Creating Bridges and Embracing Opportunities

Kari L. Schmidt, MS, RN-BC, ACC

©2015 Photograph by Rand Schmidt, used with permission. 

"What is the difference between an obstacle and an opportunity? Our attitude towards it. Every opportunity has a difficulty and every difficulty has an opportunity." —J. Sidlow Baxter

As I stop and reflect on 2016, I take pause. What an incredible year for our nursing professional development (NPD) specialty! I am truly in awe of the impact of ANPD and our members—the impact on nurses, patients and families.  We have embraced the opportunities unique to NPD. Dr. Susan Bindon challenged us in her closing address at the 2016 ANPD convention, “Building Bridges: One Question at a Time.” I reflect on continuing to meet that challenge and create bridges and embrace opportunities.

Through the leadership of Drs. Mary Harper and Patsy Maloney, our Nursing Professional Development: Scope and Standards of Practice, 3rd edition was published in July 2016. The Scope and Standards is the result of four task forces, evaluating the evidence that impacts our practice and guides us for the future. Input from ANPD members provided valuable feedback as the Scope and Standards were finalized. Significant changes to the Scope and Standards were featured in the opening session at the ANPD 2016 Annual Convention. Those of us who attended that session were also energized by the comments and call to action as Persephone Munnings of Princess Margaret Hospital in Nassau, Bahamas, and the University of The Bahamas, spoke during the comments portion of the session. Drs. Harper and Maloney shared insights and examples of practical application in the Scope and Standards of Practice column in the Journal for Nurses in Professional Development, beginning with the May/June 2016 issue. If you have not yet had the opportunity to read this column, I very much encourage you to do so—these are our standards.

I have the honor of facilitating some of our ANPD Certification Preparation Courses across the country. I met so many inspiring NPD practitioners last year, who approach their practice with enthusiasm and passion. I was humbled to see how course participants shared examples of how they apply evidence-based practice, and how they brainstormed ideas to help and support other participants—new colleagues they had just met, but would now have in their networks.

As Co-Editor with Dr. Susan Bindon for the Journal for Nurses in Professional Development, we see the research our NPD colleagues are conducting—literally across the globe. The 2-part series on return on investment for NPD has become core to planning for many of our NPD colleagues. This series was published in the May/June and July/August 2016 issues of the Journal. Dr. Bindon and I also have the opportunity to mentor new authors, and see their competence and confidence grow as they are actively engaged in the publishing process for the first time. Their enthusiasm energizes me.

The spirit of inquiry and collegiality at the 2016 convention, Aspire to Inspire, was amazing. In Pittsburgh, the city of bridges, I could see bridges being built in new professional relationships throughout convention. I attended the concurrent session featuring the panel of some of the authors for the ANPD text Leadership in Nursing Professional Development: An Organizational and System Focus. Again, I took pause at the wealth of expertise of the panel members. We truly were aspiring to inspire at convention.

As a charter member of ANPD, I am proud and humbled to be part of our NPD specialty and our organization. We continue to grow as a specialty—nurturing each other and advocating for our specialty. We will take that energy and expertise into 2017, and the 2017 ANPD Annual Convention as we Aspire to Transform. We will continue to create bridges and embrace opportunities.

References

Harper, M.G. & Maloney, P. (2016) Nursing professional development: Scope & standards of
     practice, 3^rd Ed.  Chicago: Association for Nursing Professional Development.

Opperman, C., Liebig, D., Bowling J., Johnson C.S. & Harper, M. (2016). Measuring return
     on investment for professional development activities: A review of evidence. Journal for
     Nursing Professional Development, 32(3), 122-129.

Opperman, C., Liebig, D., Bowling J., Johnson C.S. & Harper, M. (2016). Measuring return
     on investment for professional development activities:  Implications for practice. Journal
     for Nursing Professional Development, 32(4), 176-184.

Smith C.M. & Harper, M.G. (2016). Leadership in nursing professional development: An
     organizational and system focus. Chicago: Association for Nursing Professional
     Development.

NPD Roles: Generalist vs. Specialist

Mary G. Harper, PhD, RN-BC is the Director of Nursing Professional Development for ANPD. Certified in NPD, she obtained her MSN at the University of Florida and her PhD at the University of Central Florida. Dr. Harper co-chaired the work group that revised the Scope and Standards for Nursing Professional Development in 2016. 

The publication of the new Nursing Professional Development: Scope and Standards of Practice (Harper & Maloney, 2016) has ushered in an opportunity for nursing professional development practitioners to clearly articulate what we do. It also challenges us to demonstrate our value to our organizations. The new document recognizes our expanded scope of practice and delineates distinct roles for our specialty informed by research (Warren & Harper, 2016). In addition, it makes mentoring/advocating for our profession and specialty a standard of practice. 

