The very nature of nursing as a profession requires that its practitioners possess specialized knowledge and skills, but the mere acquisition of skills is not enough. Lifelong learning is required to progress within the profession. As Florence Nightingale said, “Nursing is a progressive art in which to stand still is to have gone back” (Dolan, 1968, p. 219). Throughout the history of nursing, the importance of continuing education has been emphasized (Pfefferkorn, 1928; Poole, 1953). In 1899, Columbia University was the first institution to initiate continuing education for nurses (Eustace, 2001).
Benner describes progressive levels of competence from novice to expert bedside nurse by identifying specific clinical behaviors exhibited at each level. Her levels derive from the Dreyfus Model of Skill Acquisition in which the performer moves from theoretical to experiential paradigms—from looking at a situation as a set of equally relevant parts to the ability to identify and respond to only the relevant parts and from detached observer to involved performer (Benner, 1984). Basic nursing education, continuing education, work experience, and socialization into the profession by other nurses facilitate this progression and each achieved level builds on the previous one (Benner, 2000).
In a profession where advancement comes quickly, continuing education plays a vital role in the nurse’s development once he or she enters the work force. The amount of time and effort put forth to stay current varies from individual to individual. However, to provide optimal nursing care, a personal commitment to lifelong learning is critical. For many nurses, this commitment translates into an accrual of contact hours.
However, a debate exists as to whether a mere accumulation of nursing continuing education contact hours equates clinical competence. Currently, 30 state boards of nursing and most credentialing bodies require evidence of continuing education participation, usually in the form of approved contact hours, for license and certification renewal. Although perhaps not the best gauge of competence, it at least provides some quantifiable data as to the nurse’s intent to remain up-to-date (Yoder-Wise, 2006). Most nurses surveyed agree with the American Nurses Association’s 1985 position statement that puts the onus on the individual nurse to determine his or her learning needs and to ensure those needs are met (Eustace, 2001).
Acquisition of Clinical Skills and Knowledge
For the most part, discussions of continued competence in nursing refer to clinical competence or the acquisition of knowledge and skills required to provide effective, efficient, and safe evidence-based patient care. There are many opportunities for nurses to acquire, maintain, enhance, and validate clinical skills.
Basic nursing education, whether in a baccalaureate degree, associate degree, or hospital-based program, prepares the novice to take a nationally certified examination that validates his or her entry-level knowledge. Once licensed, nurses usually have workplace opportunities for continuing professional development that are provided through staff development departments. These offerings include basic orientation, residencies, internships, certifications, and core curricula for specialty areas. Annual hospital-wide and service-based competency validations also ensure continued clinical skills. Many hospitals offer their nursing staff free internal continuing education programs on a variety of care-based topics that may be general or specialty specific.
In addition to employer-provided continuing education, external workshops and conferences offer nurses other clinical learning opportunities. Other healthcare facilities, schools of nursing, and area health education centers provide these locally. Membership in state nursing associations and professional specialty organizations is another avenue used to obtain continuing education opportunities. These groups provide nurses with access to regional, state, and national continuing education conferences, which are venues for education and networking with peers from other areas. Professional organizations also help support nurses seeking accreditation in specialty areas by offering review courses.
Some nurses take advantage of learner-paced educational opportunities such as web-based courses or journal-based continuing education articles. Our mailboxes and e-mail boxes are filled every week with these “learning” opportunities. It is up to nurses to evaluate the quality, value, and relevance of these learner-paced activities for their practice. Finally, some nurses pursue advanced practice programs and graduate degrees in specialty areas.
However, there is a developmental aspect of professional nursing that does not receive the same emphasis as clinical skills. As nurses advance within their careers, several non-clinical skills gain importance, especially when verification of these skills becomes a mandatory prerequisite for professional advancement or clinical ladders. These behaviors may include the ability to demonstrate oral presentation or poster development skills, to produce written materials (including publications), and to maintain professional portfolios.
