Professional Development in NursingBy Jennifer Thomas

Essential Questions

· Why is lifelong learning essential in health care, especially in nursing practice?

· What roles do the Institute of Medicine and the Robert Wood Johnson Foundation have on nursing education?

· What advanced degrees are available to nurses? How do the degrees differ, yet complement each other in practice?

· What role does nursing education have on patient outcomes?

Introduction

The Affordable Care Act of 2010 has stimulated the transformation of health care delivery in the United States. Nurses have the greatest impact on this transformation, as they represent the largest portion of the health care workforce in the United States (Nurse Journal, 2018). The recommendations made by the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) in  The Future of Nursing: Leading Change, Advancing Health report provide a detailed overview of the goals to advance nursing education and meet the future demands of health care in the United States. This chapter will delve into the evolution of nursing education and the impact that personal and professional development have on health care delivery.

Lifelong Learning

The dynamic and constantly changing climate of health care requires that nurses continuously seek new learning opportunities.   is necessary for nurses to stay up-to-date with the latest research and discoveries related to efficient practice methods that lead to better care and better patient outcomes. Lifelong learning is defined as the process of learning new knowledge throughout an individual’s lifetime that allows the individual to make the most informed decisions in any given situation (London, 2012). While lifelong learning can be associated with professional development, this process can also relate to personal life experiences. For example, nurses are often encouraged and required to participate in continuing education to maintain licensure, which   nurses to take part in the lifelong learning process. Personal life experiences, such as illness or a terminal condition of a loved one, may contribute to personal growth and provide meaningful opportunities for self-reflection. These experiences inform people’s perspective and shape their worldview. Additionally, many nurses feel   to reach their full academic potential by taking advantage of different learning opportunities through formal education. Advancement of learning contributes to the advancement of professional nursing practice.

Campaign for Action

The American Association for Retired Persons (AARP), the AARP Foundation, and the RWJF initiated the Campaign for Action to improve access to health care, promote interprofessional collaboration, encourage nursing leadership and education, and increase diversity in nursing (Campaign for Action, 2018). The Campaign for Action established five models for nursing education and advancement to promote the transformation of nursing through education. Currently, 30 states have adopted at least one or more of these models (Campaign for Action, 2018). Table 3.1 provides a summary of the various models for academic development in nursing.

Table 3.1

Campaign for Action Models for Academic Development in Nursing

Model	Description
RN-to-BSN degree	A baccalaureate degree in nursing that is made available to students transitioning from diploma certificate or associate’s degree program, including accelerated pathways for BSN completion.
Accelerated Options: RN-to-MSN	An academic program allowing students to earn a master’s degree in nursing without conferring a baccalaureate degree; this model allows nurses with associate’s degrees to meet graduate-level competencies through bridge courses that accelerate the pathway for graduate degree completion.
State or Regionally Shared Outcomes-Based Curriculum	Learning institutions share outcomes to promote seamless transition and completion of baccalaureate degree competencies at the university level. Curricula may differ, but outcomes are standardized to promote clarity and continuity of outcomes toward completion of a baccalaureate degree.
Shared Statewide or Regional Curriculum	Community colleges and universities enter partnerships to allow nurses with associate’s degrees to transition into baccalaureate programs while maximizing transferability of credits earned at the associate’s level.
Shared Baccalaureate Curriculum	Community colleges, colleges, or universities enter partnerships that permit students to take courses at both institutions concurrently to obtain a baccalaureate degree in a condensed time frame.

Note. Adapted from “Transforming Nursing Education,” by the Campaign for Action, 2018.

Check for Understanding

How has the Campaign for Action influenced legislation and the nurse practice laws in your state?

BSN 2020 Initiative

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Patient care and health management have become increasingly complex. Nurses must be prepared to deal with these complexities at the bedside and within the community. The IOM (2010) has determined that the greater the number of nurses prepared at the baccalaureate level, the better prepared the nursing workforce is to address complex needs.  “Nurses must be prepared to deal with these complexities at the bedside and within the community.”This is further supported by the American Association of Colleges of Nursing (AACN), which maintains that nurses must have more knowledge regarding community-based primary care, disease prevention, health promotion, and cost-effective, coordinated care (American Association of Colleges of Nursing [AACN], 2018). To meet the country’s health care demands, at least 80% of the existing nursing workforce should be prepared at the baccalaureate degree level by 2020. Concomitantly, baccalaureate-level nursing degrees should become the entry point of general nursing practice.

