Continuing Education Should it be Mandatory for All Nurses

Health Policy Debate Paper

Should Continuing Education be Mandatory for All Nurses, Why or Why Not?

The Assembly Regulated Professions Committee of the New Jersey legislature is currently deliberating Bill number A2182, sponsored by Assemblywoman Nancy Munoz of the 21st District, which seeks to expand nurses’ continuing education requirements. The Bill seeks to make it mandatory for nurses to obtain at least one continuing education credit on topics related to domestic violence as a pre-condition for biennial license renewal (New Jersey Legislature, 2024).

While there is consensus that continuing education for nurses is crucial for effective and safe professional practice, there are differing opinions on whether the same should be mandated as a regulatory requirement or left to the individual’s discretion (Mlambo et al., 2021). Continuing education is considered mandatory if it is imposed as a requirement for re-licensure (Mlambo et al., 2021). In most cases, these requirements are passed through state legislation and enforced by professional licensing boards (Mlambo at al., 2021). Conversely, continuing education is voluntary if individuals choose whether or not to participate, and what programs or topics to undertake. Thus, professionals are not mandated to participate, and often do so because they understand the importance of increasing their professional expertise and proficiency (Mlambo et al., 2021).

Arguments by Supporters of Mandatory Continuing Education

One of the primary arguments by proponents of mandatory continuing education is that such education guarantees accountability in professional practice by ensuring that nurses keep up professionally and offer competent healthcare services to patients (Lera et al., 2020). In their study assessing the effect of continuing education workshops and meetings, Forsen et al. (2021), established that mandatory continuing education significantly improved professional practice among health personnel.

Additionally, the proponents argue that mandatory continuing education helps to maintain the profession’s credibility by ensuring that individuals who are not willing to keep up professionally are prevented from practicing and endangering patients’ lives (Lera et al., 2020). Lera et al. (2020) posits that it is important for professionals to undergo some form of assessment before they can be re-licensed in a bid to ensure that their practice remains relevant to the evolving needs of patients (Lera et al., 2020).

Thirdly, participation in continuing education increases competence levels, minimizing the risk of professional scandals that could result in dwindling public confidence in the profession. In their systematic review, Main and Anderson (2023) found that mandatory continuing education requirements are a strong motivator for professionals to improve their competence. The study also found that generally, jurisdictions in Australia with mandatory continuing education requirements reported positive practitioner behavior and higher levels of knowledge than those with voluntary continuing education requirements.

Mlambo et al. (2021) posits that mandatory continuing education also provides opportunities for professional interchange among nurses. Nurses attending continuing education programs or workshops get to learn from their peers and to reflect on their practice, which could help professionals reluctant to practice move back to the mainstream. However, the authors contend that this largely depend on individuals’ personal characteristics because nurses who are uninterested in socializing with their peers will still chose to remain isolated despite participating in continuing education.

Finally, supporters of mandatory continuing education argue that it provides a means for the state and professional groups to control the content of continuing education programs and to establish requirements that participants should meet (Mlambo et al., 2021). This creates a systematic approach to continuing education, in which nurses are exposed to standard content through programs approved by relevant professional associations (Mlambo et al., 2021). Ultimately, this gives the profession greater control over the quality of professional services offered to its members.

Arguments by Opponents of Mandatory Continuing Education

Those opposed to mandatory continuing education argue that it violates adult education principles, particularly the principle of voluntary participation (Mlambo et al., 2021). Voluntary participation is the ideology that people should choose what they wish to learn, when to learn, and under what circumstances to learn (Mlambo et al., 2021). Unfortunately, mandatory continuing education denies professionals the opportunity to practice the principle of voluntary participation. This opens avenues for demotivation, particularly if participants do not perceive what they are learning to be beneficial (Mlambo et al., 2021).

Furthermore, adult education is more effective if it adopts an informal approach that allows participants to interrogate content (Mlambo et al., 2021). Unfortunately, mandatory continuing education mostly adopts a formal model of education that is designed to meet the requirements of professional bodies and the state. The formality of such programs may make it difficult for participants to question the value of the content they get. The implication is that participants may view continuing education as mere formality, and are less likely to apply what they learn in their professional practice (Mlambo et al., 2021).

Dissenters also argue that mandatory continuing education does not guarantee effective performance (Mlambo et al., 2021). According to Mlambo et al. (2021), legislation may mandate participation in mandatory continuing education, but it does not guarantee that an individual actually learns. Mostly, legislation may only address the amount of time covered in mandatory continuing professional education, but it does not guarantee that the individual participating in the learning grows and evolves by applying the knowledge learned in their professional practice. A study by Ortega-Lapiedra et al. (2023) found that mandatory continuing education did not significantly improve clinical practice among a sample of postgraduate nurses. The authors argue that this is most likely due to the fact that mandatory continuing education violates the principles of voluntary participation which favor effective adult learning. This makes it challenging for participating nurses to effectively apply the knowledge gained in their professional practice.

