Continuing Professional Development in Nursing in Australia: Current Awareness, Practice and Future Directions

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Copyright © eContent Management Pty Ltd. Contemporary Nurse (2013) 45(1): 33–45.

In 2005, the Council of Australian Governments (COAG) published their investigation into

the growing pressures on Australia’s health sys-tem (Productivity Commission, 2005). With concerns rising about whether all sectors of the Australian population have, or will continue to have, equal access to high quality and safe health care, the Australian government recognised a range of social and workforce demands including Australia’s ageing population, changes in health issues, increased community expectations, an ageing health workforce, and advances in medi-cal technology and models of care (Productivity Commission, 2005).

A number of identifi ed workforce demands related to the recruitment, education, retraining and retention of nurses and midwives. For exam-ple, between 2007–2011 the average age of nurses and midwives increased from 43.7 to 44.5 years, with the proportion of nurses and midwives aged 50 years and over rising from 33% to 38.6% (Australian Institute of Health and Welfare, 2012). Additionally, the Productivity Commission’s (2005) report noted increasing workforce short-ages within the nursing profession.

Continuing professional development in nursing in Australia: Current awareness, practice and future directions

MARY KATSIKITIS*, MARGARET MCALLISTER+, RACHAEL SHARMAN*, LISA RAITH*, ANNETTE FAITHFULL-BYRNE! AND RAE PRIAULX#

*School of Social Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia; +School of Nursing, University of the Sunshine Coast, Sippy Downs, QLD, Australia; !Sunshine Coast Hospital and Health Service, QLD, Australia; #The Sunshine Coast Private Hospital, Buderim, QLD, Australia

Abstract: Australian nurses and midwives are expected to compile a professional development portfolio during their annual registration process. This study aimed to ascertain the current understanding, practice and future continuing professional development (CPD) needs of nurses and midwives employed in a regional area of Queensland, Australia. Perceived barriers and incentives for CPD were also measured. 289 public and private hospital nurses and midwives responded to the survey. Results showed that participants understood the new requirements, valued ongoing learning, preferred education to occur within work hours, and considered their workplaces as accepting of change. Approximately two-thirds of participants believed CPD should be shared between them and their employers. Barriers to undertaking CPD included understaffi ng, and the concern that CPD would interfere with time outside work. Organisational support positively infl uenced attitudes to CPD. This study highlights the importance of supportive management in encouraging their workforce to embrace ongoing learning and change.

Keywords: nursing, midwifery, education, continuing professional development, organisational change culture

The result of the Productivity Commission’s research and COAG’s subsequent meetings was the establishment of the Australian Health Practitioner Registration Agency (AHPRA) – a ‘single national agency encompassing both the registration and accreditation functions,’ (Council of Australian Governments, 2008, p. 2) with 10 health profession-specifi c boards, one of which is nursing and midwifery. It was antici-pated that a national registration scheme, and the consolidation of the current profession-based accreditation regimes, would promote a more fl ex-ible, responsive, and sustainable health workforce. Specifi cally, AHPRA aimed to assist health pro-fessionals to move around the country more easily by providing a national registration process, and improve assurance of professional practice rele-vance and greater safeguards for Australian health care consumers by setting a minimum number of points to be accrued through training annu-ally (Australia’s Health Workforce Online, 2010). The transition to the new national regulatory body, Nursing and Midwifery Board of Australia (NMBA), which provides the regulations AHPRA oversees, has resulted in Queensland nurses and

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understanding what nurses and midwives want, and how to increase their interest in diverse pro-fessional activities.

Furthermore, diversifi ed and complex health services have led to increased demand for nurses and midwives with advanced skills who are capa-ble of managing more varied patient groups, com-plex care clusters, and the acutely ill (Duffi eld, Gardner, Chang, & Catling-Paull, 2009). The need for nurses and midwives to develop advanced skills for more challenging patient profi les, cou-pled with strategies to improve resilience and reduce burnout, has created a crucial need for regular, useful, and well-targetted CPD (Aitken et al., 2011; Bartels, 2005; Curtis, Sheerin, & de Vries, 2011; Thorne, 2006). Moreover, CPD provides the opportunity for health profession-als to remain engaged in and/or upskill them-selves in evidence-based, best practice principles, which ultimately translates to improved profes-sional commitment and job satisfaction, and continued improvements in patient care (Hallin & Danielson, 2008; Tourangeau, Cummings, Cranley, Ferron, & Harvey, 2010).

However, investigations have revealed that, for a variety of reasons, CPD is not always effective or well-received by nurses and midwives. The reasons can be categorised into three areas: (a) organisational characteristics and their effects on nurses’ and mid-wives’ engagement in CPD; (b) nurses’ and mid-wives’ attitudes to CPD; and (c) nurses’ and midwives’ pragmatic concerns about participation in CPD (Barriball, While, & Norman, 1992; Eley et al., 2008; Ellis & Nolan, 2005; Gould, Drey, & Berridge, 2007; Munro, 2008).

Organisational characteristicsOrganisational characteristics include whether CPD is valued, supported, and facilitated by managers and other staff (Dowswell, Hewison, & Millar, 1998; Gould et al., 2007). For example, in some contexts, CPD is paid for by employers and nurses and midwives are allowed time off to attend, with the unit backfi lled by replacement staff. However, this ideal situation is not always the case (Gould et al., 2007; Munro, 2008).

