Commitment to Lifelong Learning within the Nursing Profession as New Graduate Nurses

1. Commitment to Lifelong Learning within the Nursing Profession as New Graduate Nurses Angela Mitchell, Jessica Clausen, Kim Mueller, Nate Willey, Paige Nytes, Sean Decent December 8, 2010 RN 407 Nursing Internship/Professional Role Development

2. Objectives 1. Incorporate analysis of research findings with implementation of best practice within the roles of the professional nurse. 2. Demonstrate insight and self-awareness in articulation of knowledge, competency and readiness to apply principles of patient-centered care as a graduate nurse. 3. Understand the importance of lifelong learning and continued education within the nursing profession as a new graduate. 4. Identify resources available related Continued Education requirements, obtaining certification, and advancing degrees. 5. Establish an individualized professional development and lifelong learning plan. 6. Establish a networking source to share lifelong learning resources and activities, as a way to commit to professional development within the nursing profession.

3. Goals • To provide a process that supports quality nursing care to the public. • To support nurses in their professional commitment to lifelong learning and excellence. • To provide annual reporting on the Continuing Competence Process as a means to demonstrate the nursing profession’s accountability to the public.

4. What is Lifelong Learning? •Lifelong learning is a process that represents both a value of the health professions and a complex, critical competency of health professionals. •It presents as multiple facets: –May be viewed as a value embraced by the broad health professional community, or –It may be seen as a behavior advocated by health professional organizations and adopted by individual health professionals.

5. What is Lifelong Learning? •Defined by an Expert Panel, from Lifelong Learning in Medicine and Nursing, Final Conference “Macy” Report, as:  – The “lifelong, life wide, voluntary and self-motivated“ pursuit of knowledge for either personal or professional reasons.      –Competencies of Lifelong Learning Include: •reflect on one’s practice and thereby determine learning needs,     •efficiently and accurately search for learning resources and critically appraise them,     •apply these resources to clinical and other questions,     •manage large and changing bodies of evidence,     •evaluate one’s competencies and practice based on internal and external feedback,     •understanding of evidence-based healthcare and critical appraisal,     •familiarity with informatics and literature search and retrieval strategies,     •practice-based learning and improvement methods,         •self-reflection and assessment, and     •other skill sets related to knowledge management

6. Importance of Lifelong Learning for New Graduate Nurses •In making the transition from student nurse to practicing RN, the importance of CE and LLL will become clear. •It is our RESPONSIBILITY to ourselves, the profession, and patients. –Inherent to their role, nurses have a professional, moral, and legal responsibility to obtain and demonstrate continuing education and lifelong learning throughout their career. •Nursing is a fast-paced profession that is constantly changing, keeping up with these changes through lifelong learning and continued education, is essential to maintain competence to practice nursing safely and ethically. –CE and LLL promote evidence-based nursing practice, prevent poor or substandard care, and contribute to safe and quality nursing practice that aims to provide the best possible outcomes for patients.

7. Barriers to Lifelong Learning •Healthcare worker shortages and under-funding of CE programs within healthcare systems. •1989 survey in Canada, and 1993 survey in Texas –Lack of perceived need for CNE –Time constraints at work –Negative impressions regarding the course, course topic –Lack of confidence in one’s learning ability –Low personal priority –Professional disengagement (burnout) –Cost –Travel –Family and child care responsibilities –Lack of employer support •Reasons Nurses Do not implements what they learn (1987 Survey, 1993 Survey in Texas): –Lack of personal confidence in performing assessment  and skills –Lack of support from employers, colleagues, nursing supervisors, physicians, and form other employees –Job does not provide opportunity to use skills.

8. Facilitating Lifelong Learning •The most important element of lifelong learning is probably the attitude toward information acquisition •Encouragement of self-evaluation modalities: –Self-assessment, discussion with peers, in-service examinations •Create learning contracts •Other habits to be successful as a lifelong learner: –Begin with the end in mind – set goals –Accept responsibility for your own learning –View problems as challenges to learn from –Have confidence in yourself as a competent, effective learner –Create your own learning toolbox –Use technology to your advantage –Teach and mentor others

9. Qualities of Lifelong Learners •Innovativein their practice •Flexible to changing demand •Resourceful in their methods of working •Able to work as change agents •Able to share good practice and knowledge •Adaptable to changing healthcare needs •Challenging and creativein their practice •Self-reliant in their way of working •Responsible and accountable for their work

10. Modes of Lifelong Learning for New Graduate Nurses (AACN & AAMC, 2010) •You can maintain competence by using several methods of lifelong learning: –Reflection –Attending workshops –Reading nursing health journals –Participating in workplace discussions –Research online –CEU’s –Graduate Education •There will be several resourcesat your disposal including nursing websites, libraries, and in-services at your workplace.  Take advantage of this.

