Regulations, laws, pandemics, natural disasters, staffing, and technological advancements (Tachtsoglou, 2021) — what do all of these have in common? They all affect businesses and how businesses accomplish their mission. Most organizations strive to provide high-quality, effective, and efficient care centered around patients and their needs. Healthcare must look at potential events and plan according to the impact each situation could have.

The Nursing Professional Development Scope and Standards of Practice (4th ed.) (Harper & Maloney, 2022) outlines the NPD Practice Model, demonstrating that nursing professional development (NPD) practitioners function in interprofessional practice and learning environments. The NPD role of the learning facilitator is to use educational design processes and adult learning principles to bridge evident knowledge, skills, and practice gaps (Harper & Maloney, 2022). Workforce challenges pose a threat to this process. The nursing professional development team is pivotal in proactively identifying and assessing potential obstacles to ensure alignment with the organization to provide high-quality care. This article presents three modern challenges for the NPD practitioner with proposed solutions.

Challenge 1: Overuse of Technology

Education has become more in demand than ever with technological advances. Not only are virtual and self-paced education options the preferred educational format, but they have also become necessary. Recent staffing on inpatient units and ambulatory clinics no longer regularly allows nurses to step away to attend in-person education. Furthermore, the requests for education have significantly increased. Through environmental scanning and regulatory compliance needs, the NPD practitioner is identifying more practice gaps and performance improvement opportunities. We must prioritize our throughput, determining which education or competency assessments require the most immediate response. The NPD practitioner must be flexible in the role of learning facilitator to find practical and fiscally responsible yet engaging education delivery that will lead to optimal patient care.

The literature supports asynchronous education, such as a large teaching facility adapting palliative care education into an asynchronous option to reach all nurses more efficiently (Bruce et al., 2022). A modern adaptation of Peplau's Theory of Interpersonal Relations suggests that the nurse's role has dramatically broadened, and interpersonal relationships form further than just at the bedside. The NPD practitioner innovates using technological advances when delivering education to support the nurses' growing role (Vogelsang, 2022). Many platforms allow the NPD practitioner to educate the nurse in an asynchronous format, and this is evident through excellent feedback in post-evaluations. However, the use of learning management systems (LMS) for on-demand education may be excessive as of late.

The increasing demand for nurses and the prevalent time constraints for patient care are leading to burnout for nurses (Green & Kinchen, 2021). As requirements from accreditation agencies and regulatory bodies increase and become more stringent, "mandatory modules" have become commonplace, causing concern for the nurse's well-being. With the high demand for patient care, it seems impossible for nurses to complete their mandated education. When excessive education becomes required, engagement and participation dwindle. It is imperative to adjust our processes and mitigate the burden on the nurse. Finding opportunities to limit the use of multiple LMS modules and offering educational support to the nursing staff in real time are some techniques that will protect the nursing staff from an overabundance of education. For example, when there is a change in practice, such as a documentation update, instead of sending a mandatory module for nurses to review and sign off on, email or electronic communication can be sent out informing of the change, and nurse educators can be present on the unit for documentation support and just-in-time education needs.

Challenge 2: Unpredictable Acts of Nature

External factors, such as mother nature, may dictate education delivery. Severe weather is known for its effects on power sources, ultimately hindering access to technology for everyday patient care. Generators provide backup power to critical systems to keep healthcare systems running. However, the power allocation needs to be more equitable to care and education technology.      

In scenarios where there is an unexpected lack of power and access to technology, patient care can be hindered without proper preparation. Electronic health records become inaccessible, information is unavailable, medications cannot be verified, and documentation reverts to pen and paper. The NPD team helps to plan and have a streamlined process to ensure that staff know the procedures to take when online systems are offline. For example, for some healthcare employees, electronic documentation and care management are all they have experienced. Providers may not know the process of manually writing orders, and nurses may be unable to interpret the orders as intended. The world can feel like chaos and destruction.

NPD teams are responsible for knowing downtime processes and educating staff on routine tasks that might usually be automated. If proactive planning does not occur, this becomes an education emergency. NPD practitioners should collaborate with the technology team, leadership team, and other departments to develop a plan to guide staff during these events (Conn, 2012).

All departments must have a cohesive plan that allows for uninterrupted patient care. Technology downtimes occur on scheduled breaks and usually in the middle of the night. Day shift staff and providers can feel ill-prepared for these events and need immediate support. 