A review by Barriball et al. (1992) suggest that managers’ indifference, lack of encouragement or

midwives experiencing confusion over registra-tion applications and renewal dates, endorsement notations, and continuing professional develop-ment (CPD) requirements (Queensland Nurses Union, 2010a).

New CPD requirements for nurses and midwivesAustralian nurses and midwives are experienc-ing a new imperative – to engage in annual CPD [also known as continuing professional education (CPE)] in order to assure these regulation author-ities that they meet criteria for ongoing registra-tion to practise (Nursing and Midwifery Board of Australia, n.d.). From 2012, every practising nurse and midwife will be expected to be able to present a professional portfolio in their yearly application for registration renewal through the new national body.

It is not known to what extent practising nurses and midwives fully understand this imperative. Apart from having to understand the specifi cs of the new requirements (e.g., number of hours, eli-gible activities), some nurses and midwives may not be professionally engaged, and thus their awareness, motivation, and decisions pertaining to professional training may not be discerning or consistent. Further, whilst CPD may serve nurses’ and midwives’ immediate technical skill needs, it may not contribute to professional satisfaction or advancement in areas the Australian professions of nursing and midwifery are thought to need such as leadership, resilience, research, and inno-vation – defi ciencies of which lead to stress, burn-out, reduced job satisfaction, and attrition from the profession (Jackson, Firtko, & Edenborough, 2007; Katsikitis & Sharman, 2011; McAllister & McKinnon, 2009; O’Donnell, Jabareen, & Watt, 2010; Parry, 2008). Those who are interested in professional education and training may not participate because of organisational issues such as workload pressures and/or attitudes towards engagement in CPD, as well as personal barriers such as time and family pressures (Eley, Fallon, Soar, Buikstra, & Hegney, 2008; Ellis & Nolan, 2005; Hallin & Danielson, 2008; Hughes, 2005; Mayes & Schott-Baer, 2010). Insisting on involve-ment in learning will not be successful without

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in the Sunshine Coast Region, data from the results of this study should generalise to other regions of the state as well as nationally, and pro-vide a useful template for improved CPD engage-ment across Australia.

METHOD

ParticipantsEnrolled and registered nurses and registered mid-wives (ENs, RNs and RMs) were recruited from a public and a private hospital in a regional area of Queensland, Australia. Both facilities offered a broad range of general and specialist health services. A total response rate (RR) of 39% was achieved from the 750 surveys (450 public) dis-tributed across the two hospitals, with individual service RRs of 42% (public) and 33% (private). Extreme responses to survey scale items, or outli-ers, were identifi ed using standard data screening methods (Tabachnik & Fidell, 2007). After outlier deletion, 289 responses were included for analysis.

The characteristics of this sample (see Table 1) were similar to those of nurses and midwives reg-istered Australia-wide in 2011, where women dominated (90.1%) and the number of nurses and midwives aged over 50 years (38.6%) was increasing (Australian Institute of Health and Welfare, 2012).

MaterialsA paper-and-pencil survey was constructed using various sources. Participants were asked to provide basic demographic details such as age, gender, period worked in nursing, and classifi cation level, followed by questions assessing participants’ views and understanding of CPD, the requirements under the new AHPRA guidelines, and organisa-tional readiness to change. The survey ended with two qualitative questions requesting future CPD requirements and general comments about the new requirements.

Nurses’ and midwives’ current CPD activi-ties, views on the funding of CPD and number of annual CPD hours undertaken were assessed by drawing on NMBA guidelines as to what con-stitutes CPD (Nursing and Midwifery Board of Australia, 2010). Participants were required to indicate the types of CPD activities they engaged

negative attitudes towards CPD affected nurses’ and midwives’ uptake of opportunities. Other institutional issues included inadequate advance notice of coming courses and lack of information or guidance about pursuing CPD, as well as the availability of study leave or funding. Even where management were supportive of study leave dur-ing work time, attendance was often conditional on staffi ng levels and workloads, especially for courses that used external course componentry (Barriball et al., 1992; Dowswell et al., 1998).

Nurse and midwife attitudes towards CPDNurses’ and midwives’ attitudes towards CPD that may affect implementation include, how use-ful the training is for their practice or careers, how interesting it is, whether it challenges and extends him/her, and how valued it is by their colleagues. Nurses and midwives, who have managers and/or colleagues who are disinterested in the new ideas or practices gained from CPD, may experi-ence feelings of disempowerment (Ellis & Nolan, 2005; Gould et al., 2007; Hughes, 2005). This lack of collegial support may lead to disenchant-ment with ongoing education generally and fur-ther disengagement in the profession.

Pragmatic concerns of nurses and midwivesPragmatic concerns that may impact the take-up of CPD include fi tting the extra requirement for learning into lives that frequently involve shift work, and family needs. Family commitments and unique diffi culties experienced by night and part-time staff may restrict participation (Barriball et al., 1992). Some nurses and midwives may also be uncertain about their academic skills and doubt their ability to manage the competing demands of homework and study. Moreover, these may not be acknowledged or addressed by management (Eley et al., 2008).

