RN Competency Requirements-why so many obstacles?

BethCNOR, BSN, RN · Sep 25, 2009

These must be new. I didn't do any of that in Aug. I agree, it seems a little bit over the top! :confused:

elkpark · Sep 25, 2009

The idea is to make the process more intelligent and meaningful (re: maintaining competence and growing professionally) than simply requiring X number of CEUs. I've worked in states with the "X number of CEUs" standard, and it was a joke. RNs who didn't care about professional development simply got the required number of hours the easiest, cheapest way possible, regardless of whether the credits had anything to do with their clinical specialty, and the entire process was basically meaningless.

I am opposed in general to the idea of requiring cont. education for licensure renewal, but, if you're going to have some kind of requirement for renewal of licensure, at least NC's system actually makes nurses think and do cont. ed activities that relate to their real-life practice. I'm proud that my state BON chose to avoid the hypocrisy of a transparently meaningless requirement and simply "going through the motions". This is actually the first time since the system was implemented that I've heard anyone complain about finding it mysterious or burdensome. (And I'm wondering why you consider it "especially" unreasonable for BSN graduates?)

NC has always had high standards for nurses. Plenty of us think that's a good thing. :)

OR Dude · Sep 25, 2009

Thanks for the reply.

I'm still somewhat ticked. I've re-read the NC bon website. It states that the board has identified four dimensions that applies to all types of nursing (professional responsibility, knowledge based practice, legal/ethical practice, and collaborating with others). All four dimensions must be addressed in your learning plan activities. Also, your continuing education activities must be related to your learning goals (slippery slope of subjectiveness, which could be applied at a later audit; that is, you get an audit back stating...Hey, not all of your CE activities were related to your learning goals...it's evident, to the NC bon, that a few of these were chosen "arbitrarily").

So, what are the learning activities? You have the choice (wow, a choice) of eight options.

You can get national certification or re-certification by a national credentialing body recognized by the board. (Sounds good. CNOR, I believe would apply. But, I question whether national certification addresses all four dimensions...for example, do certifications directly address the dimension of collaborating with others? Or, is it somehow implied in the certification or certification process?)

You can complete 30 contact hours of continuing education activities. (Again, sounds good. But, make certain that these activities address all four dimensions, as stated above. This, in my opinion, is definitely a gray area subject to the NC board's interpretation, in case of audit, as to whether an RN's contact hours addressed all four dimensions. Conceivably, an RN could, in good faith, complete the contact hours, believing they address all four dimensions, only to be told, after audit by the NC bon, that the contact hour(s) did not address ALL four dimensions. Sorry, but after auditing your learning activities, we found that 5 of your contact hours failed your learning goals. Or, better yet, the bon decides that 5 of your contact hours were chosen "arbitrarily".)

You can complete a minimum of two semester hours of post-licensure academic ed related to nursing practice. (What exactly does this mean? Two hours of graduate work, for those with a BSN? Two hours towards a BSN, for those without a BSN? This sounds good. If you're in either area, you could claim as a learning goal, "I want to work toward completing my BSN, MSN, etc.).

Another option is completion of a board approved refersher course. (Where is the list of these approved refresher courses? Do you have to submit this info to the board and await their approval? How long would it take to get approved? Could be a timing issue.)

You can also do fifteen contact hours of continuing education activity and completion of a nursing project as prinicpal or co-principal investigator to include statement of the problem, project objectives, methods, and summary of findings. (Okay...now this one sounds right for all those RN's pulling double shifts to make the payments on those homes that they are in risk of having the bank foreclose. Of course, I'm being facetious, but seriously, how many full-time RN's, particularly those with families, are going to have time to chose this option? Hey, it's a noble option out of the eight to choose from, but realistically, I'm betting there won't be an overwhelming number of takers on this option. Also, are these investigations which include statement of problem, project objectives, methods, and summary of findings subjected to the same standards of academic investigations, say at the graduate level...complete with statistical data and correlations, etc.? Or, may I conduct an informal survey of healthcare workers who go to the crapper and return without washing their hands? I could see that as a statement problem, given how many surgeons who are guilty of this (by the way, does the state of NC require doctors to fulfill comparable competency requirements? Or, can their competency requirements be met on the beaches of Hawaii...paid for by the drug reps? I can see my problem statement: surgeons who spread fecal matter in the OR. Objectives: get them to stop spreading fecal matter in the OR. Methods: Personal observations in the men's room. Summary of findings: Nine out of ten surgeons don't wash their hands after wiping their butts after visiting the restroom eight out of ten times. Will this meet the requirements of this option? Or, do I need empirical statistical data to correlate my personal observations?)

