This year has brought several key issues into play related to continuing nursing education and nursing professional development (NPD). This article highlights six of those important issues:
- Outcome-based continuing education work initiated by the American Nurses Credentialing Center's (ANCC) accreditation program.
- New thinking about learning environments stimulated by the Josiah Macy Jr. Foundation report.
- The National Collaborative for Improving the Clinical Learning Environment initiative related to clinical learning environments.
- Calculating return on investment to evaluate the impact of NPD.
- The American Academy of Nursing position statement regarding mandating nurse residency programs.
- The professional development associate work undertaken by the Association for Nursing Professional Development (ANPD).
We have summarized each of these initiatives below.
Outcome-Based Continuing Education
The ANCC has completed a pilot study evaluating the effectiveness of an outcome-based model for continuing education, awarding credit based on achievement of levels of outcomes rather than on time. Results were impressive and will be shared in detail in an upcoming Journal of Continuing Education in Nursing article. This model evolved from the ANCC's Commission on Accreditation, recognizing that time-based credit often lacks significant focus on and measurement of outcomes that improve professional development and/or patient care. Further, the outcome-based model provides credit for individuals or teams who may not have been able to earn contact hours in traditional time-based models (Dickerson, Shinners, & Chappell, 2017). The outcome credit is a separate currency—there is no equivalency to contact hours. Credit is awarded based on completion of specific outcomes at five levels of achievement.
- Acquisition of knowledge and/or skill.
- Application of knowledge and/or skill.
- Demonstration of knowledge and/or skills in an educational setting.
- Integration of knowledge and/or skills into practice.
- Demonstrable impact on practice, patient, and/or system outcomes.
Moving forward, the ANCC's NPD accreditation program will be providing guidance to accredited providers interested in use of this model. Nurse planners can engage with one or more learners in identifying gaps, determining level of educational need, setting outcome measures, and ensuring all accreditation criteria are met in planning, implementing, and evaluating this education and awarding the outcome-based credit.
Macy Foundation Report on Learning Environments
There has been increasing emphasis this year on the importance of learning environments. A 2018 Macy Foundation Conference report defines a learning environment as “the social interactions, organizational cultures and structures, and physical and virtual spaces that surround and shape participants' experiences, perceptions, and learning” (p. 2). When individuals come together to share with and learn from each other in a space that is safe, respectful, and collaborative, learning will occur that supports individual and team performance. Individuals often tend to think of a learning environment as a physical space rather than the more global approach to the multiple factors that impact learning. Having this broader perspective will support innovation and creativity in how, when, where, and why education is provided. Specific recommendations of this report include:
- Engaging academic and health care organizational governance.
- Engaging executive leadership to provide organizational support.
- Creating physical and virtual spaces for learning.
- Providing faculty and staff development.
- Promoting research and scholarship.
- Setting policy.
On the basis of these recommendations, both individuals and systems are accountable to establish and maintain both physical and virtual environments that support learners and learning.
The National Collaborative for Improving the Clinical Learning Environment
Nursing has long been the leader in focusing on development of healthy work environments. However, recent literature has indicated that physician burnout, depression, and suicide are on the rise (West, Dyrbye, & Shanafelt, 2018). Effective solutions to addressing these problems among all health care professionals need to focus on an interprofessional approach to creating healthy clinical learning environments (CLEs). In October 2017, the Josiah Macy Jr. Foundation and the Accreditation Council for Graduate Medical Education partnered to host a symposium to identify the key characteristics of an optimal CLE. The symposium included representation from many health care organizations including academia, the Quality and Safety Education for Nurses Institute, and the ANCC. Their work has continued throughout 2018, with the ANPD joining the group to focus on nursing leadership's opportunity to join colleagues in working together to identify the key characteristics of a positive CLE. These characteristics are being used as a framework to provide further direction. They include:
- Patient centeredness.
- Creating a continuum of learning.
- Reliable communications.
- Team-based care.
- Shared accountability.
- Evidence-based patient care based on interprofessional experience.
An author group is working hard to provide guidance as to how a high-functioning CLE should be operationalized. Stay tuned for more in 2019!
Calculating Return on Investment for NPD
Opperman, Liebig, Bowling, and Johnson (2018) provided an update from their original two-part 2016 series that brought return on investment to the forefront for NPD practitioners. The premise is that to indicate value, practitioners need to justify the cost of an activity by calculating its economic outcome. An earlier article (Opperman, Liebig, Bowling, Johnson, & Harper, 2016) showed how to calculate “cost analysis, benefit-cost ratios and cost-effectiveness analysis” (p. 176). Using the most recent literature, authors updated the “Known Cost of Outcomes Table” (Opperman et al., 2018, pp. 4–8), which can serve as a useful guide for calculating costs from such conditions as workforce violence, turnover, and medication errors. The importance of this work is critical as NPD practitioners move forward in not only the development and design of NPD activities, but also in disseminating the financial impact and value they provide.