Study aimsThe study aimed to survey the current under-standing, practice, and future needs of nurses and midwives employed in various organisational types across the Sunshine Coast Region, and to ascertain any perceived barriers or incentives to participation in CPD. While the study was based

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described as fi rst, OC-Mission which measures staff aware-ness of the mission and clarity of registration requirements, and second, OC-Change which measures staff attitudes about workplace openness and efforts in keeping up with required changes (fi ve items each). The two SA scales are described as fi rst, SA-Growth which assesses the extent to which staff value and make use of professional growth oppor-tunities (fi ve items), and sec-ond, SA-Adaptability which measures staff ability to adapt to change and new ideas (four items). Originally developed for the substance abuse and health services fi eld, the TCU ORCs have been adapted and used in more than 650 organisations worldwide to measure shared perceptions of readiness for organisational change (Lehman, Greener, & Simpson, 2002; Weiner, Amick, & Lee, 2008). Satisfactory alpha coeffi cients for the four scales, 0.72–0.76 (TCU ORC-S; Lehman et al., 2002) and 0.65–0.81 (TCU ORC-D4; Lehman, Greener, Rowan-Szal, & Flynn, 2012), have been reported. To ensure suitability for this study,

question wording was modifi ed (for precedence see Reid, Bruce, Allstaff, & McLernon, 2006; Thannhauser, Russell-Mayhew, & Scott, 2010). For example, the term ‘your programme’ was altered to ‘work’ or ‘workplace’.

Interpretations of the TCU ORC-D4 scale scores are typically made on the basis of: (a) degree of agreement or disagreement on the subset of items for each scale; and (b) variance in staff responses, refl ecting the level of diver-sity in their collective perceptions or opinions.

in, and how these were funded using a ‘paid, partly paid, not paid’ response scale. As nomina-tion of more than one activity type was possible, raw numbers of each activity type were calculated.

Measuring several domains of organisational change, the Texas Christian University (TCU) Organizational Readiness for Change (ORC) short form instrument (TCU ORC-D4; TCU Institute of Behavioral Research, 2009) provided two organisational climate (OC) and two staff attributes (SA) scales. The two OC scales are

TABLE 1: PARTICIPANT CHARACTERISTICS AS PERCENTAGES ACROSS HEALTH SECTOR

Characteristic Public sector (N = 186)

Private sector (N = 98)

Total

GenderFemale 75.3 94.9 81.3Male 15.6 4.1 11.4Age group20 to less than 30 years 14.5 2 1030 to less than 40 years 19.4 13.3 1740 to less than 50 years 26.3 35.7 29.850 to less than 60 years 24.2 39.8 29.160 years or older 8.1 8.2 8Employment typeFull-time 41.9 19.4 33.9Part-time 46.2 60.2 50.2Other 3.8 19.4 9.3Years in nursingLess than 12 months 3.8 0 2.41 to less than 5 years 22.6 4.1 15.95 to less than 10 years 10.8 4.1 8.310 to less than 40 years 51.6 85.7 6340 years or more 3.8 5.1 4.1Classifi cation levelRN level 1–6 52.2 34.7 45.3

RN level 7+ 20.4 30.6 23.9

RM level 1–6 4.3 6.1 4.8

RM level 7+ 5.4 7.1 5.9

EN 8.6 17.3 11.8Other 1.6 2 1.7Work areaClinical 75.8 91.8 80.6Education 10.2 4.1 8Research 0 0 0Administration 6.5 3.1 5.2

EN, enrolled nurse; RM, registered midwife; RN, registered nurse; N = 289; Missing data not reported.

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into a sealable envelope and then into one of the secure boxes located in various workplace sites (e.g., at ward clerk desks, tearooms etc.). Boxes were collected by research staff at the end of the study. Reminder notices were placed in ward communication books approximately 2 weeks after the fi rst hand-out.

RESULTS

Data screeningRandomly missing data points were replaced using series mean imputation. A portion of absent demographic data (between 6–7%) was consid-ered to be not missing at random because it was omitted due possibly to participant concerns regarding identifi cation. These demographic data were not replaced but excluded during analyses. Despite logarithmic and square root transforma-tions, the data were not normally distributed, so relevant non-parametric techniques were used on non-transformed data.

Cronbach’s alphas for the four TCU scales were OC-Mission 0.69, OC-Change 0.48, SA-Growth 0.77, and SA-Adaptability 0.55. Examination of scale items suggested dele-tion of the reverse scored items 4.25 and 4.14 from OC-Change and SA-Adaptability respec-tively, increasing these alphas to 0.60 and 0.67 (Field, 2009; Tavakol & Dennick, 2011). All analyses involving these scales were conducted using the revised OC-Change (four items) and SA-Adaptability (three items) scales.

DemographicsGenderThere was a signifi cant association between gen-der and sector χ2(1) = 9.65, p = 0.002. A much greater percentage of participating nurses and midwives at the public hospital were male com-pared to the private sector participants, which goes against the national trend.