Another option is fifteen contact hours of continuing education activities and authoring or co-authoring a published nursing-related article, paper, book, or book chapter. (Again, this option doesn't sound like it would agree with the full-time RN, who's got a family to feed, and another shift to cover to pay this month's bills. Again, this option sounds like it's tailored to the ivory-towered crowd. I mean, heck...I wrote a paper during school that instructors, fortunately, thought I should publish...but, that was during school...when my focus was school...when all that citation, etc. stuff determined whether or not I'd pass the class...when I knew the citation rules such as APA format...not when my focus is on paying the bills.)

Yet another option is fifteen contact hours of continuing education activities and developing and conducting nursing education presentation or presentations totaling a minimum of five contact hours for nurses or other health professional to include a copy of program brochure or course syllabi, objectives, content and teaching methods, and date and location of presentation. (Uh...just how much ivory is there in this ivory-towered option? Is this option structured for the average RN? Or, again, is it structured for those RN who are working in the academic setting? Seems to me if you're an RN, working in the academic world, the NC bon has lots of options to renew your license that really just reflects you doing your job anyway...you can renew your license strictly based upon doing the job your being paid to do! How many RN's in the hospital setting have similar options as defined by the NC bon? In fact, the NC bon specifically states that on-the-job training related to new policies, procedures or equipment (you know, the stuff that applies to doing your job in the hospital) is not an accepted continuing education activity. So, you work in the OR. You're given an in-service regarding new sterilzation equipment or techniques. Information that could save someone's life. That activity does not count towards continuing education. But, get a job teaching Nursing 101 at the local community college or university, make out your syllabi, etc., and that does count as an acceptable continuing education activity. Hey, talk about being opportunistic. I mean, most of these NC board members sure have skewed the rules to favor academic nursing versus good old-lifesaving hospital nursing. That sucks!)

Lastly, you have the option of fifteen contact hours of continuing education activities and 640 hours of active practice within the previous two years. (Is this really a separate option? I mean, it basically just modifies the thirty contact hours...it's an after thought...like, oh, by the way, if you worked 640 hours during the past two years (i.e., a full-time RN), then you only have to complete fifteen contact hours. How generous. I'd like to apply those in-service hours at the hospital regarding mastering the new sterilzation equipment, etc.,...uh, wait, as stated above, that's not an acceptable continuing education activity. Okay...well, while I was working at NC State, I taught a class on nursing ethics...here's my syllabi and a copy of my lecture...Great! You're approved. We've renewed your RN license. See you at the next annual statewide nursing convention, which will be held from X date to X date. This shouldn't interfere with your summer schedule since school doesn't start back until the week after Labor Day next year. Remember to bring your swimsuit!)

Bottom line, I'm for amending these competency requirements. I believe they are not tailored to meet the needs of the average RN. Average is a loaded term, but by average I mean the RN, as I hoped I've repeatedly expressed, who's working full-time, in a hospital/LTC/homehealth care setting/etc.,...where many days/nights are consumed with work, and the next day off is spent taking care of personal home/health.

GET REAL NC BON!!!!!!!!!!

As I've said, if I'm over-reacting, if I'm on target, or if I'm in left field, I'd like to know what others think.

If you read all this, I appreciate your attention. I apologize for any offensive remarks. I hope that this can lead to clarification of the NC competency requirements for RN license renewal, or better yet, amending of the requirements to meet the needs of the average RN.

Thanks.

VickyRN, MSN, DNP, RN · Sep 25, 2009

You're in left field.

OR Dude · Sep 25, 2009

You think I'm the only one who finds these competency requirements "mysterious or burdensome"? Read the NC bon frequently asked questions...the bon itself posts a frequently asked question that states, "Is there guidance from the Board about how to do a self-assessment or create a learning plan?"

