Overcoming Barriers Associated With Continued Nursing Education to Maintain Industry Standards, Article Writing Example

Letter of Inquiry

October 15, 2011

Patricia S. Yoder-Wise

Journal of Continuing Education in Nursing

Dear Patricia S. Yoder-Wise:

I would like to enquire about your interest in a manuscript I am presently developing with the working title “Overcoming Barriers Associated with Continued Education in the Field of Nursing to Maintain Industry Standards.” Working nurses today are overwhelmed with the idea of continuing education, yet it is crucial to the maintenance of industry standards and effective patient care.

I am in the last semester of a master’s program in nursing and have encountered this topic among many of my peers.  Nursing students and nurses I have encountered have many questions about possible solutions to keep their qualifications current, without major disruptions in their professional and personal lives. Information on this topic is limited and I had to examine various articles and consolidate information from varying sources to write my manuscript. I have reviewed article requirements for the Journal of Continuing Education in Nursing and think my manuscript will be of interest to your readers. I will be able to send the manuscript for review within a week after hearing from you.

Sincerely,

Abstract

Nursing professionals who pursue further education through online learning face a variety of challenges. However, technological advancements and industry support ensure that each barrier is successfully overcome. By the end of 2009, 111 schools in Canada offered one or more Entry-to-Practice (ETP) programs for nurses. These programs offer a mode of study which allows graduates to apply for initial licensure and registration as a registered nurse (RN). Each of these ETP programs is also offered online. Based on a number of studies on the topic of continuing education, the majority of currently employed nurses prefer a virtual classroom to a traditional classroom setting. It allows them to successfully complete academic pursuits while maintaining an active professional career and personal life. This saves many non-traditional students, who have full-time employment or young families, time and money.

Key Words: continuing education, online learning, nursing education, non-traditional students, ETP programs.

Introduction

With nearly three million jobs in America alone, registered nurses (RNs) constitute the leading healthcare occupation. According to the U.S. Department of Labor, approximately one million new nurses will be needed by 2018 (U.S. Department of Labor, 2011). American RNs have a choice of pursuing a nursing diploma, an associate’s degree, or a bachelor’s degree. A licensed practical nurse (LPN), also called licensed vocational nurse (LVN) requires a diploma. It is common for RNs to start their careers as staff nurses in hospitals. However, not all nurses are content in those positions and many move on to become advanced practice nurses. Advanced practice nurses have a wider scope of patient care (CNA, 2011) which includes, but are not limited to, direct patient care, expert consultations, emergency services, and assistance in labor and delivery (U.S. Department of Labor, 2011).

This article will examine the options available to practicing nurses who wish to continue their education, while addressing the various barriers that prevent many nontraditional students from pursuing a continued education. In order to give a comprehensive overview of nursing education, this article presents a brief history of nursing education in Canada.

Background

The Board of Directors of the Canadian Nurses Association (CNA) developed a national framework in 2002 which mandates a graduate degree in nursing as the minimum academic requirement for advanced nursing practice (Canadian Nurses Association, 2008). Similarly, advanced practice nurses in America require, at a minimum, a master’s degree. In addition to the degree requirements, both Canada and the U.S. require that students pass the national licensing examinations in order to obtain a nursing license. In Canada, students must pass the Canadian Registered Nurse Examination, which is managed and updated by the CNA. Additionally, the CNA requires that prospective advanced practice nurses pass a certification exam in order to specialize in an area of nursing (Canadian Nurses Association, 2010). In the U.S., advanced practice nurses are also required to pass a certification exam to ensure specialized practice. Nursing students are required to pass the National Council Licensure Examination (NCLEX-RN), to obtain a nursing license (U.S. Department of Labor, 2011).

Development of Online Nursing Programs in Canada

Until recently, nurses in Canada had two basic options to obtain nursing degrees: they could either pursue a community college-based diploma, or they could pursue a bachelor’s degree in nursing. However, in light of recent technological changes in the field of nursing, as well as advances in medicine; educational requirements have become stricter (Buhr, 2010). Prior to changes in academic requirements, nurses received training either through hospital-based training programs, community college-based programs, or university-based programs. Each program involved classroom education and practical training in hospitals. During the early 1990s, hospital training programs were gradually phased out and distance learning programs were gradually integrated (Buhr, 2010). With the integration of online classes many nurses, who are already actively employed, now have the opportunity to work and continue their education simultaneously.

