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¶ … Education for Nurses

How Does Continuing Education for Nurses Impact Productivity

The nursing community stalwartly emphasizes the importance of continuing education and suggests that it should be an important part of the nursing profession, whether legally required or voluntary.

This emphasis is shared by the majority of the medical community. One of the primary reasons that nurses, nurse managers, and nurse educators believe that continuing education is important is because they link continued education to an increase in productivity. However, the study of productivity is very difficult, with one of the main problems being that managers and nurses tend to measure productivity in very different ways. However, they do seem to agree that an increase in productivity means being able to increase the same tasks in less time, without also increasing mistakes or stress. Therefore, while defining productivity is important when seeking to determine whether or not continued education does result in increased productivity, increased productivity is clearly meaningless unless it is a sustainable increase. After defining the term, it is then important to look at whether continued education does actually increase productivity. This is a difficult determination to make because very few empirical studies have examined the correlation between continued education and productivity, which may relate back to the difficulties of determining productivity. While there may not be substantial empirical research on the topic, nursing literature discusses the topic extensively. The general consensus is that continued education does contribute to productivity. Different scholars suggest different reasons for this impact, ranging from the emotional impact of continued education to the idea that continued education allows nurses to work smarter, thereby increasing productivity without increasing mistakes.

Defining productivity

The primary problem with determining whether or not continued education can improve productivity is that no one has yet developed a single definition of nursing productivity:

although productivity from an administrative organizational perspective is represented by cost-effectiveness, nurses often assess their own productivity by quality of care provided to patients. This fundamental difference between nurses' perception and that of managers results in different assessments. In this study, nurses believe that to improve productivity there should be adequate and qualified human resources, while organizations consider increased productivity in terms of limiting permanent employment, imposing compulsory overtime with the least financial benefit to workers, hiring FECP staff and decreased cost. (Nayeri et. al, 2005).

While the above view of the administrative definition of productivity may be cynical, the reality is that administrators and employees generally view productivity in different ways. It is clear that nurses view productivity as a measure of patient care. From a nurse's perspective, something that improves patient care without increasing the burden on a nurse would be seen as increasing productivity. In contrast, administrators have to view productivity from a financial point-of-view, as well as considering issues of patient care. For them, they have to look at changes that increase work without increasing expenses or non-financial costs to the administration. Though administrators and nurses may not agree on the definition of productivity, they do agree that the "the primary concern of nurses and nurse managers is the delivery of quality care to patients and clients in the most effective, efficient and humane manner." (Bowman, 1986).

History of continuing education for nurses

Continuing education for nurses is not a new concept. On the contrary, respected nursing professionals have been advocating for professional development for years, and have even worked on providing continuing education opportunities for themselves and for their fellow nurses long before it became an academic option. As a matter of fact,

Florence Nightingale may have been the first American nursing professional to publicly suggest that nurses needed continued education and to provide some type of continuing education for her co-worker nurses. In 1899, Columbia University established a graduate-level course for nurses, which emphasized the administrative aspects of the nursing profession. Furthermore, by 1920, professional nursing conferences offered nurses educational symposiums. The federal government assisted the push for continued education by making funds available for nursing professional development in 1959. (Ellis & Hartley, 2004). Historically, professional development has concentrated on integrating nursing skills with some management skills, allowing nurses to take more administrative roles. While such professional development may have permitted nurses to move into management and administrative oriented positions, not all nurses want to move into those types of positions. For nurses who enjoyed working with patients, there was historically little formal professional development available.

Modern continuing education

Today's nursing professional development is much more focused on professional nurses who do not necessarily want to move out of direct patient- care. Modern nursing continued education does not focus only on administrative functions, but actually offers a broad range of different types of education. For example, nurses can meet their professional continuing education obligations by merely attending meetings that require no participation and little, if any, actual learning. However, nurses also have an unprecedented opportunity today to take leadership roles in medicine, largely due to the wide range of continuing education available today.

For example, by pursuing education beyond their nursing degrees, nurses can become primary health-care providers, for example, by attaining nurse-practitioner or midwife status. Nurses can also move into administrative or management roles. Even for nurses who have no desire to move into management or primary-care provider status, continuing education is important:

Nursing is serious about education, placing major emphasis on lifelong learning as well as initial preparation. Continuing nursing education is organized by professional associations, as well as hospitals and others employing nurses. Specialty certification includes expectations of continuing education, and many jurisdictions require continuing education for licensure renewal. This is just as true for nursing faculty and educators as it is for clinicians. (Allen, Allison, & Stevens, 2006).

