Continuing education (CE) is a reality for Florida nurses. As of January 1, 1981 all nurses desiring to renew a Florida license were required to acquire 24 hours of continuing education over a two-year period. Many agencies, individuals and companies in Florida have therefore rallied to develop and present continuing education programs that will assist nurses in meeting this requirement. "The acceptance of collegiate schools of nursing of their responsibility for continuing education of nurses has evolved slowly, gaining momentum in recent years."1 The Florida State University (FSU) became involved in providing education opportunities for nurses in Leon County and other nearby areas. After various program formats, schedules and topics were attempted with little success exemplified by low enrollment and substantial monetary loses. Florida State University's Center for Professional Development and Public Service and the School of Nursing joined together in surveying RNs and LPNs to determine why nurses were not utilizing the programs offered through the university.
Before discussing this problem of poor utilization of FSU nursing programs by nurses, let us review the general premise of mandatory continuing education. Continuing education in nursing is defined by the American Nurses' Association as "planned learning experiences beyond a basic nursing educational program. These experiences are designed to promote the development of knowledge, skills and attitudes for the enhancement of nursing practice."2
According to McKennan, there are four roles the university may play in continuing education in nursing: ". . . research, the assessment of need, the evaluation of programs and assistance to other institutions in the provision of the actual educational programs."3 We believe that the additional role of public service needs to be included when discussing nursing continuing education.
In trying to fulfill its public service role to the nursing public, Florida State University's Center for Professional Development, in conjunction with the School of Nursing, attempted to put together a vital educational program through which nurses could accumulate their required continuing education units (CEUs). Hutchison stated that "major programming must be placed in the educational mainstream where a systematic approach to learning and a continuing relationship with the learner must be maintained and nurtured over time."4 Florida State University has been reviewed and accepted by the Florida Board of Nursing as an approved provider of CE. During the two years prior to the initial relicensure deadline, 16 offerings were developed and offered on an open enrollment basis. Of these, six were cancelled due to low enrollment and another three were presented at a substantial monetary loss to the university. It is significant that Florida State Legislation requires that the continuing education arm of all four-year public institutions of higher education be totally self-sufficient, nonprofit operations. These variables combined (poor enrollments, substantial program losses, and the self-sufficient nonprofit nature of the Center), left the organizers and instructors of these programs frustrated.
A primary purpose of this study was to determine why the university continuing education programs were not being utilized to a greater degree. A secondary purpose was to gather information to assist in planning future programs that might be better received. "The assessment of community needs is important to help establish appropriate goals and objectives for inclusion in the curriculum."5
A questionnaire was developed by the investigators and was divided into three sections. The first section attempted to gather demographic information from the respondents, the second pertained to the history of past attendance in continuing education programs, and the third section attempted to seek ideas and suggestions for future program planning.
Questionnaires were sent to 2,050 RNs and LPNs within four surrounding counties, selected because of their accessibility to the University. Names and addresses were acquired through the Department of Professional Regulation which purports to update their listing on a regular basis. The questionnaire was mailed to 1,174 RNs and 876 LPNs. Individuals holding both active and inactive licenses were incorporated in the study.
Twenty-one percent of all surveys mailed out were completed and returned to the investigators. Seventy-nine percent of the respondents maintained active licenses, while 21% of the respondents were currently holding inactive licenses.
Other demographic data gathered by the survey for the purpose of identifying the nurse population included their years of professional experience and current place of employment, area of specialty, and position.*
History of Past Attendance
In an attempt to determine why university programs were not being utilized, a section of the survey was designed to gather data regarding the respondents' history of past attendance. The survey results indicated that although 49% of the respondents had attended at least one program at the university, only 19% of all programs attended were sponsored by a university. The majority of the programs attended (43%) were sponsored by the nurses' local hospitals; another 28% were sponsored by nursing organizations. The reasons reported for the low level of utilization of university programs included the following:
30% - high cost of programs
30% - ability to fulfill needs elsewhere
24% - unaware of offerings
8% - selection of programs
7% - inaccessibility to campus
The investigators feel that the responses to these last two items provide insight into the poor utilization of the university programming. Since the university's continuing education organization is a nonprofit, nonsubsidized operation, fees were charged to offset programming costs. The nurses feel that the fees are out of line with our competition, particularly when local hospitals and nursing organizations, which receive various kinds of funds to support programming activities, can offer CE at lower costs.
What then is the role of the university in continuing education for nurses? Perhaps the university must begin providing an avenue for nurses to acquire skills and information not readily available through local organizations and nursing facilities, ie, national experts, new research findings, updating of credentials.
