Report of Findings Exploring the Value of Continuing ... the Value of Continuing Education Mandates ... Exploring the Value of Continuing Education Mandates ... The project also owes

VOLUME 6 ■ SEPTEMBER 2003

NCSBN Research Brief

Report of Findings

Exploring the Valueof ContinuingEducation Mandates

June Smith, PhD, RNNational Council of State Boards of Nursing, Inc. (NCSBN)

Report of Findings


June Smith, PhD, RNNational Council of State Boards of Nursing, Inc. (NCSBN)

National Council of State Boards of Nursing, Inc. (NCSBN) ◆ 2003

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Copyright © 2003 National Council of State Boards of Nursing, Inc. (NCSBN)

All rights reserved.

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Address inquiries in writing to NCSBN Permissions, 111 E. Wacker Drive, Suite 2900, Chicago, IL60601-4277.

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ISBN# 0-9720273-6-X


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THE VALUE OF CE MANDATES

MMiissssiioonn SSttaatteemmeennttThe National Council of State Boards of Nursing, composed of Member Boards, provides leadership to advance regulatory excellence for public protection.

Table of Contents

LLiisstt ooff TTaabblleess .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. vv

LLiisstt ooff FFiigguurreess .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. vvii

AAcckknnoowwlleeddggmmeennttss .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11

EExxeeccuuttiivvee SSuummmmaarryy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 33

II.. BBaacckkggrroouunndd ooff SSttuuddyy.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1133

IIII.. RReesseeaarrcchh DDeessiiggnn aanndd MMeetthhooddoollooggyy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1144Assumptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Research Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Sample Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Confidentiality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Survey Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Return Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

IIIIII.. RReeppoorrtt ooff RReessuullttss .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1177Description of Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Continuing Education Hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Beginning and Current Ability Levels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Factors Contributing to Current Ability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Correlations of Growth With Contributing Factors . . . . . . . . . . . . . . . . . . . . . . 21Comparisons of Growth Between Nurses

With and Without CE Mandates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Issues Influencing Growth in Abilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Comparison of Growth in Abilities Across Work Setting

Population Densities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

IIVV.. CCoonncclluussiioonnss .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3300

VV.. RReeffeerreenncceess .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3300


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TABLE OF CONTENTS


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LIST OF TABLES

List of Tables1. Respondent Work Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

2. Respondent Nursing Positions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

3. Correlations of Growth with Contributing Factors . . . . . . . . . . . . . . . . . . . . .24

4. Comparison of Modifying Factors for RNs and LPN/VNs

With and Without CE Mandates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26

List of Figures1. Hours of CE Accumulated by RNs and LPN/VNs . . . . . . . . . . . . . . . . . . . . . . . . . 18

2. RN Beginning and Current Ability Levels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

3. LPN/VN Beginning and Current Ability Levels. . . . . . . . . . . . . . . . . . . . . . . . . . 20

4. Estimates of Factor Contributions to Current Abilities – All Nurses. . . . . . . . . 21

5. Growth in Ability 3 by Population of Work Setting. . . . . . . . . . . . . . . . . . . . . . 28




9. Growth in Ability 10 by Population of Work Setting. . . . . . . . . . . . . . . . . . . . . 29


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AcknowledgmentsThis study could not have been completed without the 1,025 nurses fromacross the United States who took the time to fill out lengthy survey questionnaires. The information they provided will contribute to the under-standing of the effectiveness of continuing education mandates. The projectalso owes a debt of gratitude to the 2001 National Council of State Boards of Nursing Board of Directors; Practice, Education and RegulationCommittee; and Finance Committee for their review and support of this project. The author also gratefully acknowledges the assistance of LamikaObichere in coordinating the study and Matt Diehl for his patient handlingof study materials. Finally, the assistance of Rosemary Gahl in the preparationof this document was essential to completion of this study.

J.S.


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ACKNOWLEDGMENTS


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EXECUTIVE SUMMARY

Establishment of a link betweenmandatory continuing education(CE) and the development of profes-sional competence has been deemed crucial to future decision-makingabout the best methods of assuringthe continued competence of healthcare practitioners. The NationalCouncil of State Boards of Nursing(NCSBN) Research Departmentdeveloped a research study to ex-plore that issue. The plan for thestudy was reviewed and approved bythe NCSBN Board of Directors in 2001.

NCSBN was joined in the studyby the regulatory agencies for medical technologists, occupationaltherapists, physician assistants, physical therapists and respiratorytherapists through the Inter-professional Workgroup for HealthProfessions Regulation (IWHPR).This report presents the results fromregistered nurse (RN) and licensedpractical/vocational nurse (LPN/VN)study respondents.

The study was conducted Maythrough August of 2002.

RReesseeaarrcchh DDeessiiggnn aanndd MMeetthhooddssAAssssuummppttiioonnss The study was based on two sets ofassumptions. The first was that allhealth care professionals must pos-sess certain categories of abilities inorder to provide safe, effective careand services. It was assumed that all health care professionals must beable to perform the following 10 professional abilities: 1. Collect correct information in a

timely manner.

2. Identify clients’ current needs.3. Identify clients’ future needs.4. Work effectively within a health

care team.5. Perform procedures common to

their professional practice.6. Recognize situations in which

intervention is needed to im-prove outcomes or preventharm.

7. Assess client or service outcomes(e.g., responses to treatment, satisfaction with services, etc.).

8. Recognize when their own abilities are inadequate to manage the situation at hand(recognition of the limitation ofone’s own knowledge and skills).

9. Recognize areas of their ownpractice in need of improve-ment.

10. Record a clear, understandableand legally defensible account ofcare or services provided.

The second assumption concerned the various factors contributing to the development ofprofessional abilities. It was assumedthat the following factors contributeto the development of the abilities listed within the first assumption:■ Basic professional education.■ Professional work experience.■ Continuing education (including

in-service education, continuingeducation offerings, short prof-essional courses and formal academic coursework whetherleading to a higher degree recog-nized by the profession or not).

■ Informal education from mentorsor preceptors or other people whowork with the professional andgive advice or information.

Executive Summary


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■ Self-study (referral to referencebooks, texts, drug references, journal articles, etc.).

■ Other – anything else that mayhave had a part to play in buildingprofessional abilities.

QQuueessttiioonnnnaaiirree A questionnaire, which containedthree sections with an optionalprofession-specific data page, wascreated specifically for this project.The first section of the question-naire included questions related tothe 10 professional abilities listed inthe first research assumption.Respondents were asked to providethree estimates for each of the abilities: beginning ability and current ability on a 0-100 scale, and the contribution of the six factors listed in the second researchassumption to the development oftheir current ability. The respon-dents distributed 10 points amongthe six factors according to their perceptions of the factors’ contribu-tions to their current ability.

The second section containedquestions related to the numbers andtypes of continuing education hoursaccumulated by the professionalwithin the past year. The types ofcontinuing education included totalhours on all topics, hours on topicsdirectly related to current work,hours on topics attended to preparefor a new position or extra duties notrelated to current work, and hourson topics attended only to fulfillcontinuing education mandates(topics unrelated to current or futurework).

