Continuing Education/Competency-Are you exercising all of your options?
In 1978, a revision of the Kentucky Nursing Laws (KRS 314.073) mandated 30 contact hours of continuing education for relicensure of nurses each two-year licensure period. As cited in the law, the purpose of mandated continuing education (CE) is to require evidence of the nurse’s efforts to maintain and update nursing knowledge and skills necessary to make competent judgments and decisions in nursing practice, nursing administration, nursing education, and/or nursing research. Ultimately, continued competency is intended to preserve the safety of the citizens of the Commonwealth. With this legislation, Kentucky entered the arena of regulation that is designed to promote ongoing competency for members of the nursing profession. Kentucky is not alone in the initiation of this type of legislation but is one of 22 states that mandate continuing education as a requirement of licensure renewal. Since 1978, a great deal has changed. In the early years, the only way that a nurse could demonstrate his/her continued competency was through attendance at approved continuing education offerings. As the years have passed, the Board has expanded beyond traditional continuing education to a broader view of competency. With this paradigm shift, an expanded menu of options for nurses to use to document competency has been developed moving beyond the traditional in-class method of education. This article is being written to share what options are available to nurses to validate continued competence within the state of Kentucky.
How Much Do I Need?
Kentucky and all other mandatory licensure states require nurses to use the measurement of contact hours (CH) to document participation in learning events. A “contact hour” is equal to 50 minutes of learning activities. To determine the number of contact hours to be awarded for any event, the program planner determines the total number of minutes that the learner will be involved in learning and evaluating the content. This total number of minutes is then divided by “50.” For example, a class that has 85 minutes of learning activity divided by 50 would equal 1.7 CH.
Frequently, nurses will ask about the number of CELTs (continuing education unit) awarded for a course. CEU and CH are not the same. A CEU is equal to 10 contact hours. So you can see that in the example above, a 1.7 CH class would be equivalent to .17 CEU. That’s a big difference! You can quickly see that if Kentucky required 30 CEU’s that would be the same as 300 contact hours or 250 clock hours. That’s a huge difference from the Kentucky requirement of 30 contact hours or 25 clock hours of learning.
Traditional Continuing Education Classes
The old tried and true method of documenting competency by attending classes offered by approved providers of continuing education is still in existence. But even this traditional method has taken on some new features as continuing education classes have moved beyond the classroom to include home study and even classes available over the Internet. If a nurse chooses to document competency through this traditional method, he/she attends and completes continuing education classes either in person or via self-study and earns a certificate of completion. The nurse attending a class needs to be sure that the class is approved by an organization approved or recognized by the Board to grant CE contact hours (refer to Table 1). The phrases “KBN approval pending” or “KBN approval applied for” are not acceptable approval statements and do not guarantee that approved CE would be earned.
Does this mean if a nurse attends a program that is sponsored by a group that is not listed that this class can not be used as evidence of continued competency? The answer is, No. There is a process in place through the Board that an individual nurse can submit a class for individual review. This application, with specific instructions, is available for download off the website (http://www.kbn.state.ky.us). There is a $10 fee associated with the review of submitted classes.
In addition to attending classes from an approved provider, the nurse needs to be sure to obtain a certificate to validate completion of the class. Look closely at the certificate to be sure that it contains all the necessary information. Certificates must include: a place for your name, the date and title of the offering, name of the organization providing the class, provider number, number of earned contact hours, and expiration date for the offering. Regardless of the method selected to document continued competency, it is extremely important that you develop a filing system to house the materials. Save that certificate-this is the easiest way to prove attendance without having to go back to the provider and request duplicate certificates. For all but the HIV/AIDS classes, certificates need to be retained for five (5) years following the renewal period. HIV/AIDS course certificates need to be retained for a total of 12 years.
In Kentucky, the achievement of national nursing certification serves to document a nurse’s competence equivalent to the 30 contact hours required for relieensure. There are a number of nursing organizations that offer examinations to validate knowledge within a specific nursing clinical specialty. The American Nurses Credentialing Center (ANCC) is just one example of a nursing organization that has served as a leader in the development of certification examinations with over 50 specialty tests available. National certification identifies individuals that have advanced knowledge within a clinical specialty area. In order to achieve this status, a nurse must have a strong knowledge base established over years of clinical experience. The maintenance of certification requires the certified nurse to document their continued competence by various methods. To exercise this option, a Kentucky nurse must either receive their initial certification during the earning period or maintain the certification through the entire licensure period. If the certification should lapse during the licensure period, then certification would not be an option for the nurse in documenting competency.
Other Options Available for Documenting Competency
Nurses can use the following options to fulfill half of the continued competency requirement or the equivalent of 15 contact hours. Only one of these options can be exercised in combination with traditional continuing education classes to equal the 30 contact hours.
* Nursing Employment Evaluation-Nurses who receive a satisfactory performance appraisal satisfy half of the continued competency requirement or 15 contact hours. The definition of a satisfactory employment evaluation is one that permits the nurse to continue employment at that agency. To exercise this option, the nurse should maintain a copy of the evaluation form just as they would a CE certificate. This evaluation must include the name and address of the employing agency with the signature and contact phone number of the supervisor completing the appraisal.
* Competency Validation: In conjunction with annual performance evaluations, many facilities require nurses to demonstrate a series of identified competencies to maintain employment. To utilize this option, the nurse must provide validation from the employer of completion of competencies. Be sure to include the name, address, and phone number of the facility.
