Ironically, the World Health Organization designated 2020 as the International Year of the Nurse and the Midwife when at the same time, nursing has been challenged at a global level to manage care for patients, families, and other health care professionals affected by COVID-19. As an industry, health care has been one of the professions most directly affected by COVID-19, both operationally and financially. According to the American Mobile Nursing Healthcare (2020) report, 2020 Healthcare Trends White Paper Revisited, there has been a 24% decline in overall health care spending at acute care hospitals and outpatient centers, resulting in an estimated $60.1 billion loss each month. Just as concerning, the American Hospital Association (2020) has projected a $300 billion loss for all of 2020. This financial stress only adds to the demands being made on nursing professional development (NPD) practitioners in the planning, delivery, and evaluation of educational programs.
Impact of COVID-19 on Nursing Continuing Professional Development
Nurses are educated to prepare for, and adapt to, the unexpected. Nursing continuing professional development (NCPD) allows for flexibility in educational activity planning to ensure that nurses receive the critical knowledge to apply to practice when they need it the most. Quality accredited NCPD can, and should, be fluid and flexible, especially in times of crisis such as the COVID-19 pandemic. The COVID-19 pandemic has created the need for rapid development and implementation of NCPD to scale up nurses and other health care providers to meet a surge in critically ill patients (Dickerson & Graebe, 2020). Through retooling and upskilling nurses and other health care providers, professional development is more important than ever before. A heightened need for flexible professional development activity planning that fully integrates the professional environment is integral to prepare nurses to meet the challenges posed by this pandemic.
NCPD underscores the importance of learning, professional development, and competency-based education to meet the professional needs of professional nurses and health care teams. Scaling up to meet surge capacity and higher than normal critical care acuity levels was challenging for organizations. Nurses and other members of the team were asked to use NCPD to retool and reskill nurses to meet fast-growing demands while leveraging their knowledge and skills in the educational design process and quality outcomes.
A learning guide was developed by the American Nurses Credentialing Center (ANCC) to assist accredited providers in applying NCPD accreditation standards in real time by reducing documentation burden and ensuring quality NCPD was planned, implemented, and evaluated (ANCC, 2020). Moving forward, we must be nimble and readily recognize NCPD as an opportunity to promote innovation and entrepreneurship to advance professional practice and to address key organizational and community goals (Graebe & Chappell, 2019).
Impact of COVID-19 on Practice Transition Programs
Revisions in transition program design and delivery closely align with the changes mentioned above for NCPD—moving from live, in-person learning to virtual education while using best practices. What has been unique for transition programs is that clinical experiences for both students and new graduate RNs have had to adjust based on the organization's engagement with the pandemic and the availability of preceptors and other support staff.
Despite working within the limitations and challenges of 2020, practice transition leadership has continued to evolve to address issues that impact or expand the success of the program. Several articles have been published that describe the experience of coping with the pandemic, along with creative solutions to continue engagement in nurse residency programs (Houle et al., 2020; Malone et al., 2020; Shinners & Cosme, 2020; Shinners & Africa, 2020). Table 1 provides a list of resources that have been used to help meet the educational and wellness needs of nurses.
Resources for Nurses
The Nursing Professional Development: Scope and Standards of Practice speaks to outcomes identification (Harper & Maloney, 2016) as part of an NPD practitioner's competency set. Focus on outcomes speaks to both individual learning activities and broader programs. The outcome is written in measurable terms and focuses on acquisition of learning, competence, and change. Accreditation standards in NCPD and Practice Transition Accreditation Program© (PTAP) programs are outcomes that require structure and processes for program evaluation on a continuum that uses performance improvement frameworks to enhance or improve the program, performance of its nurses and the health care team, the organization, and the system and/or community. 2020 continued to demonstrate the importance of outcome measurement and management in implementation of evidence-based practices, decision-making, and providing financial justification for educational programs.