Modern nursing profession

Just as continued education for nurses has evolved, so has the nursing profession. The reality of modern health care is that nurses spend much more time caring for patients than the treating physicians. In fact, nurses are responsible for the entire range of patient care, from basic hygiene and personal care of patients, to detecting and helping treat serious medical issues. For example, any visit to an emergency room reveals the primary role that nurses play in patient care. Nurses triage patients, determining the priority of the illness, and thus how quickly a patient will receive treatment. Once a patient is actually admitted for treatment, nurses begin intake and treatment before a doctor ever sees the patients. In fact, depending on the extent of the emergency, it is possible that a patient will never see a doctor, but will only have the benefit of a doctor consulting with his treating nurse. In this way, modern nursing is similar to war-time nursing, when the lack of available doctors oftentimes meant that ill or injured people would be treated primarily, if not solely, by nurses.

In addition to the increasing role that nurses are playing in the daily practice of medicine, one also has to consider the other way that nursing has changed. Nurses are in very high-demand and the nursing shortage is well-known, both inside and outside of the profession. The result is that nurses work in extremely high-stress environments, because they are frequently expected to do work that should actually be handled by larger staffs. "Intense job-related demands are a major source of stress among managers and often have significant negative effects on job performance and personal well being." (Judkins & Ingram, unknown). The staffing shortage has had some very positive impacts on the nursing profession; nurses have an unprecedented opportunity to make significant incomes and often have their choice of work environment, if not shift hours. However, the nursing shortage has had a negative impact on the profession as well. For example, the staffing shortage also results in nurses working longer shifts and being expected to work outside of their specialty areas. Both of these issues can contribute to lowered productivity.

Professional development as part of a healthy work environment

Not surprisingly, given the increased responsibilities that today's nurses have, as well as the stressors of understaffed nursing environments, one of the emerging areas in nursing professional development has little to do with the actual practice of nursing. On the contrary, it focuses on how to help nurses deal with the realities of nursing, today.

Effectively dealing with work stressors by helping to increase hardiness may better equip managers (and their staffs) to prevent or reduce physical and psychological illness. This project demonstrates that hardiness and coping with stress among nurse managers can be learned through self-paced learning modules. Should this knowledge and skill be translated to the work environment, positive outcomes of high staff retention, low turnover rates, high job satisfaction, and low burnout may be achieved. (Judkins & Ingram, unknown).

Therefore, it seems evident that professional development classes that are aimed at teaching both nurses and nurse managers how to deal with work stressors, will help keep nurses healthy, both mentally and physically, which impacts whether or not they can actually be present to perform their jobs. Regardless of how one defines productivity, it is clear that one cannot be productive at work if one is not at work.

Human resources

Of course, not all professional development is geared at reducing the impact of work-related stressors, but the reality is that that successful professional development should help relieve stress. In fact, professional development is considered a key element of establishing a healthy nursing work environment. According to the Florida Center for Nursing, professional development is one of the twelve essential elements of a healthy work environment. (Florida Center for Nursing, 2006). Obviously, a company's human resources department determines its policies regarding continuing education, including whether a company will offer in-office opportunities for continuing education, whether a company will pay for professional development, and whether nurses will be given time off in order to pursue continuing education. Therefore, it is important to understand the role of human resources in today's health care industry. "Health care is a labor-intensive industry, and money spent on human resources constitutes a large portion of a health care organization's budget. Staff development directors have an opportunity to leverage this large investment with strategic education programs." (Fabre, 2005). Furthermore, health care administrators are coming to the conclusion that "continued professional development of every employee, regardless of role served, is necessary to provide optimal patient care; it is a shared responsibility of the organization and each individual employee. (Roussel, Swansburg, & Swansburg, 2006).

