The quality of health care depends to a large degree on the knowledge, skills, attitudes, and activities of practicing health care personnel. The emergence of new knowledge and technology, as well as continuing social changes, makes an effective staff development program necessary to assist nursing service personnel to maintain and improve competency in practice. This necessity has been identified by the American Nurses' Association in the association's Standards for Nursing Services where it is stipulated ttiat "The nursing administration provides programs for orientation and continuing learning of nursing personnel,"1 and in the Standards for Continuing Education in Nursing where it is stipulated that "The employer carries a responsibility to the health care recipients to promote the continuing education of nursing personnel."2
The Joint Commission on Accreditation of Hospitals has also stated that "There shall be continuing training programs and educational opportunities for the development of nursing personnel"3 in the nursing services section of the joint commission's Accreditation Manual lor Hospitals.
In order to meet the learning needs of nursing personnel, all potential resources, one of which is a staff development program, must be utilized. The purpose of this document is to offer guidelines for staff development directors, in-service education directors, and others who organize, implement, and evaluate educational programs for nursing personnel in health care agencies. It is also intended for use by persons designated as instructors and educators. The concepts embodied in this document are applicable regardless of the size or location of the agency or the nature of the patient population. However, modification in the implementation procedure may be necessary.
Staff development is a term describing the total process which includes both formal and informal learning opportunities. The focus of the process is on assisting individuals to perform competently in fulfillment of role expectations within a specific agency. Resources both within and outside the agency are utilized to facilitate the process.
The primary goal of a staff development program is to provide opportunities for employed nursing personnel to acquire further knowledge, skills, and attitudes necessary to perform their assigned functions safely and effectively in the provision of health care for consumers. The ultimate goal of such programming is to contribute to the provision of quality services for health care consumers at a specific health care agency or in the community. Basic concepts utilized in effective staff development programming may be applied in health care agencies of varying size, purposes, patient populations, and organizational structure. Staff development includes a variety of learning opportunities and is considered a part of the broad spectrum of continuing education in nursing.
The components of staff development include:
1. Orientation - The means by which new staff members are introduced to the philosophy, goals, policies, procedures, role expectations, physical facilities, and special services in a specific work setting. Orientation occurs at the time of employment, and precedes changes in any of the above during employment in a specific work setting.
2. Continuing Education within Staff Development - An organized planned program, under the direction of the staff development educator, in which learning experiences are designed to build upon the previously-acquired knowledge and skills of the learner. Independent endeavor is encouraged on the part of the learner. Only activities in the continuing education component qualify for the continuing education contact hour.
3. In-Service Education - An instructional or training program provided by an employing agency in the work setting which is designed to increase competence in a specific area of practice.
4. Incidental Learning - Opportunities in the work environment which may or may not be preplanned, but are significant in achieving the overall goal of the staff development process.
DEVELOPMENT OF A PHILOSOPHY
Statements of beliefs about staff development are used as guidelines for identifying a philosophical base on which a program is organized. The following statements represent common beliefs about staff development:
1. The philosophy and objectives of the staff development program reflect the philosophy and objectives of the agency and the nursing department and serve as a guide for program planning.
2. The purpose of a staff development program is to maintain and improve the quality of health care through assisting individual employees to maintain and improve their practice.
3. To be effective, the staff development program is considered an essential and valued organizational component of the health care agency.
4. The staff development offerings are relevant to meeting the health needs of consumers, the learning needs of personnel, and the goals of the specific agency.
5. The agency administrator and members of the nursing staff share the responsibility to support and to promote continuous learning experiences which insure current knowledge and practice.
6. Each individual shares the responsibility with the employer to identify his or her own learning needs and to seek ways to meet these needs.
7. The primary role of staff development educators is to facilitate the implementation of standards, policies, and procedures through planning, conducting, and evaluating learning activities.
8. Evaluation is an integral component of an effective staff development program.
9. Research relative to the impact of staff development education on the quality of patient care is an integral part of the staff development process.
GOALS FOR THE STAFF DEVELOPMENT EDUCATOR
Broad and clearly stated goals consistent with the identified staff development philosophy and purpose give direction to roles and functions of the staff development educator. Goals may include, but are not limited to, the following:
1. Fostering a climate in which nursing staff identify their own learning needs and seek opportunities to meet these needs.
2. Facilitating constructive working relationships with nursing staff in planning, implementing, and evaluating staff development programs.
3. Designing a staff development program which facilitates the attainment of standards of care established within the health agency.
