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Nurse Educator Manual:
Essential Skills and Guidelines
for Ef fective Practice

ADRIANNE E. AVILLION, DED, RN

hcPro

Nurse Educator Manual: Essential Skills and Guidelines for Effective Practice is published by HCPro, Inc.
Copyright 2005 HCPro, Inc.
All rights reserved. Printed in the United States of America.

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ISBN 1-57839-623-9
No part of this publication may be reproduced, in any form or by any means, without prior written
consent of HCPro, Inc., or the Copyright Clearance Center (978/750-8400). Please notify us immediately if you have received an unauthorized copy.
HCPro, Inc., provides information resources for the healthcare industry.
HCPro, Inc., is not affiliated in any way with the Joint Commission on Accreditation of Healthcare
Organizations, which owns the JCAHO trademark.
Adrianne E. Avillion, DEd, RN
Melanie Roberts, Associate Editor
Emily Sheahan, Executive Editor
Lauren Rubenzahl, Copy Editor
Rebecca Silverman, Proofreader
Mike Mirabello, Senior Graphic Artist

Paul Singer, Layout Artist
Jean St. Pierre, Director of Operations
Shane Katz, Cover Designer
Kathryn Levesque, Group Publisher
Suzanne Perney, Publisher

Advice given is general. Readers should consult professional counsel for specific legal, ethical, or
clinical questions.
Arrangements can be made for quantity discounts. For more information, contact:
HCPro, Inc.
P.O. Box 1168
Marblehead, MA 01945
Telephone: 800/650-6787 or 781/639-1872
Fax: 781/639-2982
E-mail: [email protected]
Visit HCPro at its World Wide Web sites:
www.hcpro.com and www.hcmarketplace.com

06/2005
20432

C ONTENTS

List of figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix
About the author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi
Chapter 1: The evolution of staff development: Response to a changing
healthcare environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Origin through World War II (WWII) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
1940s–1960s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
1970s–1990s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
1990s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
The 2000s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Final exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Chapter 2: Correlating values, vision, and mission statements with
educational programming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Recommendations for writing a vision statement . . . . . . . . . . . .
Mission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Use mission, vision, and values to design and implement education
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Final exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

N URSE E DUCATOR M ANUAL : E SSENTIAL S KILLS

AND

G UIDELINES

FOR

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E FFECTIVE P RACTICE

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.15
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.19
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.21
.23
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.24

iii

CONTENTS

Chapter 3: Qualifications and job descriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Objectives . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . .
Qualifications . . . . . . . . . . . . .
Job descriptions . . . . . . . . . . . .
Title . . . . . . . . . . . . . . . . . .
Overview of responsibilities
Qualifications . . . . . . . . . . .
Reporting mechanism . . . . . . .
Working conditions . . . . . . . . .
Competencies . . . . . . . . . . . . .
Signatures . . . . . . . . . . . . .
Conclusion . . . . . . . . . . . . . . .
Bibliography . . . . . . . . . . . . . .
Final exam . . . . . . . . . . . . . . .

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.27
.27
.28
.33
.33
.34
.34
.34
.35
.35
.36
.37
.38
.39

Chapter 4: Applying the principles of adult learning . . . . . . . . . . . . . . . . . . . . . . . . .41
Objectives . . . . .
Introduction . . .
Identification and
Conclusion . . . .
Bibliography . . .
Final exam . . . .

..............................
..............................
application of adult learning principles
..............................
..............................
..............................

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.41
.41
.42
.48
.48
.49

Chapter 5: Collecting and analyzing education needs assessments data . . . . . . . . . .53
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Preparing for data collection . . . . . . . . . . . . . . . . . . . . . .
Data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Data from program evaluations . . . . . . . . . . . . . . . . .
Data from performance evaluations . . . . . . . . . . . . . .
Data from quality improvement and risk management
Informal data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analyzing needs assessment data . . . . . . . . . . . . . . . . . . .
Differentiating learning needs from other issues . . . . .

iv

N URSE E DUCATOR M ANUAL : E SSENTIAL S KILLS

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G UIDELINES

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.53
.53
.53
.56
.56
.58
.59
.60
.61
.61

E FFECTIVE P RACTICE

CONTENTS

Prioritizing needs and planning education
Conclusion . . . . . . . . . . . . . . . . . . . . . . .
Bibliography . . . . . . . . . . . . . . . . . . . . . .
Final exam . . . . . . . . . . . . . . . . . . . . . . .

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.63
.65
.65
.66

Chapter 6: Planning and implementation of education . . . . . . . . . . . . . . . . . . . . . . .69
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . .
Identifying objectives . . . . . . . . . . . . . . . . . . . .
Selecting and implementing education strategies
Lecture/discussion . . . . . . . . . . . . . . . . . . .
Group discussions . . . . . . . . . . . . . . . . . . .
Role play . . . . . . . . . . . . . . . . . . . . . . . . . .
Skill demonstration/simulation . . . . . . . . . .
Distance learning . . . . . . . . . . . . . . . . . . . .
Audio-visual aids . . . . . . . . . . . . . . . . . . . . . . .
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . .
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . .
Final exam . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Chapter 7: Recordkeeping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83
Objectives . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . .
Types of records maintained
Recordkeeping policy . . . . .
Conclusion . . . . . . . . . . . . .
Bibliography . . . . . . . . . . . .
Final exam . . . . . . . . . . . . .

