AORN educdion

Speak up for voluntary continuing education

Should continuing education be voluntary or mandatory for relicensure of nurses? Across the United States, nurses are en- meshed in an intense philosophical battle as they struggle with the myriad issues sur- rounding this question. Unfortunately, there are those who have abdicated their respon- sibility to speak out on a subject of crucial importance to the nursing profession.

Are you as an AORN member knowledge- able of the arguments for or against man- datory certification? Have you expressed your opinions regarding certification and relicensure to your state nursing association? Or are you jeopardizing your own profes- sional status by assuming a passive role? We in nursing must have the courage to express our convictions and propose solu- tions, especially when these current deci- sions have such impact on the future of nursing.

1 agree that continuing education i s nec- essary for nurses to expand their knowledge and skills, thus mantaining competency. However, I oppose mandatory continuing education for relicensure. I can only speak

for myself when I say that I am committed to a voluntary program of certification for nurse practitioners.

One of the most cogent arguments for mandotory continuing education is that if nurses fail to take specific steps to assure the consumer of continued competence then the government, with i ts expanding role in health care, will establish federal or state requirements and regulations. Nursing would then lose control of i ts right to establish standards for continuing education. Ella Allison, ANA‘s representative on ANA’s Task Force on Continuing Education, sug- gests that the ”failure to include continuing education for continued competence as a condition of renewal of license will certainly increase the size of the wedge in the move- ment to promote the end of individual licen- sure in favor of institutional licensure.”’ Erline McGriff, vice-chairman of the ANA Task Force on Continuing Education, then asks, ”Would continuing education for nurses become mandatory? And mandated by whom?”2

Needless to say, I agree that nursing

AORN Journal, July 1973, Vol 18, N o 1 23

must have control over delineating any standards for continuing education. I do not want institutional licensure. Nor do I want the government to impose unnecessary federal or state requirements on me. How- ever, we do not need to respond prema- turely to the threat of outside forces by endorsing mandatory continuing education, particularly when we have not even evalu- ated the effectiveness of a voluntary system.

I contend that nurses, as a united group, can educate legislators, government offi- cials, members of the health care field and the general public regarding nursing‘s com- mitment to insure competent practitioners through the implementation and evaluation of a voluntary certification program. Then, I believe such persons would be assured of nursing’s ability to establish and enforce standards of practice. Restrictive legislation will not be necessary if nurses exert their power and assume the responsibility for re- inforcing competent practitioners and disci- plining incompetent practitioners.

I disagree with McGriff’s statement that ,’the majority of nurses have not recognized that education for nursing i s a continuous pro~ess.’’~ Many nurses voluntarily partici- pate in continuing education activities on a regular basis and have done so for years because of their awareness of the benefits associated with expanding their knowledge and skills. Certainly, there are incidences where nurses have failed to accept personal responsibility for continued learning. How- ever, such nurses cannot be forced to learn just because an external system dictates that they engage in continuing education. I‘m not convinced that mandatory require- ments suddenly foster accountability in nurses who lack a genuine commitment to lifelong learning. Self-direction and motiva- tion are imperative; each individual nurse must ultimately be responsible for her own continued education.4

Not only does mandatory continuing edu-

cation not guarantee that nurses will learn, but i t also reinforces the concept that con- tinuing education is something that is done to one rather than something that one does.= The real problem i s how to inculcate in nurses the values associated with the volun- tary pursuit of knowledge.

Just because we have compulsory educa- tion, i s this a valid defense for compulsory continuing education?6 As we acknowledge some of the negative consequences of com- pulsory education, how can we consider superimposing a similar system on adult learners? For example, we know that tradi- tional extrinsic motivational factors such as grades, certificates, or degrees really do not guarantee that students will complete school or college with a meaningful educa- tion. Intrinsic motivation i s what really counts. If mandatory continuing education i s required, will the nursing license be a valid external reward or will the end justify a possible corrupt process? Voluntary certi- fication enables the achievement of appro- priate educational goals, yet allows each nurse the right to assume personal responsi- bility in determining and meeting her spe- cif ic educational needs.

