Nurses’ and managers’ perceptions of continuing professional development for older and younger nurses: A focus group study
Introduction
Continuing professional development (CPD) of nurses is increasingly necessary to keep abreast of rapid changes in patient care due to advancements in knowledge and technology (Atack, 2003, Berings, 2006, Gopee, 2001). Concurrently, the nursing workforce is growing older. In Dutch hospitals, the percentage of workers over 50 years of age has grown from approximately 19% in 2003 to 27% in 2009 and is expected to grow further to 36–39% in 2018. The average age, 41 in 2008, is likely to increase in coming years (Van der Windt et al., 2009). This demographic trend is seen in other western countries, such as the United Kingdom (Harris et al., 2010, Wray et al., 2009), Canada (Spinks and Moore, 2007) and the United States (Letvak, 2002, Stewart-Amidei, 2006).
These two issues underscore the importance of understanding and managing CPD of older nurses. Employers, nurses associations and national health agencies, used to a workforce traditionally dominated by younger nurses (Palumbo et al., 2009), are challenged to develop CPD approaches geared towards the needs of all age groups (Andrews et al., 2005, Lammintakanen and Kivinen, 2012). As different age groups have different work-related concerns due to differences in experience, level of seniority, and skill set (Buchan, 1999, De Lange et al., 2009, Wray et al., 2009), it is likely that they also have different CPD needs.
There is no doubt about the importance of CPD in nursing. CPD benefits patient care, the organisation and the individual (Nolan et al., 2000, Wood, 1998). It reportedly contributes to higher job satisfaction, organisational commitment, and lower stress (Berings, 2006, Chien et al., 2008). Lack of CPD appears to influence nurses’ decisions to leave their profession (Hallin and Danielson, 2008) and to retire early (Andrews et al., 2005, Armstrong-Stassen and Schlosser, 2008).
Therefore, employers, nurses’ associations and national health agencies are developing strategies to promote CPD. In several countries, such as Canada and the United Kingdom, CPD is required for renewal of registration as a nurse (Nursing and Midwifery Council, 2010, Cutcliffe and Forster, 2010). This is different in the Netherlands, where nurses can voluntarily register their CPD activities in a National Quality Register developed by the Dutch Nurses Association (V&VN, n.d.).
Despite the importance of CPD, there seems to be little consensus on its definition. Several related concepts, such as continuing professional education (CPE) and life-long learning are used interchangeably, but sometimes with different meanings (Gallagher, 2007, Gopee, 2001). There is confusion on the definition of CPD, its purpose, the related learning activities and its beneficiaries (Friedman and Phillips, 2004).
The American Nurses Association (ANA) has defined nursing professional development as “a life-long process of active participation by nurses in learning activities that assist in developing and maintaining their continuing competence, enhancing their professional practice, and supporting achievement of their career goals” (ANA, n.d.). This is a useful definition because it encompasses different purposes of CPD. It fits with nurses’ perceptions of CPD as important for enhancing service provision, maintaining safety for patients and themselves, and increasing career and personal opportunities (Gould et al., 2007).
Nurses develop their expertise through a broad range of learning activities varying from formalised courses to interactions with colleagues and other daily work experiences (Berings, 2006, Eraut, 2007, Estabrooks et al., 2005). Opinions vary on the learning activities that can be qualified as CPD (Friedman and Phillips, 2004). Some confine CPD to formal learning or CPE, referring to intentionally planned learning in an educational setting. Others use a broader definition of CPD, and include informal learning, defined as learning in a workplace environment. Both the Dutch Quality Register and the UK PREP (CPD) standards hold this broader perspective, providing nurses the opportunity to record formal and informal learning (Nursing and Midwifery Council, 2010, Dutch Nurses Association, 2011).
In nursing, little research has been done on the relationship between participation in CPD activities and age, and existing data seem to be contradicting. Dorsett (in Letvak, 2002) found that age was a predictor of updating behaviour: older nurses (defined as age 40 and older) were more likely to keep up to date. This was confirmed by Lammintakanen and Kivinen (2012) who showed that of three age groups the youngest nurses participated least in CPD. In contrast, Wray et al. (2009) found that nurses over 50 years undertook fewer development activities than nurses under 50.