Another crucial argument by dissenters of mandatory continuing education is that such education creates a punitive attitude, especially when it imposes sanctions on committed individuals within the profession who are willing to participate voluntarily in continuing education to keep up with their professions (Ortega-Lapiedra et al., 2023). In most cases, state legislatures impose mandatory continuing education requirements to catch a few individuals in the profession who are not willing to voluntarily participate in continuing education to keep up with their professions. Unfortunately, in so doing, the legislatures end up punishing many other individuals in the profession who are already engaged in their own professional development plans. The punitive nature of such mandated programs is likely to result in unmotivated, resentful, and angry professionals who participate in continuing learning as part of meeting requirements rather than improving their professional competence.

Summary

Both assenters and dissenters of mandatory continuing education put forth crucial arguments to support their rationales. The assenters argue that mandatory continuing education guarantees accountability in the profession by ensuring that nurses keep up professionally, increase their competence levels, and benefit from cross-learning through professional interchange. Further, mandatory continuing education provides a means for the state and professional groups to control the content and standards of continuing education programs, thus enhancing their credibility. On their part, dissenters of mandatory continuous education argue that such programs violate the voluntary participation principle of adult learning, and do not guarantee competence or effective performance. Furthermore, such programs create a punitive attitude among professionals who are willing to pursue their individual professional development plans by compelling them to pursue the mandatory programs. Ultimately, this creates demotivation and animosity that makes learning ineffective.

Conclusion

Upon careful consideration of both the assenting and dissenting opinions, this text concludes that continuing education ought to take a truly voluntary approach, where nurses engage voluntarily in the learning they need to maintain professional competence and are intrinsically driven to pursue learning throughout their careers. This would involve sensitizing nurses on the need to make continuing education and learning a personal responsibility so as to fully reap its benefits.

References

Forsen, L., Mwai, L., Reinar, L., Okwen, M., Horsley, T., & Rose, C. J. (2021). Continuing education meetings and workshops: Effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev, 9(1), 62-75.

Lera, M., Taxtsoglou, K., Iliadis, C., Frantzana, A., & Kourkata, L. (2020). Nurses’ attitude towards lifelong learning via new technologies. Asian/Pacific Island Nursing Journal, 5(2), 89-102. doi: 10.31372/20200502.1088

Main, P., & Anderson, S. (2023). Evidence for continuing professional development standards for regulated health practitioners in Australia: A systematic review. Human Resources for Health, 21(1), 23-39. doi: 10.1186/s12960-023-00803-x

Mlambo, M., Silen, C., & McGrath, C. (2021). Lifelong learning and nurses’ continuing professional development, a metasynthesis of the literature. BMC Nursing, 20(1), 62-75. doi: 10.1186/s12912-021-00579-2

New Jersey Legislature (2024). Bill A2182. New Jersey Legislature. https://www.njleg.state.nj.us/bill-search/2022/A2182

Ortega-Lapiedra, R., Barrado-Narvion, M., & Bernues-Olivan, J. (2023). Acquisition of competencies of nurses: Improving the performance of the healthcare system. International Journal of Environmental Research and Public Health, 20(5), 4510-4521. doi: 10.3390/ijerph20054510

Appendix

Name

(Insert Address and contact0

19th June, 2024

Senator Polistina

District 2,

State of New Jersey,

Dear Sir,

REF: The Nurse Staffing Problem in New Jersey

I am a registered advanced practice nurse (license number XXX) practicing in the State of New Jersey. I write in regard to the nurse staffing issue that continues to affect healthcare services in the state. On 30th May this year, 3,000 nurses at the Camden’s Cooper University Healthcare, North Bergen’s Meridian Health Palisades, and Englewood Health state issued notice of strike action seeking to protest the low staffing levels at the facilities (Stainton, 2024). The notice is to take effect if the ongoing negotiations between the respective hospitals and nurse union leaders do not end in the inclusion of specific nurse-patient ratios in the contract (Stainton, 2024). This will be the second strike by nurses this year, with the chief complaint being that low staffing levels result in poor patient outcomes that are a result of frustration and burnout (Stainton, 2024).

On 9th January this year, Assemblywoman Nancy Munoz of District 21 sponsored Bill Number A244, which seeks to address the nurse staffing issue by compellings hospitals in the state to put in place staffing committees (New Jersey Legislature, 2024). The bill was referred to the Assembly Health Committee and deliberations at the committee stage are ongoing (New Jersey Legislature, 2024).

Nurses are required by their profession to abide by the non-maleficence principle, which involves doing no harm to patients in their care. Unfortunately, low staffing contradicts this principle as it leads to burnout, which consequently affects the quality of care offered to patients (Rosenberg, 2021). Low nurse numbers imply that nurses have to serve more patients (high nurse-patient ratio), which increases the risk of poor patient outcomes. Studies have found that hospitals with high nurse to patient ratios have longer hospital stays, higher readmission rates, and higher mortality (Rosenberg, 2021). One study found that an addition of one patient to a nurse’s workload increased the risk of surgery-related mortality by 7 percent in the general care setting (Aiken et al., 2018). Unfortunately, high nurse to patient ratios equally affect nurse outcomes. Studies have associated high ratios with high levels of job dissatisfaction, burnout, and intent to leave. Shin et al. (2018) found that an increase of one patient in the nurse-patient ratio increased the odds of job dissatisfaction by 8 percent and the intent to leave by 1.05 times.