4. Conducting a staff development program relevant to the learning needs of nursing staff, the health needs of the consumers, and goals of the agency.
5. Assisting nursing staff to acquire the knowledge and skills necessary to fulfill their role expectation in the health care agency.
6. Assisting nursing staff to maintain and improve their competency in the provision of health care.
7. Providing ongoing assistance to clinical nursing staff through consultation and/ or direct participation in planning, implementing, and evaluating decentralized staff development offerings.
8. Applying concepts of adult learni ng in planning, implementing, and evaluating learning experiences.
9. Using the expertise of other professionals and consumers in providing learning opportunities.
10. Including nursing staff in planning learning activities in which they are expected to participate.
11. Assessing continuously and evaluating periodically the effectiveness of staff development programs in meeting learning needs of nursing staff, health needs of consumers, and goals of the agency.
12. Promoting and supporting an environment conducive to learning that contributes to increased job enrichment and personal growth of the individual employee.
13. Initiating and/or participating in studies and research activities related to staff development and health care.
14. Utilizing, when appropriate, reported studies and research findings for application to staff development programming.
15. Promoting and exercising leadership in effecting appropriate change in health care delivery systems.
16. Collaborating with colleagues, peers, and others in the community in planning, providing, and evaluating learning experiences of mutual concern.
ORGANIZATION AND ADMINISTRATION OF STAFF DEVELOPMENT
The organization and administration of a staff development program may be structured in one of several ways according to the availability of resources and facilities, as well as the purposes of the agency. A centralized approach may best accommodate one agency's plan, while a decentralized approach may be the most desirable in another. A coordinated system which utilizes the strengths of decentralized and centralized approaches is an effective system to facilitate the total staff development process.
In some instances, the staff development program may consist of collaborative efforts of staff from several agencies to reduce duplication of effort and to obtain maximum utilization of available resources.
Collaborative efforts are important to financing continuing education for nursing. Universities, colleges, and health agencies need to seek ways to share program costs. For example, the facilities of one health agency might be used in exchange for the provision of learning opportunities for the staff by personnel of another agency. In addition, collaboration between health agencies in purchasing audiovisual hardware and software and in sharing of staff development personnel can facilitate more effective expenditure of available funds. Another approach is the establishment of a community-wide program via television, which is supported by the participating institutions.
These and other approaches are essential to meet the learning needs of nursing personnel. Creative, collaborative approaches to financing continuing education in nursing must be continuously sought to meet the obligation to the consumer for the quality of health care.
The following are considerations for the organizational structure for a staff development program:
1. Staff development is an identifiable component within the organizational structure and accorded value and administrative support along with other components in the organization.
2. The responsibility and accountability for staff development are identified in the agency's organizational structure, policies, and role expectations.
3. The organizational structure provides a communications network to facilitate effective working relationships among staff development, administrative, and clinical personnel.
4. The organizational structure provides a mechanism for communication and collaboration between all educational components within the agency.
5. An annual budget, based on identified program objectives, is developed, and adequate finances are allocated to assure the necessary human and physical resources to achieve these objectives.
6. Written policies on staff development identify participants involved, attendance expectations, and whether or not participants will be compensated.
7. Expected terminal behaviors of participants are defined for each planned and organized staff development offering and are used as a basis for determining content, teaching strategies, evaluation of behavioral change of participants, and overall program evaluation.
8. A record-keeping system is established to identify individual achievement and provide data for evaluation of program and cost effectiveness.
9. A system for periodic review of the achievement of staff development objectives is developed as one means of evaluating the effectiveness of the program.
10. The philosophy of the staff development department, the organizational structure of the agency, and the role expectations of nursing service personnel determine to what extent the staff development program is centralized or decentralized.
11. Adequate numbers of qualified personnel, physical facilities, and other resources must be available for effective staff development programming.
12. Community resources and other health disciplines are appropriately utilized to assist the staff development educator to meet selected learning needs.
13. Concepts of adult education are applied in planning the staff development program and specific offerings.
RESPONSIBILITIES, ROLES, AND FUNCTIONS
Responsibility and accountability for improving nursing practice through staff development are shared by employer and employee. However, the primary responsibility for maintaining basic competence to fulfill the requirements of a position must be assumed by the individual employee. Educators, through the staff development process, assist the individual to meet employment role expectations. The following are the responsibilities, roles, and functions delineated for individuals, nursing service administrators, staff development personnel, and educators in staff development:
1. The Individual
The individual has the responsibility to:
a) Identify his or her own learning needs;
b) Take the initiative in seeking learning opportunities both within and outside the employing agency to meet these needs;
c) Make learning needs known to the appropriate sources (e.g. immediate supervisors, staff development educators);
d) Share appropriate information obtained from learning activities with colleagues;
e) Seek ways to apply new knowledge and skills in practice;
f) Share with the agency in the financial responsibility for his or her own continuing education, when appropriate.