The third section contained anumber of questions related to issuesinfluencing professional abilitiesand/or the accumulation of continu-ing education hours.

RReesseeaarrcchh QQuueessttiioonnss1. What is the relationship

between mandated continuingeducation and self-perception ofprofessional abilities?

2. Do continuing education man-dates influence the number andtype of continuing educationofferings attended?

3. What is the relationship of continuing education to the attainment of professionalabilities?

4. What professional abilities aremost influenced by continuingeducation?

5. To what degree do initial profes-sional education, professionalwork experience, continuingeducation, professional mentorsor preceptors and self-study contribute to the attainment ofprofessional abilities?

6. What is the relationshipbetween years of practice andself-perception of professionalabilities?

7. What is the relationshipbetween the number of continu-ing education offerings attendedand the number of professionalorganizations to which the professional belongs?

8. To what extent do professionalshave access to mentors or preceptors, continuing educa-tion classes and sources of current health care informationwithin their day-to-day workingenvironments?

9. What are the relationshipsamong access to mentors or preceptors, continuing educa-tion classes and sources of current health care informationand attainment of professionalabilities?


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EXECUTIVE SUMMARY

SSuurrvveeyy pprroocceessss A four-stage mailing process wasused to send questionnaires to 4,000randomly selected nursing subjects(2,000 LPN/VNs and 2,000 RNs). Apreletter announcing the researchproject and the imminent arrival ofa survey was sent, followed by thesurvey with cover letter and returnenvelope. A reminder postcard wassent one to two weeks after the survey mailing. A second survey wasmailed to nonrespondents approxi-mately six weeks after the initial survey mailing.

RReettuurrnn RRaatteessThere were a total of 305 question-naires sent to bad addresses (158LPN/VN and 147 RN), and a total of1,025 questionnaires were returned(478 from LPN/VNs and 547 fromRNs) for an overall 27.7% returnrate, and a return rate of 26% forLPN/VNs and 30% for RNs.

RReeppoorrtt ooff RReessuullttssDDeessccrriippttiioonn ooff SSaammpplleeThe RNs answering the survey hadbeen in practice an average of 16.7years (SD 11.7 years) and in theircurrent positions an average of 6.4years (SD 6.8 years). The LPN/VNsreported practicing for an average of16.9 years (SD 11.1 years) and intheir current positions an average of8.9 years (SD 9.3 years).

The majority of the RNs report-ed working in hospitals (53%) with7% working in long-term care, 7%in home health and 5% in the officesetting. The majority of the LPN/VNs reported working in long-termcare (31%), hospitals (27%), officesettings (15%) and home health set-tings (6%).

Most of the RN (60%) and LPN/VN (78%) respondents reported

holding staff nurse, office nurse or clinic nurse positions. Six percentof the RN respondents reportedholding advanced practice nursepositions, and 10% reported beingmanagers. Managerial positions wereheld by 3% of the LPN/VN respon-dents. Most of the respondentsreported providing direct care toclients within their nursing practices(85% of RNs and 95% of LPN/VNs).

Of the RN subjects, 86, or 17%, reported diploma basic education; 175, or 35%, reportedassociate degree education; and 185,or 37%, reported baccalaureate education. Education outside theU.S. was reported by 4% of the RNrespondents.

The RN and LPN/VN subjectgroups both had 61% of respondentsworking in states requiring CE forcontinued licensure. There were 108, or 10%, who held additionalcertification in nursing and 80 ofthose were also licensed in a staterequiring CE for license renewal(these were included in the 61%described above). A variable wascreated that divided the nurses into those with a mandate (eitherfrom the state licensing board or acertifying body) to accumulate CE,and those who were not mandated in any way to collect CE hours. That variable was used in the following analyses.

CCEE HHoouurrss The RN respondents reported collecting (during the preceding 12months) an average of 35.2 totalcontinuing education hours, with28.3 related to current work, 6.5related to new or future duties and4.2 unrelated to their work or inter-ests. The LPN/VN respondents collected about 28 total hours, with 21.7 hours related to current


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work, 7 hours related to new dutiesand 5.7 hours unrelated to theirwork or interests.

The RNs and LPN/VNs who hadCE mandates collected more totalhours and hours related to currentwork, but the differences were not statistically significant. The RNand LPN/VN respondents with a CE mandate collected significantly(statistically significant at p<.05)more hours of CE unrelated to theircurrent or future work than didthose without such a mandate. If the unrelated CE hours are subtracted from the total CE hoursfor those with and without a CEmandate, the difference in the totalnumber of hours accumulated bythose with and without a CE man-date narrows to about three. Thiswould indicate that nurses attendedapproximately the same numbers ofCE hours related to current or futurework with or without a mandate.

BBeeggiinnnniinngg aanndd CCuurrrreenntt AAbbiilliittyy LLeevveellssSubjects were asked to estimate theirbeginning (at the start of their first nursing position) and currentabilities in 10 ability categories.Beginning ability estimates for theRN respondents ranged from 30 to49 and from 30 to 45 for the LPN/VNrespondents. Current ability esti-mates ranged from 78 to 87 for theRNs and 75 to 85 for the LPN/VNs.Both the RNs and the LPN/VNs provided the lowest beginning andcurrent ability estimates for Ability3 (identifying clients’ future needs)and the highest beginning estimatesfor Ability 8 (recognizing when your own abilities are inadequate to manage the situation at hand).The RN respondents provided thehighest current ability estimates forAbility 4 (working effectively within

a health care team), and the LPN/VN respondents provided the high-est current ability estimates forAbility 5 (performing procedures).

Beginning ability estimateswere subtracted from current abilityestimates for each subject to makenew variables called “growth” foreach ability category.

FFaaccttoorrss CCoonnttrriibbuuttiinngg ttoo CCuurrrreenntt AAbbiilliittyySubjects were asked to distribute 10 points among six factors (basic professional education, work experi-ence, CE, mentors or preceptors,self-study and other) according tothe factors’ contributions to theircurrent ability in each of the abilitycategories. On average, subjects gavethe greatest number of points towork experience and the secondlargest number to basic professionaleducation. Lower numbers of pointswere distributed to mentors or preceptors, CE, self-study and other,in that order.

RN and LPN/VN estimates ofthe contributions of the factors differed only slightly. The LPN/VN respondents estimated a signifi-cantly higher contribution fromwork experience than did RNs for Abilities 2 (identifying clients’ current needs), 6 (recognizing situa-tions in which intervention isneeded to improve outcomes or prevent harm), 7 (assessing clientoutcomes) and 10 (documentingcare provided). The RN subjectsestimated a significantly higher contribution from CE than didLPN/VNs for Abilities 2 (identifyingclients’ current needs) and 10 (documenting care provided); and asignificantly higher contributionfrom mentors or preceptors forAbilities 5 (performing procedures)and 8 (recognizing when your own


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EXECUTIVE SUMMARY

abilities are inadequate to managethe situation at hand).