Basic nursing education programs may incorporate some instruction about these skills, but they rarely have classes dedicated to them. Within a particular course, faculty members provide critiques of a student’s written materials and oral presentations. Pre-graduation workshops on résumé writing and interviewing skills may be options, but they are generally not a part of standard nursing curricula. An informal survey of nurse educators within our department showed that of the 24 educators who graduated from a baccalaureate nursing program between the 1960s and 1990s, one nurse had a formal class offered on résumé writing and two nurses had workshops provided by other university departments.
Richards Sheridan, Abruzzese, O’Grady, and Green-Hernandez (1996) suggested that staff development educators take on roles as mentors for the career development of others in areas such as presentation skills and writing for publication. However, they do not detail specific ways to implement this initiative. Employers may also provide nurses who choose to move into management or administrative positions with learning opportunities to build these non-clinical skill sets within courses specific to these administrative roles. However, this type of instruction and support may be less consistently offered to the experienced bedside practitioner within a hospital system.
Even when skills training sessions are offered, staff nurses may be resistant. Lack of time and the perceived lack of competence have been identified as deterrents to publication and presentation development (Cleary & Walter, 2004). Many nurses feel that it takes a great degree of skill or advanced academic preparation to successfully publish and do not see themselves as competent in this area. In the midst of a busy clinical unit, managers generally are not able to allot “on duty” time to be spent in these activities.
Internal Professional Development Programs
In 2003, all nursing education in our hospital was centralized into the Department of Nursing Practice, Education, and Research. Our chief nursing officer and the department director reviewed the roles and responsibilities of the staff. Existing positions were restructured and realigned to improve efficiency and meet the learning needs of novice and experienced nurses. In response to experienced staff nurses who voiced a need for more continuing education, the role of continuing education coordinator was defined.
The intent of the role development was to have one person responsible for facilitating professional development by looking for opportunities to identify and implement, in a consistent manner, new and existing continuing education opportunities for nurses, particularly those at the bedside. Bedside staff nurses were targeted because they often had difficulty getting time off to attend nursing continuing education conferences outside the hospital and financial support to attend these activities was not universally available within our facility.
In-house educational programs were planned to meet the nurses’ learning needs and enhance the quality of care they provide (Table). These classes are offered at times convenient for all shifts, including evenings and weekends. In special circumstances, one-to-one tuition is provided. In addition to creating programs that addressed areas of clinical competence and improved patient care, the purpose of the initiative was to find ways to enhance professional growth, recognize inherent nursing expertise, and add to job satisfaction. Evidence-based, clinically oriented, continuing education activities could address the goals of improving patient care and supporting continued competence.
Types of Professional Development Programs
To meet the latter set of goals, it was important to encourage a sense of ownership in the process from the intended audience of staff nurses. It was decided that experienced staff nurses should participate as faculty for some of these programs, thus meeting both sets of goals. This was an opportunity to showcase our staff’s nursing experience, acknowledge nursing excellence, enhance job satisfaction, and help staff develop their presentation skills in a supported environment.
Nursing grand rounds was the first educational initiative implemented to meet this dual purpose. Established in 2003, the program features staff nurses as presenters. The nursing grand rounds format is consistent with a professional presentation that would be a concurrent session at a national nursing conference and thus is more structured than the typical unit-based “lunch and learn” in-service programs staff nurses are used to presenting. Teams of nurses from nursing units and specialty areas develop these nursing grand rounds presentations with the support of the continuing education coordinator.
A class titled “How to Develop a Professional Presentation” on how to choose, refine, and develop a topic into a presentation based on venue, audience, and time frame is offered. In addition, instruction is provided on objective writing, creating PowerPoint® presentations, using other types of handouts, copyright issues, and time management and organizational skills. Presentation skills are discussed and rehearsal time is scheduled. Ongoing mentoring is provided throughout the process. The continuing education coordinator does the contact hour documentation, makes the handout packets, and assists with literature searches and PowerPoint® development if the participants do not have access to these sources and software. The presentation takes place in a small, theatre-style conference room that seats 50 people.
