Continuing Education in Washington reviewed

klwtiger · Dec 6, 2011

Staying cool under fire is vital in Nursing and is the topic of the CEU I have completed next bringing my total to 7 hours. Each unit completed requires successful completion of a quiz to receive credit with a score of 75% or better with the option of re taking the test until passed or to improve the score. For the first time I completed the test with 100% on the first try. This article was a little wordy though still informative and in many ways confirmed what I already know and put into practice though will serve as a reminder.

The main point of the article described 3 communication styles, passive, assertive, and aggressive. The ideal style depends on the situation and is a delicate balance of multiple types. The most important thing addressed by the article is the reminder that it is important to listen and acknowledge the feelings of the person communicating. As nurses we are in an important position as we deal with patients and their families who are ill, scared, and hurting. It is not at all uncommon to be approached in anger by a patient, family member or co worker. It is important that we do not react as would be a natural reaction but instead to validate their feelings and offer up a solution. Sometimes the most important thing in effective communication is to not communicate at all but to listen and if necessary express your need to take a step back and respond at a later time to refrain from responding in haste.

I once had a patient who was rather young to be in long term care because of multiple sclerosis. She was often angry, upset, and resistive to recommendations of staff and her own doctors as she was always hoping to get better. Quite often she would refuse medications or physical therapy and would spend excessive amounts of time in bed though was constantly looking for the miracle cure or quick fix. I was able to build a rapport with this patient and she would listen to me when she would not listen to anyone else. Some of the concepts discussed in this article I believe contributed to the success of our relationship. The first thing I did was listen and allow her to express her feelings. I encouraged her to acknowledge her feelings whatever they were and made it OK to say “this sucks”. Everyone always tried to encourage her to think positive and work hard and be hopeful. Positive thinking is important and that was often the mood we focused on though allowing her to mourn her losses was equally important. Being honest was also important. How often do medical personnel falsely reassure saying you will be just fine, you will be back on your feet in no time, when really no one knows. We often said hope for the best prepare for the worst. When she would have a setback we would discuss the possibility of the decline being the new normal and the steps we could take to adapt and overcome although would hope and work towards getting back what was recently lost whether it be being able to feed herself or control her wheelchair. Through it all to the end effective communication I think overall improved her quality of life.

More and more I am encountering continuing education that is applicable to both my personal and professional life and this was another one of those cases. I like to think that this can best be attributed to the fact that being a better person makes us a better nurse in general.

klwtiger · Dec 6, 2011

A benefit to the continuing education requirement is it affords us a dual benefit if we would like to learn more about something afflicting ourselves or family members. I suffer from Fibromyalgia and used the opportunity to solidify and expand upon my knowledge of my ailment. I completed a 0.75 credit using the Epocrates CME application. The majority of the information was not new to me through doctor visits and personal research via the internet though it was comforting to see it all organized in an official matter meant for physicians. The focus of the article was on diagnosis based on symptomology and the importance of recognizing that although the symptom set is fairly consistent in most fibro patients that degrees and variances in symptoms can vary dramatically. One patient might be most disturbed by sleep disturbances while another by cognitive deficits though the common major symptom is widespread pain. It also discussed the change in the school of thought of using tenderpoints as a main diagnostic tool while focusing more on the collection of symptoms and time symptoms have been present.

Although I do not really encounter fibromyalgia in long term care, managing my symptoms can affect my nursing practice. I also work along a few other nurses whom suffer as well and we can support each other as we manage our symptoms and discuss what works and doesn’t work. I have further solidified the need to take better care of myself to be a better nurse. You would think by now it would sink in but as they say nurses make the worst patients.

klwtiger · Dec 6, 2011

To round of the 0.75 I found another CEU on Epocrates for 0.25 and thought it appropriate that it was a study on pain. Although it was only 0.25 CEU’s it took me closer to 0.5 hrs to complete it which I have found common for these “short” units. Although not indicated in the title this article quickly became apparent that it was about how to deal with a patient experiencing pain from fibromyalgia. It first briefly touched on how to recognize the symptoms of fibro then how to effectively treat the pain. One of the biggest challenges of a patient with fibro is being believed and not labeled as a drug seeker. This patient felt that exact frustration as she went from doctor to doctor seeking answers to her pain until she was finally properly diagnosed. She was treated with a multidisciplinary approach using pain medications, stress relief and exercise which showed slow but steady improvement. Also discussed was the desire by many patients to immediately jump to wanting disability and that this is not necessarily the best course of action. Disability removes the social aspect of life and work as patients succumb to the symptoms and isolate themselves. Instead it was recommended to reduce workload temporarily as symptoms are brought under control.