These contradicting findings might be explained by differences in research design. Lammintakanen and Kivinen (2012) investigated participation in 23 different CPD activities, both formal and informal learning activities, while Wray et al. (2009) appeared to investigate formal learning activities. Research in other professions shows that in general, older workers tend to be less likely to participate in CPD, especially when considering formal CPD activities and workers in late career (older than 50/55 years) (Maurer et al., 2003, Taylor and Urwin, 2001).
Age differences in CPD participation rates can be caused by several factors. First, ageing can result in a higher level of knowledge and expertise. This might reduce the need for older workers to participate in learning activities (Wray et al., 2009, De Lange et al., 2009) and might influence their preferences for certain CPD activities. Daley (1999) showed that more experienced nurses preferred work-based activities such as dialogue with colleagues, while novice nurses reported to learn more from formal training. This was supported by Lammintakanen and Kivinen (2012), who found similar variation in CPD activities among nurses from different ages.
Second, lower participation in CPD by older workers might also be a result of a lack of training opportunities, limited employer support for older workers (De Lange et al., 2009, Taylor and Urwin, 2001, Lankhuijzen, 2002) and less encouragement from co-workers and others (Maurer et al., 2003, Van Roekel-Kolkhuis Tanke, 2008). This lower social support can be caused by existing stereotypes of older workers (Maurer, 2001, Gray and McGregor, 2003).
One stereotype is that older workers are often perceived as less able to learn than their younger colleagues (Maurer, 2001, Gray and McGregor, 2003). Two meta-analyses seem to confirm this. Ng and Feldman (2008) found older workers’ performance in training to be slightly lower than that of younger workers. Kubeck et al. (1996) concluded from their meta-analysis that older adults showed less mastery of training material, completed the final task more slowly, and took longer to complete the programme. However, these findings should be interpreted with caution as the outcome differences could also reflect pre-training differences, and laboratory samples showed larger age differences than field samples (Kubeck et al., 1996). In addition, a large proportion of the studies in this meta-analysis focused on technology training (Ng and Feldman, 2008). These findings therefore seem to have limited implications for informal learning. Schulz and Stamov Roßnagel (2010) found that success in self-regulated workplace learning activities is not contingent on age. They argued that these learning activities offer workers opportunities to compensate for cognitive effects of ageing.
Another stereotype is that training of older workers is a poor investment because they will retire shortly. This view is difficult to sustain as new skills often become obsolete after a few years (Gray and McGregor, 2003). Therefore, updating skills of an older worker who still has ten or more years of employment has the same benefit as doing so for a younger worker (Sterns and Doverspike, 1989). The issue of ‘return on investment’ becomes more complex when considering that younger workers leave organisations more often than older workers (Gray and McGregor, 2003).
To summarise, there is some evidence that age influences participation in formal learning activities and, to a lesser extent, in informal learning activities. This seems to be due to a complex set of interrelating factors, including internal attributes in nurses as well as factors outside the individual worker. However, the exact relationship between age and CPD remains poorly understood. Therefore more research on this theme is needed (Lammintakanen and Kivinen, 2012, Schalk et al., 2010).
The aim of the present study was to explore nurses’ and their managers’ perceptions of the differences in CPD between younger and older nurses. Understanding of the relationship between age and CPD will help to better adjust CPD approaches to the needs of different age groups.
Section snippets
Methods
We employed a qualitative, exploratory study design using focus group discussions in a Dutch university medical centre.
Findings
In total, 22 nurses and 10 managers from various wards in a Dutch university medical centre participated. Table 1 shows that age and tenure are highly interrelated: ageing coincided with years of working experience as a nurse.
The findings were grouped in two categories: perceptions of CPD in general and of differences in CPD between younger and older nurses.
Discussion
This study used a qualitative design that centres on nurses’ and managers’ perceptions of differences in CPD between younger and older nurses. Its findings confirm and extend existing data on this topic. Like others (Friedman and Phillips, 2004), we found that participants have different perceptions of CPD. Their perceptions were found to diverge on three dimensions of CPD. In addition, six themes regarding differences in CPD between younger and older nurses were found. When combining these
Acknowledgement
We would like to thank Aart Pool, PhD, for moderating the focus group discussions and assisting with the data analysis, and Dr. Sandrijn van Schaik for her helpful suggestions with a previous version of the manuscript.
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