Poster Presentations and Writing For Publication
Because of the considerable effort put into developing a nursing grand rounds program, it was also decided to encourage the presenters to find other venues for sharing their work. As noted previously, nurses are encouraged to repeat the presentation in other settings. Classes on developing poster presentations and writing for publication were added in the spring of 2004.
“How to Develop a Poster Presentation” starts by describing how a poster submitted for presentation at a regional, state, or national nursing or scientific meeting differs from the informational poster used to instruct unit-based nursing staff. Nurses who do not have experience attending this type of external meeting often are unfamiliar with this type of presentation opportunity. The class content includes practical pointers on finding venues for presentations, abstract writing, and theme development. Our department also has support from a media specialist who assists with the design and technical aspects of creating a poster presentation.
Another means of sharing expertise is through publications. “Writing for Publication: How to Get Started” introduces participants to the idea of writing for a nursing publication. Discussion includes the different types of nursing publications from the general nursing news type sent by mass mailings to highly specialized and competitive peer-reviewed professional journals. Participants are encouraged to read many different publications to see which style and audience best matches their skills and interests. The intent is for the participant to read an article in a journal or publication and feel as though he or she is able to write a similar one. Authors’ instructions, letters of intent, and contacts with editors are discussed. If the participant has already developed a topic as an oral or poster presentation, we explore how it can be converted into an article.
Whether converting another presentation to paper or developing a new article, we concentrate on the practicalities of writing for publication, including topic selection and refinement, literature review, solo versus shared authorship, the importance of grammar, and time management. Also included is a discussion of the review process, how to respond to reviewer comments, and typical timeframes from submission to publication. The continuing education coordinator, who has experience publishing and as a peer reviewer, is available throughout the writing process to mentor novice writers.
In 2005, the Division of Nursing launched a professional advancement ladder based on Benner’s progression from novice to expert. One of the requirements for both the Clinical Nurse III Benner Proficient and Clinical Nurse IV Benner Expert positions is the submission of a professional portfolio. Our department was asked to support this initiative by offering “how to” classes on portfolio development.
A portfolio is used to document learning, experiences, competencies, and accomplishments. However, it is also a tool used for self-reflection that allows nurses the opportunity to identify their strengths, preferences, areas in need of improvement, and learning needs. It provides a framework to formulate a career path.
One key element in a portfolio is a personal statement or essay that reflects the nurse’s synthesis of the collected materials. This makes the portfolio a learning tool and a documentation tool, setting it apart from résumés or curriculum vitae, which only present data without interpretation (Billings, 2005). The class material covers several topics, including how to use a portfolio for self-assessment and career planning, what to include, how to create a professional look for the document, and an in-depth discussion of the personal essay and its meaning to the writer.
Writing Résumés and Interviewing Skills
While engaged in the “How to Develop a Portfolio” class, participants requested a class on résumé writing because inclusion of a résumé was part of the application process for the Clinical Nurse III and Clinical Nurse IV positions. Some of our nurses had only been employed at our facility and had never assembled a résumé. Thus, “Winning Résumés and Interviews” was the fifth professional development class added in 2005. This class discusses what to include in a résumé, style points, legal issues, resources for résumé writing, and how to present oneself during a job interview.
Broader Use of Classes
Although these professional development classes were initially developed with a specific audience in mind, such as nursing grand rounds presenters or applicants for advancement on the clinical ladder, we now encourage all nurses to take advantage of them. Each class provides nurses with opportunities to gain or improve their non-clinical skills in support of professional growth. Classes are offered during all shifts and days of the week. Mentoring is offered to support all classes.
In 2006, our State Board of Nursing launched a reflective practice approach to support its commitment to the continued competency of professional nurses licensed in our state. At the time of the biennial license renewal, each nurse will be required develop a self-reflection tool about his or her practice and a learning plan for the next 2-year period to maintain or enhance his or her professional competence. Although nurses will not need to submit documentation, each nurse will be subjected to a random audit at the time of license renewal to verify that he or she has fulfilled the self-assessment learning plan developed in the previous renewal.
