Lifelong Learning

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New nurses receive their graduation diploma, school pin and later the news of passing NCLEX with great pride. For nurses who received their entry credentials some time ago, viewing the crop of newly graduated nurses stimulates reflection.

Think back to your first day as a nurse. Try to remember the knowledge base, skill set and attitudes you brought to your first nursing position. Take a minute to recall that first day as completely as you can your assignment, the equipment and medications in use, your patients' length of stay, your uniform. Pause a moment to remember.

Now, fast forward to today. Whether your first day was only a year ago or many years ago, every passing day has brought changes. One of the most remarkable is your evolution as a nurse. Think about all you have learned and take a moment to celebrate your accomplishments! You are a lifelong learning case study.

Life & Change

Here is a deceptively simple, somewhat philosophical expression:

Life = Learning

Learning = Change

Needless to say, life has many rich dimensions and cannot be summed up by learning alone. Yet, most days challenge us to learn something - a new person, a new store in the community, a new boss, a new experience - or refinement of a passion for cooking, gardening or some other interest. Or, it may be learning to deal with health challenges - for ourselves or individuals close to us.

Whether you are getting to know a new car, a new pet or the latest generation intra-aortic balloon pump, the changed aspects of your life cause you to alter your knowledge base, skills and attitudes. In other words, you learn, and what you learn changes how you go about things.

In nursing, experience alone, as commonly defined, does not necessarily equal expertise. Benner proposed a definition of experience in nursing that distinguishes experience from longevity: "Experience is necessary for moving from one level of expertise to another; however, experience is not the equivalent of longevity, seniority or passage of time."1

At the extreme, some nurses who have been on the job for 20 years have had 1 year of experience 20 times. That is, if a nurse lacks awareness of changing circumstances or lacks an attitude that embraces change and new learning, that nurse's professional growth is stunted. Benner states experience "is the refinement of preconceived notions and theory through encounters with many actual practical situations that add nuances or shades of difference to theory when preconceived notions and expectations are challenged, refined or disconfirmed by the actual situation."2

For nurses, lifelong learning complements the professional growth that comes with self-conscious experience. Nurses commit to lifelong learning for their own professional development. And further, licensure requirements and professional standards mandate lifelong learning. The provisions of states' nurse practice acts and professional organizations' codes of ethics and standards of practice emphasize learning throughout one's career.

ANA Code of Ethics

There are a host of mandates for lifelong learning. The American Nurses Association states: "The nurse owes the same duties to self as to others, including responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth."3 The ANA Code of Ethics for Nurses further specifies that continual professional growth, particularly in knowledge and skills, requires a commitment to lifelong learning. ANA suggests lifelong learning opportunities include, but are not limited to:

 completing continuing education courses;

 networking with professional colleagues;

 using self-study materials;

 reading professional literature;

 completing certification requirements; and

 pursuing advanced degrees.

ANA identifies some of the dimensions of lifelong learning: current scope and standards of practice, changing issues, concerns, controversies and ethics. ANA urges nurses to seek consultation when practice situations arise that are outside of their competencies.3

State Requirements

"Lifelong learning and professional development have never been more important," according to the National Council of State Boards of Nursing (NCSBN).4 NCSBN, which coordinates and advises state boards of nursing, cites the explosion of new technology and the short half-life of knowledge as major drivers of the need for lifelong learning. NCSBN continues to define and recommend continuing competency requirements. Future recommendations may require testing and documented practice hours for relicensure.

Annually, in its first issue of the calendar year, the Journal of Continuing Education in Nursing publishes the current status of each state's relicensure requirements. Approximately 25 states require evidence of a specific number of continuing education contact hours as a part of the relicensure process. Access this information online at www.slackinc.com/allied/jcen/2004ce.asp.

Evidence-Based Practice

In recent years, evidence-based practice has captured the attention of professional nursing organizations and nurses at many healthcare facilities. Evidence-based practice rests upon the application of research findings to patient care.

Evidence-based practice is "conscientious, explicit and judicious use of theory-driven, research-based information in making decisions about care delivery to individuals or groups of patients and in consideration of individual needs and preferences."5

Evidence-based practice uses research findings that explicitly relate to patient outcomes and employ other evidence such as quality improvement and risk management data, expert consensus and affirmed experience. The criteria for use of evidence include not only the strength of the evidence related to patient outcomes, but also considerations of patient preference, ease of integration into the practice setting and cost-effectiveness.

Models of evidence-based practice highlight knowledge of new findings and identification of opportunities for improvement in patient care as drivers.6 To implement evidence-based practice, nurses need both knowledge of new findings and an approach to practice that identifies problems and opportunities for improvement. Evidence-based practice thrives only in practice environments in which nurses can exhibit questioning attitudes and mind-sets that favor lifelong learning.

The mandate for lifelong learning specifies neither what a particular nurse must learn nor which method the nurse must use. The professional responsibility for designing a customized lifelong learning plan rests squarely on the shoulders of each nurse.

Your Learning Plan

Respect the principles of adult learning to assure success of your plan. Many authorities have identified and researched principles of adult learning. Three concepts summarize principles of adult learning. The acronym AIR represents these concepts, as defined below.7

Active Involvement:

 Actively develop and initiate your lifelong learning plan.

 Seek learning activities that will allow for active involvement with the content. Any activity that engages you - with questions, case studies, situations similar to your practice - satisfies the requirement of active involvement. Learning activities in which you interact with others who are present in a class or communicating with you online take further advantage of active involvement.

Individual Differences:

 Your lifelong learning goals are unique to you. Explore your own goals, needs and preferred methods of learning to form the basis of your lifelong learning plan.

 Respect your own needs in creating your plan. Most adult learning principles emphasize that adults prefer self-directed learning experiences. Although this is generally true, it also is true that individual adults, because of multiple demands on their time and energy, may prefer packaged, structured learning activities to activities that require significant self-direction. Nevertheless, your plan will succeed best if you first assess your own learning needs and preferences carefully, then choose learning activities based upon your self-assessment.

 Assess yourself. What learning experiences have proved most effective for you in the past? Look for activities that tap into your learning style.

 Remain open to new methods. They may offer some valuable learning experiences.

Relevance and Motivation:

 In your lifelong learning plan, relevance and motivation are moving targets. External motivators such as meeting requirements for licensure, certification or clinical ladder promotion operate consistently, causing you to seek learning activities. However, the content and methods of the activities you seek will depend upon your current professional role, changes in the patient population for which you give care, new developments in your specialty and new career goals.

 A lifelong learning plan is not one plan carved in stone that lasts a lifetime. It is a dynamic guideline, flexible enough to respond to your goals and needs as they evolve. To retain its relevance and your motivation to follow it, revisit your plan at intervals to incorporate new goals. Even if your goals remain constant, the short half-life of knowledge requires that you regularly update your learning.

 To remain relevant and capture your motivation, your plan must be realistic and achievable. Identify discrete steps and milestones toward achieving your learning goals, whether your plan leads to a long-range goal such as an academic degree, or a short-range goal such as learning to incorporate non-pharmacological pain-relief techniques. A good time to update your plan is after your annual review each year.


Lifelong Learning

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