One of the more groundbreaking concepts of the new scope and standards is the introduction of “NPD practitioner” as an umbrella term to represent those who practice NPD. Practitioners may function at two levels: generalist and specialist. A generalist is an NPD practitioner with a baccalaureate degree with or without NPD certification or a graduate degree without NPD certification. A specialist is someone with a graduate degree AND certification in NPD. If the graduate degree is not in nursing, the baccalaureate must be (Harper & Maloney, 2016).

Differentiation of the generalist and specialist roles is the result of several factors. First, we recognize that many individuals who practice NPD are baccalaureate prepared. In spite of the requirement for a graduate degree as the minimal preparation for NPD in prior editions of the scope and standards, the reality is that many nurses who practice NPD do not have graduate education. Recent research indicates that nearly 40% of our colleagues have baccalaureate or associate degrees (Harper, Aucoin, & Warren, 2016). The new scope and standards now acknowledges that not all members of our specialty have graduate degrees.

In addition to nurses without graduate degrees, the requirement for certification in NPD is a baccalaureate degree. So while a nurse could become certified in the specialty, that individual did not meet the minimal requirement of the scope and standards to identify as a member of the specialty. The new scope and standards has rectified that. 

Finally, the American Nurses Association (ANA, 2010), which defines and approves specialty nursing practices, requires that a nursing specialty must be able to differentiate the responsibilities of the graduate prepared nurse in the specialty. This requirement was initiated shortly after the publication of the 2010 Nursing Professional Development: Scope and Standards of Practice (ANA & NNSDO, 2010), so the previous edition of the scope and standards did not identify two levels of NPD practitioners. 

The new designations of generalist and specialist have been met with overwhelmingly positive responses. Some NPD practitioners indicate that the designation provides a mechanism for career advancement within the specialty. Others applaud the ability to differentiate role functions in the practice environment. Still others state that the differentiation supports the focus on advanced education and certification.

Unfortunately, not all responses to the new differentiation of NPD practitioner levels have been positive. Some NPD practitioners indicate that the new terminology creates additional role confusion. Role confusion in NPD is not new. A plethora of titles currently exist with little consistency among organizations. Many of our diverse titles make it difficult to differentiate between academic nurse educators and NPD practitioners. While we share many similarities with our academic colleagues, our practice has unique differences, particularly in the areas of identification of practice gaps, gap analysis (needs assessment), and evaluation of educational activities. 

Others who are not thrilled with the new levels of NPD practitioners posit that their graduate or doctoral levels of education should be sufficient for recognition as an NPD specialist. While advanced education is one requirement for recognition as an NPD specialist, it alone is not sufficient. Graduate education does not typically provide specialty knowledge. Most master’s degrees in nursing education focus on the roles and responsibilities of the academic educator with little or no content on the NPD specialty and its unique scope of practice. Certification provides evidence of knowledge in the specialty.

One of the most common questions we’ve received about the NPD specialist designation in the new scope and standards is “What if I’m certified in another specialty? Can I still be recognized as an NPD specialist?” Unfortunately, no. Many, if not most of us, were selected for our NPD roles because we were excellent clinicians. Being an excellent clinician does not mean that an individual is automatically a good learning facilitator (think of the expert clinician who struggles when serving as a preceptor to help the novice nurse transition to the role of a professional nurse). NPD is its own unique specialty and requires a unique set of competencies. As a result, certification in critical care nursing, pediatric nursing, or even as an academic nurse educator does not demonstrate knowledge of the NPD specialty.

The purpose of certification is to demonstrate competence in a specialty. As a group, NPD practitioners do not excel in this area. Two national research studies have demonstrated that only 16 – 20% of the NPD practitioners who participated were certified in NPD. On the other hand, approximately 50% were certified in a clinical specialty. While dual certification may be indicated for some NPD practitioners—especially those who are unit based—the lack of certification in NPD is alarming. 

In the current complex healthcare environment, NPD departments are being challenged to demonstrate their value to their organizations or face reduction in forces or even elimination. The days of simply reporting numbers of classes conducted or numbers of staff participants are gone. We must be able to demonstrate how we contribute to the organization’s goals related to patient safety and quality, staff satisfaction and retention, and financial stability. NPD practitioners who are not certified in the specialty may lack the knowledge and skill to measure educational outcomes in a meaningful way.

I challenge you to read our new scope and standards and allow it to guide your practice.  Become immersed in our specialty. If you’re not certified, become certified. If you don’t have a graduate degree, get one! Look for meaningful ways to contribute to your organization. Learn to articulate what you do so that others in the organization, and especially the C-suite, recognize your value. Get involved in your professional association on both a local and national level. If there is not an ANPD affiliate in your area, start one. Continue your own professional development. Advocate for our specialty!