Age group and years in nursingThere was also a signifi cant association between age group (when collapsed into three age groups) and sector χ2(2) = 13.60, p = 0.001. That is, the age of participants was dependent on the sector they worked in. The percentage of participants

The Likert-type items are scored using a 1 = strongly agree to 5 = strongly disagree scale, and then averaged within scales and multiplied by 10 to yield fi nal scores that range from 10–50. In this survey, higher scale scores (i.e., above 30) represent stronger disagreement, and lower scores (i.e., below 30) represent stronger agreement which is opposite to that customarily used.

A preliminary battery of questions about par-ticipants’ understanding of, and attitudes towards CPD, and barriers to CPD engagement, was con-structed using the nursing CPD literature (Fahey & Monaghan, 2005; Hallin & Danielson, 2008; Hughes, 2005). These were examined by the authorship team and a fi nal set of questions deter-mined regarding (a) participant understanding of and (b) attitudes about CPD (four and fi ve items respectively); and (c) barriers to participating in CPD (eight items). Listed with similar-meaning items from the organisational readiness to change scales, these used the TCU ORC-D4’s Likert-type scoring scale of ‘agree–disagree’ responses. The averages for each of these items were not aggregated, but analysed individually.

The fi nal qualitative questions requesting future CPD requirements and general comments about the new requirements were analysed using an inductive, content analysis technique, where responses were simply categorised (Elo & Kyngäs, 2008). The questionnaire can be obtained from the fi rst author.

ProcedureEthical approval for the study was received from the Queensland Health Human Research and University of the Sunshine Coast Ethics Committees (approval numbers HREC/11/QRBW/165 and A/11/272 respectively). Participants were recruited on-site at the pub-lic and private hospitals. Information about the research was provided via research project infor-mation sheets (RPIS) placed in ward communi-cation books and in person by research staff and nurse educators. Surveys and RPIS packages were left with staff at shift changes or in prominent locations (e.g., tearooms) for nurses and midwives to access and complete voluntarily and anony-mously. Participants placed their fi nished survey

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in-services and administration accounting for the majority. Likewise, 70% of participants’ current CPD activity was partly paid for with 25% fully paid for and 5% unpaid. There was also a signifi -cant difference between public and private sector employer payment of CPD activity, χ2(2) = 6.09, p = 0.048, with nearly 31% of the public partici-pants indicating their CPD was paid for compared to 17% of private participants. This difference was accounted for in nearly inverse proportions in the partly paid for category.

Just over one-third of participants indicated they annually engaged in 20 to less than 30 hours of CPD, while another 20% indicated they engaged in 50 plus hours. There were no signifi -cant differences across sector or level. Expected patterns of level of engagement in CPD were found across employment type (i.e., participants employed full-time indicating the highest lev-els of annual CPD hours), but a comparatively large 23% of participants employed part-time (compared to 39% of participants employed full-time) said they engaged in 40–50 or more hours of CPD.

TCU Organisational readiness for change scalesTable 4 summarises scores on the OC and SA scales. Scores for both OC scales ranged fully

aged 20 to less than 40 years employed in the public sector was signifi cantly greater than the percentage employed in the private (more than double; see Table 2). The percentage of private hospital participants aged 50 years or over was nearly 10% greater than the proportion (38.6%) of that age group employed nationally. A similar asso-ciation was also found with the percentage of time spent in nursing (when collapsed into three groups) and sector χ2(2) = 30.95, p = 0.001. Particularly, 40.1% of the public participants had been nursing for up to 10 years while for the private sector this percentage was 8.2–86.6% of that sector’s staff having nursed for between 10–40 years.

Classifi cation levelConsistent with the sector differences in age and years in nursing, there was a signifi cant association between nurses’ levels and sector χ2(2) = 11.64, p = 0.02. Of the public hospital participants, only 9.5% were ENs compared to 18.1% of the private hospital participants, but 20% more public hospital participants were RNs level 1–6 (57.4%) compared to the private hospi-tal participants (36.2%).

Employment type and work areaSimilarly, there was a signifi cant association between employment type and sector χ2(2) = 28.17, p = 0.001. That is, whether par-ticipants were employed in a part-time or full-time capacity was dependent on the sector they worked in. Specifi cally, 41.9% of the participants from the public hospital were full-time compared to 19.6% of the participants from the private hospital, with 60.2% of the private participants being employed part-time. Compared to 75.8% of the participants at the public hospital, 91.2% of the participants employed by the private hospital worked in clini-cal areas.

Continuing professional developmentCurrent CPD activities and hoursTable 3 indicates the type of CPD activi-ties undertaken with workplace tasks such as

TABLE 2: MERGED AGE GROUP PERCENTAGES ACROSS HEALTH SECTOR

Public sector (N = 172)

Private sector (N = 97)

Total

Age group20 to less than 40 years 36.6 15.5 2940 to less than 50 years 28.5 36.1 31.250 years or older 34.9 48.5 39.8

TABLE 3: FREQUENCY RANKING OF TYPE OF CPD ACTIVITY

Activity N

Workplace tasks 264Education 194Workplace admin 178Research 158Memberships 154

CPD, continuing professional development.

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U = 7639, z = −2.44, p = 0.015, r = −0.14, nearly 13% more privately than publicly employed participants strongly agreed they knew the total number of CPD hours required, and only 10% of the privately employed participants indicated they were unsure of this knowledge compared with 20% of the publicly employed participants. These sector differences corroborate the median analyses on the OC-Mission scale.