The estimates of the contribu-tions of factors were compared for those with and without CEmandates. There were only twosmall, but statistically significant,differences found. The LPN/VN subjects without a CE mandate estimated a slightly higher contribu-tion of basic education for Ability 3(identifying clients’ future needs)than did those with a CE mandate.The RN subjects without a mandateestimated a slightly higher contribu-tion of mentors or preceptors forAbility 8 (recognizing when yourown abilities are inadequate to manage the situation at hand) thandid RNs with a mandate.

CCoorrrreellaattiioonnss ooff GGrroowwtthh WWiitthh CCoonnttrriibbuuttiinngg FFaaccttoorrssGrowth in each of the 10 ability categories was correlated with thecontribution attributed to basic education, work experience, CE,mentors or preceptors, self-study andother factors. Nine sets of correla-tions were run: ■ All nurse subjects■ Nurses with a CE mandate■ Nurses without a CE mandate■ All RNs■ RNs with a CE mandate■ RNs without a CE mandate■ All LPN/VNs■ LPN/VNs with a CE mandate■ LPN/VNs without a CE mandate

Results for the RN data demon-strated several consistent findingsacross all 10 ability categories. There was a moderate negative correlation of growth with initialprofessional education for RNsubjects with and without a CEmandate. This indicated that themore the RNs had grown, the less

they attributed that growth to theirinitial professional education. Therewas also a small to moderate positivecorrelation of growth with workexperience for RNs with and withouta CE mandate, meaning that themore the RNs had grown, the morethey attributed that growth to theirwork experience.

The data from the RNs with aCE mandate also demonstrated somesmall to moderate correlations with several other factors. Therewere small to moderate positive correlations of growth with the contribution of mentors or precep-tors for three ability categories,including Abilities 5 (performingprocedures), 2 (identifying clients’current needs) and 8 (recognizingwhen your own abilities are inade-quate to manage the situation at hand). There was a small to moderate negative correlation of“other” with growth (the more contribution the subject had estimated from other factors, the less the subject had grown) forAbility 4 (working within a healthcare team). There was only onesmall positive correlation of growthwith CE and that was for Ability 10 (documenting care provided).

The LPN/VN correlations alsodemonstrated the negative correla-tions of growth with initial education for nine of the 10 abilitycategories. A positive correlation ofgrowth with work experience wasfound for LPN/VNs with and withouta CE mandate for seven of the 10ability categories.

There were several other signif-icant correlations of growth withcontributing factors for LPN/VNsubjects. There were small to moderate negative correlations ofgrowth with self-study for LPN/VNswith a CE mandate for Ability


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4 (working effectively within ahealth care team), and for LPN/VNswithout a CE mandate for Ability 8(recognizing when your own abilitiesare inadequate to manage the situa-tion at hand). There was a small to moderate negative correlation of growth with the contribution of mentors or preceptors for LPN/VNs without a CE mandate forAbility 7 (assessing client or serviceoutcomes); and a positive correla-tion of growth with the contributionof CE for LPN/VNs without a man-date for Ability 1 (collecting correctinformation in a timely manner).

CCoommppaarriissoonnss ooff GGrroowwtthh BBeettwweeeennNNuurrsseess WWiitthh aanndd WWiitthhoouutt CCEE MMaannddaatteess Growth in each of the 10 ability categories was compared for nurseswith and without a CE mandate.ANCOVA analyses were performedon the data from all nurses, datafrom RNs and data from LPN/VNs.Total CE hours, years in current position, years in practice, credithours and beginning ability esti-mates were used as covariates. Nosignificant or practically relevantdifferences were found in theamount of growth experienced bynurses (all nurses, RNs or LPN/VNs)with and without CE mandates.

IIssssuueess IInnfflluueenncciinngg GGrroowwtthh iinn AAbbiilliittiieessA number of questions on the surveyaddressed various work setting andcontinuing education issues thatmight influence growth in abilities.Many of these issues were directly orindirectly related to the nurses’delivery of safe, effective care. There were some differences seen inthese issues for those nurses with andwithout CE mandates.

One important issue was accessto CE. Only 78% of the RN and 65% of the LPN/VN respondents

reported that their employers provided adequate continuing edu-cation for their professional needs.The provision of CE varied by typeof nurse and by type of employmentsetting. In hospitals, 87% of RNs and86% of LPN/VNs reported receivingCE from their employer; however,71% of RNs and only 48% ofLPN/VNs working in long-term carereported receiving CE from theiremployers.

When asked about barriers toparticipation in CE, 43% of the RNs and 45% of the LPN/VNsreported that they sometimes or frequently were not allowed time off for continuing education. Thiswas a problem for a greater percent-age of RNs working in hospitals and for more LPN/VNs working inlong-term care.

RNs with a CE mandate weremore likely to report getting CEfrom professional organizations/conferences (75% with a mandateand 66% without) and from academ-ic institutions (43% with a mandateand 27% without). Both RN andLPN/VN respondents with a CEmandate were more likely to reportreceiving CE from CE vendors than were those without a mandate (RN – 69% with and 47% without;LPN/VN – 63% with and 29% with-out). Those nurses with a CEmandate were more likely to takecorrespondence classes to earn CE (RN – 30% with and 10% without; LPN/VN – 42% with and11% without). Only 25% of the RNrespondents and 12% of the LPN/VN subjects reported using theInternet for CE.

Another issue of importance torespondent nurses was the reimbursement of expenses for pro-fessional development. About 60%


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EXECUTIVE SUMMARY

of the RN respondents and 50% ofthe LPN/VNs reported being reim-bursed for one or more aspect(s) ofprofessional development.

Experienced, professional assis-tance within the health care settingmay play a major role in professionaldevelopment and the delivery of safe care. While approximately halfthe nurse respondents to this study reported that their employinginstitutions had a formal mentoring program, most of them reported that these programs were only fornew employees. About 75% of RNsand LPN/VNs working in hospitalsreported having access to staff development personnel, but only40-50% of those working in nursinghomes reported the same. Whenasked about the availability of experienced professionals to answerquestions, 69% of the RNs and 75%of the LPN/VNs reported havingaccess to such people most or all of the time, and 25% of the RNs and 21% of the LPN/VNs reported having such individuals available atleast some of the time.

CCoommppaarriissoonn ooff GGrroowwtthh iinn AAbbiilliittiieess AAccrroossss WWoorrkk SSeettttiinngg PPooppuullaattiioonn DDeennssiittiieessSurvey respondents were asked toidentify the population of their geographic area of employment.Growth in all 10 ability categorieswas compared across populationareas using beginning ability as acovariate. Nurses working in areas of lower population demonstrated significantly lower growth thanthose in areas of higher populationin five of the 10 ability categories: 3(identifying clients’ future needs), 6(recognizing situations in whichintervention is needed to improveoutcomes or prevent harm), 7

(assessing client outcomes), 8 (rec-ognizing when your own abilities areinadequate to manage the situationat hand) and 10 (documenting careprovided).