Nurse Residency Programs
There is a lot written regarding the need for new graduate RNs to take part in a standardized, evidence-based nurse residency program (NRP). The benefits are well documented and multiple resources are available to assist organizations in their design and development. To date, nurse residency programs, although highly recommended, are not mandatory. Earlier this year, the American Academy of Nursing issued a position statement to mandate employers to “fund and require all newly licensed graduate RNs to complete an accredited NRP” (Goode, Glassman, Ponte, Krugman, & Peterman, 2018, p. 331). They cite support from “the American Nurses Credentialing Center, the American Organization of Nurse Executives, the National Academy of Medicine, the National Council of State Boards of Nursing, the Carnegie Report, and The Joint Commission.” Although there is little disagreement regarding the need for programs to support RNs in transition, there are many considerations that would impact the health care organization—namely how such a mandate would be operationalized and who would pay for it. The American Academy of Nursing is committed to continuing work on their policy recommendation, so this will be a topic of interest for all NPD practitioners to follow in 2019.
Professional Development Associate Education
The ANPD, in collaboration with the Montana Nurses Association, has developed role recognition and education for the professional development associate, defined as “an individual who contributes to the overall functioning of a continuing education/professional development department in a substantive, measurable way” (Spangola, Dickerson, & Harper, 2018, p. 1). The role is competency based, grounded in the ANPD's standards of practice (Harper & Maloney, 2016) and national learning competencies from the Alliance for Continuing Education in the Health Professions (2014). Two cohorts of participants have completed an eight-webinar series and a full-day preconference workshop held at the ANPD convention in July that provided a deep dive into competency-based roles and responsibilities for professional development associates. Recognition of the knowledge and skills these individuals bring to continuing education departments will strengthen their work and improve outcomes. The ANPD will continue to provide education, support, and resources for this role, including a preconference workshop at the ANPD in the spring of 2019.
Environmental scanning is an important role of the NPD practitioner. Awareness and implementation of these key issues and others impacting the work will lead to improved practice, improved educational initiatives, and improved outcomes.
- Alliance for Continuing Education in the Health Professions. (2014). National learning competencies. Washington, DC: Author.
- Dickerson, P., Shinners, J. & Chappell, K. (2017). Awarding credit for outcome-based professional development. The Journal of Continuing Education in Nursing48, 97–98. doi:10.3928/00220124-20170220-02 [CrossRef]
- Goode, C.J., Glassman, K.S., Ponte, P.R., Krugman, M. & Peterman, T. (2018). Requiring a nurse residency for newly licensed registered nurses. Nursing Outlook, 66, 329–332. doi:10.1016/j.outlook.2018.04.004 [CrossRef]
- Harper, M. & Maloney, P. (2016). Nursing professional development: Scope and standards of practice (3rd ed.). Chicago, IL: Association for Nursing Professional Development.
- Josiah Macy Jr. Foundation. ( 2018, April. ). Improving environments for learning in the health professions. Paper presented at the Macy Foundation Conference. , Atlanta, GA. . Retrieved from http://macyfoundation.org/docs/macy_pubs/June2018_Summary_webfile_7.20.18.pdf
- Opperman, C., Liebig, D., Bowling, J., Johnson, C.S. & Harper, M. (2016). Measuring return on investment for professional development activities: Implications for practice. Journal for Nurses in Professional Development, 32, 176–184. doi:10.1097/NND.0000000000000274 [CrossRef]
- Opperman, C., Liebig, D., Bowling, J. & Johnson, C.S. (2018). Measuring return on investment for professional development activities: 2018 updates. Journal for Nurses in Professional Development. Retrieved from https://journals.lww.com/jnsdonline/Abstract/publishahead/Measuring_Return_on_Investment_for_Professional.99973.aspx doi:10.1097/NND.0000000000000483 [CrossRef]
- Spagnola, T., Dickerson, P. & Harper, M. (2018). Professional development associate: Results of a national survey. Chicago, IL: Association for Nursing Professional Development.
- West, C.P., Dyrbye, L.N. & Shanafelt, T.D. (2018). Physician burnout: Contributors, consequences and solutions. Journal of Internal Medicine, 283, 516–529. doi:10.1111/joim.12752 [CrossRef]