Nonetheless, only 54% of participants who completed the questionnaire chose to nomi-nate the number of CPD hours they would be required to undertake compared to the propor-tion who agreed or strongly agreed that they knew the total number of CPD hours required. Based on the minimum requirement of 20 hours per annum, 94% (147) of the participants who did nominate the number of CPD hours required were correct in their knowledge. Nevertheless, the mean and SD [32.5 (10.7)] for the OC-Mission item (‘Some staff members seem confused about the main goals of the new registration require-ments.’) indicated that participants were still uncertain about the new requirements’ main goals. Additionally, only half the participants agreed they understood the documentation of written evidence required, with signifi cantly more of the private sector participants agree-ing that they understood these documentation requirements, U = 6699, z = −3.846, p = 0.001, r = −0.22.

across the agreement–disagreement scale (score range 10–45), although 34% of OC-Mission and 65% of OC-Change responses fell within the favourable zone (10–25 score). Scores for both SA scales ranged more narrowly between strong agreement and moderate disagreement scores of 10–37. Moreover, more than 62% of SA-Growth and SA-Adaptability responses fell within the highly favourable range (10–20).

Signifi cant differences existed between the health sectors on two of the four scales: OC-Mission, U = 5385, z = −5.71, p = 0.001, r = −0.34 (Mdn public = 28; private = 24); and SA-Adaptability, U = 7700, z = −1.98, p = 0.05, r = −0.12 (Mdn public & private = 20). Despite the statistical signif-icance for SA-Adaptability, the equivalent medians and small effect size suggest there was little substan-tive difference between the sectors in this scale.

The signifi cant association between health sec-tor and age group reported earlier, along with the generally accepted negative association between age and adaptability, suggested further analyses controlling for age group effects. OC-Mission scores remained dependent on sector mem-bership, F(1, 266) = 30.69, p = 0.001, partial η2 = 0.10, after controlling for a very small, but signifi cant, effect of age group, F(1, 266) = 5.37, p = 0.05, partial η2 = 0.02.

Knowledge of CPD requirementsThe majority of participants indicated they knew the total number of CPD hours required under the new requirements, and what it meant to refl ect on one’s learning (78% and 82% respec-tively; see Table 5). Although there was no statis-tically signifi cant difference between the sectors,

TABLE 4: MEANS AND STANDARD DEVIATIONS FOR TCU ORC SCALES

Scale M SD 95% CI

OC-Mission 27.5 5.8 [26.8, 28.2]OC-Change 24.7 5.4 [24.1, 25.3]SA-Growth 20.1 5.6 [19.5, 20.8]SA-Adaptability 20.5 5.2 [19.9, 21.2]

TCU ORC, Texas Christian University Organisational Readiness for Change; OC, organisational climate; SA, staff attributes; CI, confi dence interval; N = 287.

TABLE 5: PERCENTAGE LEVELS OF NURSE AND MIDWIFE UNDERSTANDING OF NEW CPD REQUIREMENTS

CPD knowledge area

% Level of agreement

SA A U D SD

The total number of CPD hours requireda

28.4 49.6 17.4 3.9 0.7

Documentation of written evidence of CPDb

13.1 38.5 29.7 14.8 3.9

The meaning of refl ecting on learningc

25.6 56.2 12.5 4.6 1.1

CPD, continuing professional development; SA, strongly agree; A, agree; U, unsure; D, disagree; SD, strongly disagree; aN = 282, bN = 283, cN = 281.

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for CPD did not deter them from participating in CPD. The main barriers to CPD engagement were understaffi ng and CPD’s interference in time outside of nursing work (nearly 50% agreed or strongly agreed with these items).

Table 8 presents correlations of the barri-ers to CPD with OC-Change, SA-Growth and SA-Adaptability. All the barriers, except changes to work schedules, were signifi cantly correlated with these scales. The strongest relationships were between having a supportive manager and the OC-Change and SA-Growth scales. Moreover, it appears that employer payment of CPD and shift work issues, were similarly related to the SA-Growth scale.

Future CPD activitiesOver half the nurses and midwives (164 partici-pants) commented on the CPD activities they would like to undertake in the future. The most common suggestions related to technical nursing procedures such as learning the latest in wound care, or advanced life support. These were fol-lowed by preferences for the process of profes-sional development (conferences and workshops) and access to higher degree studies. Participants wanted to be able to learn about options for higher degree studies and be able to undertake higher degree studies on-site. This pattern was similar across health sectors. A large number of

Attitudes to CPDWho should pay?: Just under two-thirds of participants indicated that the payment responsibility for CPD should be shared between themselves and their employers. However, this was signifi cantly related to health sector, with greater numbers of privately employed participants (72%) compared to publicly employed participants (54%) indicating they were willing to share payment responsibility, χ2(1) = 7.97, p = 0.005, (N = 271). Additionally, of those participants who identifi ed that their employers currently, either partly or fully paid for CPD, 65% and 48% respectively indicated that payment responsibility for CPD should be shared.