11. Maintaining an Active and Current RN License in Minnesota, if not Currently Practicing as an RN. “In order to maintain current licensure the board requires a nurse to renew their license on time and complete all of their continuing education requirements. The board does not require that a nurse practices in order to maintain current licensure.”                                            -Melissa Fure, MN Board of Nursing

12. Continuing Education Unit(CEU)

13. What are CEU's? - A unit of credit equal to ten hours of participation in an accredited program designed for professionals with certificates or licenses to practice various professions. - Proof of credits earned is necessary in order to renew a license to practice. The number of credits required varies by industry and state. -During a typical continuing education participation period (24 months) an RN must participate in 24 contact hours of continuing education.

14. How to obtain/submit CEU's Many professions organize national conferences to provide members with an opportunity to meet, network and learn. Activities which may meet continuing education requirements may be fulfilled in one of three ways: 1.  Obtain a current nursing specialty certificate 2.  Participate in continuing education activities offered by providers of continuing education, or 3. Participate in certain professional activities

15. CEU's: Professional Activities • Publication of an article or book on nursing or health related issues • Delivery of a professional paper related to nursing or health care • Participation on a professional panel that addressed nursing or health related issues • Participation in quality assurance or risk management studies • Participation in nursing or health care research • You cannot claim more than 10 contact hours for professional activities • Complete the professional activity during your participation period • Maintain a copy of the evidence of the professional activity for two years after using the activity for renewal.

16. Continuing Education Requirements • Be designed to enhance your ability to practice nursing. • Last at least one contact hour (50 minutes). Every additional five minutes is one-tenth of a contact hour. An academic course can be converted to contact hours. A quarter credit is equivalent to 10 contact hours. A semester credit is equivalent to 15 contact hours. • Be approved by a health licensing board or association or the provider of the continuing education must identify the objectives of the continuing education. • Be taught by an individual qualified to teach the subject matter of the continuing education.

17. Continuing Education Requirements **It is your responsibility as an licensed RN to determine whether a current nursing certificate, a continuing education activity, or a professional activity meets the continuing education requirements.

18. Where to obtain CEU's? Hospitals Clinics Colleges Universities Online Government Agencies Seminars Minnesota Nursing Board: Continuing Education And Refresher Course Resources http://www.state.mn.us/portal/mn/jsp/content.do?rc_layout=bottom&subchannel=-536893594&programid=536913940&sc3=null&sc2=null&id=-536893080&agency=NursingBoard

19. Advanced Nursing Practice • A nurse educationally prepared at the post-graduate level with advanced didactic and clinical education, knowledge, skills, and scope of practice applied within the nurse/patient relationship to achieve optimal outcomes through clinical analysis, problem solving, and evidence based decision making. • 4 types of APN degrees • Certified Registered Nurse Anesthetist (CRNA) • Certified Nurse Midwives (CNM) • Clinical Nurse Specialist (CNS) • Nurse Practitioners (NP)

20. Advanced Nursing Practice • Educated differently depending on specialty, yet require attainment of at least a master’s degree in respected concentration (Masters of Science in Nursing). • In 2004, The American Association of Colleges of Nursing (AACN) in collaboration with the National Council of State Boards of Nursing (NCSBN) recommended that APN’s move the entry level degree to the doctorate level by 2015. • All APRN training programs are required to convert master’s degree to a clinical/practice doctorate degree by 2015. • American Association of Nurse Anesthetist (AANA) program compliance by 2025. Programs will then offer a Doctor of Nursing Practice (DNP). (Grandfather Exception)

21. Certified Registered Nurse Anesthetist • Education and experience required to become a CRNA include: • BSN degree or other appropriate bachelors degree • Current license as a registered nurse • One year minimum experience in an acute care nursing setting • Graduation from a graduate school of nurse anesthesia (Programs are 24-36 months) • Programs include training in university-based or large community hospitals • Pass a national certification examination following graduation *Minimum 7 calendar years of education and experience to prepare a CRNA. *Avg. student nurse = 1,694 clinical hours and administers more than 790 anesthetics. *Avg. annual salary= $154, 567