Obviously, the NC bon acknowledges it has had a few more people, than myself, who have doubts or maybe as you'd say, find these competency requirements "mysterious", since they felt compelled to post such a question under the FREQUENTLY ASKED QUESTIONS link.

As for getting RN's to think, I do plenty of thinking every day on the job, and I too have completed competency requirements in other states, which consisted of attending conferences, etc. Did I have to think while doing these? Or, was I just going through the motions? Maybe I could say that everyone attending was just sitting there mindlessly going through the motions...motions of what? Thought?

As for burdensome, I'll refer you to my other post. Ponder it, then I'll discuss any thoughts you'd like to share.

It seems odd to me that you are opposed to the general idea of continuing education for license renewal, but yet, you are proud of NC avoiding the hypocrsiy of other states? So, 49 out of 50 states got it wrong?

I like your statement of this is the first time you've heard anyone complain. Seems to me you're portraying me as being on the fringe...a lone dissenter. Maybe you're correct. But, oddly enough, I've talked with others, and similar complaints were offered. I suppose there will always be a few that don't fall into lock and step (like those in 49 other states). But, instead of waving the proud flag of NC bon, maybe I can be one of those who seeks to help the NC bon reduce the number of FREQUENTLY ASKED QUESTIONS. Maybe the competency requirements can be written more clearly without having to post such a frequently asked question as, "Is there guidance from the Board..."

Think about it.

OR Dude · Sep 25, 2009

Hey, I'm in left field. Okay, why am I in left field? Are you going to explain your reason for referring to me in this manner? Or, are you just going to post an undignified and unprofessional response? Stating that I'm in left field is acceptable. But, not explaining why you think such is the case borders on crude.

elkpark · Sep 25, 2009

Look, I'm not trying to argue with you about this. You asked what other people thought, and you've gotten responses from two people who happen to disagree with you. Sorry you don't like that. You're entitled to your opinion, and we're entitled to ours.

kids · Sep 26, 2009

you're about to go 3 for 3, i also think you're in "left field" because i don't think you read all the info from the bon or if you did you were too busy arguing with it to absorb it.

you can get national certification or re-certification by a national credentialing body recognized by the board. (sounds good. cnor, i believe would apply. but, i question whether national certification addresses all four dimensions...for example, do certifications directly address the dimension of collaborating with others? or, is it somehow implied in the certification or certification process?)

why nitpick this to death. if the certification comes from a national entity recognized by the bon it satisfies the requirements, end of story. they are doing the leg work and spoon feeding you the information, they aren't asking you to guess anything. do a national certification (or re-certify) that applies to your practice and you're done.

you can complete 30 contact hours of continuing education activities. (again, sounds good. but, make certain that these activities address all four dimensions, as stated above. this, in my opinion, is definitely a gray area subject to the nc board's interpretation, in case of audit, as to whether an rn's contact hours addressed all four dimensions. conceivably, an rn could, in good faith, complete the contact hours, believing they address all four dimensions, only to be told, after audit by the nc bon, that the contact hour(s) did not address all four dimensions. sorry, but after auditing your learning activities, we found that 5 of your contact hours failed your learning goals. or, better yet, the bon decides that 5 of your contact hours were chosen "arbitrarily".)

you keep mentioning the need for the activities have to "address all four dimensions", please link me to where it says that because i really don't think you have a clear understanding of the instructions. no 'activity' has to address all four dimensions. you have to create a learning plan with 1-3 objectives (goals) and each objective (goal) has to relate to one of the four dimensions of practice (professional responsibility or knowledge-based practice or legal/ethical or collaborative practice).

another option is completion of a board approved refersher course. (where is the list of these approved refresher courses? do you have to submit this info to the board and await their approval? how long would it take to get approved? could be a timing issue.)

the list is right there on the bon website! from the menu on the left...education ->continuing education->refresher courses. http://www.ncbon.com/content.aspx?id=410

time shouldn't be a factor, this isn't something you're supposed to whip together in the week before you mail off your renewal check. these requirements aren't new, a person should be planning and working toward satisfying their next renewal requirements the day their current license goes into effect.