2. The Nursing Service Administrator
The nursing service administrator carries a responsibility to the health care recipient to promote continuing education for nursing personnel. It is the responsibility of the nursing service administrator to:
a) Establish and publicize policies related to continuing education participation by personnel;
b) Assist nursing personnel in the identification of learning needs;
c) Provide opportunities for learning experiences based upon established guidelines;
d) Provide released time and/or finances for staff to attend continuing education offerings outside the institution or agency, when appropriate;
e) Appoint and supervise the person responsible for staff development education;
f) Assist in the implementation of concepts and the application of knowledge obtained through continuing education activities, when appropriate;
g) Provide opportunities for nurses to share with colleagues information gained from continuing education activities;
h) Provide recognition for participation in continuing education activities;
i) Evaluate the changes in performance resulting from continuing education;
j) Evaluate the effect of the participation of the nursing service personnel in staff development on the quality of health care to the recipient;
k) Seek resources to provide appropriate reference materials in the health care facility.
3. The Staff Development Personnel
Major roles of the staff development educator are those of facilitator, teacher, and resource person. Expectations of this role include the responsibility of assessing needs, planning, organizing, implementing, and. evaluating the staff development program. Staff development directors should be registered nurses prepared at the graduate level and should be knowledgeable in the areas of clinical nursing practice, adult education, and administration.
4. Educator in Staff Development
It is the responsibility of the educator in staff development to:
a) Collaborate with the nursing service personnel to provide educational programming consistent with expected clinical performance through such means as:
(1) Participating in regularly established meetings of the nursing department;
(2) Establishing meeting times with other leadership personnel concerned with specific programming;
(3) Establishing and using the assistance of a staff development planning or advisory committee. This Committee may be comprised of personnel both within and outside the particular agency;
(4) Contributing to the development of philosophy, objectives, policies, procedures, and position descriptions for the nursing service department;
(5) Participating in establishing priorities for staff development activities.
b) Provide leadership in formulating the philosophy and objectives of the staff development activities in accordance with the philosophy and objectives of the nursing service department.
c) Project a budget plan which provides for necessary human and physical resources to achieve identified program objectives.
d) Identify learning needs of employees by using, but not being limited to:
(1) Position descriptions;
(2) Personal observations and those of others;
(3} Interviews, questionnaires, surveys, and reports;
(4) Minutes of meetings;
(5) Policies, procedures, and directives;
(6) Current literature;
(7) Incident/accident reports;
(8) Quality assurance review;
(9) Employee performance appraisals;
(10) Achievement results of personnel in relation to expected outcomes of staff development offerings;
(11) The employee's identification of his or her own learning needs;
(12) Established standards of care;
(13) Conferences with supervisory personnel and the director of nursing service.
e) Plan offerings that will correlate with the total program or curriculum and that will lead to the desired behavior, e.g.:
(1) Establishing priorities for learning;
(2) Allowing sufficient planning time;
(3) Setting reasonable and attainable objectives;
(4) Determining criteria for measurement of expected behavioral change(s);
(5) Developing course outlines and teaching strategies;
(6) Identifying appropriate media, teaching methods, and resources;
(7) Arranging for space, equipment, and teaching aids;
(8) Informing participants and others concerned.
f) Communicate the plan for the program to encourage and foster participation and cooperation through:
(1) Presentation of program and/or offering plans at regularly scheduled nursing department meetings;
(2) Discussion with appropriate individuals regarding program aspects of specific concern;
(3) Development of posters, flyers, newsletter copy, and other visual materials to publicize educational offerings.
g) Implement the established plan to meet learning needs by:
(1) Establishing an effective teaching/learning climate;
(2) Exercising flexibility in use of time, space, equipment, and instructional plans.
h) Evaluate results of the total staff development program effort as well as specific learning offerings.
i) Participate with others in counseling personnel about their educational needs.
i) Initiate and/or participate in studies and research activities related to staff development education and evaluate reported studies and research findings for application to staff development programming.
k} Develop, maintain, and utilize records and reports pertinent to the staff development program.
