Should Continuing Education for Nurses be mandatory in all states?

[Brian]

Should Continuing Education for Nurses be mandatory in all states?

If so, why? If not, why not?

Clarification: CEUs, ie. some states require 24-30 hours of continuing education units every 2 years to maintain their license.

FYI: You can find each States Board of Nursing links and contact info here:

https://allnurses.com/boards-of-nursing-info.html

(also found in the yellow "Resources" Tab at the top of each page.

[Wishinonastar, BSN]

Under the old system, much of the continuing ed requirements were related to facility certification. For example all hospitals have to do infection control, HIPPA, CPR, fire and safety, disaster training, and training in new equipment, etc. every year- to name a few. JCAHO requirements are stricter yet. Long-term care has their own requirements, drug and alcohol and psych have their own requirements, it goes on and on. So a lot depended on where you worked. In home health we generally had an inservice every month with our staff meetings, in addition to the hospital-wide trainings. I never had a lack of inservices in any area that I have worked in, plus I did things outside of work on my own such as getting a BSN, certificates in nursing admin., train the trainer, MBA, etc. Most nurses are always getting education. It is just that there was no offficial way to track these things other than internally where you work. Now it has to be official CEU's, approved by the board.

So do not assume that we were not getting continuing education before, we were. We just were not tracking it as closely and the requirements were not state-wide, they were practice-specific.

[psychonaut]

Just to be controversial...how about mandated recertification every x-number of years (i.e. retaking an nclex-type exam)?

[nurse430+yrs]

Just to be controversial...how about mandated recertification every x-number of years (i.e. retaking an nclex-type exam)?

:nurse:Nurse430+yrs

For the most part that sounds like a good idea! However, let's say you are a Cardiology Nurse for 10 years---should you be expected to pass the OB-GYN section? Or should one be required to pass the specific specialty area?

[llg, PhD, RN]

So, a question for you: YOU are an ICU patient and you have the choice of choosing your nurse.Choose your nurse: no other factors consider except the ones described here:

Nurse #1: Has kept up on Continuing Education in the ICU field he/she has 30 continuing education hours plus an excellent work and performance record. He/she serves as a mentor for new nurses.

Nurse #2. Has NOT kept up on his/her Continuing Education in his/her field; he/she does have continuing education in other areas of nursing. He/she is consider a "good nurse: and has an excellent work and performance record. He/she seems to have lots of experience.

Nurse #3. Is a nurse from a temp agency---her past work performance is not known, but you do know she has NO continuing education in the ICU area.

WHICH nurse would YOU want to care for you?

nurse430+yrs:nurse:

Which of the two nurses below would YOU choose?

Nurse #4: She has 10 years of experience and regularly attends inservices, read journals, etc. However, due to financial concerns she has not officially earned CEU's for most of that education. She is, however, considered to be the best nurse in the unit and the other nurses go to her for help and advice. She precepts, acts as Charge Nurse, and represents the unit on the hospital practice committee where she helps to write the policies and procedures used by all. She is considered by her colleagues as the expert in her field.

Nurse #5: She also has 10 years experience and has never attended a national or regional conference and rarely reads professional journals, etc. She does however, pay her money and submits the paperwork for the CEU's those journals provide (after copying the answers from a friend). She rarely does more than the minimal required to avoid getting fired and has a history of frequent medication errors and notes in her file about not practicing according to the updated policies and procedures. But she has those CEU's she paid for ...

My point: Until the system is improved dramatically, CEU's mean very little in determining the quality of care provided by the nurse.

[Patti 2nd gen RN]

I voted "No" for a couple of reasons.

1. I believe that the state should not enact expensive requirements unless there is reasonable evidence to support that those requirements actually result in better practice, improved patient outcomes, etc. I have followed this issue off-and-on over the years and I am not aware of a sufficient amount of research having been done on the topic to justify the government to add such a requirement.

2. There is very little evidence that shows that a nurse who sleeps in the back of a conference room or copies the answers from a friend of a mailed in CEU test from a journal etc. actually learns anything that improves her practice. Until the CEU system includes more legitimate methods to evaluate actual learning, it is not a suuitable to use as a basis for increased government regulation and increased expensed for everyone involved.

3. There is virtually NO regulation of the relevance of the educational content to a nurse's practice in the current system. For example, if a nurse completes a CE program (i.e. copies her friend's answers from a post test in a journal) on a topic that has absolutely nothing to do with her field of practice, she still gets the CEU's -- even though no one in their right mind would believe that activity had made her a better nurse in any way.

So ... the current system of "earning" CEU's does virtually nothing to assure the quality or relevance of the education provided by the programs. People are free to buy CEU's without actually learning anything -- or improving their knowledge base or actual practice in any way. There is also no check to assure that the content of the CE programs is at all relevant to the nurse's field of practice. And there is no solid evidence to support that people who buy CEU's actually give better care than people who don't.

Until the above-mentioned problems in the CEU system are addressed ... the state cannot justify making the purchase of CEU's mandatory. So, I voted "No." However, if the currently broken system were to be "fixed," I would probably change my vote.

llg, PhD, RN (Someone who works in staff developed and actually served on committees that approved CEU's for credit.)