References

American Nurses Association. (2010a). Recognition of a nursing specialty, approval of a specialty nursing scope of practice, and acknowledgement of specialty nursing standards of practice.  Retrieved from: http://www.nursingworld.org/MainMenuCategories/Tools/3-S-Booklet.pdf

American Nurses Association and National Nursing Staff Development Organization. (2010). Nursing professional development: Scope and standards of practice. Silver Spring, MD: ANA.

Harper, M.G., Aucoin, J., and Warren, J.I. (2016). Nursing professional development organizational value demonstration project. Journal for Nurses in Professional Development, 32(5), 242 –247.

Harper, M. G. & Maloney, P. (2016). Nursing professional development: Scope and standards of practice (3^rd ed.). Chicago, IL: ANPD.

Warren, J. I. & Harper, M. G. (2015, July). Nursing professional development role delineation study. Presented at the ANPD Annual Convention, Las Vegas, NV.

The 2016 NPD Scope and Standards: Began with Florence

Patsy Maloney, EdD, MSN, RN-BC, CEN, NEA-BC is a Senior Lecturer of Nursing and Healthcare Leadership at University of Washington Tacoma.

"Let us never consider ourselves finished nurses...we must be learning all our lives."

                                                                                                  -Florence Nightingale

There has been much excitement about the release of the 2016 Nursing Professional Development (NPD) Scope and Standards. The workgroup of NPD experts did a great job. The workgroup stood on the shoulders of the nursing and NPD leaders that went before us. This blog entry will briefly describe what a scope and standards document is, the history of our current scope and standards, a brief overview of the major changes in our current scope and standards, and a call to implement the standards by advancing the NPD specialty.

What is a Scope and Standards document? A nursing specialty scope of practice describes the specialty practice, its boundaries, and its practitioners (Anderson, 2011).  The American Nurses Association (ANA) (2015) publishes a Nursing Scope and Standards that applies to all nurses, including all specialty nurses. The scope is an overview of nursing and answers the who, what, when, where, how, and why questions of nursing practice. The standards of professional practice have two parts, a description of each standard followed by a list of competencies (Strong, 2016). The second edition of Nursing Scope and Standards (ANA, 2010) is available online. The third edition (2015) can be purchased online.

History of the NPD Scope and Standards. The history of our scope and standards begins with the history of our specialty. The roots of our specialty go back to the founder of modern nursing, Florence Nightingale. Ms. Nightingale’s belief that life-long learning was crucial influenced her opposition to registration (licensure) of nurses. She believed that if nurses were licensed after completing their training program, they would consider themselves “finished nurses” and would not continue learning (http://www.austincc.edu/adnlev1/rnsg1413online/mod_prof/history_notes.htm).
Pfefferkorn stated “The improvement of the nurse in service, in its broadest implications is as old as nursing…but the improvement of the graduate nurse for professional or cultural growth, is yet in its infancy”  (1928, p.700). So the improvement of nursing practice “in service” of the patient is as old as nursing, but including the professional development of the nurse beyond the immediacy of care of the patient was in its infancy in 1928 (88 years ago). The word in-service and in-service education took hold and articles about in-service education started to appear in the nursing literature. As more nurses moved from independent practice to hospital employees and the need for nurses increased, in-service education to orient and refresh nurses became even more important. By 1953 the in-service education role began to separate from that of nursing administrator, and divisions of in-service education were established within departments of nursing service (Abruzzese & Yoder-Wise, 1996).

Concurrent with the development of divisions of in-service education within hospitals, ANA started to develop the forerunners to scope and standards. These documents were called statements of functions. One of the earliest mentions of these was in the American Journal of Nursing in 1954. These statements of functions were developed by ANA committees. The 1954 statements included education, but not in-service education. By 1956 the statements of functions had evolved to statements of functions, standards, and qualifications for practice. Over the next few years American Journal of Nursing published these statements for a variety of nursing areas. They did not use the term specialties. Although in-service education was not included in the first statements of functions, standards, and qualifications, the specialty was included in The Yearbook of Modern Nursing 1956. It was not until 1966 that the Nursing Service Administrators section of ANA developed a “statement of functions and qualifications for in-service educators (Abruzzese & Yoder-Wise, 1996). This document was the precursor of our scope and standards.

By 1970 in-service education was subsumed under continuing education, which had come to include all education that took place outside degree granting nursing school programs. The Journal of Continuing Education published the ANA’s landmark statement on in-service education in 1970 and in 1972 published ANA’s landmark statement on continuing education. The Council on Continuing Education was organized with members from both in-service education and college continuing education programs in 1973. In 1974 ANA published the first standards for continuing education and in 1976 published guidelines, not standards for staff development. (Abruzzese & Yoder-Wise, 1996). With the publication of these guidelines the term in-service education was replaced with the term nursing staff development. Instead of referring to an area of practice, in-service education came to mean education and training delivered in the practice setting to facilitate an individual’s ability to function within a given agency (ANA, 2000). 