Another reason cited by nurses for not attending university programs was lack of knowledge of the existence of such programs. This suggests that the university must expand its marketing of such programs so as to be sure that nurses are well aware of schedules, offerings and locations. Programs might also be scheduled in other locations besides the university campus in order to cut down on apprehensions often associated with attending programs in university facilities which are often unfamiliar to non-student populations.
Other data collected reflect that 96% of the offerings that respondents have attended have been moderate (4-9 hours) or short (1V&-3 hours) in duration. Sixty percent of respondents had only paid up to $15 for these offerings while only fourteen percent had paid over $30 for an offering.
Future Program Planning Data
The third segment of the survey was designed to acquire information to assist in planning future educational programs for nurses that would better meet their needs. Data were gathered to determine nurses' preference for topics, length of programs, best time for the offering, and program fee structures.
When reviewing responses to questions in this portion of the survey it was obvious that nurses cannot easily predict their scheduling needs. Since hospitals, in particular, require 24-hour coverage, there is no one time period that is a "good" time for CE for nurses in general. This held true when nurses were indicating preference for a specific day of the week as well. Saturdays were chosen as a preferred day of the week for offerings by 43% of the respondents, with the other 57% indicating a preference for weekday programming.
Respondents indicated a willingness to pay up to $30 for a three-hour workshop, but only 8% were willing to pay over $30 for six-hour programs. Nurses are not paid at the rate of many other professionals and therefore have difficulty attending highcost programs even if the quality and duration of the program requires the higher fee.
An open-ended question was provided to nurses requesting topics that they would be interested in attending. It was hoped that responses could be used to generate programs that would have a wide appeal. No one topic was suggested more than seven times. Those with the highest incidence of occurrence were as follows:
Physical Assessment - 7
Legal Aspects - 4
Renal Nursing - 3
Another 68 topics were suggested by only one or two individuals.
This suggests that in order to offer programs that will appeal to 15 or 20 individuals who are all avallale on a given day for a specific time period, those programs must be very broad in nature.
As the survey results came in, it became apparent to the researchers that several issues, not covered by our study, might be addressed at a future date. Currently in the state of Florida, no guidelines are established that require nurses to acquire their CE units in any specific areas. It is possible for a nurse to fulfill his/her 24-hour requirement in areas not related to the updating of actual nursing skills. For example, a pediatric nurse may obtain the required hours by taking a 30-hour supervisory development course in the 1981 to 1982 biennium and by taking a 12-hour writing skills workshop, a 6-hour workshop on patient abuse, and a 6-hour workshop on legal aspects of nursing in the 1983 to 1984 biennium. In this case, there is no doubt that useful knowledge is being acquired; however, in a four-year period the nurse may have gained no updating of skills in the area in which she works every day. If the purpose of mandatory CE is to assure that nurses update skills to enhance the practice of nursing, should there not be requirements within the mandatory 24hour requirement that encourage nurses to strive to update actual nursing skills, as well as other, more philosophical areas?
If this were the case, not only would nurses be obligated to acquire continuing education in their area of specialty, but approved providers would also be encouraged to offer more varied programs.
Another question to be reviewed in future studies concerns the effect that the completion of mandatory CE in a given biennium has upon the nurse's pursuit of further education. When a nurse fulfills his/her requirements is there a tendency to forego other worthwhile programs until the next biennium? Would a nurse's inclination to obtain more than the required hours be increased if "CE Banks" were established from which nurses could draw in the next biennium?
As a result of information acquired through the survey, this university needs to review its role inproviding CE for nurses. It appears that local hospitals and nursing organizations can offer programs at a lesser cost as a result of their ability to offset program costs from sources other than participant fees.
Unless program costs can be reduced at the university by appealing to a broader group of nurses or unique programming can be provided for which nurses will be glad to attend at university rates, there is little chance that this university can compete with other agencies.
- 1. Cooper SS : A brief history of continuing education in nursing in the US. J Cont Educ Nurs 1973; 4:5-14.
- 2. Standards for Continuing Education in Nursing. Kansas City, American Nurses' Association, 1974, ? 2.
- 3. McKennan ME: A perspective on the impact of mandatory continuing education on public supported colleges and universities. J Cont Educ Nurs 1978; 9(3):15-20.
- 4. Hutchison DJ: The process of planning programs of continuing education for health manpower, in Edelstein R, Bunnell M (eds): Determinants of continuing nursing education. J Cont Educ Nurs 1978; 9(1):29-34.
- 5. Kunstel F: Assessing community needs: Implications for curriculum and staff development in health education. J School Health, April 1978, p 220.