and the ability to apply that knowledge in a real-world or realistically simulated situation. The transition-to-practice or nurse residency programs discussed in Chapter 3 could offer an extended opportunity to reinforce and test core competencies in real-world settings that are both safe and monitored.

Lifelong Learning and Continuing Competence

Many professions, such as nursing, that depend heavily on knowledge are becoming increasingly technical and complex (The Lewin Group, 2009). No individual can know all there is to know about providing safe and effective care, which is why nurses must be integral members of teams that include other health professionals. Nor can a single initial degree provide a nurse with all she or he will need to know over an entire career. Creating an expectation and culture of lifelong learning for nurses is therefore essential.

From Continuing Education to Continuing Competence

Nurses, physicians, and other health professionals have long depended on continuing education programs to maintain and develop new competencies over the course of their careers. Yet the 2009 IOM study Redesigning Continuing Education in the Health Professions cites “major flaws in the way [continuing education] is conducted, financed, regulated, and evaluated” and states that the evidence base underlying current continuing education programs is “fragmented and undeveloped.” These shortcomings, the report suggests, have hindered the identification of effective educational methods and their integration into coordinated, comprehensive programs that meet the needs of all health professionals (IOM, 2009). Likewise, the NCSBN has found that there is no clear link between continuing education requirements and continued competency.18 A new vision of professional development is needed that enables learning both individually and from a collaborative, team perspective and ensures that “all health professionals engage effectively in a process of lifelong learning aimed squarely at improving patient care and population health” (IOM, 2009).

This new comprehensive vision is often termed “continuing competence.” The practice setting, like the academic setting, is challenged by the need to integrate traditional and emerging competencies. Therefore, building the capacity for lifelong learning—which encompasses both continuing competence and advanced degrees—requires ingenuity on the part of employers, businesses, schools, community and government leaders, and philanthropies. The case study in Box 4-6 describes a program that extends the careers of nurses by training them to transition from the acute care to the community setting.


Personal communication, Kathy Apple, CEO, NCSBN, May 30, 2010.

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