In addition to adhering to recent changes made by the CNA, many nurses choose to pursue graduate education because they find that increased education leads to increased earnings. Buhr (2010) found that in addition to higher earnings, Canadian nurses with advanced degrees are more likely to be promoted to supervisory positions (p. 131). In fact, Buhr’s study found that nurses with an advanced degree are five percent more likely than nurses without an advanced degree to hold supervisory positions (p.129). An online degree makes it possible for professionals to effectively balance family, work, and school. It is therefore an increasingly acceptable method to obtain a nursing degree.

Methods

Based on the findings of 99 qualitative studies conducted from 1996 to 2008, students enrolled in online courses scored in the 59^th percentile in tested performance. This was in comparison to students enrolled in traditional classrooms, who scored in the 50^th percentile in tested performance (Lohr, 2009). Students from all backgrounds, enrolled in courses ranging from medical to military, were involved in the research. Barbara Means, lead author of the study, said the statistics show that online learning is rapidly becoming “better than traditional instruction,” (Lohr, 2009). Means predicts that although online learning will not take the place of traditional classrooms, it will undoubtedly expand in the near future.

A virtual classroom is a non-traditional learning environment where students and educators are separated by time or space. Course content is provided by the educator through multimedia resources such as email and videoconferencing (Kurbel, 2001). Students submit work through similar methods. Virtual classrooms or virtual schools provide an online education by using the internet. Courses are offered through varied instruction modes like hypertext courses, video-based courses, animated courses, virtual classrooms, audio-based classrooms, and web-supported textbook courses. A virtual classroom therefore is a complete digital experience. Experts agree that online education provides a more tailored experience for students in comparison to traditional classrooms, because it thrives on independent learning methods, instead of collaborative learning methods. Students in a virtual environment learn more by doing more, and research proves that students respond favorable to such a learning environment (Lohr, 2009).

Today’s virtual schools are technologically advanced derivatives of correspondence schools. Correspondence schools offered an alternative to traditional classroom settings by offering education through distance learning methods. With distance learning, teacher-student interaction happened mainly through the postal service or pre-recorded television broadcasts. With modern technology, the traditional postal service has been replaced by email, and pre-recorded media has been replaced by real-time video-conferencing or internet chat. Although virtual classrooms are being integrated into k-12 curriculums, most students enrolled in online courses are continuing education students.

Findings

Virtual classrooms remove students from a traditional classroom setting; in other words, students in an online course do not have customary peer interaction. Critics say this lack of socialization is harmful to strong character development (Kurbel, 2001). However, opinion polls indicate that peer-to-peer interaction is not lacking; it is merely different. A plethora of social networking sites like Facebook and MySpace have introduced a fresh way of peer communication and have even allowed users, who would otherwise act more introverted, to participate in structured group discussions. This can be attributed to the fact that online students do not face the pressure of public speaking within a set time limit (Kramer, 2005). Experts recommend that students, who are engaged in full-time online learning, should make an effort to socialize outside of school. Similar recommendations are made for students who are homeschooled (Hiltz, 1994, p. 24).

In comparison to traditional classrooms, which offer scheduled class-times and encourage rigorous time-management, virtual classrooms afford students the luxury to perform work on their own schedules. Although assignment deadlines exist, students are challenged to stay focused in a home environment as learning becomes completely self-directed. Students enrolled in online courses should ideally be self-motivated. As a result, opinion polls reveal that students find the act of focusing, to be the most challenging aspect of online learning (Hiltz, 1994, p. 23). Self-motivation ensures the successful completion of online degrees.

There are students who prefer a virtual classroom to a traditional setting because it allows them to avoid the hassle of traveling back and forth to a physical location regularly. This saves many non-traditional students, who have full-time employment or young families, time and money (Hiltz, 1994). The fact that virtual classrooms are accessible at any time, and at any location with computer access, allows online classes to be more accessible to a greater variety of students. It is also more convenient for handicapped students, or students with behavioral issues, to enroll in online classes. Unlike traditional classrooms, students are not limited by class times or class locations.