Finally, in 1990 ANA published Standards for Nursing Staff Development (ANA, 1990). This was followed in 1994 by Standards for Nursing Professional Development: Continuing Education and Staff Development. Nursing professional development had become the umbrella term to encompass both continuing education and staff development. Embracing this new term, the Scope and Standards of Practice for Nursing Professional Development was published by ANA in 2000. The 2010 Nursing Professional Development: Scope and Standards of Practice was published jointly by ANA and National Nursing Staff Development Organization (NNSDO) (ANA & NNSDO, 2010). Our scope and standards led the way for the re-naming and re-branding of our specialty from NNSDO to the Association for Nursing Professional Development (ANPD) in 2012.

The nursing and NPD leaders on whose work the 2016 NPD Scope and Standards of Practice is built are too numerous to name. But I think it is really important to acknowledge Ms. Barb Brunt, who served with the 1994, 2000, and the 2016 standards work groups. Her contributions to our current scope and standards are immeasurable. Another NPD giant is Dr. Dora Bradley, who led the work group for the 2010 NPD Scope and Standards of Practice. This work group created the NPD Practice Model as a systems model that maintained much of its relevance and only required the 2016 workgroup. The 2010 Scope and Standards was an outstanding foundational document for the 2016 scope and standards work group.

Overview of the revisions in the 2016 NPD Scope and Standards. The significant revisions in the NPD Scope and Standards of Practice (ANPD, 2016) include expanding the settings in which the NPD specialty is practiced beyond acute care and even including virtual environments, replacement of the intertwined elements with seven NPD roles, identification of general (NPD Generalist) and advanced levels (NPD Specialist) of NPD practice. NPD practitioner became the umbrella term that incorporates both the NPD generalist and the NPD specialist (Harper & Shinners, 2016). Two standards of performance (Collegiality and Advocacy) were removed and integrated throughout the other standards. Change Management and Mentorship/Advancing the Profession were added in response to the NPD Role Delineation Study (Warren & Harper, 2015).

Conclusion. The seeds of the 2016 NPD Scope and Standards of Practice were planted by Florence Nightingale when she emphasized the need for life-long learning.  These seeds started to take root when Blanche Pfefferkorn addressed the National League for Nursing Education’s convention and discussed the deliberate pursuit of professional growth post-graduation from nursing school (Pfefferkorn, 1928). After the publication of Pfefferkorn’s address articles on in-service education started to appear in the nursing literature. In the 1950’s in-service education divisions started to appear in hospitals and by the 1960’s the predecessor of the current scope and standards was developed. Our current 2016 Scope and Standards is the result of the work of well over 100 years of thought leaders. The last, but not least standard of performance, Standard 16: Mentoring and Advancing the Profession, calls us to advance our specialty. Our specialty is one of the oldest of nursing specialties. Be proud. Call your specialty by name, Nursing Professional Development. 

References

Abruzzese, R. S., & Yoder-Wise, P. S. (1996).  Staff development: Our visions.  In R. S. Abruzzese (Ed.).  Nursing staff development: Strategies for success (pp. 3-14). St. Louis, MO: Mosby Yearbook.

American Nurses Association. (2000). Scope and standards of practice for nursing professional development. Washington DC: Author.

American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Author.

American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.

American Nurses Association and National Nursing Staff Development Organization. (2010). Nursing professional development: Scope and standards of practice. Silver Spring, MD: ANA.

ANA Statements of functions. (1954). The American Journal of Nursing, 56(10), 1305-1309.

ANA Statements of functions, standards, and qualifications. (1956). The American Journal of Nursing, 56(8), 1027-1030.

Anderson, T. (2011). Nursing professional development: Scope and standards of practice (2010). Nebraska Nurse, 44(3), 8-9.

Harper, M. G.  & Maloney, P. (2016).  Nursing professional development:  Scope and standards of practice (3^rd ed.).  Chicago, IL:  ANPD.

Harper, M.G. & Shinners, J. (2016). Overview of nursing professional development. Journal for Nurses in Professional Development, 32(4), 228-229.

History Notes. (n.d.). Nursing as a profession. Retrieved from http://www.austincc.edu/adnlev1/rnsg1413online/mod_prof/history_notes.htm

Pfefferkorn, B. (1928). Improvement of the nurse in service: An historical review. The American Journal of Nursing, 28(7), 700-710.

Strong, M. (2016). Maintaining clinical competency is your responsibility. American Nurse Today, 11(7), 46-47.

Warren, J. I., & Harper, M. G. (2015, July). Nursing professional development role delineation study. Presentation at the annual meeting of the Association for Nursing Professional Development, Las Vegas, NV