Beliefs about CPD: Ninety-two percent of participants agreed or strongly agreed that CPD was important to their nursing practice: 85.4% indicated that it helped them to stay interested, and 84.4% and 80.3% respectively stated it was an important part of refl ection and career progression. Just 17% of participants said they only participated in CPD to keep their hours up.

Correlation of these beliefs with the relevant TCU Organisational Readiness to Change scales (OC-Change, SA-Growth and SA-Adaptability) revealed signifi cant relationships for all variables. Table 6 shows that the strongest relationships were with the SA-Growth scale, which is expected given this scale’s measurement of participants’ value of professional growth.

Barriers to CPD engagementAs Table 7 shows, 76.8% of participants agreed or strongly agreed that they felt supported to partici-pate in CPD, and 92.4% of participants refuted that they did not learn anything new from CPD. Moreover, further confi rming the fi ndings that participants were willing to share the cost of CPD, 77.5% indicated that their employer not paying

TABLE 6: CORRELATION MATRIX OF ATTITUDES TO CPD AND TCU ORC SCALES

Item OC-Changea SA-Growthb SA-Adaptb

CPD is very important to my overall nursing/midwifery practice

0.284 0.457 0.283

I only participate in CPD because I need to get my hours up

−0.207 −0.424 −0.270

CPD helps me stay interested and motivated

0.234 0.500 0.322

CPD is an important part of my refl ective practice

0.278 0.529 0.262

CPD helps me progress in my nursing/midwifery career

0.274 0.474 0.349

CPD, continuing professional development; TCU ORC, Texas Christian University Organisational Readiness for Change; OC, organisational climate; SA, staff attributes; aN = 284, bN = 282; all correlations were signifi cant at p < 0.01 two-tailed.

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Other issuesOnly a small number of participants volunteered information for this ques-tion. The majority of com-ments related to a lack of clarity about what counts as CPD, and wanting a simple resource to docu-ment CPD (hardcopy or online), for example ‘a well designed sheet or book-let that I can use to list my CPD courses; lectures etc. attended’.

DISCUSSION

Results from this study have captured a snapshot of the current awareness, practice, and barriers to CPD from publicly and

privately employed nurses and midwives in the Sunshine Coast Region of Australia. Overall, the characteristics of these nurses and midwives mir-rored that of the national demographic; however there were signifi cant differences between the sectors. The public hos-pital participants were employed almost equally full- and part-time, were younger, were of more junior levels, and thus had less overall nursing expe-rience. In comparison, the private hospital par-ticipants were predomi-nantly female, older, and predominantly employed in clinical areas.

This study suggests that the majority of nurses and midwives are currently completing suffi cient annual hours to comply with the new

TABLE 7: PERCENTAGE LEVELS OF BARRIERS TO CPD ENGAGEMENT

Barrier Agreement level (%)

SA A U D SD

I feel supported by my manager to undertake CPD

23.2 53.6 15.2 7.6 0.3

Understaffi ng means it is too hard for me to participate in CPD

13.8 32.5 15.9 34.6 3.1

I don’t participate in CPD because my employer does not pay for it

3.8 7.6 11.1 53.6 23.9

Last minute changes to work schedules make it hard to participate in CPD

6.9 28 17.3 41.9 5.9

CPD affects my time outside of my nursing/midwifery work

9 35.6 12.8 38.8 3.8

My role as carer (child or other family member) makes it diffi cult for me to participate in CPD

4.2 23.2 13.1 47.8 11.8

I don’t learn anything new from CPD

1 2.1 4.5 62.6 29.8

Shift work makes it hard for me to attend CPD

4.2 26.6 11.8 44.6 12.8

CPD, continuing professional development; SA, strongly agree; A, agree; U, unsure; D, disagree; SD, strongly disagree; N = 289.

TABLE 8: CORRELATION MATRIX OF BARRIERS TO CPD WITH TCU ORC SCALES

Item OC-Changea SA-Growthb SA-Adaptb

I feel supported by my manager to undertake CPD

0.366** 0.358** 0.223**

Understaffi ng means it is too hard for me to participate in CPD

– −0.228** –

I don’t participate in CPD because my employer does not pay for it

−0.200** −0.308** −0.242**

Last minute changes to work schedules make it hard to participate in CPD

– – –

CPD affects my time outside of my nursing/midwifery work

−0.127** – –

My role as carer (child or other family member) makes it diffi cult for me to participate in CPD

– −0.224** −0.121*

I don’t learn anything new from CPD

−0.185** −0.273** −0.125*

Shift work makes it hard for me to attend CPD

−0.226** −0.302** −0.211**

CPD, continuing professional development; TCU ORC, Texas Christian University Organisational Readiness for Change; OC, organisational climate; SA, staff attributes; aN = 284, bN = 282; **p < 0.01 two-tailed, *p < 0.05 two-tailed.

public participants also requested CPD in leader-ship and management skills such as learning how to mentor and how to delegate.

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or a lack of clarity of AHPRA’s guidelines or it may be indicative of both. Additionally, doubts may exist as to AHPRA’s ability to adequately scrutinise the records. NMBA and organisations could enhance staff awareness by clearer guide-lines and explicit in-house discussions.