CCoonncclluussiioonnss1. Nurses tend to accumulate CE

hours whether or not they aremandated to do so.

2. Nurses with a CE mandateattend more hours of CE unrelat-ed to their work or interests.

3. Nurses consider work experienceas the greatest contributor totheir current levels of ability.

4. Those nurses with and withoutCE mandates estimate the same levels of growth in 10 professional abilities.

5. Access to CE and other factorsrelated to professional learningvaries among nurses in differentwork settings and possiblyamong nurses in different popu-lation settings.

6. Nurses with CE mandates mayhave greater access to somesources of CE such as CE vendorsbecause nurses with mandatesare targeted by those providers.

7. Nurses in lower population areasexperience less growth in someabilities than do those in morepopulous regions.


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Report of Findings


June Smith, PhD, RN

National Council of State Boards of Nursing, Inc. (NCSBN)


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BACKGROUND OF STUDY

Health care regulatory bodies arecharged with protection of the public from the unsafe practices of health care professionals. Boardsof nursing must prevent unsafe individuals from entering the nurs-ing profession, and monitor themaintenance of adequate ongoingcompetence. While licensure testinghas become an accepted means of assuring entry-level nursing competence, effective assessment ofongoing competence has provided amuch greater challenge. Mandatoryaccumulation of continuing educa-tion hours has been a means of assuring the maintenance of an adequate knowledge base for 22 ofthe 61 boards of nursing in theUnited States and its territories. Theactual effect of such mandates on the attainment of professionalabilities has not been explored.

The findings from the NationalCouncil of State Boards of Nursing(NCSBN) Continuing EducationEffectiveness study are reported here in the sixth of a series of mono-graphs called NCSBN ResearchBriefs. These briefs provide themeans to quickly disseminateNCSBN research findings.

Establishment of a link betweenmandatory continuing educationand the development of professionalcompetence has been deemed crucial to future decision-makingabout the best methods of assuringthe continued competence of health care practitioners (McGuire,Stanhope & Weisenbeck, 1998;Hewlett & Eichelberger, 1996;Slusher, Logsdon, Johnson, Parker,

Rice & Hawkins, 2000; Perrin,Boyett & McDermott, 2000).

The need to identify such a linkhad become evident to the Inter-professional Workgroup for HealthProfessions Regulation (IWHPR).IWHPR is composed of nationalorganizations that work to meet the needs of regulatory bodies allover the United States and its territories. The organizations serveregulatory bodies in (among others)chiropractic, medical technology,nursing, occupational therapy, op-tometry, physical therapy, physicianassistance, respiratory therapy and the speech-hearing-language profes-sions. The group has focused itsenergies on the problem of assessingthe continued competence of health care professionals. After careful study of the problem, itbecame evident that research intothe link (or lack thereof) betweenmandatory continuing educationand the development of professionalabilities was necessary. In Decemberof 2000, the NCSBN ResearchDepartment took to the IWHPR a proposal for a research study address-ing those issues.

Five organizations within theIWHPR along with the NCSBNBoard of Directors collaborated inthe study. Representatives from theorganizations worked together torefine and review the research toolfor content validation. The studywas conducted by NCSBN Maythrough August of 2002.

Background of Study


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AAssssuummppttiioonnss The study was based on two sets ofassumptions. The first was that allhealth care professionals must possess certain categories of abilitiesin order to provide safe, effectivecare and services. It was assumedthat all health care professionalsmust be able to perform the follow-ing 10 professional abilities: 1. Collect correct information in a

timely manner.2. Identify clients’ current needs.3. Identify clients’ future needs.4. Work effectively within a health

care team.5. Perform procedures common to

their professional practice.6. Recognize situations in which

intervention is needed toimprove outcomes or preventharm.

7. Assess client or service outcomes(e.g., responses to treatment, satisfaction with services, etc.).

8. Recognize when their own abili-ties are inadequate to managethe situation at hand (recogni-tion of the limitation of one’sown knowledge and skills).

9. Recognize areas of their own practice in need of improvement.

10. Record a clear, understandableand legally defensible account ofcare or services provided.

The second assumption concerned the various factors con-tributing to the development of professional abilities. It was assumedthat the following factors contribute

to the development of the abilitieslisted within the first assumption:■ Basic professional education.■ Professional work experience.■ Continuing education (including

in-service education, continuingeducation offerings, short profes-sional courses and formal academic coursework whetherleading to a higher degree recognized by the profession ornot).

■ Informal education from mentors,preceptors or other people whowork with the professional andgive advice or information.

■ Self-study (referral to referencebooks, texts, drug references,journal articles, etc.).

■ Other – anything else that mayhave had a part to play in build-ing professional abilities.

QQuueessttiioonnnnaaiirree A questionnaire, which containedthree sections with an optional profession-specific data page, wascreated specifically for this project.The first section of the question-naire included questions related to the 10 professional abilities identified within the first researchassumption. Three questions wereasked about each of these abilities.The first question asked respondentsto estimate their abilities at the beginning of their first professionalposition. The second question askedrespondents to estimate their current abilities. Those estimateswere provided utilizing a 0 to 100

Research Design and Methodology


1155

DESIGN & METHODOLOGY

scale with 0 equaling no ability and 100 equaling full ability 100% of the time. The third questionasked respondents to estimate theamount of contribution of six factors (basic professional education,professional work experience, continuing education, mentors orpreceptors, self-study and other) tothe development of their currentabilities. The respondents distribut-ed 10 points among the six factorsaccording to their perceptions of the factors’ contributions to theircurrent abilities.

The second section containedquestions related to the numbers andtypes of continuing education hoursaccumulated by the professionalwithin the past year. The types ofcontinuing education included totalhours on all topics, hours on topicsdirectly related to current work,hours on topics attended to preparefor a new position or duties notrelated to current work, and hourson topics of courses attended only to fulfill continuing education mandates (topics unrelated to cur-rent or future work).

The third section contained a number of demographic and otherquestions. One set of questionsascertained information about eachrespondent’s work setting and pro-fession. Those questions includedinformation related to the provisionof continuing education classes,mentors or preceptors and informa-tional resources by employers.Another set collected informationabout formal credit hours attainedafter the initial professional program, length of time since initial licensure or certification andtime in current position. One question ascertained the number ofprofessional organizations to whichthe respondent belonged. Two

questions elicited data about thecontinuing education mandates gov-erning the professional’s practiceincluding the number of mandatedhours. Two questions gathered infor-mation about the sources and typesof continuing education utilized. A final set of questions asked aboutthe frequency with which certaindifficulties were encountered in the pursuit of continuing educationofferings. At the end of the questionnaire, the respondent wasgiven an opportunity to record comments.

The survey was reviewed forcontent validity by experienced professional nurses. A pilot test of the survey revealed a reliabilitycoefficient of .87 for the first section.

RReesseeaarrcchh QQuueessttiioonnss1. What is the relationship

between mandated continuingeducation and self-perception of professional abilities?

