Cross (1981) argued that accurate information was the educational ‘broker’ for recruitment to a learning opportunity. She further outlined how failure to provide sufficient information resulted in lost opportunities to link learners with appropriate opportunities even in the presence of other motivating factors. This research showed how the complexity of understanding of continuing competence requirements
impacted on nurses’ decisions to participate in PDRP.
6.7.1 Meeting continuing competence requirements
Most nurses showed they could accurately identify the three basic requirements for continuing competence (i.e., the number of continuing professional development (CPD) hours, clinical practice hours and validation of Nursing Council competencies for their scope of practice). Their knowledge began to unravel however, when they were asked to explain the connections between these requirements and Annual Practising Certificates (APC), PDRP requirements and employer competencies. At interview, confusion between the NZBS internal quality assurance competencies and Nursing Council competencies became apparent. Secure knowledge links between continuing competence requirements and APC renewal were also difficult to establish. Further, it appeared that nurses viewed payment for APC renewal as a completely separate activity and there was no surety that the regulatory significance of the on-line payment was understood. Nurses did appreciate that Nursing Council may conduct random recertification audits to determine compliance with continuing competence
requirements. However, avoiding selection was described as ‘dodging a bullet’ meaning that the effort of validating competencies was evaded until the next audit cycle. The issues related to recertification audits were narrowed down to the difficulties of
186 providing evidence for validation of Nursing Council competencies. It included both interpreting and responding appropriately to demonstrate what was required.
When explained in this way, a picture emerged of the complex structure of requirements which nurses must navigate and the depth of knowledge required to do so. Further complexity was added by the mixture of mandatory and voluntary
requirements for each system and its links to another. Inevitably, there were mixed messages and subsequent confusion in explaining the relationship between continuing competence requirements and APC or PDRP. In the absence of clarity, nurses appear to have made the systems work for themselves linking PDRP and Nursing Council
requirements at the most pragmatic level. Nurses do not engage with NZBS PDRP as a professional development activity. Rather, the primary educational purpose of PDRP is overshadowed by the more pressing need of this nursing community to avoid
recertification audit. Consequently, the difficulties of reconciling pedagogical, regulatory and employment objectives within one professional development programme are well illustrated.
The complexities of situations where several groups of apparently similar objectives are to be met have been noted by others. In accounting for multiple needs, Fleet et al. (2008) and Collin et al. (2012) observed the considerable challenges involved when CPD was expected to account for the needs of several parties including the
worker, organisation and profession. McColgan (2008) however, took the opposing view, suggesting that the goals of both lifelong learning and regulatory requirements could be merged. McColgan (2008) and others argued for the use of professional portfolios as a suitable strategy for the concurrent collection of evidence to support lifelong learning, competency and workplace goals (Byrne et al., 2009; Ng, 2010). The
187 latter view of portfolio completion was not the experience of the majority of nurses in this study. Very few identified PDRP as their preferred method of documenting their ongoing learning. However, there was at least one nurse in this study who was able to show it was possible. It would be interesting to canvas the opinion of others like her, who had completed her initial registration via undergraduate degree, completed an entry to practice programme and who ‘knew no different.’
6.7.2 Nursing Council competencies
Mandated to deliver on initial and recertification processes in the interests of public safety, Nursing Council has chosen, like many other international nursing regulatory bodies, to require its registrants to demonstrate their continuing competence using a variety of measures that can be audited. Validation of nursing council competencies are one such requirement. For the first time in this research, consternation caused during competency completion was detailed. Both self and peer assessments appeared to be problematic. Various examples were provided about the associated difficulties of writing competency responses these are detailed elsewhere (see page 157). A further area of issue related to the commitment required to complete a peer competency assessment within the required time frame and to the appropriate standard.
Understanding how competencies should be completed and the quality of the evidence to be provided, concerned nurses. Perceptions were that the activity was too hard, it took too long and many did not know what was needed. Nurses appeared to struggle to translate practical work into words that would make sense and usefully validate their professional competencies. These findings show different thinking about competency completion when compared with that related by Carryer et al. (2007). In
188 their study, one group of nurses felt that years of experience alone should account for the required evidence. Further, Vernon, Chiarella, Papps, and Dignam (2013) identified nurses’ confusion about recertification and PDRP processes in their evaluation of the Nursing Council of New Zealand continuing competence framework. As with the current study, Havill (2010) and Carryer et al. (2007) identified that there was little difference in understanding between those who had and who had not completed PDRP. It seems that levels of confusion about what counts and how to present evidence is a perpetual issue. That it endures, is problematic.
The terminal objectives of courses leading to registration require that initial competencies for registration are met for the relevant scope of practice. Nurses returning to practice after a career break are also educated about regulatory
requirements. So too, those nurses who are admitted to the New Zealand register from overseas. Whether the conversation is clear enough about recertification requirements being an annual requirement related to APC renewal is outside the scope of this study, but it is also worthy of consideration in context. The continuing level of confusion has been consistently reported over the past decade and raises the spectre of wider issues about professional accountability for upkeep of registration. Given their obligation to the maintenance of public safety, this recurring theme should be sufficient warning for Nursing Council to consider the support it provides to new and already registered nurses to properly achieve their recertification requirements.