I agree with Signe Cooper, chairman of the ANA Task Force on Continuing Educa- tion and a leading proponent of voluntary continuing education, who argues that ”a licensure requirement for continuing educa- tion could force nurses to take courses to meet requirements, rather than select those activities appropriate to their practice.”’ She further expresses her concern that com- pulsory education requirements might fai l to allow for individual differences, especially since informal, unstructured methods of learning are not recognized to the degree that formal courses are. Instead of nurses assuming the personal responsibility to de- termine their own educational needs, they could become dependent upon fulfilling the criteria as delineated by a select group of

24 AORN Journal, July 1973, Vol 18, N o 1

"others" who supposedly represent their needs. Accountability will be compromised if individual nurses are dependent upon ofher nurses or persons not directly affiliated with nursing to tell them what continuing education activities will enable them to ful- fill certification criteria and qualify as com- petent practitioners.

Advocating mandatory continuing educa- tion, Allison contends, "For those who insist that having to participate in some form of continuing education will not guarantee learning nor competent practice, I can only respond that not having to do it guarantees even less."8 Surely those of us who endorse voluntary certification can sell the advan- tages of pursuing continuing education, such as the improvement of clinical performance, prevention of theoretical obsolescence, and development of one's self-potential, to the extent that nurses willingly engage in learn- ing and voluntarily evaluate and document their current competency.

Nurses who sanction mandotory certifica- tion often state, "If you are engaging in continuing education activities, why should you object to being asked to show evidence of it?"9 My resistance i s not to voluntarily demonstrating proof of my continuing edu- cation activities. I do resent having to fulfill mandatory requirements because "it i s the only way to get nurses to prove that they are engaging in continuing education." For me, the democratic principle of being able to submit credentials documenting my com- pentency because I choose to do so based on personal commitment to my own learn- ing, the nursing profession, and the con- sumer is extremely important. I dislike being penalized because of the nurse who i s apathetic regarding her own continuing education.

Perhaps we need to devise a system whereby those who are willing to be certi- fied voluntarily are given the opportunity to do so and are positively reinforced for their behavior. Personnel responsible for hir-

ing and promoting nurses should utilize cer- tified nurses in preference to non-certified nurses. A salary differential should exist. More responsibility should be delegated to certified nurses. The expectation for crea- tive, innovative expanded roles should be limited to nurses who care enough to main- tain their competency voluntarily. If a nurse chooses not to be certified, we in the nursing profession need to exert peer pressure to the degree that the nurse questions her reluctance to be certified.

Jean Hayter, professor of clinical nursing at the College of Nursing, University of Kentucky, identifies six reasons why nurses may not engage in continuing education:

1.

2.

3.

4.

5.

6.

Available opportunities for continuing education may not be convenient.

Available programs and materials may be inappropriate.

Our extreme emphasis on degrees and formal education may have de- emphasized the value of learning on a continuing basis.

There may be implied criticism in the suggestion that one needs to continue learning.

There may be no opportunity to use what is learned.

There is conflict in role identity- nurses may have trouble deciding what they should be learning because they are not sure what they should be doing.I0

Nursing educators need to address them- selves to these issues and correct deficiencies when possible before nurses are required to fulfill mandatory requirements. They spe- cifically need to improve the tools whereby the effectiveness of continuing education programs can be measured.

Before endorsing mandatory certification programs, nursing leaders should assess whether educational opportunities exist

26 AORN Journal, July 1973, Vol 18, N o 1

that allow nurses to fulfill continuing educa- tion requirements. Cooper states, ”if learn- ing resources are not readily available, compulsory requirements will create hostility, engender feelings of guilt, and create fur- ther division in an already divided profes- sion.”l I

I disagree with the premise that manda- tory certification for relicensure will force educators to develop appropriate continuing education programs. Will the quality of such programs improve or disintegrate under the dictates of a mandatory system? How strin- gent will the so-called minimum requirements of a mandatory system be? Would our mo- tives for setting up continuing education programs be valid educationally or would we be complying with rules? Would a volun- tary certification program permit more flexi- bility and creativity in terms of structuring continuing education programs?

Nursing leaders have to examine realis- tically the external forces which influence the quality of continuing education. For ex- ample, is there financial support available for development of adult continuing educa- tion programs? If adequate funding or qual- ified nursing faculty are not available, can nursing promise effective programs to its membership? Can we meet the stipulations of mandatory certification if external re- sources do not exist?

There are many nurses who believe my concerns are unrealistic. instead, they ac- knowledge that many opportunities present- ly exist and that mandatory requirements will encourage the programs to be devel- oped as needs are identified. I think such statements are naive. Chaos will result if programs are rapidly developed and im- plemented in order to meet mandatory re- quirements.