I) Pursue activities which further the professional growth and development of the educator in staff development by:
(1) Seeking new concepts in professional and other relevant literature and sharing such knowledge and information with colleagues;
(2) Participating in inter and intradepartmental meetings within the health care facility;
(3) Participating in professional organizations and community 'projects;
(4) Attending workshops, seminars, and academic courses;
(5) Engaging in appropriate independent learning activities or projects.
Evaluation is a systematic and continous process of ascertaining and appraising the effectiveness of an endeavor. Included in the evaluation of a staff development program is the appraisal of the learner's progress, of the single offering, and of the total program. Because the major focus of the staff development program is on meeting the learning needs of the nursing staff in relationship to health care needs of the consumers, evaluation requires learner participation as well as that of other nursing service personnel, staff development educators, and consumers. Information acquired through the evaluation process is used in planning future programs.
An individual learner is evaluated according to the following criteria:
1. Achievement of the established learner and/or instructor objectives;
2. Utilization of the knowledge attained in the learning activity which improves health care services to the consumer;
3. The fulfillment of role expectations. Role expectations include the responsibility of the individual to identify his or her own learning needs, to make these needs known to appropriate sources, to seek learning opportunities, and to share gained information acquired from learning events with colleagues.
A single offering is evaluated according to the following criteria:
1. The offering is relevant to the learning needs of the student, to the health care needs of the consumer, and to the goals of the agency;
2. Principles of adult education are the basis for the teaching strategies;
3. Persons knowledgeable about the content area assist in planning, conducting, and evaluating the educational offering;
4. A statement of objectives is used as a basis for determining content, learning experiences, and evaluation;
5. Objectives include description of expected measurable outcomes for the learner;
6. Learning experiences and teaching methods are appropriate to achieving the objectives;
7. Sufficient time is allotted to each activity for the learner to meet the objectives;
8. The degree of accomplishment of the objectives is assessed;
9. Appropriate facilities and resources are available to implement the educational offering;
10. Records are maintained in a systematic manner.
Evaluation of the total program is based on short- and long-range goals and utilizes the following criteria:
1. Administrative support for program achievement is present;
2. The program is consistent with the stated philosophy;
3. Policies and procedures permit achievement of program goals;
4. Adequate qualified personnel, physical facilities, and other resources, are available for effective staff development programming;
5. The annual budget includes an allocation of funds to accomplish program goals;
6. Program content and goals are reviewed periodically;
7. A record-keeping system is maintained and utilized in the evaluation of program goals;
8. Adult education principles are incorporated in the instructional design;
9. Community resources and other health disciplines are appropriately utilized.
Centralized Staff Development - An organizational approach in which a central nursing administrative authority is vested with the major responsibility to meet the learning needs of the nursing staff.
Continuing Education within Staff Development - An organized planned program under the direction of the staff development educator in which learning experiences are designed to build upon the previously-acquired knowledge and skills of the learner. Independent learning endeavors are encouraged on the part of the learner. Only activities in the continuing education component qualify for the continuing education contact hour.
Coordinated Staff Development - An organizational approach in which the strengths of both centralized and decentralized systems are utilized to meet the learning needs of the nurses.
Decentralized Staff Development - An organizational approach in which nursing leadership personnel in a designated clinical area are vested with the maj or responsibility to meet the learning needs of the nursing staff within their designated clinical area.
In-Service Education - An instructional or training program provided by an employing agency in the work setting and designed to increase competence in a specific area of practice. In-service education is one aspect of staff development, but the terms are not interchangable.
Orientation - The means by which new staff members are introduced to the philosophy, goals, policies, procedures, role expectations, physical facilities, and special sen/ices in a specific work setting. Orientation occurs at the time of employment and precedes changes in any of the above during employment in a specific work setting.
Staff Development - A term describing the total process which includes both formal and informal learning opportunities. The focus of the process is on assisting individuals to perform competently in fulfillment of role expectations within a specific agency. Resources both within and outside the agency are utilized to facilitate the process.
- 1. American Nurses' Association Commission on Nursing Services, Standards for Nursing Services (Kansas City, Missouri: American Nurses' Association, 1973).
- 2. American Nurses' Association Council on Continuing Education, Standards for Continuing Education in Nursing (Kansas City, Missouri: American Nurses' Association, 1975), p. 5.
- 3. Joint Commission on Accreditation of H ospi ta Is, Accreditation Manual for Hospitals (Chicago: Joint Commission on Accreditation of Hospitals, 1972).