22. Certified Nurse Midwives • ANP with specialized education and training in both Nursing and Midwifery. • Midwives are primary health care providers to women throughout the lifespan. This means that midwives perform physical exams, prescribe medications including contraceptive methods, order laboratory tests as needed, provide prenatal care, gynecological care, labor and birth care, as well as health education and counseling to women of all ages. • Certified Nurse Midwives may work closely, or in collaboration, with an Obstetrician & Gynecologist, who provides consultation and/or assistance to patients who develop complications or have complex medical histories or disease(s). • Currently 2% of Nursing Midwifes are men • *Avg. annual salary= $ 90,231

23. Clinical Nurse Specialist • Clinical nurse specialist programs provide skilled nurses with advanced theoretical knowledge and practical experience for work with targeted population groups. Areas of specialization include community health, gerontology, adult medical/surgical and mental health. Clinical nurse specialists are trained to work directly with patients as well as in supervisory or administrative roles. • Experts in a specialized area of nursing practice and in the delivery of evidence-based nursing interventions • Coursework will depend on area of focus. • 24-26 months for completion of degree • Avg. annual salary= $ 85, 858 CNS-Core Competencies • Direct clinical practice includes expertise in advanced assessment, implementing nursing care, and evaluating outcomes. • Expert coaching and guidance encompasses modeling clinical expertise while helping nurses integrate new evidence into practice. It also means providing education or teaching skills to patients and family. • Collaboration focuses on multidisciplinary team building. • Consultation involves reviewing alternative approaches and implementing planned change. • Research involves interpreting and using research, evaluating practice, and collaborating in research. • Clinical and professional leadership involves responsibility for innovation and change in the patient care system. • Ethical decision-making involves influence in negotiating moral dilemmas, allocating resources, directing patient care and access to care

24. Nurse Practitioner • At least Master’s degree needed (phasing-out to DNP) • 2-4 years education in specialty area • Licensed independent practitioners who practice in ambulatory, acute, and long-term care as primary and/or specialty care providers • Education provides theoretical and evidence-based clinical knowledge for role development as an NP. • Emphasis on development of clinical and professional expertise necessary for comprehensive primary care and specialty care practice in a variety of settings. • Apprx. 350 universities nation-wide have NP programs • NP’s specialize: Acute care, Adult Health, Family Health, Gerontology Health, Neonatal Health, Oncology, Pediatric/Child Health, Psychiatric/Mental Health, Women’s Health • Subspecialties: Cardiovascular, Dermatology, Emergency, Neurology, Orthopedics, Urology, Sports Medicine • *Avg. annual salary= $ 87,721

25. Doctorates in Nursing Both require and original research project and the completion/defense of a dissertation or linked research papers. Minimum 12 months post master’s studies necessary to acquire the additional doctorate level competencies. • Doctor of Philosophy in Nursing (PhD) • Focus on academic research and teaching (research focused) theory, meta-theory, research methodology, and statistics • Doctor of Nursing Practice (DNP) • Focuses on clinical aspects of nursing (practice focused) • Advanced practice, leadership, application of clinical research

26. Med/Surg and Oncology Certification Med/Surg CMSRN-Clinical Med Surg RN Oncology AOCNP-Advanced Oncology Certified Nurse Practitioner

27. OB and Pediatric Certification OB RNC-OB RNC-MNN-Maternal Newborn RNC-LRN-Low Risk Neonatal NNP-BC-Neonatal NP WHNP-BC-Women's Health NPRNC-NIC-Neonatal Intensive Care Pediatric CPN-Certified Pediatric RN CPEN-Certified Pediatric Emergency RN CPNP-Certified Pediatric NP ACPNP-Acute Care Pediatric NP

28. Critical Care and Mental Health Certification Critical Care CCRN-Critical Care RN PCCN-Progressive Care RN CMC-Cardiac Medicine RN CSC-Cardiac Surgery RN ACNPC-Acute Care Nurse Practitioner CCNS-Critical Care Nurse Specialist Mental Health APRN,BC-Advanced Practice RN, Board Certified RN,BC-Registered Nurse, Board Certified RN,C-RN, Certified APRN, BC in child and adolescent mental and behavioral health

29. Certification Example: CCRN What is it? Validates knowledge of nursing care of acutely and critically ill patients Requirements-     1. Current RN or APRN in the U.S.     2. 1,750 hours in direct bedside care of acutely and/or critically ill patients during 2 year period prior to application.     3. 875 hours need to be accrued in most recent year of application. How long is certification effective? 3 years How many CEU's are required each year?     -Complete a minimum of 100 CEU hours in a 3 year period         -60 CEU's in category A, 10 CEU's in both category B and C, and the other 20 CEU's in category A, B, or C.