Both classroom types are learner centered; they both have the student’s success at heart. Students in both settings learn by engaging in group discussions and projects. Both the virtual classroom and the traditional classroom therefore employ a similar learning theory, curriculum design and instruction method (Hiltz, 1994). Although the means of student-instructor communication differ in each setting, both forms of instruction include homework assignments, deadlines, and tests. The difference between the two types of classrooms is that virtual classrooms often lack verbal discussions and explanations as most content is communicated digitally in text form (Kramer, 2005). However, virtual classrooms have discussion forums that give students an opportunity to communicate effectively with instructors and other students.

Research conducted through PBS.org shows that students who engage in online learning are more likely to retain course material. Interactive reading and writing produces 40 percent memory retention, compared to 15 percent memory retention from lectures. Reading and writing causes students to actively participate; listening to a lecture or watching a presentation causes apathetic student participation. The virtual classroom promotes in-depth student engagement, because students have to express thoughts through writing.  Written communication causes a deeper depth of thought than verbal communication. Furthermore, online communication creates a unique avenue of communication between students and teachers. Traditional classrooms are often limited by space constraints and time limits. In those settings students have a limited opportunity to interact with teachers on a one-to-one basis. Online classrooms create an avenue of one-to-one communication between students and teachers, without time or space constraints. This allows for a valued, private time-sharing opportunity between students and teachers. Lastly, online classrooms exist in a space without time. Students and teachers have an opportunity to learn and teach without a set time limit, so a constant flow communication exists.

Obstacles, Benefits, and Challenges of Returning to the Academic World

Experts in the field of nursing argue that continuing education should be mandatory for all nurses because it ensures that they retain their competence in the healthcare industry (Russel, 2011). Studies that focus on the importance of mandatory continuation of nursing education found that nurses are generally in favor of the topic. Thirty-eight U.S. states currently mandate continuing education (Russel, 2011).  Canada does not have a national mandate for continuing competency; however, most provinces have requirements for continuing competency as a requirement for continued licensure. The CNA has implemented an informal request that “to provide competent nursing care, a registered nurse must maintain and continuously enhance the knowledge, skills, attitude and judgement required to meet client needs in an evolving health care system,” (CNA, 1999).

Nursing programs take place in colleges and universities.  Statistical data provided by the CNA demonstrates an increase in both nursing programs and student enrolment.  These demographic trends suggest that the pursuit of higher learning is becoming the standard in nurse education.

The Canadian Nurses Association (2010) National Student and Faculty Survey of Canadian Schools of Nursing (NSFS) notes that as of 2008-2009, 111 schools in Canada offered one or more Entry-to-Practice (ETP) programs. These programs offer a mode of study which allows for graduates to apply for initial licensure and registration as a RN. The report makes it clear that the current trend in nursing education is to provide a variety of pedagogic models.         While all nursing graduates must adhere to established competency guidelines in order to receive licensure and begin practice, the number of ways in which this can be achieved is much more varied than in preceding decades.  Of the 111 schools surveyed, 80.2 percent of them provided ETP programs, with 41 colleges joining forces with university programs to deliver their program mandates.  Additionally, the NSFS reports that admission to nursing programs reached a ten-year high during the 2008-2009 survey period, where “14, 010 students entered ETP programs, continuing the upward trend of past years” (Canadian Nurses Association, 2010, p. 5).  Additionally, statistics gathered by Health Canada (2006) indicate that while the number of nursing programs for baccalaureate, Post-RN, Master’s, Doctoral degrees and Nurse Practitioner certification did not change greatly in the early part of the 2000s, diploma-based nursing programs have declined.  As well, the enrolment rates for diploma programs in nursing have declined by almost half since the late 1990s while enrolment rates for baccalaureate programs have increased almost threefold (Health Canada, 2006).  These statistics also reflect trends in the current competitive job market, wherein nurses can increase their desirability as an employee, and thus their career prospects, by acquiring post-RN degrees and accreditation.

