Nurses' Attitudes toward Continuing Formal Education: A Comparison by Level of Education and Geography

Article excerpt

ABSTRACT The education of nurses has an influence on patient safety and outcomes, the nursing shortage, the faculty shortage, and nurses' attitudes and actions.This article reports on a dissertation study designed to examine the attitudes of nurses, initially registered with an associate degree or diploma in nursing, toward continuing formal education. Actively licensed registered nurses in the eastern and western United States (n = 535) participated. The main finding of this study was that, although nurses held positive attitudes overall, attitudes ranked barely above neutral. The findings suggest that work needs to be done to improve nurses' attitudes toward continuing formal education and research needs to be undertaken to understand what would entice nurses back to school. Implications for nursing practice and education are discussed along with suggestions for future research.

Key Words Nurse Attitudes--Nursing Education--RN-BSN Education--Postregistration

IT IS RECOMMENDED THAT NURSING STRIVE FOR A WORKFORCE COMPRISED OF 80 PERCENT BACCALAUREATE-PREPARED REGISTERED NURSES BY 2020 AND THAT NURSES ENGAGE IN LIFELONG LEARNING (Institute of Medicine, 2011). However, only 50 percent of the current RN workforce is prepared with a bachelor of science in nursing (BSN) or graduate degree (American Association of Colleges of Nursing [AACN], 2011). Even in countries that have adopted the BSN as a requirement for entry into practice, such as Canada, many nurses are practicing with associates degrees (ADN) or diplomas in nursing.

The three educational routes to become an RN in the United States are unique for a profession and lead to concern that RNs may he seen as undereducated when compared with other members of the health care team (Donley & Flaherty, 2002). Megginson (2008) stated that the educational mobility of ADN and diploma nurses "to the BSN level is crucial to positive patient outcomes, creation of a credible professional identity and to cohesion among nurses" (p. 48). Understanding nurses' attitudes is key to achieving the goal of "enticing and enabling nurses to achieve higher educational levels consistent with the trends of other health care professionals" (Hihon, 2004, p. 14).

The Theory of Planned Behavior (TPB) (Ajzen, & Fishbein, 1980) was the organizing framework for this study. It has proven reliability and validity and proposes a connection between the concepts of attitude toward behavior, subjective norms (social pressures), and perceived behavioral control. This study examined the attitudes of nurses initially registered with an ADN or diploma toward continuing to the BSN level and/or beyond. The goal was to provide direction for change. Four research questions were asked: * What are the attitudes of ADN and diploma nurses toward continuing formal education?

* Do attitudes change over time as determined by years of nursing practice?

* How do the attitudes of those who return to school for a BSN or higher differ from those who have not returned or from those planning to return?

* Do attitudes differ according to geographical location (west vs. east)?

Background and Literature Search Patient outcomes are a primary reason to encourage continuing formal education. The literature is replete with research and anecdotal support for the contention that patient health care outcomes are linked to nursing education. Researchers have identified: a) improved patient safety and lower rates of patient morbidity and mortality (Aiken, Clarke, Cheung, Sloane, & Silber, 2003; Estabrooks, Midodzi, Cummings, Ricker, & Giovannetti, 2005; Friese, Lake, Aiken, Silber, & Sochalski, 2008; Tourangeau et al., 2007), b) lower levels of medication errors and procedural (or practice-related) violations (AACN. 2008; Delgado, 2002), and c) fewer disciplinary actions for BSNs (Delgado). The knowledge needed by practicing nurses increases as medical knowledge evolves and becomes ever more complex. …