Pleasingly, and similar to other studies (Gould et al., 2007; Hallin & Danielson, 2008), the vast majority of nurses and midwives valued the ben-efi ts of ongoing learning and took up opportuni-ties for CPD, seeing this as a joint effort between themselves and their employer (although there was a sector difference – participants employed in the public sector were more likely to believe their employer should pay for CPD). Nurses’ and mid-wives’ value of CPD, and their altruism in self-fi nancing and undertaking ongoing learning in their own time (ultimately benefi tting the health sector), needs continuing support and greater rec-ognition both in organisations and through regu-latory certifi cation (Levett-Jones, 2005; Munro, 2008).

An encouraging fi nding was that these nurses and midwives generally felt their workplaces were accepting of change. This is notable given the many studies in which participants have reported a lack of manager or work area interest in imple-menting new ideas gained from CPD (Dowswell et al., 1998; Gould et al., 2007; Hughes, 2005). Additionally, they were confi dent about their own ability to change and accept new ideas. Moreover, opinions about CPD were positively related to their perceptions of adaptability: the more adapt-able nurses and midwives saw themselves, the more favourable they were towards CPD.

Organisational culture, especially support from management and willingness to change, also positively infl uenced nurses’ and midwives’ atti-tudes towards, and value of, CPD. This fi nding is important, as it highlights the need for manage-ment to be supportive and positive towards the new requirements if they want their workforce to embrace the changes wholeheartedly. Additionally, management appreciation of staff ability to change and accept new ideas is an essential ingredient of positive attitudes towards engagement in CPD (Gould et al., 2007). Furthermore, considering nurses’ and midwives’ apparent preferences for

regulations. This was regardless of whether they were employed part- or full-time, with a large proportion of part-time nurses and midwives indicating they engaged in levels of CPD similar to their full-time counterparts.

It was also evident that most CPD activities are undertaken within work hours, and relate directly to immediate practice needs (e.g., just-in-time skill-set coaching, case review). This is understand-able given the diffi culties part-time and shift work can have on undertaking CPD outside work hours, and health services’ need to ensure their nurses’ and midwives’ knowledge and skills are current. However, a predominance of workplace CPD may limit broader knowledge acquisition from other sources and on topics that develop a more long-term vision of practice and the profession.

The majority of nurses and midwives appeared to understand the hours of CPD required and what it meant to refl ect on their learning. However, only half the participants were willing or able to actually specify the number of CPD hours required by the new regulations, suggesting that some uncertainty still exists regarding this aspect of the CPD stan-dard. This confusion may be because the number of hours required depends upon the endorsements held and/or the practice relevance of CPD.

Additionally, only a small number of nurses and midwives could articulate the main goals of the programme (particularly those in the pub-lic system), and a number expressed confusion regarding how CPD was to be documented. This lack of clarity was evident mainly from the public sector participants.

Documenting CPD is a key aspect of the new requirements, with the NMBA issuing a registra-tion standard and a fact sheet outlining this along with suggested types of CPD activities, while the Queensland Nurses Union has developed a record of CPD for its members’ use (Nursing and Midwifery Board of Australia, 2010; Queensland Nurses Union, 2010b). Our research suggests that nurses and midwives know they have to do CPD and are doing so, but managing their account-ability to AHPRA is another matter. This may be indicative of either nurses’ and midwives’ self-doubts about what constitutes appropriate CPD activity and their ability to keep suitable records,

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McAllister & McKinnon, 2009; Munro, 2008). Areas for improvement in terms of information and education for nurses and midwives centre on clearer guidelines about the documentation of CPD, along with a better articulation of the main goals of the new requirements, and the types of eligible CPD activities.

In all, results from this study have highlighted some minor gaps in understanding of the new requirements, and some specifi c concerns: how-ever, the majority of nurses and midwives surveyed appear positive and embracing of the regulatory changes. Some improvements in information from AHPRA may assist a smoother transition, and this study has demonstrated that the organisational change culture will be of great importance for the effective and successful adoption of the new requirements. Additionally, AHPRA can support organisational recognition of the efforts of nurses and midwives in pursuing ongoing education.

LimitationsWhile the sample size was suffi cient to provide a snapshot of the sample population, caution should be exercised as the data refl ect the views of nurses and midwives from one geographi-cal locale and may not represent urban or rural populations. However, our sample demographics were refl ective of national fi gures. Additionally, the small numbers of ENs and midwives in the sample preclude generalisations being made about these groups and further research needs to include greater numbers of these practitioners.

Another limitation is that this study did not differentiate between alternate modes of CPD delivery. It would be benefi cial for further research to investigate possible variations in nurses’ and midwives’ attitudes and barriers to specifi c forms of CPD, for example online education or internet courses that can be undertaken on-site or at home.

Future directionsThis research suggests that CPD for most nurses and midwives equates with technical and specifi c practice-based content. However, literature sug-gests that the increasing complexity and diversity of practice requires the acquisition of skills to assure provision of patient safety and skills competence,

workplace education, and their restricted focus of topic content, management can further facilitate this by continuing to provide CPD within work hours while encouraging an awareness of the use-fulness and relevance of more generic topic areas to their practice and careers.

