Nurses need to participate in CPE to update their knowledge and increase their competencies. This research was carried out to explore their current practice and the future general needs for CPE. This cross-sectional descriptive study involved registered nurses from government hospitals and health clinics from Peninsular Malaysia. Multistage cluster sampling was used to recruit 1000 nurses from four states of Malaysia. Self-explanatory questionnaires were used to collect the data, which were analyzed using SPSS version 16. Seven hundred and ninety-two nurses participated in this survey. Only 80% (562) of the nurses had engaged in CPE activities during the past 12 months. All attendance for the various activities was below 50%. Workshops were the most popular CPE activity (345, 43.6%) and tertiary education was the most unpopular activity (10, 1.3%). The respondents did perceive the importance of future CPE activities for career development. Mandatory continuing professional education (MCPE) is a key measure to ensure that nurses upgrade their knowledge and skills; however, it is recommended that policy makers and nurse leaders in the continuing professional development unit of health service facilities plan CPE activities to meet registered nurses’ (RNs) needs and not simply organizational requirements.
Globally, all professionals have recognized the phenomenon of continuing professional education (CPE) as a primary method to enhance basic professional education regularly [
In view of the important role of CPE to nurses, many countries have implemented mandatory continuing professional education (MCPE), beginning with the State of California in 1971 [
Similarly, in the United Kingdom, legislation was passed and MCPE was introduced to ensure the quality of nursing [
The need for MCPE is not a practice restricted to Western countries. China implemented MCPE for nurses in 1996 [
In Malaysia, the Nursing and Midwifery Board has long recognized the importance of CPE. Initially the Board required nurses to comply with a provision in the code of professional conduct to participate in a minimum of ten hours of CPE, although this expectation was not checked with each application for practice license renewal. The Malaysian Nursing and Midwifery Board introduced MCPE in 2008. All registered nurses (RN) are now required to participate in and provide documentary evidence that they have met the minimum requirement of 25 credit points of CPE annually before renewal of licensure is granted [
A quantitative cross-sectional survey was designed to obtain information from the nursing population regarding CPE practice. The aim of this study was to explore the current CPE practice of Malaysian nurses and to identify the future CPE needs of this population.
The study population consisted of 70,000 registered nurses working in 178 Ministry of Health hospitals and 2987 community clinics. A three-stage, multistage cluster, stratified sampling method was used for this survey [
Cluster stratified sampling.
Cluster | Tertiary hospital | Secondary hospital | Primary hospital | Health clinic | Total for each state |
---|---|---|---|---|---|
Proportional | 1000 | 500 | 100 | 80 | |
|
135 | 65 | 30 | 20 | 250 |
The inclusion criteria for the sample were that they must be state RNs with at least one-year working experience. The RNs selected were based on implied consent to participate in the study. Nurses who were on maternity leave, study leave, unpaid leave, or long medical leave were excluded from the study.
The questionnaire was developed with considerable attention given to construct clear and unambiguous items. When items were developed, care was taken to use simple language and short sentences that were neither double-barreled nor leading. The questionnaire consist of close ended questions; likert scale was used to rank the future need of nurses on activities and topics. The present study used agreement statement “1 = not at all, 2 = a little, 3 = somewhat, 4 = moderately, 5 = a great deal” for opinion scale for importance of CPE. The questionnaire was developed based on literature search, with the main tools related to CPE [
Application of ethical approval to conduct research in Malaysia was submitted to the Malaysia Economic Planning Unit, Ministry of Health in Malaysia, and University of Malaya Medical Centre. The research proposal was submitted to the Monash University Human Research Ethics Committee for ethical approval. A written cover letter was distributed to the participants clarifying the purpose of the study, together with the questionnaire. Participation was voluntary and the information provided was treated with the utmost regard for confidentially and anonymity. Since this survey was a low-risk research, consent was based on implied consent and did not require a written consent.
Data were collected in November 2008. One thousand questionnaires were distributed to RNs from 12 hospitals and 4 community health centers. By the end of January 2009, a total of 850 questionnaires had been returned; however, only 792 of the participants had correctly completed the questionnaire.