I think learning outside your specialty can be very valuable...I have worked L&D and am now on a TCU unit...and taking classes on grieving, the legal issues with documentation, and with meds I don't usually use..have helped me a lot. Also, I believe that the nurses who sleep and copy answers will be that quality of nurse regardless, but working in several different states, I have seen a difference in the attitude about furthering our education, taking the time to research what you don't know (vs. just pushing the pill and not caring) and reading professional journals overall is significantly better in states that hold nurses accountable for furthering their education. I do believe though, that our employer should pay for at least half..and the ones that apply to our work setting.

[nurse430+yrs]

Great disucssion! The Agency for Healthcare Research and Policy recently present a report on physician CME's and Effectivenss of CME.

Here's the results:

Results: Of the 68,000 citations identified by literature searching, 136 articles and 9 systematic reviews ultimately met our eligibility criteria. The overall quality of the literature was low and consequently firm conclusions were not possible.

Despite this, the literature overall supported the concept that CME was effective, at least to some degree, in achieving and maintaining the objectives studied, including knowledge (22 of 28 studies), attitudes (22 of 26), skills (12 of 15), practice behavior (61 of 105), and clinical practice outcomes (14 of 33).

Common themes concluded that:

• Live media was more effective than print.
  
• Multimedia was more effective than single media interventions.
  
• Multiple exposures were more effective than a single exposure.

The number of articles that addressed internal and/or external characteristics of CME activities was too small and the studies too heterogeneous to determine if any of these are crucial for CME success. Evidence was limited on the reliability and validity of the tools that have been used to assess CME effectiveness.

Based on previous reviews, the evidence indicates that simulation methods in medical education are effective in the dissemination of psychomotor and procedural skills.

Conclusion: Despite the low quality of the evidence, CME appears to be effective at the acquisition and retention of knowledge, attitudes, skills, behaviors and clinical outcomes.

More research is needed to determine with any degree of certainty which types of media, techniques, and exposure volumes as well as what internal and external audience characteristics are associated with improvements in outcomes.

Source: http://www.ahrq.gov/clinic/tp/cmetp.htm

Given the methods of delivery of Continuing Education is similar for nurses--it is possible to generalize the results of this study to the nursing profession. Looks like additional research IS need to determine the effectiveness of the education and well as the correlation to clinical outcomes. Nurse430+yrs:nurse:

[WalkieTalkie, RN]

It's not already mandatory in all states? Seriously!??!!

[Thornbird]

I thought it was a dumb requirement until working in CT where it is not required. I thought that it was redundant since there are so many "mandatory" inservices along with the optional ones. Now I realize that they had all those inservices because we needed CEU's. I work in LTC here, mostly as an agency nurse. I meet many nurses that have stayed in the same little home for 10 or 20 years and done no continuing education. Many are woefully out of date with best practices. Most of the homes do only the OSHA mandated annual training. I went to one recently that used videos from the 70's and 80's! Other training isn't required so it isn't done. Where CEU's are required, employers are more apt to offer programs so that nurses don't take time off to do their required CEU's. In support of this, all the LTC's offer CNA inservices because CNA's are required to have continuing ed. The only healthcare providers in this state not mandated for continuing ed are LPN's and RN's who are not NP's.

I'm sure there are places that provide good inservice training and people attend. I worked for a couple of years at a clinic that encouraged us to attend (paid time with a good lunch) the CME presentations held for the MD's and NP's. I learned so much during that time.

We would all like to believe that everyone is responsible enough to keep up their education, but it just isn't so. Almost all health related professions have some kind of continuing ed requirements now as well as teachers. In some places even hairdressers have to do continuing ed!

[MAISY, RN-ER, BSN, RN]

Not only should education be mandatory, every healthcare facility should have to post it's numbers with regards to degree, and specialty certifications. I would also like to see information regarding new grad training infused into this posting. For instance, if CEN certification is the standard a hospital or the general public would like to see in their facility...it should be encouraged and compensated by the hospital. If your staff are all certified in their specialty, I believe it says that the facility encourages both personal growth and customer service.

It is not hard to take online courses, attend seminars, or do CE online. It makes you better as a nurse, gives you a different perspective of the patient population and new technology, and can bolster self-confidence.

When I hear nurses say they don't need to continue with school, I cringe. Human beings have a natural penchant for learning....it's criminal not to use that ability to make ourselves better.

[statphleb SN]

Healthcare changes so fast---no sooner do you learn one way than another way is developed. I personally want to give every patient I care for the most up-to-date nursing care. I would say yes to CEU's:nuke:

[mayvst]

Medscape.com offers free CEU. The question is, would the BON accept it and honor it when you take it for free online, when you renew your license..

Thanks nurses!.

[Mike A. Fungin RN]

WHOA! Is this for real? It seems appalling to me that there are states where Registered Nurses aren't required to do any continuing education!

Even an EMT-Basic has to do a 24-hour refresher course (including a reexamination of skills proficiency) and 48 additional hours of continuing education every two years. That's 72-hours and a skills exam every two years.

No wonder our profession isn't as respected as it is trusted when we don't even hold Registered Nurses to the same standard of continuing education as we do EMT-Basics.