you can also do fifteen contact hours of continuing education activity and completion of a nursing project as prinicpal or co-principal investigator to include statement of the problem, project objectives, methods, and summary of findings. (okay...now this one sounds right for all those rn's pulling double shifts to make the payments on those homes that they are in risk of having the bank foreclose. of course, i'm being facetious, but seriously, how many full-time rn's, particularly those with families, are going to have time to chose this option?

how many nurses who work full time in an area of nursing completely unrelated to the above are going to bother? i think it's great that the bon has structured the requirement in such a way that nurses for who it is applicable can capture some of the paid work they are doing.

another option is fifteen contact hours of continuing education activities and authoring or co-authoring a published nursing-related article, paper, book, or book chapter. (again, this option doesn't sound like it would agree with the full-time rn, who's got a family to feed, and another shift to cover to pay this month's bills. again, this option sounds like it's tailored to the ivory-towered crowd. i mean, heck...i wrote a paper during school that instructors, fortunately, thought i should publish...but, that was during school...when my focus was school...when all that citation, etc. stuff determined whether or not i'd pass the class...when i knew the citation rules such as apa format...not when my focus is on paying the bills.)

no, but it will surely be utilized by the nurses who do make their living doing this.

yet another option is fifteen contact hours of continuing education activities and developing and conducting nursing education presentation or presentations totaling a minimum of five contact hours for nurses or other health professional to include a copy of program brochure or course syllabi, objectives, content and teaching methods, and date and location of presentation. (uh...just how much ivory is there in this ivory-towered option? is this option structured for the average rn? or, again, is it structured for those rn who are working in the academic setting? seems to me if you're an rn, working in the academic world, the nc bon has lots of options to renew your license that really just reflects you doing your job anyway...you can renew your license strictly based upon doing the job your being paid to do!

again, i think it's great that the bon has made it possible for nurses who aren't in traditional practice to satisfy the requirements.

in fact, the nc bon specifically states that on-the-job training related to new policies, procedures or equipment (you know, the stuff that applies to doing your job in the hospital) is not an accepted continuing education activity. so, you work in the or. you're given an in-service regarding new sterilzation equipment or techniques. information that could save someone's life. that activity does not count towards continuing education. but, get a job teaching nursing 101 at the local community college or university, make out your syllabi, etc., and that does count as an acceptable continuing education activity. hey, talk about being opportunistic. i mean, most of these nc board members sure have skewed the rules to favor academic nursing versus good old-lifesaving hospital nursing. that sucks!)

dude, really. on the job inservices are not and never have been a source of ceus unless your employer arranges to have someone come in to do it. those rules that are "skewed" for favor nursing in academia are very difficult and more time consuming requirements to achieve than 15 hours on online ceus that nursing working in 'front line' positions have to take.

bottom line, i'm for amending these competency requirements. i believe they are not tailored to meet the needs of the average rn. average is a loaded term, but by average i mean the rn, as i hoped i've repeatedly expressed, who's working full-time, in a hospital/ltc/homehealth care setting/etc.,...where many days/nights are consumed with work, and the next day off is spent taking care of personal home/health.

and i believe they are very reasonable and i hope my state implements something very similar.

i hope that this can lead to clarification of the nc competency requirements for rn license renewal, or better yet, amending of the requirements to meet the needs of the average rn.

i don't get what is so unclear to you. i'm not even from nc and the requirements are simple as hell.

lastly, you have the option of fifteen contact hours of continuing education activities and 640 hours of active practice within the previous two years. (is this really a separate option? i mean, it basically just modifies the thirty contact hours...it's an after thought...like, oh, by the way, if you worked 640 hours during the past two years (i.e., a full-time rn), then you only have to complete fifteen contact hours.

640 hours over 2 years is less than 6.5 hours per week, not full time. i think the ceu requirement should be much higher unless the person is in nursing school.

really, you sound like someone who feels entitled to you license because you took boards & gave the bon money. there are a lot of states that feel that way too, i'd suggest moving. i mean really, how dare nc require you to put any time or effort into advancing your practice as a nurse.

i read this: http://www.ncbon.com/content.aspx?id=664 and in under an hour completed all the requirements to renew a nc rn license and found free, online ceus accredited by sources approved by the nc bon that satisfied the 3 objectives i wrote for myself.