The statistical package for social sciences (SPSS) version 16.0 for Windows was used for statistical analyses. Statistical methods included frequency, percentage, mean, and standard deviation (SD) for descriptive analysis.
A total of 1000 questionnaires were distributed to participants, of which 792 were returned completed giving a response rate of 79.2%. Table
Demographic characteristics (
Characteristic | Frequency | % |
---|---|---|
Sex | ||
Female | 769 | 97.1 |
Male | 23 | 2.9 |
Age (in years) | ||
≤28.0 | 288 | 36.4 |
29–35 | 252 | 31.8 |
≥36 | 252 | 31.8 |
Mean: 33.89 (SD = 9.11) | ||
Marital status | ||
Married | 611 | 77.1 |
Single | 166 | 21.0 |
Separated/divorced | 6 | 0.8 |
Widow/widower | 9 | 1.1 |
Number of children | ||
0 | 80 | 12.8 |
1-2 | 327 | 52.2 |
3-4 | 183 | 29.2 |
≥5 | 37 | 5.8 |
Household income/month (RM) | ||
≤2914.00 | 202 | 25.5 |
2915–3980 | 215 | 27.2 |
3981–4630 | 177 | 22.3 |
≥4631 | 198 | 25.0 |
Mean: 3941.40 (SD = 1633.38) | ||
Working institution | ||
Tertiary hospital | 441 | 55.7 |
Secondary hospital | 164 | 20.7 |
Primary hospital | 117 | 14.8 |
Health clinic | 70 | 8.8 |
Years of service | ||
≤3 | 203 | 25.6 |
4–8 | 234 | 29.5 |
9–14 | 164 | 20.7 |
≥15 | 191 | 24.2 |
Mean: 10.16 (SD = 8.54) | ||
Professional education | ||
Diploma in nursing | 602 | 76.0 |
Advance diploma in nursing | 172 | 21.7 |
Degree in nursing | 18 | 2.3 |
Five hundred and sixty-two (71%) of the RNs had participated in CPE activities in the past 12 months; however only 324 (40.9%) of them had achieved the 25 or more credit points required to renew their licenses. Two hundred and thirty-eight (30.05%) had obtained less than 25 credit points, which had excluded them from relicensing. Table
The topics of CPE attended by respondents were consistent with their identified future needs. The nurses highlighted specialty nursing CPE, for example, renal nursing, orthopedic nursing, and community health nursing, as the most important topic.
Only 71% of the RNs from this study had participated in CPE in the last 12 months, despite the introduction of MCPE for Malaysian RNs since 2008. Previous studies, which had been undertaken before the introduction of MCPE, showed higher rates of participation by nurses. Salim [
Most of the RNs in this study participated in workshops or attended conferences, followed by in-service education. These findings are consistent with previous studies that found participation in workshops, seminars, conferences, in-service programmes, and academic programmes was often the choice of CPE activities among nurses [
In this study, participation in reading and undertaking research was low. This finding is similar to that reported by [
This study found that the rates of participation in degrees and diplomas were low compared to other activities but this is consistent with previous research [
The nurses from this study preferred the face-to-face and structured didactic short course opportunity for CPE is often suggested by the employer. The purpose of CPE is merely to collect point to review their practice license. The fact that very few nurses attended tertiary study may be an effect of the lack of opportunity, arising from the limited number. In addition, the courses are full time and the universities are located in cities. Even though some public universities offer online courses for nurses, the cost has deterred nurses from pursuing tertiary education. The scarcity of degree-level qualifications among nurses may affect their interest in research, as they may not have the skills to undertake research and learn independently.