Creating Healthy Work Environments
Healthy work environments continue to focus on the creation of an optimal clinical learning experience that influences health care professionals, no matter where they are in their professional careers. Strategies to build such an environment are based on an interprofessional, multilevel approach that starts with an assessment that moves from anecdotal to baseline data. After issues are identified, measures are taken to increase awareness, providing education and opportunities for dialogue. Patient-focused communication that occurs during grand rounds, committee meetings, and daily interactions follow agreed-upon expectations for professional behaviors. Then, these professional behaviors are reflected in policies that address disruptive behaviors and their consequences. The goal is to see improvement over time that is sustainable, resulting in increased nurse and patient satisfaction.
Education and Training
The importance of precepting continues to be recognized as a key component for successful transition and nursing professional development programs. The Association for Nursing Professional Development (ANPD) fully appreciates the role preceptors play, as reflected in their 2020 position statement, Preceptors. According to M. Harper (personal communication, October 20, 2020), ANPD's director of nursing professional development, ANPD has commissioned a national study conducted by Harper et al. to further investigate the role of the preceptor. Broadly, the study supports Ulrich's model of precepting, as delineated in her book, Mastering Precepting: A Nurse's Handbook for Success (Ulrich, 2018). Data have been analyzed and findings will be published in 2021.
The American Academy for Preceptor Advancement (AAPA) continues to provide individuals with resources and certification while promoting preceptoring as a specialty practice with its own core of knowledge and expertise. In a personal communication (October 28, 2020), D. Swihart, CEO and managing partner of AAPA, declared that AAPA continues their work as they recognize “how competent and engaged preceptor specialists contribute to critical role and job transitions across organizations, supporting a just culture and high reliability in practice and patient safety.” D. Swihart also emphasized that “AAPA is committed to promoting the highest standards for qualified preceptors through competency-based certifications, increasing their credibility and value, and expanding their ability to help organizations achieve the best possible outcomes for their students and employees in all work systems, programs, and environments.” Finally, leveraging preceptor programs against ANCC, NCPD, and PTAP program accreditation standards recognize the impact of preceptor programs to achieve organizational goals such as recruitment, retention, and patient safety.
2020 brought on a tremendous increase in work-related stress, anxiety, and burnout for health care professionals, resulting in the need to focus on mental health behaviors and organizational responses. Further, we must recognize that wellness in NCPD allows for the nurse to identify stressors that contribute to their work environment and performance. Through NCPD, nurses can apply learned wellness tactics to reduce stress and burnout. For the NPD practitioner, their initial response needs to stay in tune with their own mental health. As a profession, we need to care for ourselves, our patients, and our families by practicing mindfulness and reflection. We need to be watchful of the effects of constant stress on all staff and act accordingly. Finally, we need to advocate and recognize behaviors that support the well-being of front-line workers.
There is no denying that NPD practitioners have been affected in 2020 by COVID-19, but they have also created opportunities to expand current practices to meet the needs of nurses in real time. Going into 2021, it is important that these programs and practices continue to evolve, be valued, and be leveraged. We need to learn from what the pandemic has taught us while we strengthen our health system processes. Preparing for future situations where a coordinate response by NPD practitioners will help to create additional capacity to meet the educational needs of nurses.
- American Hospital Association. (2020). Hospitals and health systems continue to face unprecedented financial challenges due to COVID-19. https://www.aha.org/guidesreports/2020-05-05-hospitals-and-health-systems-face-unprecedented-financial-pressures-due
- American Mobile Nursing Healthcare. (2020). 2020 healthcare trends white paper revisited. https://www.amnhealthcare.com/2020-healthcare-trends-revisited/
- American Nurses Credentialing Center. (2020). NCPD guide for leading learning in real-time.
- Dickerson, P. & Graebe, J. (2020). Nursing continuing professional development—A paradigm shift. The Journal of Continuing Education in Nursing, 51(7), 297–299.