Each nurse at our facility is encouraged to develop a professional portfolio to document his or her professional progress and continued competency. To support this effort, a sixth professional development course titled “Continued Competence and the Professional Portfolio” was initiated in 2006. Its contents include specific information about changes in licensing requirements, a discussion of continued competence and self-reflective practice, and an explanation about how a portfolio functions as a professional development tool.
The professional development series has been well received. Since their inception, more than 205 nurses have attended classes in the series. The most popular and frequently offered workshop was the “How to Develop a Portfolio” class because this supported the application for professional advancement initiative. Members of the panel reviewing portfolio submissions commented that there was a “definite difference” between applicants who had attended the portfolio development class and those who had not. Staff nurses calling for information about the class report that “word on the street” says the class is helpful.
Of the nurses who presented a nursing ground rounds session, three had journal articles published on their topics, another used the topic for a poster presentation at a state-wide nursing convention, and several have repeated their presentations at other venues, including national and regional nursing conferences.
Lifelong learning is an integral part of nursing professional development. As nurses progress through their careers, opportunities arise to share both the science and the art of nursing with those who come after them. Professional development classes support this effort by providing nurses with education and mentoring to develop the non-clinical skills that enable them to share their wisdom in thoughtful, articulate, and enduring ways.
- Benner, P. (1984). The Dreyfus Model of Skill Acquisition applied to nursing. In Benner, P., From novice to expert: Excellence and power in clinical nursing practice (pp. 13–38). Menlo Park, CA: Addison-Wesley.
- Benner, P. (2000). The wisdom of our practice. American Journal of Nursing, 100(10), 99–101, 103, 105.
- Billings, D. (2005). Learning portfolios. The Journal of Continuing Education in Nursing, 36, 149–150.
- Cleary, M. & Walter, G. (2004). Apportioning our time and energy: Oral presentation, poster, journal article or other?International Journal of Mental Health Nursing, 13, 204–207. doi:10.1111/j.1440-0979.2004.0334.x [CrossRef]
- Dolan, J. A. (1968). History of nursing (12th ed.). Philadelphia: W. B. Saunders.
- Eustace, L. W. (2001). Mandatory continuing education: Past, present, and future trends and issues. The Journal of Continuing Education in Nursing, 32, 133–137.
- Pfefferkorn, B. (1928). Improvement of the nurse in service: An historical review. American Journal of Nursing, 28, 700–710.
- Poole, D. R. (1953). In service education reaches a milestone. American Journal of Nursing, 53, 1456–1460.
- Richards Sheridan, D., Abruzzese, R. S., O’Grady, T. & Green-Hernandez, C. (1996). Nursing staff development in the 1990s. In Abruzzese, R. S. (Ed.), Nursing staff development: Strategies for success (2nd ed., pp. 16–29). St. Louis, MO: C. V. Mosby.
- Yoder-Wise, P. S. (2006). State and certifying boards/associations: CE and competency requirements. The Journal of Continuing Education in Nursing, 37, 3. doi:10.3928/00220124-20060101-01 [CrossRef]
Types of Professional Development Programs
|Professional presentations||How to develop a formal evidence-based presentation similar to that given at a state, regional, or national conference; generally case oriented|
|Poster presentations||How to create a graphic presentation of the results of a research project or educational initiative for display in the unit or at a state, regional, or national conference|
|Writing for publication||How to prepare articles for nursing newsletters or specialized, peer-reviewed professional nursing publications|
|Portfolio development||How to document an individual’s experiences, skills, and accomplishments in a personal professional portfolio; includes framework for the individual’s career path and serves as a tool for self-reflection|
|Writing résumés and interviewing skills||How to prepare a résumé, which offers a summary of an individual’s education, work experience, and qualifications, and how to prepare for a formal pre-employment interview|