In this study, 60.7% of the nurses reported attending nursing courses in specialized areas, such as cardiothoracic nursing, wound care management, and cardio pulmonary resuscitation. This is consistent with Pathan [
Almost all the nurses in this study positively perceived that CPE activities (641, 80.9%) and the topic (730, 92.2%) are important. The need for future CPE activities was consistent with the previous participation rate activities for in-service training, conferences, and workshops (Table
CPE practice (
CPE practices | Respondents’ attendance ( |
Perceived need for future CPE activities and topics to | ||
---|---|---|---|---|
Never | 1-2 | >2 | ||
|
|
|
Mean | |
Type of activity | ||||
In-service education | 501 (63.3) | 96 (12.1) | 195 (24.6) | 4.10 |
Advanced nursing courses | 690 (87.1) | 102 (12.9) | 0 | 4.01 |
Workshops | 447 (56.4) | 290 (36.6) | 55 (6.9) | 3.83 |
Orientation programme | 591 (74.6) | 189 (23.9) | 12 (1.5) | 3.80 |
Conference | 469 (59.2) | 261 (33.0) | 62 (7.8) | 3.67 |
Tertiary education | 782 (98.7) | 10 (1.3) | 0 | 3.67 |
Reading nursing journals | 649 (81.9) | 82 (10.4) | 61 (7.7) | 3.61 |
Carried out research | 756 (95.5) | 36 (4.5) | 0 | 3.21 |
Presented at a conference | 719 (90.8) | 63 (8.0) | 10 (1.3) | 3.19 |
Topic of CPE | ||||
Specialty nursing | 311 (39.3) | 317 (40) | 164 (20.7) | 4.90 |
General nursing | 396 (50) | 192 (24.2) | 204 (25.8) | 4.20 |
Indirect nursing | 544 (68.7) | 150 (18.9) | 98 (12.4) | 4.00 |
Management | 658 (83.1) | 109 (13.8) | 25 (3.2) | 4.00 |
Teaching | 728 (91.9) | 63 (8.0) | 1 (0.1) | 3.90 |
Research | 641 (80.9) | 141 (17.8) | 10 (1.3) | 3.50 |
CPE attendance was highest when the topics reflected the needs of the nurses. Specialist nursing topics, such as cardiothoracic nursing, wound care management, and cardio pulmonary resuscitation generally perceived to be advanced practice skills, were rated the most important, and this is reflective of the trend for specialization [
The inventory of future learning need for CPE serves as a yard stick to provide relevant and timely courses planned for nurses. The provision of CPE should focus on the learners’ need to ensure they receive latest learning experience that they will be able to apply to improve their current practice. The staff development and in-service training unit should consider providing a more structured programme based on nurses’ learning needs in cooperated collaboration in three aspects of nursing: practice, education, and research. Without proper planning and research, mandatory CPE is unlikely to deliver the anticipated development of reflective practice and critical thinking that is considered crucial to improving patient care. It is also imperative for CPE providers to examine critically the existing education approach and explore more innovative teaching methods such as e-learning and self-directed learning, taking a problem-solving approach such as problem-based learning or evidence-based nursing.
This study found that Malaysian nurses participation in CPE was not convincing despite of implementation of MCPE by Malaysian Nursing Board. However, the nurses acknowledge the importance and the need for future CPE. Thus, MCPE would not improve the CPE participation among nurses unless the programmes are planned and implemented based on the nurses’ needs. Collaboration among the nursing leaders in every area is vital to improve our practice, and most importantly, our nursing profession.
The authors declare that there is no conflict of interests regarding the publication of this paper.
Mei Chan Chong and Karen Francis were responsible for the study conception and design. Under Karen Francis’s supervision, Mei Chan Chong conducted the data collection and analysis. Mei Chan Chong was responsible for the draft of the paper. Karen Francis, Simon Cooper, and Khatijah Lim Abdullah made critical revisions for more significant intellectual content. Simon Cooper provided statistical expertise. Mei Chan Chong and Khatijah Lim Abdullah were responsible for obtaining the funding. All researchers were involved in administrative, technical, or material support. Karen Francis, Simon Cooper, and Khatijah Lim Abdullah supervised the study.
The authors would like to express their sincere gratitude to late Dr. Ken Sellick for his selfless commitment in supervising this project. Many thanks are due to the Malaysia Economic Planning Unit and MOH Malaysia for allowing the authors to conduct this research. Thanks you due to the Malaysian RNs for engaging in this study and to the University of Malaya for funding this survey. This research was supported by University of Malaya short-term research funds: UMRG:RG487-12HTM.