The pre-printed worksheets for all orders, documentation, and progress notes should be readily available in all care areas, including areas not commonly affected by scheduled downtimes. Sample sheets these forms should be laminated and provided in one secure location. Frequent verification should occur to ensure forms are available. Provider contact methods must also be kept in a secure location. Patient flow coordinators need to develop a technique for patient flow and tracking. Other support includes providing real-time hands-on training to all, including the lab, providers, and patient transport. Mock downtime drills for all areas should be considered to educate staff and identify areas of concern.

Challenge 3: When Education Alone Is Not Enough

Education is only the solution to some things that afflict nursing. Findings from regulatory surveys and safety events result in multidisciplinary brainstorming sessions hosted by education and risk professional committees to identify and analyze every thread of an error or poor patient outcome. The solutions to all errors seemingly, and almost always, point to the direction that education is the solution. Today, nursing competency in large nursing departments within health systems can be the all-day nursing skills fair with the completion of several skill stations requiring individual return demonstrations, hours of computer-based training, and competency/education culminating in nerve-wracking tests and quizzes. Consistent learning and assessments contribute to continuous improvement among team members. While occasional perceptions of accountability and feedback from management may arise, education remains a valuable solution for preventing corrective actions. However, it is essential to recognize that education is not a one-size-fits-all solution for avoiding errors.

Education is effective if combined with a cohesive approach. It would be hard to pinpoint education as the only solution when other factors may have contributed to a poor outcome. The first step is to analyze errors to identify if lack of education is the root cause. According to Donna Wright (2021), education can be used as an intervention method after thoroughly identifying that education is the major contributor. The result of a thorough analysis of errors can also point to other causes, such as poor systems in place, tools and resources that are underutilized, ignored accountability issues, and not addressing employee performance issues. Organizations often use easy-to-implement or low-leverage strategies such as education to address issues (ISMP, 2020).  Low-leverage strategies are the least effective method for risk reduction (ISMP, 2020). The Institute for Safe Medication Practices recommends utilizing several high-leveraged risk-reduction strategies, such as forcing functions, barriers, and fail-safe methods. High-leverage strategies are more challenging to implement, requiring higher capital investments, but are superior in eliminating risks and errors (ISMP, 2020). Forced functions within learning platforms are considered high-leverage strategies (ISMP, 2020).  However, NPD practitioners must collaborate and partner with leaders in the approach choices and expanded functionality within such platforms to enhance learning and promote optimal patient outcomes.

Next is to find the best method of education and learning. As leaders, NPD practitioners must support and foster collaborative partnerships within the organization to align NPD activities towards shared goals and objectives. As change agents and facilitators of learning, NPD practitioners strive to find the most effective learning methods. COVID-19 has taught us that our healthcare associates and learners have adapted to technology, and organizations have done a great job investing in multiple platforms to support teammates' learning. While this investment in teammates learning is crucial, many teammates require more information due to the many available learning platforms. Collaborating and pinpointing the necessary education, along with targeted evaluation methods, NPDs can guide the selection of the most suitable platform that can facilitate and enhance learning.  For instance, when advocating for high-leveraged risk reduction strategies that demand intricate planning and strategic implementation of education, NPD practitioners can judiciously choose the appropriate education method to optimize learning. For example, when educating on a sepsis protocol or early discontinuation of an indwelling catheter, NPDs can create and embed forced functions in the learning platform that mimic a real-world scenario. In the rapidly evolving world, NPD practitioners can integrate technology, incorporate various learning styles, and address learning style differences using available learning platforms.

NPD practitioners are often regarded as silent heroes as we don multiple hats and fulfill various roles. As healthcare demands become increasingly complex, NPDs must broaden their environmental scans and find ways to expand and grow in our profession. Mitigating the use of LMS modules when able, preparing staff for a seamless, unexpected downtime process, and advocating for high-leveraged risk-reduction strategies can overcome common challenges in a modern workforce.

References

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Green, A.A., & Kinchen, E.V. (2021). The effects of mindfulness meditation on stress and

burnout in nurses. Journal of Holistic Nursing, 39(4), 356 - 368

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Education is ‘predictably disappointing’ and should never be relied upon alone to improve

safety. ISMP. https://www.ismp.org/resources/education-predictably-disappointing-and-should-never-be-relied-upon-alone-improve-safety 

Vogelsang, L. (2022). Peplau’s Theory of Interpersonal Relations: Application to

Asynchronous Nursing Education. Canadian Journal of Nursing Informatics,

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Wright, D. (2021, April). Education is not always the answer in healthcare. 

HealthStream Resources. https://www.healthstream.com/resource/blog/education-is-not-always-the-answer-in-healthcare