As reported by the NSFS through its review of the Canadian Council on Learning’s 2009 report, “lifelong learning allows individuals as well as communities to benefit from higher levels of education:  health, life satisfaction, volunteering, donating, employment stability, and income all increase as levels of educational attainment increase” (Canadian Nurses Association, 2010, p. 7).  The availability of advanced degree programs at a wide variety of Canadian institutions attests to this increased emphasis on higher learning, illustrating how many educational trends have changed within Canada over the past century.  The NSFS (2010) reported that 37.8 percent of schools surveyed offered one or more post-RN baccalaureate programs for nurses who already had nursing diplomas.  The Northwest Territories and the Yukon were the sole provinces/territories that did not report any post-graduate nursing programs, likely due to their small populations.  While there were fewer schools offering master’s and doctoral programs and a lower number of students admitted into said programs, the NSFS report notes that “historically, recessions produce jumps in the enrolment of short-course programs.  Enrolment jumps are therefore likeliest in two-year college programs and university graduate programs” (Canadian Nurses Association, 2010, p. 8).

On the topic of nurses’ perceptions about continuing education, various studies found the challenges most cited as family responsibilities, inability to get time off work to attend class, and limited financial support to attend school  (Russel, 2011). Similarly, a 2006 study found that nurses in rural areas of Canada found continuing education demanding for several reasons. First, rural nurse practitioners are often the primary form of care in a community. If they have to leave in order to pursue continued education, the community would suffer (Curren, Fleet, & Kirby, 2006). In addition, many rural communities have inadequate facilities for nurses to continue professional education. Study particiapnts favored online or distance learning as a favorable solution to those barriers  (Curren, Fleet, & Kirby, 2006).

Conclusion

Reasons for Pursuing Further Education

In addition to higher salaries and increased opportunity for promotions to supervisory positions, continued education is crucial to the quality of healthcare services. Continued nursing education ensures that nurses are current on latest healthcare developments and competent to administer effective care (Russel, 2011). The Tri-Council for Nursing (AACN, AONE, and NLN) issues a consensus statement in 2010 calling for all RNs to continue education in the interest of promoting safety and quality of healthcare practices (American Association of Colleges of Nursing, 2011). Of the nearly 300,000 registered nurses in Canada, nearly 86 percent cited direct patient care as their primary area of responsibility. Continued education is, therefore, beneficial to healthcare professionals and their patients.

In an effort to help nurses overcome barriers that prevent them from continuing education, several methods of assistance have been implemented: many hospitals or healthcare institutions are willing to adapt nurses’ schedules to allow time for continued education; many hospitals will offer full or partial financial assistance to nurses who wish to pursue continued education; most nurses who complete a continued education degree or course are eligible for positions with increased responsibility resulting in significant pay increases; higher qualified nurses often receive huge sign-on bonuses; nurses who successfully completed continued education courses are often recruited by larger and busier employers, and their relocation costs to these new facilities are generally paid  (Buhr, 2010).

Summary

In a 2010 report issued by the Institute of Medicine, the Robert Wood Johnson Foundation called for an increase in the number of nurses within the workforce with a bachelor’s degree. The Foundation recommended that at least 80 percent of all practicing nurses in 2020 have bachelor degrees (American Association of Colleges of Nursing, 2011). The Foundation based its request on the changing demands of the healthcare system, as well as on the evolving needs of patients. Similarly, the Carnegie Foundation for the Advancement of Teaching recommended that all entry-level RNs earn a master’s degree within 10 years of licensure. This recommendation was based on the Foundation’s assessment that large numbers of new nurses are ill-equipped to meet industry standards (American Association of Colleges of Nursing, 2011). In response to the increased demands of industry leaders, nurses and nursing students are faced with various challenges to attain set goals. Some of the challenges include conflicting work schedules to attend classes, expensive tuition costs, and difficulty balancing personal life, such as family, with work and education.

In order to help nurses overcome these barriers, various solutions have been implemented. For instance, many accredited and reputable universities and colleges offer online degrees. As a result, nurses do not have to be concerned with the varying demands of traditional classes. Also, many employers offer financial assistance to nurses who choose to continue education through online schooling.