Again this does not directly affect my current nursing practice though it does help me to remember to encourage patients to do even a little through pain rather than succumbing. It is also a reminder to take a patients word at pain as it might not show but be very real and it is important to validate the patients feelings.

Guest717236 · Dec 7, 2011

This part bothers me, a lot. If a nurse decides to take time away from nursing to start a family, or if a nurse must take an extended medical leave (let's say for cancer treatment) I feel this requirement creates a hardship. If one cannot work, one probably can't volunteer either.

It is very much a hardship for many nurses who are carrying for elderly family members .

With the advancing age of the workforce in nursing in many areas, nurses should not be punished for taking time off imo to care for their family members or themselves.

The healthcare system is not user friendly in many ways so many

are doing the best they can to balance personal and professional

needs.

klwtiger · Dec 7, 2011

If volunteer work qualifies then I would think caring for a family member would to if it requires any use at all of nursing knowledge. I will look into that possibility as well. I know many people who have stepped away from careers to be a full time caregiver for a family member so it is a very real problem that needs addressed.

Guest717236 · Dec 7, 2011

If volunteer work qualifies then I would think caring for a family member would to if it requires any use at all of nursing knowledge. I will look into that possibility as well. I know many people who have stepped away from careers to be a full time caregiver for a family member so it is a very real problem that needs addressed.

Thank you for addressing this issue, many nurses are currently in this situation.

Apology, in my above post it should read caring not carrying.

klwtiger · Dec 10, 2011

In thinking of what I would do next to complete continuing education requirements I wanted to try something different than just read and answer so I did a Google search for interactive continuing education for nurses. I was directed to RN.com that had a handful of courses available for free as well as some that can be purchased. Another option they offer is a subscription for unlimited CEU’s for a year for approximately $35. Again I do not find it necessary to pay for continuing education with so many free options available. I also immediately noticed on this site that among even the free choices, there are a few options for more than 1 hour which is nice if you have the time to get more than an hour in at a time and it is on one subject matter.

I first chose a unit on Critical thinking for 2 contact hours. This unit was interactive slide show based meaning rather than just scrolling through and reading the slides were colorful with bulleted information that was clear and easy to understand. There were case studies that were simple yet really demonstrated the point being made. The course examined three major uses of critical thinking, how to use critical thinking to approach a patient problem, collaborate with other disciplines, and teaching new nurses to develop their critical thinking skills when precepting. The most useful thing I gained from this course was the reminder that critical thinking is an ever present process that when used properly streamlines and improves patient care. As I prepare to enter a patients room to do an assessment or address a problem I quickly think of what I already know about the patient and the disease process. This will help me streamline their assessment focusing on the areas most important to them then branch out as the findings lead. If I am assessing someone with a respiratory then to start with blood pressure , Finger stick, or skin check might delay an important finding or lead me in the wrong direction. I would first do a thorough respiratory and infection directed assessment and branch out from there. If I find the patient to have low O2 sats or a high fever I can find those values and address them sooner than if I were to start with BP or start ant the head and work to the foot which can delay the simple interventions such as administering O2 or Tylenol then proceeding with the assessment. Another valuable piece to the puzzle that often gets over looked is reflection. Especially in a n emergent situation it is important to mentally debrief and think over what went well and what did not. The next time a similar situation occurs I can than remember what worked well and avoid what did not and will have broadened my knowledge base to know what to look for if a similar patient needs my attention.

Aside from being more interactive this made the unit more engaging and held my attention, the assessment tool was longer and more specific. It was 15 questions with a 75% required for passing. Which is usual but I found myself taking my time to really think about the answers which assisted in really reviewing the unit. I was able to pass on the first try though if I did not I had the option to review my wrong answers (though the right answer was not reviewed) then re take the exam for credit. A certificate was then made available which I could email and/or print out and add to my file. The unit took me approximately 90 minutes to complete, 15 minutes to take the test for a total of 105 minutes for which I received 2 contact hours. I will definitely be using this web site as a future option.

klwtiger · Dec 10, 2011

To bring my total up to 13 hours, I completed a 3 hour course on Heart Failure also from RN.com. This course was also interactive and had the addition of mini quizzes along the way which did not count in grading though did assist in solidifying the information presented. Although this course was worth 3 hours credit the entire process took me about an hour and a half. I can see this taking significantly shorter or significantly longer depending on how quickly the learner reads and grasps the information as well as level of prior knowledge of the subject matter. Heart failure in general is of course not new information for me although the way this was presented was so clear and concise some confusions I had were cleared up and I overall feel I have a better grasp on the subject. The unit covered symptomology, diagnostics, treatment including surgery, medications and life style changes and medications. The post test was again longer though more straightforward yet in depth to other units I have completed and I was able to pass on the first attempt as well as review the answers I had gotten wrong for additional clarification. This unit was presented by the same source as the critical thinking course and I definitely plan on continuing to seek learning opportunities from them in the future because of the thoroughness and clarity of the information they present. It was put together by the masters of nursing education program through Georgetown University.

