Continuing Nursing Education in Tsuen Wan Adventist Hospital
Mrs. Trudy Ho, MHA. RN
Director of Nursing, Tsuen Wan Adventist Hospital
Mr. Peter Chuk, MclinN. RN
Assistant Director of Nursing, Tsuen Wan Adventist Hospital
Although the benefits of continuing nurse education (CNE) were examined in the November 2001 Issue of the Newsletter of Hong Kong Society for Nursing Education, a direct relationship between mandatory learning activity for nurses and quality patient care has yet to be established (Twinn, 2000). Continuing education, however, provides an active learning activity and culture for nurses working in Tsuen Wan Adventist Hospital. The significance of CNE as a learning experience for nurses has been indicated by the support of the management team in taking a proactive role to plan and formulate hospital policy, to acknowledge the need of continuous learning to meet the demands of constant changing health technology and evidenced-based nursing practice. Definition, planning and implementation of Continuing Nursing Education as stated in the Hospital Policies and Procedures Manual of Tsuen Wan Adventist Hospital refers to any specific learning experience that enhances the individual nurse's capability and potential within his/her present work role and facilitates the nurse to achieve the hospital mission in providing quality health services for the community (Tsuen Wan Adventist Hospital, 2000). From this perspective, the learning activities of nurses cover a wide range of programs, such as staff development, in-service and external courses, cross-training, clinical attachment, community health services, and policies and guidelines review. Programs such as these have been implemented in the hospital.
Staff Development Program
To sustain the hospital mission and values and maintain quality services,
nurses are encouraged and assisted in developing a yearly staff development
plan to achieve quality service provision as well as professional development.
Both Nursing Unit Managers and Nursing Administration monitor the plans
of individual nurses and facilitate learning opportunities for them whenever
appropriate.
At six-monthly intervals the plan is discussed by the nurse and Nursing
Unit Manager to identify any further necessary action. A record of the study
plan is kept in the Nursing Unit. When any unsatisfactory performance is
identified by the Nursing Unit Manager or Nursing Administration appropriate
remedial and development programs will be offered. Individual coaching and
counseling will be provided according to the needs of nurses.
In-service Program
The goals of in-service program are to provide nurses with up-to-date knowledge
and skills in order to promote a learning culture and improve work efficiency
and effectiveness. Another important goal is to facilitate the provision
of holistic care by cultivating insights and clarifying with nurses their
responsibilities and commitments and skills in their expanding roles through
education and supervision.
A hospital-wide or Nursing Unit level ongoing in-service program is planned
for the whole year and evaluated at the end of the year. The contents include
health promotion and prevention, occupational safety and health, spiritual
and legal aspects, infection control, continuous quality improvement, management,
nursing skills and standards, and other job-related training (Tsuen Wan
Adventist Hospital, 2000).
The hospital requires attendance for some important topics such as Manual
Lifting, Basic Life Support, Infection Control Nursing and Intravenous Therapy.
The in-service programs are conducted by appropriate experts and usually
take place within the hospital venue. The experts include doctors, nurse
specialists, university lecturers or professors, pastors, administrators
and paramedical personnel.
In-service programs providing training on topics such as policies, guidelines
and procedures review, equipment operation drill and specialty sharing are
arranged according to the specific needs of individual Nursing Units. Nursing
Unit Managers and Nursing Administration jointly play an important role
in planning and implementing these learning activities. The overall in-service
programs will be evaluated at the end of the year to obtain feedback from
participating nurses. Evaluation forms are distributed to obtain nurses'
opinions and the data are used as indicators for future planning direction
for in-service programs.
External Course
In order to build a culture of continuous learning, nurses are encouraged
to attend formal courses or conferences/seminars/workshops to maximize their
potential and further enhance their knowledge and skills. They can attend
relevant courses, which have been highlighted in their agreed staff development
plan, or when a special need arises from their work situation.
In order to maintain a regulatory system of continuing education for nurses
the Hospital administration provides study records and subsidizes educational
fees (Tsuen Wan Adventist Hospital, 2000). Detailed study applications are
submitted to the Nursing Unit Manager, Nursing Administration and Human
Resource Department for approval. A copy of certificate or diploma obtained
following completion of the course is kept in the Human Resource Department
as a permanent record on the nurses' personal file and serves as an appraisal
for the nurses' professional development.
Nurses undertake self-evaluation of their learning during their annual performance
appraisal. This mechanism helps consolidate their learning and is considered
a valuable contribution to the hospital. It also allows the administration
to identify what it can offer to assist nurses in achieving their goals
and needs. To contribute to the learning culture, nurses who have attended
formal courses and special training from external resources participate
in hospital-wide or Nursing Unit in-service programs.