Stakeholders

This continued professional development has positive benefits for nurses and for their employers. However, there is another player in the relationship between productivity and continuing education, and it can have a critical impact on the nature of professional development. This entity is the regulatory agency in charge of nursing licensing. Depending on the states, some nurses are required to take continuing education classes in order to maintain their nursing licenses. Some states have not made continuing education mandatory, but do make it more difficult for nurses to renew their licenses if they have not obtained continuing education. However, other states do not require any type of continuing education. It is important to understand why some regulatory agencies demand continuing education, in order to understand why the government is considered a stakeholder in this relationship. Government regulatory agencies push for continued education to make sure that nurses are up-to-date with new advances in medicine and nursing. Such a practice makes sense, given that some medical truisms from past days have proven to be both ineffective and dangerous. Without requiring nurses to engage in continuing education, regulating bodies have no way of knowing whether or not a nurse is keeping up-to-date with the latest medical practices. Therefore, one must always keep in mind that there are three stakeholders in professional development: the nurse, the regulatory body, and the employer. (Hall, 2005).

Nursing view of productivity

The nurse view of productivity tends to focus on two different elements. First, like most other professionals, "nursing personnel generally want to earn a good living and live a good life, two goals that are inextricably linked. (Swansburg & Swansburg, 2002). In addition, nurses want to give their patient's better care. Combining those two elements, one comes to the conclusion that nurses look at productivity as a function of the care they give their patients, and also as a function of their personal productivity, as that relates to their own lives. Therefore, for nurses to perceive a continuing education course as contributing to productivity, they would need to believe that the education provided either improved patient care or led to personal benefits for the nurse. Fortunately, there are many different types of nursing continuing education that could cause an increase in productivity, as defined from the nurses' perspective.

Because this paper has already discussed the fact that nurses are the triage intake personnel in emergency rooms, the author will now examine a type of continuing education that could increase productivity in exactly such a setting. Training geared at teaching nurses how to diagnose and treat minor medical problems that would actually be more appropriately diverted to urgent care facilities or primary doctor's offices would help eliminate emergency room waiting time and dissatisfaction, resulting in better patient care. For example, many uninsured parents bring their children to an emergency room when their children experience inconvenient, but not very conditions, such as the croup. If a nurse could do a complete intake, including all vitals and a thorough patient history on each patient, and begin treatment of a patient based on that information without consulting with a doctor, it would greatly reduce waiting time. It would reduce even more time if some treatment could be done without any consultations with a doctor, which should be possible for standard illnesses. Obviously, if the treatment involves dispensing medication of any sort, then, unless the triage nurse is a nurse-practitioner, the nurse will have to consult with a doctor before dismissing the patient.

However, providing nurses with the professional development they need to have more independence in assessment and treatment would increase the productivity of individual nurses, because they would not be dependent on doctors to administer treatment, increase the productivity of the emergency room by driving down waiting times, and do so without exposing patients to the risk of inappropriate treatment, because of the continued education.

Professional development can also increase productivity in an office setting. Nurse education focuses on health care concerns. However, many nurses find themselves confronted by a wide variety of issues outside of the healthcare arena. Providing nurses with training in these various areas could help increase their productivity by giving them the education that they need to further their careers. For example, a school nurse has a defined set of duties and expectations, which works to limit opportunities for advancement. Furthermore, unlike other professionals in the educational setting, a nurse's primary duties can prevent her from taking on additional duties in the school setting, like coaching a team. However, some school nurses can participate in running other activities, such as ROPES leadership skills training courses. While becoming a ROPES facilitator is not something one normally considers when looking at nursing professional development, it is exactly the type of professional development that is likely to increase a nurse's personal productivity. By teaching a nurse to become an outstanding leader and providing her with the skills to build strong teams, continuing education allows her to step up in any setting, especially a school environment, and take a leadership position as the center of a strong team. In fact, any training that allows nursing staff to take a more hands-on approach to the leadership of an organization is likely to increase productivity, because it provides the nurse with an opportunity to increase compensation and responsibility, without the normal concomitant increase in stress.

Management view of productivity

Of course, the management view of productivity differs from the nurse view of productivity and focuses on the financial bottom line. Because professional development involves significant expense to an organization, many in management do not see how such continuing education can enhance the bottom line. For example, for a nurse to take one-day of a company-sponsored continuing education course, it involves the company losing that nurse for a day, having to pay another nurse to cover her shift, which could involve the payment of overtime, and the out-of-pocket expenses related to the course. Especially in large organizations, those costs can quickly become prohibitive. Therefore, many in management view professional development in a negative light, which may actually strip it of many of its benefits. Maintenance education will enhance nurses' productivity when management recognizes that education and productivity are linked." (Swansburg & Swansburg, 2002).