2. Do continuing education man-dates influence the number andtype of continuing educationofferings attended?

3. What is the relationship of continuing education to the attainment of professionalabilities?

4. What professional abilities aremost influenced by continuingeducation?

5. To what degree do initial profes-sional education, professionalwork experience, continuingeducation, professional mentorsor preceptors and self-study contribute to the attainment ofprofessional abilities?

6. What is the relationshipbetween years of practice andself-perception of professionalabilities?


1166


7. What is the relationshipbetween the number of continu-ing education offerings attendedand the number of professionalorganizations to which therespondent belongs?

8. To what extent do professionalshave access to mentors or preceptors, continuing educa-tion classes and sources of current health care informationwithin their day-to-day workingenvironments?

9. What are the relationshipsamong access to mentors or preceptors, continuing educa-tion classes, and sources of current health care informationand attainment of professionalabilities?

SSaammppllee SSeelleeccttiioonn Random samples of 2,000 RNs and2,000 LPN/VNs were selected fromlists of actively licensed nurses in 35 United States jurisdictions. Apower analysis revealed the need for as few as 85 subjects per group(mandated and nonmandated) totest for a difference in group meansof +/- .15 at p = .05. A return rate aslow as 10-15% from these randomsamples was anticipated to provideadequate group samples for the proposed statistical analyses.

CCoonnffiiddeennttiiaalliittyyAll potential participants werepromised confidentiality with regardto their participation and theirresponses. Pre-assigned code num-bers were used to facilitate costeffective follow-up mailings butthose numbers were not used toidentify individual participants inany other way. Files containing mailing information were kept

separate from the data files. Thestudy protocol was reviewed by the NCSBN executive director for compliance with organizationalguidelines for research studiesinvolving human subjects.

SSuurrvveeyy PPrroocceessssA four-stage mailing procedure wasused to engage subjects in the study.A preletter announcing the researchproject and the imminent arrival ofa survey was sent, followed by thesurvey with cover letter and returnenvelope. A reminder postcard wassent one to two weeks after the survey mailing. A second survey wasmailed to nonrespondents approxi-mately six weeks after the initial survey mailing.

RReettuurrnn RRaatteessThere were a total of 305 question-naires sent to bad addresses (158LPN/VNs and 147 RNs), and a total of 1,025 questionnaires were returned (478 from LPN/VNs and547 from RNs) for an overall 27.7%return rate, and a return rate of 26%for LPN/VNs and 30% for RNs.

SSuummmmaarryyThis research project was created toprovide information about the rela-tionship of continuing education tothe growth of professional abilities.The study included professionalsfrom six health care professionsincluding nursing. Random samplesof RNs and LPN/VNs received surveys developed specifically for theproject. Return rates of 26% forLPN/VNs and 30% for RNs were adequate to provide statistical powerfor data analysis.


1177

REPORT OF RESULTS

DDeessccrriippttiioonn ooff SSaammpplleeThe RNs answering the survey hadbeen in practice an average of 16.7years (SD 11.7 years) and in theircurrent positions an average of 6.4years (SD 6.8 years). The LPN/VNsreported practicing for an average of16.9 years (SD 11.1 years) and intheir current positions an average of8.9 years (SD 9.3 years).

The majority of the RNs report-ed working in hospitals (53%) with7% working in long-term care, 7% in home health and 5% in the office setting. The majority ofthe LPN/VNs reported working inlong-term care (31%), hospitals(27%), office settings (15%) andhome health settings (6%). SeeTable 1 for a listing of RN andLPN/VN work settings.

Most of the RN (60%) andLPN/VN (78%) respondents report-ed holding staff nurse, office nurse or clinic nurse positions. Six percent of the RN respondentsreported holding advanced practicenurse positions and 10% reportedbeing managers. Managerial posi-tions were held by 3% of theLPN/VN respondents. Most of therespondents reported providingdirect care to clients within theirnursing practices (85% of RNs and95% of LPN/VNs). See Table 2 for alisting of RN and LPN/VN positions.

Of the RN subjects, 86 (17%) reported diploma basic education, 175 (35%) reported associate degree education and 185 (37%) reported baccalaureate education. Four percent of RNrespondents were educated outsidethe U.S.

Report of Results

TTaabbllee 11.. RReessppoonnddeenntt WWoorrkk SSeettttiinnggss

RRNN LLPPNN//VVNN%% nn %% nn

Hospital or other acute care setting 53 289 27 115

Ambulatory surgical setting 2 13 1 4

Office (physician, dentist, optometrist, chiropractic) 5 25 15 62

Clinic (outpatient care settings) 4 20 3 14

Long-term care 7 38 31 128

Home health 7 37 6 24

Public health (other than home visits) 1 6 1 6

School-based practice 4 20 1 5

Education – faculty of school or college 3 16 0.2 1

Health care regulation 2 8 0.2 1

Industrial setting 1 6 0.7 3

Other 9 50 9 36

Currently unemployed 2 13 5 21

TTaabbllee 22.. RReessppoonnddeenntt NNuurrssiinngg PPoossiittiioonnss

RRNN LLPPNN//VVNN

%% nn %% nn

Staff nurse, office nurse orclinic nurse 60 301 78 315

Advanced practice nurse (i.e., nurse practitioner or CNS) 6 28

Nursing clinical manager/supervisor 10 50 3 13

Administrator of a health care organization 3 13 0.5 2

Educator of staff 1 6 0.5 2

School of nursing faculty 2 11

School of nursing administrator 0.2 1

Health care regulator 1 7 0.2 1

Other 17 84 18 72


1188


The RN and LPN/VN subjectgroups both had 61% of respondentsworking in states requiring CE forcontinued licensure. There were108, or 10%, who held additionalcertification in nursing, and 80 ofthose were also licensed in a staterequiring CE for licensure renewal(included in the 61% describedabove). A variable was created thatdivided the nurses into those with amandate (either from the statelicensing board or from a certifyingbody) to accumulate CE and thosewho were not mandated in any wayto collect CE hours. This variablewas used in the following analyses.

CCoonnttiinnuuiinngg EEdduuccaattiioonn HHoouurrss Survey subjects were asked to recordthe numbers of hours of CE they hadaccumulated in the previous 12months. They were asked to recordthe total number of hours, the hoursthey had attended related to theircurrent work, hours they had attend-ed related to future work or newduties, and hours they had attendedthat were unrelated to their work

and not of interest to them (hoursthey had accumulated only to meetlicensure or certification require-ments). All categories of CE hoursaccumulated were explored for outliers (i.e., much larger numbersthan would be possible or probableto accumulate in a 12-month period). Approximately 10 outlierdata points were removed from thenursing data set. Figure 1 shows theaverage numbers of hours of CEin the four categories for all RNs and all LPN/VNs, and for RNs andLPN/VNs who did and did not havea CE mandate.

Overall, the RN respondentscollected approximately seven moretotal CE hours and CE hours relatedto current work than did theLPN/VN respondents. The LPN/VNrespondents collected more hoursrelated to preparation for new duties.