30. CEU Categories Category A: Lab values, BLS, ACLS, PALS, NRP, ECG, IV therapy, heart failure, pharmacology, assessment, pathophysiology, statistics, clinical research, evidence-based practice, exam reviews, practice protocols, and CCRN self-assessment exam. Category B: Safety, legal or ethical issues, charting/documentation, reducing medication errors, public policy, HIPPA, end-of-life care, advance directives, stress management, medical Spanish, therapeutic communication, cultural and psychosocial aspects of care, diversity, and preceptorship/mentoring. Category C: Communication skills, teamwork, healthy work environments, redesigning hospital care, committees, management, leadership, community resources, case management, and ACCN membership.

31. Benefits of Acquiring CCRN -Provides a competitive advantage against others vying for the same position. -Even though the pay raise is not significant, the knowledge gained will benefit patient care and increase self-confidence (in 2006, nurses with advanced certification receive on average 7,000 more a year). -Respect gained from other coworkers. -Demonstrates a commitment to life-long learning. -Assuring consumers that you are meeting evidence-based practice. -Advancement in clinical practice (86% of managers said they would hire a CCRN vsa BSN RN. -Increased satisfaction and confidence.

32. Your Professional Development Plan Purpose: To support and demonstrate the ongoing competence of nurses who are practicing as Registered Nurses  The interest in the continuing competence of nurses has developed locally, nationally and internationally as the public demands for accountability of professionals has increased.

33. The Professional Development Plan • A method used to measure the on-going competence and lifelong learning of graduate nurses  • It is intended to be a tool that is relatively easy to use, and recognizes and builds on the fact that most nurses are already taking advantage of learning opportunities and continuing education whenever possible.

34. Your Professional Development Plan includes… Self Assessment – ask yourself the questions: 1.“What do I need to learn this year?”  2.“What would I like to learn more about this year?”

35. Your Professional Development Plan includes… 2.  Identification of learning activities – ask yourself:  3.“What can I do to learn more about…?  “What activities, reading, courses could help me learn about…?” (These activities can include formal training or non-formal, self-directed learning)

36. Your Professional Development Plan includes… Evaluation – ask yourself:  1. “Was I successful in meeting my learning goals?” 2. “How do I know – what changes can I see in my practice/knowledge”?”

37. Professional Development Plan Our goal is to encourage nurses to be proactive about meeting their learning needs by developing an annual plan identifying learning needs including the steps to be taken to meet those needs and an evaluation of the success of the learning. We also encourage nurses to keep a portfolio to record professional development activities – the planned activities and the “incidental” activities.

38. Sample Plan A. SELF-ASSESSMENT To learn more about treatment options for chronic pain syndrome. B. PROPOSED LEARNING ACTIVITIES Attend a workshop on CPS Review the current research on CPS from the Institute for Work and Health C. COMPLETED LEARNING ACTIVITIES Completed pre-reading package for workshop Attended  CPS workshop on (date) Read online articles from Institute of Work and Health   (specify title and date retrieved) D. EVALUATION I feel confident in helping staff to understand the causes and treatments for Chronic Pain Syndrome.

39. References American Association of Colleges of Nursing (AACN), & Association of American Medical Colleges (AAMC). (2010).     Lifelong learning in medicine and nursing: Final conference report. Retrieved November 24, 2010, from     http://www.aacn.nche.edu/Education/pdf/MacyReport.pdf.  Crocker, S.V. (2008). Fall into lifelong learning. Nebraska Nurse, 41(4), 12-13. Gopee, N. (2000). Self-assessment and the concept of the lifelong learning nurse. British Journal of Nursing, 9(11), 724-9. Minnesota Board of Nursing. (2010). Continuing Education.  from http://www.state.mn.us/portal/mn/jsp/content.do?rc_layout=bottom&subchannel=-536893594&programid=536913940&sc3=null&sc2=null&id=-536893080&agency=NursingBoard My Professional Development Plan. (n.d.), Retrieved November 24, 2010 from http://www.rnantnu.ca/Portals/0/MicrosoftWord-PDP.pdf Nursing BC. (2008). From nursing student to RN: lifelong learning and continuing competence starts here!. Nursing BC, 40(2), 27. Registered Nurses Association of the Northwest Territories and Nunavut. (2003). Continuing Competence: My Professional Devleopment Plan. Retrieved Novemnber 24, 2010, from http://www.rnantnu.ca/Portals/0/Documents/ContinuingCompetence/myprodevplan.pdf Willcox, A. (2005). How to succeed as a lifelong learner. Primary Health Care, 15(10), 43-50.