Facilitating flexibility in postgraduate nursing education through entrustable professional activities to address nursing shortages and career prospects.

AIM: To communicate how the Dutch postgraduate nursing education landscape was redesigned using entrustable professional activities (EPAs). The goal of this initiative was to reduce training time, enhance transfer across nursing specialities and contribute to a better-aligned continuum of initial education, postgraduate education and continuing professional development. BACKGROUND: Nursing shortages continue to worsen worldwide. An approach to address this growing shortage is to create a more flexible postgraduate training structure, offering training in the just-in-time and just-as-needed models. EPAs can be used as building blocks for training and assessment. Experience with EPAs (i.e. units of professional practice that can be entrusted once a trainee has demonstrated the required competencies) in health professions education, including nursing, is rising rapidly. While EPAs are largely used to create training flexibility within a programme, they can also be used to create flexibility across programmes. In 2018-2022, training hospitals and education institutions in the Netherlands collaborated in the CZO Flex Level Project to redesign the postgraduate nursing education landscape using EPAs. DISCUSSION: The implementation of a flexible postgraduate nursing education model nationwide will face several challenges. An overview of these challenges and suggestions for future research on the effects of the new structure on nursing competence, satisfaction and career development are provided. CONCLUSION: EPAs can imbue flexibility within and across training programmes. Designing an EPA-based educational landscape requires nationally coordinated efforts. IMPLICATIONS FOR NURSING POLICY: Redesigning educational structures to allow for more flexibility is critical to address major societal challenges in healthcare.

Preceptors' considerations when entrusting professional activities to postgraduate nursing students: A qualitative study.

BACKGROUND: Nurse-preceptors regularly struggle to evaluate students' readiness to take care of patients unsupervised, even with sophisticated workplace-based assessment tools. Preceptors' gut feelings are not always captured well, but are critical for judgement of readiness for learner entrustment with care tasks. Studies in medical education report features that clinicians consider important when trusting students with clinical responsibilities that might also apply in nursing. OBJECTIVES: To unravel preceptors' considerations when entrusting professional activities to postgraduate nursing students. The findings may contribute to the improvement of workplace-based assessments and the training of preceptors. METHODS: Thematic analysis of semi-structured interviews with sixteen nurse-preceptors from three postgraduate nursing specialisations in Dutch hospitals. RESULTS: Three themes emerged: CONCLUSIONS: For preceptors of postgraduate nursing students, entrustment requires more than merely insight into objectively measurable competencies. Entrusting is accompanied by subjectivity related to what preceptors expected of students. These expectations are in line with suggested factors in the literature-capability, integrity, reliability, agency, and humility-considered before entrusting students with clinical responsibilities identified in medical training. Entrusting is also accompanied by what preceptors realise about their own role in entrustment decisions. Combining different information sources made assessment more transparent and the implicit more explicit.

Transdisciplinary entrustable professional activities.

Healthcare has become highly specialized. Specialists, in medicine as well as in nursing, determine much of the high quality of current health care. But healthcare has also become increasingly fragmented, with professionals trained in separate postgraduate silos, with boundaries often difficult to cross. While a century ago, generalists dominated patient care provision, now specialists prevail and risk becoming alienated from each other, losing the ability to adapt to neighboring professional domains. Current health care requires a flexible workforce, ready to serve in multiple contexts, as the COVID-19 crisis has shown.The new concept of transdisciplinary entrustable professional activities, EPAs applicable in more than one specialty, was recently conceived to enhance collaboration and transfer between educational programs in postgraduate nursing in the Netherlands.In this paper, we reflect on our experiences so far, and on practical and conceptual issues concerning transdisciplinary EPAs, such as: who should define, train, assess, and register transdisciplinary EPAs? How can different prior education prepare for similar EPAs? And how do transdisciplinary EPAs affect professional identity?We believe that transdisciplinary EPAs can contribute to creating more flexible curricula and hence to a more coherent, collaborative healthcare workforce, less determined by the boundaries of traditional specialties.

The viability of interprofessional entrustable professional activities.

Interprofessional education (IPE) and entrustable professional activities (EPAs) represent two topics in health professions education that have attracted significant attention in recent years. IPE (when different health professionals learn with, from and about each other with the aim of optimal care) has an inherent focus on the collective. EPAs (units of professional practice that can be fully entrusted to a trainee, once he or she has demonstrated the necessary competence to execute this activity unsupervised) have a focus on the individual. Attempts to relate the two may cause friction and the question is: can they be reconciled? Are interprofessional EPAs or team-EPAs useful concepts and if so what should they look like? The authors argue that most work in modern healthcare involves interprofessional collaboration. Some EPAs have an inherent strong interprofessional nature, such as emergency teamwork, running multidisciplinary team meetings, and surgery. Other EPAs are less inherently dependent on interprofessional collaboration. The authors conclude that neither interprofessional team-EPAs (for which a team can or should be certified), nor IP-EPAs for individuals, as opposed to other EPAs, are viable concepts. However, the authors do not question that certifying health care professionals and entrusting trainees with most clinical tasks will require to ascertain their competence in interprofessional collaboration. This must be included when assessing learners for most EPAs and making entrustment decisions. This can help to strengthen interprofessional competence in the clinical workplace.