The RNs and LPN/VNs who hadCE mandates collected more totalhours and hours related to currentwork than did those without CEmandates, but the differences werenot statistically significant. Both theRN and LPN/VN respondents with a

FFiigguurree 11.. HHoouurrss ooff CCEE AAccccuummuullaatteedd bbyy RRNNss aanndd LLPPNN//VVNNss


1199

REPORT OF RESULTS

CE mandate collected significantly(statistically significant at p < .05)more hours of CE unrelated to theircurrent or future work than didthose without such a mandate. If theunrelated CE hours are subtractedfrom the total CE hours for thosewith and without a CE mandate, thenumbers of hours accumulated bythose with and without CE mandatesbecome nearly equal. This wouldindicate that nurses attend approxi-mately the same number of CE hoursrelated to current or future workwith or without a mandate to do so.

BBeeggiinnnniinngg aanndd CCuurrrreenntt AAbbiilliittyy LLeevveellssSubjects were asked to estimate theirbeginning (at the start of their first nursing position) and currentabilities in 10 ability categories.Beginning ability estimates for theRN respondents ranged from 30 to49 and from 30 to 45 for the LPN/VN respondents. Current abili-ty estimates ranged from 78 to 87 forthe RNs (see Figure 2) and 75 to 85 for the LPN/VNs (see Figure 3). TheRNs and LPN/VNs provided the lowest beginning and current abilityestimates for Ability 3 (identifyingclients’ future needs) and the highest beginning estimates for Ability 8 (recognizing when yourown abilities are inadequate to manage the situation at hand). TheRN respondents provided the highest current ability estimates forAbility 4 (working effectively withina health care team), and the LPN/VN respondents provided the high-est current ability estimates forAbility 5 (performing procedures).

Beginning and current abilityestimates were compared for thosewith and without a CE mandate.

The only statistically significant difference found was for LPN/VNrespondents; the LPN/VN subjectswith a CE mandate estimated a higher current level of ability forAbility 7 (assessing client outcomes)than those without a CE mandate.

In order to assess for factors possibly contributing to change inabilities, beginning ability estimateswere subtracted from current abilityestimates for each subject to makenew variables called “growth” foreach ability category.

FFaaccttoorrss CCoonnttrriibbuuttiinngg ttooCCuurrrreenntt AAbbiilliittyySubjects were asked to distribute 10 points among six factors (basic professional education, work experi-ence, CE, mentors or preceptors,self-study, and other) according to the factors’ contributions to theircurrent ability in each of the abilitycategories. Figure 4 shows the aver-age contribution of each of the sixfactors to current ability in each ofthe 10 categories for all nurses. Onaverage, the nurse respondents gavethe greatest number of points towork experience and the secondlargest number to basic professionaleducation. A much lower number ofpoints was distributed to mentors or preceptors, CE, self-study and other, in that order. Some variations in point distribution maybe noted. For Ability 4 (ability towork within a health care team),subjects apportioned most of thepoints among work experience, basic professional education and mentorsor preceptors. CE, self-study andother each received an average of less than one point. For Abilities5 (performing procedures) and 10 (documenting care provided)


2200


FFiigguurree 22.. RRNN BBeeggiinnnniinngg aanndd CCuurrrreenntt AAbbiilliittyy LLeevveellss

FFiigguurree 33.. LLPPNN//VVNN BBeeggiinnnniinngg aanndd CCuurrrreenntt AAbbiilliittyy LLeevveellss

LLiisstt bbiilliittyy CCaatteeggoorriieess

1. Collect correct informa-tion in a timely manner.

2. Identify clients’ currentneeds.

3. Identify clients’ futureneeds.

4. Work effectively within a health care team.

5. Perform procedurescommon to their professional practice.

6. Recognize situations inwhich intervention isneeded to improve outcomes or preventharm.

7. Assess client or serviceoutcomes (e.g., res-ponses to treatment, satisfaction with services, etc.).

8. Recognize when theirown abilities are inade-quate to manage the situation at hand (recognition of the limi-tation of one’s ownknowledge and skills).

9. Recognize areas of theirown practice in need ofimprovement.

10. Record a clear, under-standable and legallydefensible account of care or services provided.

AAbbiilliittyy CCaatteeggoorriieess


2211

REPORT OF RESULTS

subjects appeared to place morevalue on the contribution of basicprofessional education than theyhad in the other ability categoriesand slightly less on the contributionof work experience.

RN and LPN/VN estimates ofthe contributions of the factors differed only slightly. The LPN/VNrespondents estimated a significant-ly higher contribution from work experience than did RNs forAbilities 2 (identifying clients’ current needs), 6 (recognizing situa-tions in which intervention is needed to improve outcomes or prevent harm), 7 (assessing clientoutcomes), and 10 (documenting care provided). The RN subjectsestimated a significantly higher contribution from CE than didLPN/VNs for Abilities 2 (identifyingclients’ current needs), and 10 (documenting care provided); and a significantly higher contributionfrom mentors for Abilities 5 (performing procedures) and 8 (recognizing when your own abilities

are inadequate to manage the situation at hand).

The estimates of the contribu-tions of factors were compared for those with and without CE mandates. There were two small, but statistically significant,differences found. The LPN/VNsubjects without a CE mandate estimated a slightly higher contribu-tion of basic education for Ability 3 (identifying clients’ future needs)than did those with a CE mandate.The RN subjects without a mandateestimated a slightly higher contribu-tion of mentors or preceptors forAbility 8 (recognizing when yourown abilities are inadequate to manage the situation at hand) thandid RNs with a mandate.

CCoorrrreellaattiioonnss ooff GGrroowwtthh WWiitthhCCoonnttrriibbuuttiinngg FFaaccttoorrssGrowth in each of the 10 ability categories was correlated with thecontribution attributed to basic education, work experience, CE,

FFiigguurree 44.. EEssttiimmaatteess ooff FFaaccttoorr CCoonnttrriibbuuttiioonnss ttoo CCuurrrreenntt AAbbiilliittiieess –– AAllll NNuurrsseess


2222


mentors and preceptors, self-studyand other. Nine sets of correlationswere run: ■ All nurse subjects■ Nurses with a CE mandate■ Nurses without a CE mandate■ All RNs■ RNs with a CE mandate■ RNs without a CE mandate■ All LPN/VNs■ LPN/VNs with a CE mandate■ LPN/VNs without a CE mandate

Results for the RN data demon-strated several consistent findingsacross all 10 ability categories. Therewas a moderate negative correlationof growth with initial professionaleducation for RN subjects with and without a CE mandate. Thisindicated that the more the RNs hadgrown, the less they attributed thatgrowth to their initial professionaleducation. There was also a small tomoderate positive correlation ofgrowth with work experience forRNs with and without a CE mandate,meaning that the more the RNs hadgrown, the more they attributed thatgrowth to their work experience.

