A commitment to safe, quality care

Nurses, like all professionals, must have current knowledge to ensure the best possible care for their patients and communities. Practicing professional nursing requires a commitment to lifelong learning. With the advances in healthcare and technology due to research, it is imperative that nurses participate in knowledge development for themselves and the profession. Nursing has the opportunity to improve the health and wellbeing of their patients by participating in educational opportunities post degree and sharing best evidence for safe practice with others in their care community. The International Nursing Council (ICN) Code of Ethics (2000) stipulates that the practicing nurse "is active in developing a core of research-based professional knowledge" (p. 3)(ICN, 2000). The most effective way for nurses to meet this ethical standard is to participate in continuing education.

Continuing education (CE) is pursued by nurses internationally as a means to maintain licensure and/or certification in a specialty, to develop new skills, and to obtain current knowledge of evidence based medical practice. Most developed and some developing countries have adopted a standardized national test (such as the National Council Licensure Examination (NCLEX) in the United States) or established requirements that nurses graduate from an accredited nursing program to ensure competency to practice as a novice nurse. After graduation and passing examinations, Registered Nurses in many settings must pursue continuing professional education to ensure that they are current with new healthcare practices and that they are competent to continue to provide nursing care. For example, in the United Kingdom nurses and midwives must participate in 35 hours of continuous professional development every three years to maintain their registration to practice (Council of Nursing and Midwifery, 2011). Other countries, especially those who do not consistently register all practicing nurses and midwives, do not require any continuous professional development. This lack of knowledge development places the nurse at a disadvantage within the health care team and can potentially cause harm to patients. According to the ICN, it is an ethical imperative for nurses to continually seek out opportunities to increase their knowledge.

Yet does participating in professional development, ensure that nurses are competent? To establish this link, the National Council of State Boards of Nursing (NCSBN) in the United States examined the link between professional competency and participation in CE programs. Continuing education assumes that practicing nurses already possess certain abilities in order to provide safe, effective care and services. These abilities include recognizing patients needs, providing timely care and interventions, assessing outcomes and understanding when they need to seek collaboration and recognizing when one's own knowledge and skills are inadequate and areas of their own practice that need improvement (NCSBN, 2003). A second assumption is that professional nursing practice requires basic education, professional work experience, continuing education that takes many forms such as informal mentoring in the work setting or professional development programs. When analyzing data from over 1000 nurses, this study revealed that nurses who practice in settings where these assumptions are met, seek out continuing education and value new knowledge that they acquire from their colleagues in the work place. These data support the premise of life long learning and the need for nurses to work together to acquire new knowledge and skills.

Continuing education can occur in many settings and include a range of teaching methods such as simulation exercises, online tutorial, or education and skills development for improved competency or degree advancement. Simulation exercises include role playing, the use of mannequin, or high fidelity full body simulators that attempt to imitate the clinical environment yet offer the ability of faculty to interact within the patient care experience to provide immediate support and feedback. This type of teaching method allows the nurse and the teacher to deconstruct a care interaction in a safe and non judgmental manner which builds confidence for future real time performance (Nagle, McHale, Alexander, & French, 2009). This method of continuing education is being implemented in many practice settings and allows nurses the ability to integrate skills and clinical knowledge to improve critical thinking.

Improved connectivity and internet access has allowed for the implementation of on line computer educational programs that target specific skills or clinical knowledge. Current knowledge of the importance of improved hand hygiene has been widely disseminated with the use of on line tutorials (RCSI, 2011). Nurses are able to access web based programs that provide powerpoint and audio education with assessment of understanding using a post test. Other educational offerings include real time education sessions that provide nurses globally with information on a topic with the ability to ask questions and interact with a clinical expert. The MGH Institute of Health Professions in the United States offers the HOPE HIV nursing education conferences monthly to nurses in India, China, South Africa and throughout the United States (MGH, 2011). Using low band width internet access, nurses can participate in a live educational program whereby they can ask questions and interact with other nurses. This method of teaching allows for shared nursing knowledge and creates an international community of awareness specifically for vulnerable populations.

Developing improved competency and knowledge acquisition for the practicing nurse has become a focus globally. Recognizing that the nursing workforce is a valuable commodity, medical institutions are implementing continuing education for their nurses. These programs focus on improving clinical knowledge, skills acquisition, and interdisciplinary communication often including English language acquisition. The goal is to elevate the nurse to practice as a professional member of the patient care team. The Good HEAL Trust is collaborating with multiple hospitals and nursing colleges around the world to offer a highly concentrated continuing education program for the practicing nurses of Bangladesh. This Nurses' Skill Enhancement Program is designed to 'bridge' the differences between standard nursing practice in South Asia region and Western countries that promote professional nursing. The program focuses on improving skills and clinical knowledge, leadership skills and promoting the value of nursing in improving patient care outcomes. Practicing Registered Nurses enroll in a 12 month curriculum offered three days a week usually at their place of employment. International faculty and nursing leader's first focus on improving English as a second language followed by matriculation of a curriculum that enhances their current abilities and improves their general knowledge of nursing and medical care with the application of evidence based medicine. This method of CE allows the nurse to apply new knowledge to everyday practice.

Continuing education is necessary for the practice of professional nursing. Development programs are not a substitute for initial nursing education. They provide the practicing nurse with the confidence and competency to provide patients with the best evidence based quality care as required by the International Nursing Council Code of Ethics. Professional development programs should be a requirement of nurses and supported by employers for all members of the interdisciplinary healthcare team. As a professional, nurses are expected to seek out education and to participate in life long learning. The reward of engaging in continuing education is that the nurse will be confident in providing care and patients will receive excellent healthcare.

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Lynda A. Tyer is an assistant professor of nursing at MGH Institute of Health Professions. She is also a nurse scientist at Massachusetts General Hospital, Boston, USA and advisor to Good HEAL Trust.

References:
Council of Nursing and Midwifery (UK) (2011). The Requirements for maintaining your registration Retrieved May 10, 2011, from http://www.nmc-uk.org/Registration/Staying-on-the-register/Meeting-the-Prep-standards/

International Council of Nurses. (2000). The ICN code of ethics for nurses (pp. 8). Geneva: International Council of Nurses.

Royal College of Surgeons Ireland (RCSI) (2011). Hand hygiene tutorial. SurgInfection Retrieved May 15 2011, 2011, from http://www.surginfection.com/handhygieneppt.php

Massachusetts General Hospital (MGH) (2011). HIV HOPE Conference Series  Retrieved May 14, 2011, 2011, from www.hivconsult.org

Nagle, B. M., McHale, J. M., Alexander, G. A., & French, B. M. (2009). Incorporating scenario-based simulation into a hospital nursing education program. Journal of Continuing Education in Nursing, 40(1), 18-25.