The barriers that emerged for undertaking CPD included understaffi ng and the concern that CPD would interfere with time outside work. Moreover, the perceptions of barriers, in terms of rostering and scheduling of CPD, were slightly increased if nurses and midwives were under-taking shift work. These perceived barriers echo concerns raised in other studies particularly lack of backfi ll and diffi culties of ‘night’ nurses (Eley et al., 2008; Gould et al., 2007; Hughes, 2005; Mayes & Schott-Baer, 2010).

Results further supported the notion that organisational change culture remains an impor-tant determinant of CPD participation. Having a supportive manager was positively correlated with all readiness to change scales, particularly with change culture and with the value staff place on professional growth. Moreover, it appears that as employer payment for CPD increases, the greater the value staff place on ongoing education and professional growth. Employer provision of consistent and equitable access to training and study time, as well as man-agers who facilitate the use of new knowledge and skills are vital aspects of staff engagement with CPD (Gould et al., 2007), completion of the mandatory number of hours and overall job satisfaction (Levett-Jones, 2005).

Similar to current CPD activities, the majority of nurses and midwives envisioned future CPD activities to mainly be based in technical knowl-edge and updates, thus clearly identifying unique nursing skills and the need for them to be devel-oped and shared. However, nurses and midwives could also be encouraged to explore CPD that presents them with opportunities for advance-ment (e.g., resilience, empowerment, research, leadership), that relate to expanded nursing and midwifery roles, or are problematic for their pro-fessions (e.g., public health information, social and political issues; Gould, Kelly, Goldstone, & Maidwell, 2001; Hallin & Danielson, 2008;

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Adelaide, SA: Author. Retrieved from http://www.ahwo.gov.au/natreg.asp

Curtis, E. A., Sheerin, F. K., & de Vries, J. (2011). Developing leadership in nursing: The impact of education and training. The British Journal of Nursing, 20(6), 344–352. doi:10.1016/j.aucc.2011.01.004

Dowswell, T., Hewison, J., & Millar, B. (1998). Enrolled nurse conversion: Trapped into training. Journal of Advanced Nursing, 28(3), 540–547. Retrieved from http://onlinelibrary.wiley.com/store/10.1046/j.1365-2648.1998.00805.x/asset/j.1365-2648.1998.00805.x.pdf?v=1&t=h78a7sa4&s=b15b7ff7df20d40611c236c718ab183750b3859a

Duffi eld, C., Gardner, G., Chang, A. M., & Catling-Paull, C. (2009). Advanced nursing practice: A global perspective. Collegian, 16, 55–62. doi:10.1016/j.colegn.2009.02.001

Eley, R., Fallon, T., Soar, J., Buikstra, E., & Hegney, D. (2008). The status of training and education in information and computer tech-nology of Australian nurses: A national survey. Journal of Clinical Nursing, 17, 2758–2767. doi:10.1111/j.1365-2702.2008.02285.x

Ellis, L., & Nolan, M. (2005). Illuminating continuing professional education: Unpacking the black box. International Journal of Nursing Studies, 42, 97–106. doi:10.1016/j.ijnurstu.2004.05.006

Elo, S., & Kyngäs, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107–115. doi:10.1111/j.1365-2648.2007.04569.x

Fahey, C., & Monaghan, J. (2005). Australian rural midwives: Perspectives on continuing professional development. Rural and Remote Health, 5(4). Retrieved from http://www.rrh.org.au

Field, A. (2009). Discovering statistics using SPSS (3rd ed.). London, England: Sage.

Gould, D., Drey, N., & Berridge, E. J. (2007). Nurses’ experiences of continuing professional develop-ment. Nurse Education Today, 27(6), 602–609. doi:10.1016/j.nedt.2006.08.021

Gould, D., Kelly, D., Goldstone, L., & Maidwell, A. (2001). The changing training needs of clinical nurse managers: Exploring issues for continuing professional development. Journal of Advanced Nursing, 34(1), 7–17. doi:10.1046/j.1365-2648.2001.3411735.x

Hallin, K., & Danielson, E. (2008). Registered Nurses’ perceptions of their work and professional development. Journal of Advanced Nursing, 61(1), 62–70. doi:10.1111/j.1365-2648.2007.04466.x

Hughes, E. (2005). Nurses’ perceptions of continuing professional development. Nursing Standard, 19(43), 41–49.

career development and fulfi lment, and effec-tive participation in health policy and direction through leadership, change management, and crit-ical thinking about the future (Aitken et al., 2011; Bartels, 2005; Curtis et al., 2011; Thorne, 2006). Further investigation is required to examine how these ‘soft’ skills can be incorporated into learn-ing in practice, and the best delivery modality. Moreover, further investigation would also dis-cover the short and long-term benefi ts of learning that focuses not just on immediate skills but on longer term thinking and practice change.

ACKNOWLEDGEMENTS

This research was funded by the Sunshine Coast Health Foundation Research Grants programme. The authors would like to thank the nurses and mid-wives for their valuable participation, and acknowl-edge Kieran Eaton for data collection assistance.

AUTHOR NOTE

Margaret McAllister is now at the Centre for Mental Health Nursing Innovation, Central Queensland University, Noosa, Australia.

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Received 10 October 2012 Accepted 21 January 2013

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