Dorothy, it is a pleasure to be with you today. Tell me, how and when you first became interested in continuing education?
I got into it by accident, not by design, which so often happens as you know. It was in the early 1960s and I was a newly appointed supervisor at Henry Ford Hospital. We were in the process of forming an association of RNs with standing committees, and the director asked me to be chairperson of the inservice education committee - I wasn't even sure what the title meant. It didn't take me very long to decide that I didn't know very much about inservice education, and I certainly didn't know very much about being a supervisor. So I left to attend school full-time because by that time I decided that inservice education was a rather important activity and I wanted to prepare myself to be a director of a staff development department. In those days, as you may remember, there were no programs designed to prepare you to be a director of continuing education and/or staff development. You created your own program by reviewing the catalog and selecting the courses you thought would help. (That isn't too different today!) I have been in staff development education ever since. I got into the business by accident, when I was made chairperson of a committee.
Well, we're awfully glad for CE in nursing that that accident happened. What were some of the early kinds of activities that you did in continuing education?
Most of the earlier CE and staff development activities with which I was involved in addition to my position were related to the professional associations - the American Nurses' Association (ANA), the Michigan Nurses' Association, and the Michigan League for Nursing. Back in 1968 my first appointment to an ANA committee evolved because Virginia Cleland wasn't able to accept the assignment and referred the appointment to me. The committee was designed to develop guidelines for refresher courses, and was funded by a US Department of Labor grant. The need stemmed from a report of the Surgeon General's Consultant Group on Nursing which was studying the critical shortage of nurses at the time. They discovered that there were 300,000 inactive nurses in the US who might come back to work if refresher course guidelines could be developed to help set up courses in the US. That was the purpose of the committee and that was my first involvement with the Committee on Continuing Education.
A little later, in the early 1970s, I became involved in a Michigan Nurses' Association study funded by the Public Health Service. The purpose ofthat program was to determine the continuing education needs and resources in Michigan. We had an excellent response to a survey - 3,700 nurses responded and identified their continuing education needs. It was their opinion in those days that continuing education was good; but it was not their responsibility. They also felt that CE should be offered on weekdays, 25 miles or less from home, one or two days long, and held in the fall, spring, maybe the winter, and absolutely never in the summer. We also learned from this study that there were great barren areas in the state where no continuing education was available to anyone at all. As a result ofthat study, we designed, tested, and implemented a regional continuing education approval system. This was before the National Accreditation System was in effect. We developed a CE program rating tool which is still in use and has been adopted by at least one other state and by some organizations. It was especially helpful at that time to use that tool to inform nurses of standards for continuing education. I think this pilot project was probably the most useful continuing education activity that I was in at the time. I have always been pleased with that tool. I also was involved in developing my own staff development department at the time.
If I recall correctly, yours was probably one of the early well-organized, big units in staff development.
Well, I don't know how big. When I went to William Beaumont 16 years ago there were only four instructors in the department and we are now a group of 18 persons. I have a fine staff who make me look very smart. They've really done a great deal to make my image quite glowing. Yes, I think it was a growing program. It was a trial and error process - here I come, ready or not.
Unfortunately, that's still how a lot of people go about CE and they do have more resources now than they did when you started. What kinds of things were going on in nursing and society in general at that time?
A significant thing that was going on then was a ground swell of interest and controversy over continuing education and licensure. It seemed to be the big worry at the time. There were articles coming out, pro and con. It seemed everyone was required to take sides and there was a lot of anxiety among nurses that they would lose their jobs if they didn't get a baccalaureate degree in nursing. There were lots of defensive activities going on for the non-BSN generic program and anger and lots of strong feelings. Then along about that time the state nurses' associations began developing their own Continuing Education Approval and Recognition Programs (CEARP). A few were not too well thought out as I remember. One state awarded credit for driving 100 miles to a meeting which may have been very educational in that state come to think of it, but . . . They received credit for being elected to a committee. I am delighted to say that there's a lot of improvement today over that. The staff development process was also beginning to improve early in those days. Pioneers, like Drusilla Poole and Mary Annis Miller, did a great deal to create much needed guidelines to follow. At that time we were still appointing the good followers to instructors' positions. They performed procedures accurately but had no teaching preparation. Another approach was to appoint the young BSN graduate into staff development. But the staff development process was beginning to mature. People were taking a hard look at the whole educational process. There was a growing interest in staff development among nursing service administrators and nursing educators around the country and there seemed to be a growing concern to offer educational programs to the nursing staff. It was again one of those "Here I come, ready or not" situations: we'd better have something educational no matter what it is.
I hate to discourage you, Dorothy, but I did a workshop yesterday and the people said the same thing. Either you're a good staff nurse and you get promoted or you have a BSN and thats how you get in.