The data from the RNs with aCE mandate demonstrated somesmall to moderate correlations with several other factors. There were small to moderate positive correlations of growth with the contribution of mentors or precep-tors for three ability categories.The strongest of those correlations was for Ability 5 (performing procedures), and smaller significantcorrelations were found for Abilities2 (identifying clients’ current needs)and 8 (recognizing when your own abilities are inadequate to manage the situation at hand).There was a small to moderate negative correlation of “other” with

growth (the more contribution thesubject had estimated from otherfactors, the less the subject hadgrown) for Ability 4 (working with-in a health care team). There wasonly one small positive correlationof growth with CE and that was for Ability 10 (documenting careprovided).

The LPN/VN correlations alsodemonstrated the negative correla-tions of growth with initial education for nine of the 10 abilitycategories. The relationship was notpresent for either LPN/VNs with orwithout a CE mandate for Ability 3(identifying clients’ future needs). A positive correlation of growthwith work experience was found forLPN/VNs with and without a CEmandate for seven of the 10 abilitycategories. The correlation withwork experience was not found foreither those with or without a CEmandate for Ability 2 (identifyingclients’ current needs), and was not found for LPN/VNs with a CEmandate for Ability 1 (collectingcorrect information in a timely manner) or Ability 4 (working within a health care team).

There were several other signif-icant correlations of growth withcontributing factors for LPN/VN subjects. There were small tomoderate negative correlations ofgrowth with self-study for LPN/VNswith a CE mandate for Ability 4 (working effectively within ahealth care team), and for LPN/VNswithout a CE mandate for Ability 8 (recognizing when your own abilitiesare inadequate to manage the situa-tion at hand). There was a small to moderate negative correlation ofgrowth with the contribution ofmentors or preceptors for LPN/VNswithout a CE mandate for Ability


2233

REPORT OF RESULTS

7 (assessing client or service out-comes); and a positive correlation ofgrowth with the contribution of CEfor LPN/VNs without a mandate for Ability 1 (collecting correctinformation in a timely manner).See Table 3 for a listing of RN andLPN/VN correlations.

CCoommppaarriissoonnss ooff GGrroowwtthhBBeettwweeeenn NNuurrsseess WWiitthh aannddWWiitthhoouutt CCEE MMaannddaatteess Growth in each of the 10 ability categories was compared for nurseswith and without a CE mandate.ANCOVA analyses were performedon the data from all nurses, datafrom RNs and data from LPN/VNs.Total CE hours, years in current position, years in practice, credithours and beginning ability estimates were used as covariates.No significant or practically relevantdifferences were found in theamount of growth experienced bynurses (all nurses, RNs, or LPN/VNs)with and without CE mandates.

IIssssuueess IInnfflluueenncciinngg GGrroowwtthhiinn AAbbiilliittiieessA number of questions on the surveyaddressed various work setting andcontinuing education issues thatmight influence growth in abilities.Many of these issues were directly orindirectly related to the nurses’delivery of safe and effective care.There were some differences seen inthese issues for those nurses with andwithout CE mandates (see Table 4).

One important issue was accessto CE. Only 78% of the RN and 65%of the LPN/VN respondents reportedthat their employers provided

continuing education adequate fortheir professional needs. The provi-sion of CE varied by type of nurseand by type of employment setting.In hospitals, 87% of RNs and 86% ofLPN/VNs reported receiving CE fromtheir employers; however, 71% ofRNs and only 48% of LPN/VNsworking in long-term care reportedreceiving CE from their employers.

When asked about barriers toparticipation in CE, 43% of the RNsand 45% of the LPN/VNs reportedthat they sometimes or frequentlywere not allowed time off for continuing education. This was aproblem for a greater percentage of RNs working in hospitals and for LPN/VNs working in long-term care.

RNs with a CE mandate weremore likely to report getting CE fromprofessional organizations/confer-ences (75% with a mandate and66% without), and from academicinstitutions (43% with a mandateand 27% without). Both RN andLPN/VN respondents with a CEmandate were more likely to reportreceiving CE from CE vendors than were those without a mandate (RN – 69% with and 47% without;LPN/VN – 63% with and 29% with-out). Those nurses with a CEmandate were more likely to take correspondence classes to earn CE(RN – 30% with and 10% without;LPN/VN – 42% with and 11% without). Only 25% of the RNrespondents and 12% of the LPN/VN subjects reported using theInternet for CE.

Another issue of importance to respondence nurses was the reimbursement of expenses for pro-fessional development. About 60%of the RN respondents and 50% of


2244


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2255

REPORT OF RESULTS

the LPN/VNs reported being reimbursed for one or more aspectsof professional development.

Experienced, professional assis-tance within the health care settingmay play a major role in professionaldevelopment and the delivery of safecare. While approximately half thenurse respondents to this studyreported that their employing institutions had a formal mentoringprogram, most of them reported thatthese programs were only for newemployees. About 75% of RNs andLPN/VNs working in hospitalsreported having access to staff development personnel, but only40-50% of those working in nursinghomes reported the same. Whenasked about the availability of experienced professionals to answerquestions, 69% of the RNs and 75%of the LPN/VNs reported havingaccess to such people most or all ofthe time, and 25% of the RNs and21% of the LPN/VNs reported having such individuals available atleast some of the time.

CCoommppaarriissoonn ooff GGrroowwtthh iinnAAbbiilliittiieess AAccrroossss WWoorrkk SSeettttiinnggPPooppuullaattiioonn DDeennssiittiieessSurvey respondents were asked toidentify the population of their geographic area of employment.Growth in all 10 ability categorieswas compared across five categoriesof population density.

Combined nursing data for RNsand LPN/VNs demonstrated statisti-cally significant differences for fiveof the 10 ability categories: Ability 3(identifying clients’ future needs);Ability 6 (recognizing situations in

which intervention is needed toimprove outcomes or prevent harm);Ability 7 (assessing client out-comes); Ability 8 (recognizing whenyour own abilities are inadequate tomanage the situation at hand); andAbility 10 (documenting care provided).

Figures 3 through 7 illustratethe differences found in growthacross areas of population density.

SSuummmmaarryyThe RNs and LPN/VNs participatingin the study reported an average ofabout 17 years of practice experi-ence. The RN respondents collectedmore overall hours of CE than didthe LPN/VNs; however, for bothgroups of nurses, those mandated tocollect CE did not accumulate signif-icantly more total hours of CE thandid those without such a mandate.Those nurses with a mandate alsodid not report any greater growth in abilities than did those without a mandate. Respondents to the study rated the contributions ofwork experience, initial professional education and mentors above thecontribution of CE in assisting themto their current levels of ability.Further, it was found that nursesworking in different settings had differing access to CE and other factors contributing to the attain-ment of professional abilities, andthat CE mandates influenced thesources and types of CE attended.Significant differences were alsofound in the growth in abilities of those working in different population areas.