* Serving as a Clinical Preceptor. Both nursing education and agency staff development faculty rely heavily on clinically competent nurses to serve in the capacity of clinical preceptor for the novice or nursing student. The Board recognizes that nurses serving in this capacity are those that demonstrate clinical competence every day. As a means of validating this accomplishment, nurses that serve as a clinical preceptor can use this activity to document competency. Preceptorship implies that there exists a one-toone relationship between the licensed nurse and a student or new employee. The preceptorship must be evidenced by written documentation from the educational institution or preceptor’s supervisor. This preceptored relationship must equal a total of 120 hours over the licensure period. These 120 hours do not have to be all completed with the same student or new employee but can include several relationships over the licensure period. The preceptor will need to document the names of persons that were precepted, amount of time involved, name of the educational or agency involved, and the name of the clinical faculty or supervisor that can validate the event. A sample “preceptor verification form” is available” through the Kentucky Board of Nursing website as a guide for documenting this information.
* Publishing of a Nursing Related Article: If you remember back to those days of nursing school, you can recall the amount of time it takes to write a nursing paper. Submitting an article for publication is just like those nursing schools days. Finally, those hours and hours of research and writing and rewriting are being recognized as a method of demonstrating clinical competence. To utilize this option, the nurse needs to maintain a copy of the article including the publication date that occurred during the renewal period.
* A Professional Nursing Education Presentation: Nurses that plan and present education classes are eligible for this option of validating competency. Presenting an education offering is similar in nature to the preparation of an article for publication with the added burden of bringing the content to life during the class. Presenters not only need to know their material, but they also need to review the various teaching methodologies in order to select the method(s) that will move the participant from passive to active learner. To qualify for this option, the nurse must both develop and present the program. A copy of the program brochure, course syllabi, or a letter from the offering provider will provide evidence of meeting the competency requirement for renewal of license.
* Completion of Nursing Research Project; Nurses that serve in the role as principal or coinvestigator or project director for a nursing research study may use this activity to document continued competency. Proof of participation would include a summary of the findings including research methodology (qualitative or quantitative).
Back in School?
If you have returned to school to advance your education, those college credits could serve as equivalent to traditional continuing education classes. Academic courses applicable to nursing practice and appropriate for the nurse employed in fields of clinical practice, administration, education, or research may meet the continuing education (CE) requirements. Nursing courses, designated by a nursing course number, and social or physical sciences, such as Psychology, Biology, or Sociology, will meet the CE requirements for relicensure. Prelicensure general education courses, either electives or designated to meet degree requirements, are not acceptable. CPR/BLS, inservice education, or nurse aide training are not acceptable for nursing CE. If a nurse has taken a class that qualifies, one semester credit hour equals 15 contact hours or one quarter hour equals 12 contact hours. A traditional 3 credit college course would be equal to 45 contact hours (for semester course) or 36 contact hours (for quarter system)-either way, this one class would more than meet the renewal requirements for relicensure.
Domestic Violence and HIV/AIDS
There continues to be frequent calls to the Board office related to questions about attendance at classes on the topics of Domestic Violence and HIV/AIDS. In 1998, all licensed active nurses in the Commonwealth were required to complete a one time 3 contact hour program related to domestic violence. This class does not have to be repeated. For nurses just becoming licensed, they do not have to take this class if educated within the state of Kentucky. This waiver is due to the fact that all Kentucky programs of nursing were required by law to include the domestic violence content within their curriculum as of 1998.
HIV/AIDS maintains a different requirement for active licensed nurses. In 1990, the General Assembly required all health care licensees to complete a twocontact hour program on acquired immune deficiency syndrome (AIDS) each two-year licensing period. Originally when this continuing education requirement was initiated, the treatment of AIDS was undergoing a tremendous amount of change. New information about the disease itself, the progress, treatment plans, and prognosis were changing daily. Now some 10 years later, the information on the disease has stabilized and the rapid changes are no longer occurring. To ensure that nurses maintain a working knowledge of HIV/AIDS, the CE requirement was adjusted from a mandatory class attendance each licensure period or two years to requiring attendance once every ten (10) years. LPNs are required to earn the two contact hours between 11/1/2001 and 10/31/2011, and RNs must earn their two hours between 11/1/2002 and 10/31/2012.
Maintaining Competence Documentation
A continuing question is how long should nurses keep those certificates? By statute, the Board of Nursing audits a percentage of licensed nurses each licensure year. Following each renewal period, 2% of all licensed nurses are randomly selected to be audited for compliance with competency determination requirements. If a nurse is selected for this audit group, they will receive a letter in the mail and will need to submit to the Board proof that they have met the requirement. Copies of all materials will need to be sent to the Board to validate this determination. Newly licensed nurses in Kentucky are exempt from the competency requirement for the first renewal period following graduation or endorsement.
What does the future of nursing look like? Though many people will predict various possibilities, the one thing that we do know is that it will not look like it does today. Then it goes without saying that nursing curricula can only possibly prepare graduates for the reality of now, not for the unpredictable world that lies ahead. It is an established fact that there has been more information produced within the last 30 years than in the prior 5000 years. Ensuring patients continue to receive the best possible care continues to be the mission of the Board of Nursing. Regulating continued competence is just one step in an effort to ensure a safer tomorrow for our families, our patients, and for us as nursing professionals.
Patricia Spurr, EdD, MSN, RN
Nursing Education Consultant
Kentucky Board of Nursing
Copyright Kentucky Nurses Association Oct-Dec 2004
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