That's right. A good staff nurse who followed the procedures, put the little cottonballs on the right side of the tray and so on, became an instructor. Although that still happens, I wear rose-tinted glasses so I feel optimistic.
I think the improvement in general has been great.
No question about it. At the 1983 Philadelphia Annual CE Conference, I was impressed with the quality of those who were attending, both staff development educators and continuing education educators. Really, there is no comparison to those early days. Lots of light and less heat now. Their thinking today is more sophisticated and more mature. There's no question about it.
Has your concept about continuing education changed over the years?
Well I don't know that it has changed - I have always held a basic philosophy. From the beginning it seemed clear to my way of thinking about the differences in the purpose of continuing education and inservice education. There are those who still argue to the point, but the concept hasn't changed to me. I had then, and still have now very strong feelings that quality assurance of patient care and inservice education are indivisible. I'm thinking now of putting that on my tombstone. My belief that continuing education exists to enhance the career growth of the individual hasn't changed. There will always be gray areas between continuing education and inservice education. Some seem to pursue that problem and it may always exist. Nothing has happened to change my mind about the purpose of continuing education and inservice education.
What kinds of changes do you think have occurred in continuingeducation that you believe have been influential in shaping where we are today?
The move toward a uniform accreditation system is certainly going to influence continuing education for the good, as hard as it's going to be for that to be implemented. I think the changes in a proposed accreditation system are going to influence a lot of today's practices in continuing education. It should improve the quality globally for the continuing education curriculum. Certainly, the economy and the federal regulations are having their impact on CE.
Yes, and the programs to be subsidized are going to be a big issue as well as what is going to be needed to meet these regulations. For example, we will need both a lot of continuing education, and a lot of inservice education to help the nurses today in planning for early patient discharges that are required in the federal regulations. And they're going to need a lot of help today and in the future. The influence of today's economy will affect the educational program in a variety of ways. The author of the ever-popular Megatrends points out that we are entering into the hightech era which will emphasize a special need for social interaction. We've already seen universities dropping such courses as humanities and some of the social studies due to budget cuts. Where will we close those gaps, the social interaction skills? If they're not going to get it in their generic program, I suppose continuing education and inservice education will provide it. Additionally, James Naisbitt points out that the high-tech era is going to require nurses to learn to synthesize the multitude of information they receive to make decisions about patient care. Someone has to close this gap and I think it's got to be continuing education and inservice education: not just one but both.
Would you share, who, if anyone, was most influential in the direction youVe taken to develop continuing education?
Well, no one person in particular, it's a combination of all those knowledgeable and wise persons with whom I was privileged to work on all those committees and task forces. You know, you learn an awful lot in limousines and cabs on the way to the airport following a committee meeting or over coffee, or a drink or lunch with people like Helen Tobin, Signe Cooper, Elda Popiel, Dorothy del Bueno, Audrey Spector, and you, Pat, just to name a few. These people were very significant in my life and I've learned a great deal by keeping my mouth shut and listening to them. I'll have to say that I've been many times blessed to have contacts with these fine leaders in both the continuing education and staff development businesses. It's been my privilege.
Well, based on that response, I have to tell you that whichever state that was that allowed CEARP points for riding in the car evidently had the right idea, didn't they?
You know, you have a point.
The question is, however, were they riding with all those people you just mentioned?
I don't know, that is a good point.
If you could select only one or two outstanding events in nursing that influenced continuing education, what would they be?
I'd have to say, first of all, that the state that passed the first licensure law mandating continuing education made us conscious of a need for continuing education. And, I guess California would be blamed for that but it did us a lot of good because it made us aware. Another outstanding event certainly had to be the continuing education accreditation program and the identification of standards for continuing education. Those upgraded the quality of continuing education. The maturation of attitude toward continuing education as a lifelong process which came as a result of the emphasis on the need by many, many faculty members in the generic graduate program was another important event.
I think you're probably right. From all of your experience, what have you found to be some of the necessary abilities that one needs to become a continuing educator?
Well, of course, a skill in the use of the principles of adult learning and planning curriculum and programs is one necessary ability. Another one would be whatever skill or talent it takes to keep abreast of the current issues, practices, and trends in nursing. Being able to sort out the real learning needs from those that are just fads in order to plan meaningful programs is crucial. It's a real talent to be able to do this! You also need some skill in research, at least enough to study outcomes and justify programs and your own existence. There is a need for acquiring a skill in recognizing and implementing the practical aspects of research outcomes. There are some outcomes that are just obvious - you don't have to study everything. Skill too is needed in being comfortable as a risk taker and having the courage to try innovative programs and also to abandon those things that just didn't work.
That kind of courage really is needed, that's true. What have you seen, from your perspective, to be the greatest concerns as well as advantages in your role as a continuing nurse educator?