Though this is commonly understood among the nursing profession, it is imperative to discuss why. Two new graduate nurses at the bedside have seemingly similar skills and knowledge and require the same amount of real-world experience and training, regardless of education level; however, there is knowledge as well as critical-thinking and clinical-reasoning skills emphasized within baccalaureate nursing programs that are necessary to address the complex decision making that occurs at the bedside. This is evident in the research findings pertaining to nursing education and the rates of patient morbidity and patient mortality, which are significantly less among baccalaureate-prepared nurses (Kutney-Lee, Sloane, & Aiken, 2013).

Table 3.2

Recommendations to Support the Percentage of Baccalaureate-Prepared Nurses

Institution	Initiative
Commission on Collegiate Nursing Education (CCNE) and National League of Nursing (NLN)	Recognize the Bachelor of Science in Nursing degree as the foundational degree for professional nursing practice. Develop educational pathways that promote seamless transition from Diploma Certificate in Nursing and Associate Degree in Nursing to Bachelor of Science in Nursing degree.
Health Care Organizations	Support opportunities for educational advancement by offering tuition assistance, differentiated pay or promotion for advanced degrees, and initiatives that encourage a culture that values lifelong learning.
Private and Public Organizations	Actively develop initiatives to support educational advancement in nursing through scholarships, loan forgiveness, and funding of workforce studies that focus on nontraditional educational pathways.
Government Agencies	Develop initiatives to support educational advancement in nursing through scholarships, loan forgiveness for nurses working with underserved populations, and grant funding for workforce development in acute and community health settings.
Academic Institutions	Promote collaboration across educational institutions to develop a shared baccalaureate curriculum that encourages seamless transition across institutions.
Academic Nurse Leaders	Support and recruit a diverse nursing student population (e.g. race/ethnicity, gender, and geographic location).

Note. Adapted from “The Future of Nursing: Focus on Education,” by the Institute of Medicine, 2010.

Advanced Degrees

Nursing education has evolved tremendously since the early 1900s. At the beginning of the 20th century, the shift from preparation in practice settings and hospitals to formal education and training in university settings has fundamentally changed the disciplinary focus of nursing from basic skills to advanced knowledge and practice. At that time, advanced degrees in nursing were uncommon. Rather, nurses obtained a Doctor of Philosophy (PhD) or Doctor of Education (EdD) degree with an emphasis in education or other health-related field as preparation for teaching at the university level; however, nursing content was often missing from these programs (Carter, 2013). It was not until the 1950s and 1960s that PhD programs focusing on nursing science were offered.

The advent of PhD programs focusing on nursing science allowed nurses to develop research skills and test theories relating to nursing practice that would later contribute to the existing body of nursing knowledge and the standards of practice used by nurses across clinical settings. There continues to be a need for research, specific to nursing, and timely translation of the research into nursing practice. The need for clinically focused preparation of nurses to accomplish this goal at the doctoral level has led to the development of a new advanced degree, the Doctor of Nursing Practice (DNP).

The focus of the DNP is to prepare nurses to become expert clinicians by applying research and knowledge to create more efficient practices and better patient outcomes. While PhD-prepared nurses focus on the discovery of new knowledge, DNP-prepared nurses focus on the application of new knowledge and research into practice in order to promote better health care and patient outcomes. Carter (2013) further suggested that, “this level of expertise will be critical as the nation focuses on improving patient care and the safety of the systems that deliver health care” (p. 34).

Practice-focused doctoral nursing programs include seven essential areas of content:

1. Scientific underpinnings for practice;

2. Advanced nursing practice;

3. Organization and system leadership/management, quality improvement, and system thinking;

4. Analytic methodologies related to the evaluation of practice and the application of evidence for practice;

5. Utilization of technology and information for the improvement and transformation of health care;

6. Health policy development, implementation, and evaluation; and

7. Interdisciplinary collaboration for improving patient and population health care outcomes.

Impact of Education on Patient Care and Outcomes

The link between advanced nursing education and improved patient outcomes has been studied in various settings over the past few decades. Linda Aiken (1995), professor and Director for the Center for Health Outcomes and Policy, is the most notable nurse researcher to study the work of nurses across clinical environments. Aiken (1995) determined that nurses were not being used to the full extent of their education and skill and that changes would need to be established to ensure that nurses engaged in work that aligns with their scope of practice. Research studies focusing on the relationship between nursing education and patient outcomes followed, and the results were consistent with Aiken’s initial assumptions—improved levels of education and training result in improved patient outcomes, particularly in complex and technologically advanced clinical environments. From these initial findings, additional data was obtained in a series of studies that culminated in the 2010 IOM report  The Future of Nursing: Leading Change, Advancing Health. The report definitively articulated that increasing educational preparation improves patient care and quality patient outcomes.