Cross-training Program
Following negotiation among nurses, their Nursing Unit Managers and Nursing
Administration, they are encouraged to work in another specialty area of
the hospital. This scheduled cross-training program creates opportunities
for the nurses to acquire multi-skills and assists them to work competently
in different specialty areas at times of hospital urgent needs. Senior nurses
in the training areas act as preceptors to facilitate learning and training
activities. The preceptors are to ensure effective orientation review the
cross-training programs and learning for the preceptees and documentation
is kept by the Nursing Administration for continuous review.
Clinical Attachment Program
This program aims to improve nurses' practice and communication skill as
well as to consolidate and/or enhance new knowledge and skills to cope with
the increasing complexity of service demand of patient care and clinical
decision-making. An arrangement is made to attach nurses to a special clinical
unit of another hospital for observation. Learning objectives are identified
for the attachment. The attachment program is based on the needs and requirements
of individual Nursing Unit identified collaboratively by nurses and the
administration. It
is anticipated that participating nurses gain new understanding, nursing
knowledge and skills by exploring a different clinical environment.
Community Health Service
The goals of community health service programs are to involve nurses in
health promotion and prepare them to gain better understanding of the integration
of hospital services in community health promotion. They also learn to conceptualise
holistic care within the context of family and community. This program is
arranged on a volunteer basis with activities such as physical check-up,
health promotion and first-aid services being undertaken.
Implementation Issues and Management
The implementation of continuing nursing education in Tsuen Wan Adventist Hospital therefore not only includes in-service and external course programs but also a range of other programs. Nurses may feel discouraged if they fail to meet the required CNE as stated in the hospital policy and it is crucial for management to provide time and support for nurses to understand the value of ongoing learning.
Continuing education, in-service training and employee scholarship loan policies have been developed and implemented to motivate nurses to self-initiate continuing nursing education. A certain amount of study allowance and study leave for different ranks is granted to each nurse, when taking on external course approved by Nursing Unit Manager and Nursing Administration. Ownership of continuing nursing education and responsibility for assessment and planning are considered to be mutual between nurses and hospital administrators. Both parties have responsibility for making a feasible and individualized schedule to achieve the goals of personal capability and potential to provide learning opportunities to improve health services. Most important of all, the management team takes time to assist nurses in understanding their own responsibilities in continuing education through formal and informal sharing. In addition, educational and journal corners have been specially designed to facilitate nurses accessing references with update-to-date information and learning resources. The information is available on a 24-hour basis and includes reference books, current journals, videos, cassettes, research and patient education files, and computer facilities. To facilitate nurses to actively participate in the in-service programs, program information is available and posted in all Nursing Units or via e-mail. As a departmental policy, nurses must attend a minimum of 50% of the scheduled in-service programs. However frequently due to shift duties nurses are not able to meet this requirement. Two to four identical in-service sessions are usually planned at different times in order to facilitate the required attendance. Tape recordings are currently on trial and available for nurses on permanent night duty to review the required sessions if necessary. It may be difficult at times to ensure effective communication and successful participation. Providing support, building a culture of learning and belonging, having easy access to resources and exercising strong leadership are the key strategies for effectively implementing a wide range of learning programs in the hospital.
Conclusion and Recommendation
It is anticipated that nurses working in Tsuen Wan Adventist Hospital perceive
continuing education as an important learning activity for expanding their professional
development and the provision of quality health services. Thus, a collaborative
effort amongst nurses and the management team in implementing continuing nursing
education in the work setting has been emphasized and maintained. Although an
ongoing evaluation of the various learning programs is being undertaken, it
is recommended that a valid measuring tool should be used to evaluate the quality,
effectiveness and desired outcomes, of the current activities of continuing
nursing education implemented in the hospital (Dodgson, 2000).
Although the implemented programs do not guarantee full success in achieving the anticipated goals, we as nursing administrators must move beyond this and focus on developing a value-driven learning culture. It is important for us to recognize that changes in the hospital system, nurses' behavior and attitudes require a life-long investment in learning. We deeply believe that a well-structured learning program with consistent strategies to sustain a learning culture and a trustful relationship with nurses, which includes their active participation in the learning experience, is an effective way to capture the essence of professional development and quality services.
References
Dodgson, J.E. (2000). Strategies to improve the quality of continuing education.
Hong Kong Society for Nursing Education Newsletter, November, 4-7.
Tsuen Wan Adventist Hospital (TWAH) (2000). Continuing Education Policy, Hospital Policies and Procedures Manual. Unpublished internal document. Hong Kong: TWAH.
Tsuen Wan Adventist Hospital (TWAH) (2000). Training and In-service Program, Hospital Policies and Procedures Manual. Unpublished internal document. Hong Kong: TWAH.
Twinn, S. (2000). The contribution of mandatory continuing education to professional practice: a continuing debate. Hong Kong Society for Nursing Education Newsletter, November, 2-4