OR Dude · Sep 26, 2009

I respectfully appreciate your opinions. I'd prefer to think of this as a healthy debate. I apologize for coming across as argumentative. I have strong emotions concerning this issue. I would like to think there are others who want more clarity from the NC bon concerning this issue, and I believe there are (referring to the bon's Frequently Asked Questions link, again).

If I've come across as being disrespectful and offensive, then let me know, and I will apologize, since my intention is to remain civil and respectful. Yet, I request, in reference to another post, please support any opinions and refrain from disparagingly terse labels.

OR Dude · Sep 26, 2009

really, you sound like someone who feels entitled to you license because you took boards & gave the bon money. there are a lot of states that feel that way too, i'd suggest moving. i mean really, how dare nc require you to put any time or effort into advancing your practice as a nurse.
i read this: http://www.ncbon.com/content.aspx?id=664 and in under an hour completed all the requirements to renew a nc rn license and found free, online ceus accredited by sources approved by the nc bon that satisfied the 3 objectives i wrote for myself.

do i feel entitled to my license? uh, yes. why? because i've invested the time and money (i.e., nursing school/boards and fees). should i not feel entitled to my license? would it be unreasonable for me to have done all that was required and then not feel a sense of entitlement? i think it would be unreasonable to have invested so much and not feel a sense of entitlement. supposing a person went through four years of nursing school, paid their fees, passed boards, completed all the requirements, shouldn't they feel a sense of entitlement?

how dare the nc bon require me to put any time or effort into advancing my practice as a nurse? you're getting a bit edgy, huh? i don't have any problem putting forth the time or effort into advancing my practice as a nurse. i've done it for years.

hey, if you believe the requirements posted by the nc bon are simple as hell, that's great. but, apparently, the bon knows some people may have doubts (or, maybe they're just nitpicking...maybe, instead, you mean they aren't certain).

"you keep going on about how the activities have to "address all four dimensions", please link me to where it says that because i really don't think you read the instructions. again, i don't think you actually read the instructions. no 'activity' has to address all four dimensions. you have to create a learning plan with 1-3 objectives (goals) and each objective (goal) has to relate to one of the four dimensions of practice (professional responsibility or knowledge-based practice or legal/ethical or collaborative practice)."

now, this is may be helpful. your understanding is that the objective/goal has to relate to one of the four dimensions, but not the activity. i can see that. but, i'm still concerned about what the nc bon means when they state contact hours cannot be chosen "arbitrarily". what's the standard for chosing "arbitrarily", and if the audit finds your choice of contact hours were chosen "arbitrarily", then what is your recourse?

"dude, really. on the job inservices are not and never have been a source of ceus unless your employer arranges to have someone come in to do it. those rules that are "skewed" for favor nursing in academia are very difficult and more time consuming requirements to achieve than 15 hours on online ceus that nursing working in 'front line' positions have to take."

i agree. on the job inservices are not and never have been a source of ceus. but, i don't consider the learning that takes place working in "front line" positions to be less difficult or less time consuming than that in the academic workplace. i'd contend that learning on the "front line", in some/many forms, is more difficult and can be more time consuming when they are directly related to a patient's outcome. i think a person would be very concerned to make certain a "front line" nurse has learned their job inservice, as opposed to the academic accuracy of a syllabus. for instance, if a person is receiving an implant in an orthopedic surgery, i'd contend that learning the inservice for proper sterilzation carries more substantive value than the lecture at the local community college. or, an inservice on proper medication dosage administration, say of heparin...don't give the babies adult doses...learn how to identify the medication label properly...remember all the infants several months ago who suffered the consequences? maybe i shouldn't weigh the differences between "front line" nurses and academic nurses. yet, i know, when i'm a patient in the hospital, or my family member is, my nurse's knowledge or learning from inservices has value and meaning.

refresher course list...thank you, i overlooked it.

yes, 640 hours is less than full-time, and i am very aware of that.

you stated after reading the reference link, "...in under an hour completed all the requirements to renew a nc rn license and found free, online ceus accredited by sources approved by the nc bon that satisfied the 3 objectives i wrote for myself." i'm curious which option you chose? since you mentioned online ceus, i'm wondering if you chose the option of completing 15 contact hours? or, was it 30 contact hours? it took you less than 60 minutes to complete all the requirements? did it take you less than 60 minutes to complete the 15 or 30 contact hours? this, i'd like to know.