- Graebe, J. & Chappell, K. (2019). Looking back and leaping forward: A reflection on the evolution of nursing continuing professional development credentialing. The Journal of Continuing Education in Nursing, 50(12), 531–533 doi:10.3928/00220124-20191115-01 [CrossRef] PMID:31774921
- Harper, M. G. & Maloney, P (Eds.). (2016). Nursing professional development: Scope and standards of practice (3rd ed.). Association for Nursing Professional Development.
- Houle, J., Fleming, D., Wright, A. & Windey, M. (2020). Residency classes going virtual: The COVID-19 crisis. Journal for Nurses in Professional Development, 36(5), 301–303 doi:10.1097/NND.0000000000000673 [CrossRef] PMID:32890187
- Malone, M., John, E. & Ridgeway, P. (2020). Rapid deployment of a virtual nurse residency program; virtually no idea where to start. Journal for Nurses in Professional Development. Advanced online publication. doi:10.1097/NND.0000000000000683 [CrossRef]
- Shinners, J. & Cosme, S. (2020). COVID-19: Perspectives from nurses across the country. The Journal of Continuing Education in Nursing, 51(7), 304–308 doi:10.3928/00220124-20200611-05 [CrossRef] PMID:32579225
- Shinners, J. S. & Africa, L. A. (2020). Rapid validation of clinical competencies in a time of crisis. Nurse Leader. Advance online publication. doi:10.1016/j.mnl.2020.06.012 [CrossRef] PMID:32837352.
- Ulrich, B. (2018). Mastering precepting: A nurse's handbook for success: Vol. 2. Sigma Theta Tau.
Resources for Nurses
|Wellness||The Emotional PPE Project. The website offers free mental health care from licensed professionals for health care workers.||https://www.emotionalppe.org/|
|American Association for Critical Care Nursing. Coaching nurses on building resilience in a turbulent time. This webinar provides strategies to promote resilience in staff nurses.||https://www.aacn.org/education/ce-activities/wb0061/coaching-nurses-on-building-resilience-in-a-turbulent-time?target=ce-library|
|Education & Training||American Nurses Credentialing Center. NCPD guide of leading learning in real time. An online resource that provides potential topics and educational strategies for COVID-19.||https://cdn2.hubspot.net/hubfs/4850206/ANCC-2417%20NCPD%20Real%20Time%20Learning%20Guide-FNL2.pdf?utm_campaign=261878%20ANCC%20Brand%20Engagement&utm_source=Jennifer%20Graebe%20Social%20Media&utm_medium=Accredited%20Providers%20&utm_term=NCPD%20Real%20Time%20Guide&utm_content=NCPD%20Customer%20Engagement%20|
|American Association for Critical Care Nursing. Agile COVID education: Adapting nurse orientation & residency. This podcast provides methods for adapting nurse residency programs to the changing environment amidst the pandemic.||https://www.aacn.org/clinical-resources/covid-19/podcast-series/agile-covid-education|
|Healthy Work Environment||American Association for Critical Care Nursing. AACN health work environment assessment tool. This free assessment tool helps you to evaluate your work environment||https://www.aacn.org/nursing-excellence/healthy-work-environments/aacn-healthy-work-environment-assessment-tool|
|National Collaborative for Improving the Clinical Learning Environment. Achieving the optional interprofessional clinical learning environment. Offers several free publications that address the creation of a positive interprofessional clinical learning environment||https://ncicle.org/|
|Education & Training||Association for Nursing Professional Development. Preparing for educational emergencies. A recorded webinar that provides strategies for rapid deployment of staff education.||https://www.anpd.org/blog/anpd-webinar-recording-preparing-for-educational-emergencies-0|
|Association for Nursing Professional Development. Tap into technology to make education more accessible—using videos and QR codes. A recorded webinar providing strategies for optimizing virtual education.||https://www.anpd.org/p/cm/ld/fid=1401&blogaid=1738|