My greatest concern has been and always will be the great responsibility in planning curriculum offerings which waste neither the time nor the dollar outlay of the learner. I am concerned about the accelerating costs. I don't know how long nurses are going to be able to continue to pay for continuing education and who else is going to pay for all of this. One unpublished study that I read recently reported that if all 50 states mandated continuing education for relicensure, it would cost $8 billion a year. That's a real concern. Who's going to pay for all this? Finally, I am concerned that there are so few graduate programs to prepare continuing education and staff development leaders. Where will these prepared leaders come from? I don't know. How many people will go to the trouble to design their own program? I think that's a big concern.
I think that's a well-stated concern for many of us in continuing education and staff development, while, in fact, those of us who entered later than perhaps you did had people such as you to look to for guidance. I'm not suggesting that those who are currently in practice are not strong, but we have moved educationally to a point where we could expect a different kind of educational opportunity.
The real advantage that I've seen refers to what you just said, and that is that the continuing education and staff development educational program system does allow an enormous amount of latitude and freedom in exploring creative approaches. That's a real advantage. I would say my very greatest advantage was that my career in the staff development arena and the whole continuing education era evolved at the same time. It was great fun and a neat advantage, if I can refer to it as pioneering. I have to remember that Fm that ancient.
No, continuing education is that recent.
Well, that's true. One of my relatives, who was in the continuing education business in a state nurses' association, put it very well. She said, "You know, my job was more fun when I didn't know what I was doing." I think there was a glory in it in those days. It was more fun when you didn't know what you were doing and you had the advantage of trying out all these nice new things - that was fun.
Now that you know so much about CE, you have the advantage of a real challenge.
I know, it's not as much fun. You have all these things that you're supposed to do that you didn't know you were supposed to do originally.
What kinds of things, in addition to those you've already mentioned, do you see influencing the future of continuing education?
As we've said many times, both continuing education and staff development will be shaped by the economy and by upcoming regulations. I believe it was Malcolm Knowles who said that "sooner or later all of us in education will have to prove that what we do makes a difference or we're all going to be out of work." We're going to be affected by the economy and by the regulations and we will have to justify our existence. I think the future of continuing education and staff development will be shaped by a move toward regionalization of health care. Someone predicted that by the year 2000 there will be only 25 health care systems in the US. I don't know how accurate that is, but should that happen, it may help to reduce the cost. I think it will impact a great deal on the more global continuing education and will be available to many more. It may also result in institutional licensure and then what, I don't know. That would certainly impact on continuing education. Hopefully, the rapid growth of a sophisticated technological communication system such as satellite teleconference will have its impact on continuing education and make it more available. It's in business now, it just needs to be more widespread. I'm also optimistic for the future of continuing education and staff development in that the providers of nursing education and nursing service will increase their collaboration to meet our mutual needs in this era, because there are many, many needs that aren't being met. I'm sure they will think about it more seriously and get closer together. I feel optimistic about that.
One of the efforts that we've made in continuing education in recent years is really to look at marketing strategies and cost-effectiveness analysis so that maybe what we do in the future will be very different, but still very much needed.
Yes, and of course the current and recent efforts in networking is going to help too. I think we're more aware of each other now and that will hopefully increase in the future, and be for the good of everyone.
I hope you're right. Dorothy, of all the things that you've done in continuing education and staff development in Michigan and on the national level, for other nurses external to William Beaumont, and for nurses within William Beaumont, what do you think are your greatest contributions?
Not to beat an old dead horse to death again, but the opportunity I've had to serve on many of the local, state, and national committees gave me some visibility which resulted in opportunities to share my useful accomplishments as well as my mistakes with others who were starting out in the business and who sought my help. I'm pleased about that. Td like to think also that I made some useful contributions in writing all those guidelines and standards. I am proud of the continuing education rating tool that I worked on and the committee I chaired which served to inform many in the continuing education process. It stood the test of time very well and I'm proud about that. But if I were to be pleased about a particular contribution, I'd like most of all to think that there are patients who are better off because of my strong convictions and programs and that the quality of their care is enhanced through an ongoing and sound staff development education program. I'd like to think that I had a little influence on the care of patients.
Well, I sure hope you're right, Dorothy, because I know many things that you've done in your positions, both at Henry Ford and at William Beaumont, certainly have been geared in that direction.
Well, I hope so.
I'd just like to say one other thing. From my perspective, not beingin the employment setting with you, one of the greatest contributions that you have made to many of us is your special sense of humor. You often have allowed us to look at difficult problems with a new insight and I really have appreciated that as I know others have.
That was the fun of it. There were some funny things that happened along the way. As my relative says, it was fun in the beginning.
Thanks a lot for the interview, we really appreciate it.
I appreciate the opportunity to do it, Pat, good luck to you.