurse leaders develop plans to ensure that, from an education perspective, they have addressed the full range of practice when considering their professional development. Learners can also use these practice domains to identify their areas of strength and areas that may need to be refreshed or reinforced. www.aornjournal.org BARRIERS TO PROFESSIONAL DEVELOPMENT In a nationwide survey of more than 600 nurses across various settings and age groups, many participants commented that nursing’s emphasis on lifelong learning, continuing education, and returning to school are things AORN Journal j 103 Bindon that nurses do well.9 Self Care and Lifelong Learning Discussion Paper

However, nurses face certain challenges regarding their ongoing education and professional development. Because of the inherent nature of perioperative nursing, limited time, lack of access, and irregular staffing patterns can create system barriers to education. Scheduling can be unpredictable in the perioperative setting; preplanned education activities or blocks of time reserved for education may change or be lost at a moment’s notice. Perioperative staff members may work in less accessible areas of a hospital or care setting, making it more difficult for equipment, education classes, or training to be available to them. Perioperative staff members also work in separate rooms or on distinct teams. This case-based work pattern can pose challenges for educators. They may find it difficult to provide education to a large number of staff members at one time, with the exception of early morning huddles or full staff meetings. Another concern for many nurses is the cost of some continuing education or professional development activities. Certification review courses, academic programs, memberships to professional organizations, journal subscriptions, and national conferences can be costly. Some employers provide special funds for professional development or build financial allowances into a clinical ladder or other professional advancement model. Other organizations do not, prompting some nurses to consider these activities as nonviable options for ongoing education. A final barrier to professional development that applies across settings is a real or perceived lack of support from leaders or peers. Perlstein et al10 noted lack of support as one of the primary barriers to nurses seeking specialty certification. Nurses wishing to return to school have cited a need for leadership support related to inflexible work schedules.11 Peer pressure to maintain the status quo on a team or a particular unit may serve as a barrier to professional development. However, when positively channeled, peer pressure could serve as a catalyst to support success.12 Not knowing what education is needed and what educational opportunities are available can also stifle nurses’ efforts t Self Care and Lifelong Learning Discussion Paper