Motives and activities for continuing professional development: An exploration of their relationships by integrating literature and interview data.

BACKGROUND: To effectively enhance professional development, it is important to understand the motivational factors behind nurses' engagement in particular types of learning activities. Nurses have various motives for professional development and utilise different learning activities. Not much is known about how these relate. OBJECTIVES: The aim of this study was to explore the relationship between nurses' motives and activities for continuing professional development, by examining in which types of learning activities nurses engage, with which motives, and whether certain motives are associated with certain learning activities. DESIGN: A qualitative study using semi-structured interviews. SETTINGS AND PARTICIPANTS: Twenty-one nurses in academic and general Dutch hospitals participated. METHODS: Interview data on nurses' learning biographies were analysed using a literature-based framework on motives and learning activities for continuing professional development. As recent classifications of nurses' motives for professional development were absent, the literature was reviewed for motives, using three databases. The interview transcripts were analysed for motives, learning activities and their relationships. RESULTS: Nine motives and four categories of learning activities for continuing professional development were delineated. Increasing competence was the primary motive that stimulated nurses to engage in self-directed learning during work, and in formal learning activities. To comply with requirements, they engaged in mandatory courses. To deepen knowledge, they registered for conferences. To develop their careers, they enrolled in postgraduate education. Five other motives were not mentioned as frequently. CONCLUSIONS: Specific motives were found to be related to engagement in particular learning activities. Nurses could use these findings to increase their awareness of why and how they develop professionally, and managers and human resource development professionals could develop approaches that would better suit nurses' needs.

Strategies for continuing professional development among younger, middle-aged, and older nurses: a biographical approach.

BACKGROUND: A nursing career can last for more than 40 years, during which continuing professional development is essential. Nurses participate in a variety of learning activities that correspond with their developmental motives. Lifespan psychology shows that work-related motives change with age, leading to the expectation that motives for continuing professional development also change. Nevertheless, little is known about nurses' continuing professional development strategies in different age groups. OBJECTIVES: To explore continuing professional development strategies among younger, middle-aged, and older nurses. METHODS: A qualitative study using semi-structured interviews, from a biographical perspective. Data were analysed using a vertical process aimed at creating individual learning biographies, and a horizontal process directed at discovering differences and similarities between age groups. PARTICIPANTS: Twenty-one nurses in three age groups from general and academic hospitals in the Netherlands. RESULTS: In all age groups, daily work was an important trigger for professional development on the ward. Performing extra or new tasks appeared to be an additional trigger for undertaking learning activities external to the ward. Learning experiences in nurses' private lives also contributed to their continuing professional development. Besides these similarities, the data revealed differences in career stages and private lives, which appeared to be related to differences in continuing professional development strategy; 'gaining experience and building a career' held particularly true among younger nurses, 'work-life balance' and 'keeping work interesting and varied' to middle-aged nurses, and 'consistency at work' to older nurses. CONCLUSIONS: Professional development strategies can aim at performing daily patient care, extra tasks and other roles. Age differences in these strategies appear to relate to tenure, perspectives on the future, and situations at home. These insights could help hospitals to orientate continuing professional development approaches toward the needs of all age groups. This should be particularly relevant in the face of present demographic changes in the nursing workforce.

Nurses' and managers' perceptions of continuing professional development for older and younger nurses: a focus group study.

BACKGROUND: Continuing professional development of nurses is increasingly necessary to keep abreast of rapid changes in nursing care. Concurrently, the nursing workforce is growing older. Therefore, future strategies for continuing professional development should be directed at both younger and older nurses. Although there is some evidence that various personal, organisational and social factors result in lower participation of older workers in development activities, age-related differences in continuing professional development among nurses remain under-explored. OBJECTIVE: This study explored nurses' and their managers' perceptions of the differences in continuing professional development between younger and older nurses. DESIGN: A qualitative study using focus groups. The interviews were analysed using a thematic analysis strategy. SETTINGS: A large academic hospital in the Netherlands. PARTICIPANTS: 22 nurses in three age groups (20-34 years, 35-49 years and 50-65 years) and 10 nurse managers participated in four focus groups. RESULTS: Six themes regarding differences in continuing professional development for younger and older nurses emerged from the data: (1) level of focus, (2) creating possibilities to leave the bedside, (3) ambitious young nurses, (4) same resources, different requirements, (5) ceiling in courses for older nurses, and (6) social status and self esteem. Overall, participants seemed to conceptualise continuing professional development along three dimensions: purpose, level of formality of learning activities, and scope of development. CONCLUSIONS: The findings suggest that participants perceive differences in continuing professional development between younger and older nurses. Its purpose and the contributing learning activities are considered to change during the lifespan. When developing strategies for continuing professional development, the requirements and needs of different age groups need to be taken into account. Whether the scope of professional development is confined to "keeping up to date" or used more broad, including "expansion of skills and knowledge" seems to relate more to nurses' attitudes towards work than to their age.