Other studies (Aiken, Clarke, Cheung, Sloan, & Silber, 2003) used administrative and survey data regarding education, staffing, and other work-related characteristics across 168 Pennsylvania hospitals between April 1, 1998 and November 30, 1999 to determine the relationship between nurse education levels and patient mortality or failure to rescue rates within 30 days of admission. This research provided valuable data providing new insights where previous studies were inconclusive. The study determined that a “10% increase in the proportion of nurses holding a bachelor’s degree was associated with a 5% decrease  in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue” (Aiken et al., 2003, p. 1617). The combination of advanced education and improved nurse-to-patient ratios also significantly enhanced patient outcome overall (Aiken et al., 2003).

To further validate the results, a repeat study was conducted between 2009 and 2010. The study measured similar data, but the sample size spanned different hospitals in nine countries throughout Europe (Aiken et al., 2014). The results were similar to the Pennsylvania research—an increase of 10% in baccalaureate-prepared nurses was associated with a 7% decrease in patient mortality rates within 30 days of admission. These results further reinforce the relationship between advanced degrees in nursing and patient outcome (Aiken et al., 2014). These studies’ (Aiken et al., 2014) contributions to the nursing discipline have been instrumental in advancing the goals of the profession, while gathering evidence to support the development of initiatives to promote nurses seeking advanced education.

Continuing Education

The process of being a lifelong learner for every nurse involves acquiring further knowledge and skills in the form of continuing education units (CEUs) as well as reading research and attaining advanced practice certifications in specific specialty areas. This is true of every nurse at every educational level and continues long after a nursing student has completed a degree. Continuing education occurs in a variety of ways for nurses in every setting and is often associated with employment or licensure. From online vignettes and quizzes on various topics, to in classroom courses that can be taken in conjunction with annual competency testing, CEUs are meant to keep nursing staff refreshed and up-to-date on the latest evidence-based practice methods to improve patient care outcomes (Fletcher, 2016).

Research articles are a valuable way of gaining knowledge throughout one’s nursing career. Many professional journals publish articles on a variety of topics and specialties in nursing. Reading these articles on a regular basis, completing the associated quiz, and participating in discussions or research circles with colleagues is one way to earn required CEUs and gain valuable knowledge that can be applied at the bedside or any clinical setting (Fletcher, 2016).

Attaining specialty certification is another formal way to strengthen skills and demonstrate clinical competency in a specific area of nursing practice. Each specialty area, such as hospice, critical care, emergency medicine, or surgical nursing, have associated specialty certifications that can be earned by taking a certification examination or developing a professional portfolio. Studies have also determined that patient safety increases when nurses hold specialty certifications. One study found a decrease in patient falls in the acute care setting with increased levels of specialized education, including certification (Boyle, Cramer, Potter, & Staggs, 2015).

Check for Understanding

1. What correlation do you see between Aiken’s research and the recommendations established in the IOM’s report  The Future of Nursing: Leading Change, Advancing Health?

2. How does educational advancement at all levels impact patient care?

Reflective Summary

Nurses represent the largest part of the health care workforce in the United States, and the impact nurses have on health care transformation is immeasurable (Nurse Journal, 2018). The 2010 IOM report stresses the importance of advancing education in nursing and its impact on patient outcomes. Lifelong learning and continuing education are essential elements to meet increasingly complex needs.

Key Terms

Extrinsic Motivation: External factors, such as raises, bonuses, or employment, that encourage one to perform a task or activity.

Intrinsic Motivation: Internal factors, such as personal reward or meeting personal goals, that encourage one to perform a task or activity.

Lifelong Learning: Formal and informal learning opportunities throughout nurses’ lives to utilize continuous development and improvement of the knowledge and skills for nursing practice.

References

Aiken, L. (1995). Transformation of the nursing workforce.  Nursing Outlook, 43(5), 201-209. doi: 10.1016/S0029-6554(05)80005-3

Aiken, L. H., Clarke, S., Cheung, R. B., Sloan, D. M., & Silber, J. H. (2003). Educational levels of hospital nurses and surgical patient mortality.  Journal of the American Medical Association (JAMA), 290(12), 1617-1623. doi: 10.1001/jama.290.12.1617

Aiken, L. H., Sloane, D. M., Bruynell, L., Van den Heede, K., Griffiths, P., Busse, R., … Sermeus, W. (2014). Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study.  Lancet, 2014(383), 1824-1830. doi: 10.1016/S0140-6736(13)62631-8

American Association of Colleges of Nursing. (n.d.). Baccalaureate education. Retrieved from https://www.aacnnursing.org/Nursing-Education-Programs/Baccalaureate-Education

Boyle, D. K., Cramer, E., Potter, C., & Staggs, V. S. (2015). Longitudinal association of registered nurse national nursing specialty certification and patient falls in acute care hospitals.  Nursing Research,  64(4), 291–299. doi: 10.1097/NNR.0000000000000107