i'll agree the end of the story is to do or renew a national certification. that does seem straightforward, and very clear.

thanks for your input into this discussion.

sincerely.

kids · Sep 26, 2009

You stated after reading the reference link, "...in under an hour completed all the requirements to renew a NC RN license AND found free, online CEUs accredited by sources approved by the NC BoN that satisfied the 3 objectives I wrote for myself." I'm curious which option you chose? Since you mentioned online CEUs, I'm wondering if you chose the option of completing 15 contact hours? Or, was it 30 contact hours? It took you less than 60 minutes to complete all the requirements? Did it take you less than 60 minutes to complete the 15 or 30 contact hours? This, I'd like to know.

Perhaps I wasn't clear in the portion you quoted so I'll rephrase it. In under an hour I printed and read all the instructions from the BoN website, completed all the forms and exercise and went online to Medscape and found free CEUs accredited by sources approved by the NC BoN that directly related to the 3 objectives I wrote for myself. As I'm employed full time and the BoN provides for the bare minimum of 15 hours I stopped looking for them at 15. Fifteen hours of online CEUs over 2 years is hardly a time or financial burden..

Now, this is may be helpful. Your understanding is that the objective/goal has to relate to one of the four dimensions, but not the activity. I can see that.

That isn't my understanding, taken directly from the 'Learning Plan' worksheet on the BoN website:

Next, create a learning plan that will address your needs and interests. Your learning plan should include
from one to three learning objectives that can be achieved within the next two years, consistent with your
license renewal cycle. Each learning objective should be related to a dimension of practice.
Learning Objective I want to:
________________________________________________
This learning objective relates to the following dimension of my practice: (circle one or more)
1)professional responsibility 2)knowledge-based practice 3)legal/ethical 4)collaborative practice
But, I'm still concerned about what the NC bon means when they state contact hours cannot be chosen "arbitrarily". What's the standard for chosing "arbitrarily", and if the audit finds your choice of contact hours were chosen "arbitrarily", then what is your recourse?
From the FAQs page:
The self assessment, personal learning plan, and goals are the driving forces for the Continuing Competence process. Continuing education activities should not be selected arbitrarily; they must be related to your learning goals.
The logical standard for whether or not a source was chosen arbitrarily would be how close it relates to the learning goals. And the recourse for would be the same as anytime you disagree with the BoN's decision...appeal.
But, I don't consider the learning that takes place working in "front line" positions to be less difficult or less time consuming than that in the academic workplace. I'd contend that learning on the "front line", in some/many forms, is more difficult and can be more time consuming when they are directly related to a patient's outcome. I think a person would be very concerned to make certain a "front line" nurse has learned their job inservice, as opposed to the academic accuracy of a syllabus. For instance, if a person is receiving an implant in an orthopedic surgery, I'd contend that learning the inservice for proper sterilzation carries more substantive value than the lecture at the local community college. Or, an inservice on proper medication dosage administration, say of heparin...don't give the babies adult doses...learn how to identify the medication label properly...remember all the infants several months ago who suffered the consequences? Maybe I shouldn't weigh the differences between "front line" nurses and academic nurses. Yet, I know, when I'm a patient in the hospital, or my family member is, my nurse's knowledge or learning from inservices has value and meaning.
Who do you suppose writes those inservices? Researching evidence based practices, compiling the information and presenting it in a cohesive format is extremely time consuming, nurses base entire careers on it.
Teaching requires at minimum a Masters, the syllabus is simply an outline of the material to be taught/course objectives and is based on the college's requirements for the course.
Personally I don't care how many hospital based inservices my nurse has attended, I do however care how much continuing ed they have had from accredited sources where the facts have been checked for consistency with current standards of care and practice. I've encountered far to much misinformation presented as fact at employer presented inservices.
You seem hostile that the BoN puts conditions on your continued practice as a nurse, you come across as seeing monsters where there are none.
I fail to see how requiring self reflection and evaluation and that the CEUs taken relate to your practice is a bad thing. No one is without weakness in their practice as a nurse and CEUs that have no relevance to ones practice is useless.