McGriff states, ”Militating ogainst the voluntary system is the very obvious fact that fewer than one-third of the nurses in this country belong to ANA. Such a

voluntary system, then, would affect only a fraction of the practicing nurses in this country.’”* Although I support the state nursing associations as being appropriate institutions to sponsor voluntary certification programs, 1 do not believe that they should require or coerce nurses to belong to ANA in order to participate in the certification program. Regardless of whether or not you are a member of ANA, you should be al- lowed to submit your credentials to the state nursing association. If such opportun- ities are readily provided, I believe that the majority of nurses will support a voluntary system.

Nursing leaders in ANA cannot afford to ignore and negate the support given by organizations representing specialty groups of nurses. Such organizations are also em- phasizing the importance of certification and encouraging their members to submit their credentials through the state nursing associ- ations. Certainly, AORN has worked dili- gently to inform its members of the complex issues surrounding certification. We have explicitly urged our members to become active in both delineating and fulfilling certification criteria through appropriate activities associated with ANA at both the national and state level.

Do nurses care eno’ugh to fight for their right to retain the professional responsibility of voluntarily maintaining and demonstrat- ing competency? Yes, nurses are taking a stand.

During the 1972 ANA biennial conven- tion, the House of Delegates defeated a resolution that ANA go on record as sup- porting evidence of continuing education as one condition for renewal of license as a registered nurse. Recently, statewide hear- ings in New York convinced nurses to capitulate in relation to their attempt to legislate mandatory continuing education. Nurses in the state of Washington also abandoned similar legislative endeavors.

28 AORN Journal, July 1973, Vol 18, No 1

Only California has a mandatory continuing education law in effect at this time; and the Council responsible for implementing the law i s grappling with numerous questions and problems.'3

Many states (West Virginia, Colorado, Utah, North Dakota, Arizona, Texas, Vir- ginia, Maryland, District of Columbia) are exploring or implementing voluntary certifi- cation programs. Such states have openly acknowledged the many unresolved issues associated with promoting premature legis- lation that requires mandatory continuing education. A provocative statement issued by the Task Force for Review and Revision of ANA's Model Practice Act effectively enumerates some of the problems associated with the transfer of professional responsibil- ity to the state.14

Will the opinions of nurses make a differ- ence? Or will we have voluntary certifica- tion for several years, eventually allowing legislation for mandatory continuing educa- tion to occur because of our reluctance to demand adequate time to evaluate thor- oughly voluntary certification?

Will operating room nurses speak out now or complain of being victimized at a later date? It i s your decision. 0

Carol Alexander, RN, MS Director of education

REFERENCES

1 . E Allison, "9. Should Continuing Education Be Mandatory? Yes," American Journal of Nursing, March 1973, p 443.

2. E McGrif f , "A Case for Mandatory Con- tinuing Education in Nursing," Nursing Outlook, November 1972, p 713.

3, /bid.

4. S Cooper, "This I Believe About Continuing Education in Nursing," Nursing Outlook, Septem- ber 1972, p 580.

5. /bid.

6. S Cooper, "9. Should Continuing Education Be Mandatory? No," American Journal of Nursing, March 1973, p 442.

7. Cooper, "This I Believe About Continuing Ed- ucation in Nursing," op cit, p 582.

8. Allison, op cit.

9. J Hayter, "Individual Responsibility for Con- tinuing Education," Jou rnd of Continuing €duca- fion in Nursing, November-December 1972, p 33.

10. /bid, p p 33-37.

I I. Cooper, "9. Should Continuing Education Be Mandatory? No," op cit.

12. McGrif f , op cit.

13. "California's Law, Nation's First, Goes Into Operation," RN, February 1973, pp 62-64.

14. "Continuing Education: Mandatory for Re- newal of License?" Unpublished stdement paper o f the Task Force for Review and Revision of ANA's Model Practice A c t of the ANA Congress for Nurs- ing Practice, January 1973.

I I Hyperfension fherapy Physicians can delay or prevent complications of high blood pressure, according to Cheves McC Smythe, MD, dean of the University of Texas Medical School, Houston.

He told registrants at a workshop on hypertension that the benefits of high blood pressure therapies must be widely known and appreciated by physicians and students as well.

Research and development of new drugs for treating high blood pressure continues to be needed, Dr Smythe added.

The workshop was sponsored by the Medical School and Division of Con- tinuing Education of the University of Texas Health Science Center at Houston.

AORN Journal, July 1973, VoE 18, N o 1 29