2266


RRNNss LLPPNN//VVNNssVVaarriiaabbllee AAllll ((%%)) WW MMaanndd.. ((%%)) WW//OO MMaanndd.. ((%%)) AAllll ((%%)) WW MMaanndd.. ((%%)) WW//OO MMaanndd.. ((%%))

Years in practice*^ 16.7 18 14.8 16.9 16.2 19.4Years in current position^ 6.4 6.9 5.8 9 8.3 10.8Credit hours earned* 57 70 33.5 54 60.9 52.2Number of clients 13 14 13 23 21 26

Does employer offer CE pertinent to professional needs?** 78 77 78 65 67 63

Does employer-offered CE adequately meet CE needs?^

Yes, definitely 38 37 38 34 41 24Yes, somewhat 52 50 56 58 52 66No 11 13 7 8 7 10

Does your facility provide a formal mentoring program for employees ofyour professional type?** 57 56 56 42 43 41

Is the mentoring program only for new employees?** 76 76 76 65 65 70

Does your facility employ individuals to perform staff development?** 63 61 62 59 60 56

Are staff development employees available to you?

Yes, most or all of the time 45 45 46 53 58 43At least some of the time 40 39 40 37 34 42No 15 16 15 10 9 15

Are there experienced professionals available to answer questions?

Yes, most or all of the time 69 69 69 75 74 78At least some of the time 25 26 25 21 23 18No 0.4 0.3 0.6 1 1 0.7I am the only professional of my type

at employing facility 5 5 6 3 2 4

Are there adequate reference materialsavailable to you?** 76 76 73 76 74 81

Are you reimbursed for professional development expenses?

Not reimbursed for following items: 40 40 41 50 50 51Reference books 14 15 12 9 9 9Professional journals 8 9 5 6 7 5Professional assoc. memberships* 11 12 7 6 7 4CE outside workplace 48 48 49 41 42 39Adv. prac. or specialist certification* 20 22 16 11 12 9

Does reimbursement cover your expenses?Yes, most or all 22 21 25 20 22 19At least partially 31 32 31 21 22 25No 13 15 11 11 11 10Not reimbursed for listed items 34 33 33 48 45 46

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*Significantly different for RNs with and without CE mandate, p < .05. ^Significantly different for LPN/VNs with and without CE mandate, p < .05.** Numbers represent percent who answered “yes” to the given question.


2277

REPORT OF RESULTS

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To how many professional organizations do you belong?*

None 47 40 56 74 71 81One 30 31 31 17 20 12Two 14 19 8 7 8 5Three 6 7 2 0.9 0.9 1Four 2 3 1 0.5 0.4 0.7Five 0.6 0.6 0.6 0.2

Which of the following sources of CE have you used?

Place of employment* 79 76 85 67 66 70Professional org/conferences* 72 75 66 48 48 47Continuing education vendors*^ 62 69 47 50 63 29Pharmacy/diag. industry reps 33 32 36 27 26 28Academic institution* 38 43 27 25 27 22

Which of the following methods of CE provision have you used?

Live 93 93 92 79 80 77Internet-based 25 26 23 12 10 15Non-Internet computer-based 10 10 11 4 3 5Audio*^ 19 16 23 14 10 19Video^ 37 36 40 30 24 39Journals/books 58 59 56 47 48 46Correspondence classes^ 24 30 10 30 42 11

To what degree have you experienced anyof the following difficulties with CE? (the values given are the sum of the percentages of “sometimes” and “frequently” answers).

Too few pertinent offerings*^ 54 48 67 55 53 59Offerings are too expensive 82 82 84 78 77 82Must belong to prof. org. to be informed^ 41 39 45 40 35 48Must travel over 50 miles^ 70 67 75 62 57 73Must pay for overnight lodging^ 59 59 61 55 52 64Employer unwilling to allow time off^ 43 40 46 45 40 58

Which of the following best describes the population of the geographic area where you are employed?*

Less than 20,000 19 18 22 30 27 3520,000 to 49,999 18 22 10 20 21 1950,000 to 99,999 18 13 28 15 15 17100,000 to 500,000 20 21 16 13 15 10Greater than 500,000 18 19 16 8 9 8Don’t know 8 7 8 14 14 11

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*Significantly different for RNs with and without CE mandate, p < .05. ^Significantly different for LPN/VNs with and without CE mandate, p < .05.** Numbers represent percent who answered “yes” to the given question.


2288


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LLiisstt bbiilliittyy CCaatteeggoorriieess

1. Collect correct informa-tion in a timely manner.

2. Identify clients’ currentneeds.

3. Identify clients’ futureneeds.

4. Work effectively within a health care team.

5. Perform procedurescommon to their professional practice.

6. Recognize situations inwhich intervention isneeded to improve outcomes or preventharm.

7. Assess client or serviceoutcomes (e.g., res-ponses to treatment, satisfaction with services, etc.).

8. Recognize when theirown abilities are inade-quate to manage the situation at hand (recognition of the limi-tation of one’s ownknowledge and skills).

9. Recognize areas of theirown practice in need ofimprovement.

10. Record a clear, under-standable and legallydefensible account of care or services provided.

AAbbiilliittyy CCaatteeggoorriieess

Area 1 = < 20,000 Area 2 = 20,000-49,999 Area 3 = 50,000-99,999 Area 4 = 100,000-500,000 Area 5 = > 500,000

PPooppuullaattiioonn AArreeaass


2299

REPORT OF RESULTS




3300


Conclusions1. Nurses tend to accumulate CE

hours whether or not they aremandated to do so.

2. Nurses with a CE mandateattend more hours of CE unrelat-ed to their work or interests.

3. Nurses consider work experienceas the greatest contributor totheir current levels of ability.

4. Nurses with and without CEmandates estimate the same levels of growth in 10 profes-sional abilities.

5. Access to CE and other factorsrelated to professional learningvaries among nurses in differentwork settings and possiblyamong nurses in different population settings.

6. Nurses with CE mandates mayhave greater access to somesources of CE such as CE vendorsbecause nurses with mandatesare targeted by those providers.

7. Nurses in lower population areasexperience less growth in someabilities than do those in morepopulous regions.

RReeffeerreenncceess Hewlett, P. O. & Eichelberger, L. W. (1996).The case against mandatory continuing education. Journal of Continuing Educationin Nursing, 27(4), pp. 176-181.

McGuire, C. A., Stanhope, M. &Weisenbeck, S. M. (1998). Nursing com-petence – an evolving regulatory issue inKentucky. Nursing Administration Quarterly,23(1), pp. 24-28.

Perrin, K. M., Boyett, T. P. & McDermott, R.J. (2000). Continuing education about physically abusive relationships: Does education change the perceptions of healthcare practitioners? The Journal of ContinuingEducation In Nursing, 31(6), pp. 269-274.

Slusher, I. L., Logsdon, M. C., Johnson, E.,Parker, B., Rice, J. & Hawkins, B. (2000).Continuing education in nursing: A 10-year retrospective study of CE offerings presentedby the Kentucky Nurses Association. TheJournal of Continuing Education in Nursing,31(5), pp. 219-223.

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