Virtual classrooms have opened a new avenue of learning for students of all walks of life. Students can access an academic career from anywhere in the world, and gain a degree in their field of choice. Students have the freedom to pursue a degree in the comfort of their own homes. With the rising popularity of virtual classrooms, academic institutions can successfully strive to the ideal of the Socratic small group interaction, which is often an unrealistic goal in traditional classrooms. Unlike traditional classrooms, virtual classrooms do not see diversity in background, attitude, and other factors as challenges. In fact, they embrace that diversity by providing an education to anyone, anywhere.

Virtual classrooms have been successful in helping students graduate with accredited degrees from reputable academic institutions. Students can adjust their school schedules to fit their lifestyles, and not the other way around. The benefits of a virtual education are too many to discredit it as a dubious. Its benefits are being integrated into high schools and colleges, nationwide. Virtual classrooms are emotively supportive, in a medium that is rapidly changing the way we live. The internet allows for real-time, global, and instant communication. Students enrolled in a virtual course, no longer endure pressure from time constraints or public speaking. Each student is afforded the unique opportunity to excel on a personal level, on their own time.

As a student who has participated in a traditional classroom setting as well as an online classroom setting, I am in favor of online methods of instruction. Course-based information is delivered effectively and in a timely fashion. Online classes have useful tools that allow for real-time student-to-instructor and student-to-student communication. Lastly, and perhaps most importantly, I find that online education creates an equal opportunity for student interaction. In traditional classroom settings, many students may find it difficult to participate; mostly due to lower levels of self-esteem. In an online setting, each student is afforded the opportunity to communicate effectively from the comfort of their own homes. This promotes self-confidence and, in turn, effective participation. Practical skills are learned in the actual healthcare environment and under the supervision of qualified, seasoned nurses. Online education, therefore, provides the solid foundation that nurses require before entering into actual practice. It does not deprive a prospective nurse of anything, instead it contributes to develop a well-rounded, and well-qualified candidate for the healthcare industry. Continuing education remains the primary goal for nurses today. As Florence Nightingale said; “If you ever stop learning, you might as well stop nursing.”

References

American Association of Colleges of Nursing. (2011, July 15). The Impact of Education on Nursing Practice : 2011 Fact Sheet. Retrieved from American Association of Colleges of Nursing: http://www.aacn.nche.edu/media/factsheets/impactednp.htm

Buhr, K. J. (2010). Does Increasing Education Increase the Probability of Promotion? The Case of Registered Nurses in Canada. Journal of Continuing Education in Nursing, 41(3), 123-132.

Canadian Nurses Association. (1999, June). RN Education: continuing education. Retrieved from Canadian Nurses Association: http://www.cna-aiic.ca/CNA/nursing/education/continuing/default_e.aspx

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Canadian Nurses Association. (2010, August 5). Nursing in Canada. Retrieved from  http://www.cna-aiic.ca/CNA/nursing/default_e.aspx

Canadian Nurses Association (2011).  Nursing Practice.  Clinical Nurse Specialist and Nurse Practitioners.  Retrieved from http://www.cna-aiic.ca/CNA/practice/advanced/default_e.aspx

Curren, V. R., Fleet, L., & Kirby, F. (2006). Factors influencing rural health care professionals’ access to continuing professional education. Australian Journal of Rural Health, 14(2), 51-55.

Hiltz, S. (1994). The Virtual Classroom: Learning without Limits via Computer Networks. New Jersey: Ablex Publishing Corporation.

Kramer, C. (2005). The Online Classroom. Retrieved December 18, 2010, from www.pbs.org: http://www.pbs.org/campus/006_News/006-dec-03.html

Kurbel, K. (2001). Virtuality on the Students’ and on the Teachers’ sides: A Multimedia and Internet based International Master Program. Berlin: Online Education.

Lohr, S. (2009, August 19). Business Day Technology. Retrieved December 18, 2010, from New York Times: http://bits.blogs.nytimes.com/2009/08/19/study-finds-that-online-education-beats-the-classroom/

Russel, S. S. (2011). If you ever stop learning, you might as well stop nursing: the challenges of continuing nursing education. Med-Surg Matters, 20(1), 6-7.

U.S. Department of Labor. (2011, October 12). Occupational Outlook Handbook, 2010-11 Edition: Registered Nurses. Retrieved from Bureau of Labor Statistics: http://www.bls.gov/oco/ocos083.htm