klwtiger · Dec 10, 2011

One of the things I discussed early on in this process was the value of a certified continuing education unit versus participation in an independent reading activity or work in-service which does not have to meet any standards but rather somehow advance your knowledge in nursing. I began thinking about the validity of this and wondering if it was plausible that a person could complete an independent activity and gain more than someone with a fancy certificate showing completion of a certified unit. I then looked at the next unit I was planning to complete which was Infection Control for 3 hours. I thought in all my nursing education and in-services at work and basic knowledge, I wonder if I could complete this course without completing the required reading? I then took the test without even opening the unit and passed easily with an 84%. This was quite an eye opener in that I realized a person could easily look for CEU’s online that they have a good base of knowledge in and if it allows the user to go straight to the test they could easily complete their required hours with fancy certificates to show for it without ever having learned anything. On the contrary if a person spends time researching something regarding them or a patient, attends in-services, or sits down to read a nursing magazine article they will have in actuality gained more knowledge than the person with the fancy certificates. As is in most situations in life it comes down to integrity. The purpose of the requirement is to ensure nurses are continuing to further their medical knowledge for the good of the patient but like most other things there are loop holes and ways around the system.

klwtiger · Dec 10, 2011

Officially I have now completed 15 certified continuing education units and now have the fancy certificates to show for it. Although I did not really need the units since I am currently in school, I did gain a lot of knowledge through this process and not just about the topics I studied to get the units. I learned I did better with the more interactive units, second on the webinars and lastly on those based on reading just a plain long article. I was able to focus better, grasp the information as well as retain it and did better on the first try of the post test. There is a vast array of ways to complete the requirement be it independent or attending an official workshop or in service. In all the most insight I gained was that like in most things in life, what effort you put into something will equate what you get out of it. Some topics I was able to really able to take to heart and some were more time passers that may or may not apply. Overall if the requirement is a good thing or not, is yet to be seen. There are ways around it as demonstrated in the last 3 hours of credit I obtained, not much might be gained by it if it is information that may not apply, and if you are anything like me or many nurses I know our knowledge of nursing is ever expanding and in no way can be measured or tallied by a log sheet or certificate. How many times in a week do we look up a new medication or disease process or research alternative treatments for a patient not responding well to conventional ways? If I kept track of each of these instances that actually added to my knowledge I would need a pretty big notebook. Hopefully if nothing else those that have followed me along on this journey will learn there are several ways to complete the requirement that are free and will add to the knowledge base of the learner.

I want to thank you all for following along and engaging. So far this thread has almost 500 visits, which is exciting. If I helped demystify the process for even one fellow nurse then I have succeeded in what I set out to do. Although in an official capacity my work here is done, I plan on continuing to follow this thread and interact. I am still looking into the possibility of using care of a loved one as fulfilling the hours required for nursing practice, I have not found the right person yet though I assure an answer will come hopefully sooner than later.

:tku::tku::tku:

kids · Dec 10, 2011

"In a three year period it is required to have completed 531 hours of active nursing practice. This can be in a professional paid or volunteer capacity. The requirement only states that it must be performing duties required of licensed personnel."
This part bothers me, a lot. If a nurse decides to take time away from nursing to start a family, or if a nurse must take an extended medical leave (let's say for cancer treatment) I feel this requirement creates a hardship. If one cannot work, one probably can't volunteer either.

As someone who has had to take lengthy breaks from nursing for health reasons I diagree. It really is a low number of hours that can be spread over 3 years or done all at once. As heartless as it sounds do we really want people returning to work after a lengthy absence without having refreshed or maintained their skills at all?

The roll out of this does include some exceptions for newly graduated nurses. Even if one were unable to obtain employment immediately following graduation they have 3 years in which to complete required hours.

kids · Dec 10, 2011

I do want to say thank you to klwtiger for starting this thread and posting so much information about Washington's new requirements, it is a new requirement and the information can be overwhelming for people who are new to it.

I hold licenses in multiple states, each with their own practice and CEU requirements.

I keep a notebook tabbed by quarterly and file paystubs/payroll print outs, certificates and personal exercises there. It's just another part of the monthly book keeping for my household. When WA announced the changes I simply added them to the mix.

The vast majority of us, in any given state, will never be asked to produce our documentation. By staying on top of it from the outset you'll never (if chosen for audit) be in the position of trying to scramble for your supporting documentation.