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Chapter 8: Learning styles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
Objectives . . . . . . .
Introduction . . . . .
Auditory learners . .
Visual learners . . . .
Kinesthetic learners

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E FFECTIVE P RACTICE

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v

CONTENTS

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99
Final exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100

Chapter 9: Planning education for multicultural and
multigenerational participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cultural diversity and the practice of staff development
Identifying topics in cultural diversity . . . . . . . . . . . . . .
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Education planning for multigenerational learners . . . . .
Veterans (1922–1945) . . . . . . . . . . . . . . . . . . . . . . .
Baby Boomers (1946–1960) . . . . . . . . . . . . . . . . . .
Generation X (Xers) (1961–1980) . . . . . . . . . . . . . .
Generation Y (Yers) (1981–2000) . . . . . . . . . . . . . .
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Final exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Chapter 10: Strategies for dealing with the resistant learner . . . . . . . . . . . . . . . . .121
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Why learners are resistant . . . . . . . . . . . . . . . . .
Important questions to answer about the learning
Dealing with overt hostility . . . . . . . . . . . . . . . .
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . .
Final exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Chapter 11: Tips for planning orientation, inservice, and continuing education . . . .133
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133

vi

N URSE E DUCATOR M ANUAL : E SSENTIAL S KILLS

AND

G UIDELINES

FOR

E FFECTIVE P RACTICE

CONTENTS

Introduction . . . . . . .
Orientation . . . . . . .
Inservice education .
Continuing education
Conclusion . . . . . . .
Bibliography . . . . . .
Final exam . . . . . . . .

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Chapter 12: Quality improvement and evaluation of education effectiveness . . . . . .147
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Level I evaluation: Reaction and learner satisfaction
Level II: Knowledge acquisition (learning) . . . . . . .
Level III: Behavior . . . . . . . . . . . . . . . . . . . . . . . . .
Level IV: Results/impact . . . . . . . . . . . . . . . . . . . . .
Level V: Return on investment . . . . . . . . . . . . . . . .
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Final exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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.147
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Chapter 13: Writing test items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . .
Components of well-written test questions . . . .
Tactics to avoid when writing test questions
Measuring objective achievement . . . . . . . . . . .
Knowledge . . . . . . . . . . . . . . . . . . . . . . . .
Comprehension . . . . . . . . . . . . . . . . . . . . .
Application . . . . . . . . . . . . . . . . . . . . . . . .
Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . .
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . .
Final exam . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Chapter 14: Overview of a staff development business plan . . . . . . . . . . . . . . . . . .171
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171

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CONTENTS

Introduction . . . . . . . . . . . . . . . .
Components of the business plan
Executive summary . . . . . . .
Departmental description . . .
Departmental structure . . . . .
Products and services . . . . . .
Marketing strategies . . . . . . .
Action plan . . . . . . . . . . . . .
Budget overview . . . . . . . . .
Conclusion . . . . . . . . . . . . . . . .
Resource . . . . . . . . . . . . . . . . . .
Final exam . . . . . . . . . . . . . . . . .

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Chapter 15: Ethical scenarios in staff development . . . . . . . . . . . . . . . . . . . . . . . .179
Objectives . .
Introduction .
Scenarios
Conclusion .
Bibliography
Final exam . .

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.179
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Nursing education instructional guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183
Instructions for obtaining your nursing contact hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . .188
Nursing education exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .189
Nursing education evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .197

viii

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L IST

OF FIGURES

Chapter 1
Figure 1.1: The evolution of staff development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Chapter 2
Figure 2.1: Sample values statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Figure 2.2: Sample vision statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Figure 2.3: Sample mission statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Chapter 3
Figure 3.1: Guidelines for determining qualifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
Figure 3.2: Job description template . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37

Chapter 4
Figure 4.1: Tips for incorporating principles of adult learning . . . . . . . . . . . . . . . . . . . . . . . .46

Chapter 6
Figure 6.1: Education strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75

Chapter 7
Figure 7.1: Sample recordkeeping policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86

Chapter 8
Figure 8.1: Summary of learning styles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96

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LIST

OF FIGURES

Chapter 9
Figure 9.1: Cultural diversity education planner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107

Chapter 11
Figure 11.1: Inservice documentation form for review of written materials . . . . . . . . . . . . . .137
Figure 11.2: Inservice documentation form for skill training . . . . . . . . . . . . . . . . . . . . . . . .138

Chapter 12
Figure
Figure
Figure
Figure

12.1:
12.2:
12.3:
12.4:

Classroom evaluation form . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Distance learning evaluation form . . . . . . . . . . . . . . . . . . . . . . . .
Skill demonstration form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Evaluation of behavior (application of new knowledge and skills)

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Chapter 14
Figure 14.1: Sample action statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175

x

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A BOUT

THE AUTHOR

Adrianne E. Avillion, DEd, RN
Adrianne E. Avillion, DEd, RN, is the president and owner of AEA Consulting in York, PA. She
specializes in designing continuing education programs for healthcare professionals and freelance medical writing. Avillion also offers consulting services in work redesign, quality improvement, and staff development.
She has published extensively and has served as editor of the first and second editions of Core
Curriculum for Staff Development, published by the National Nursing Staff Development Organization (NNSDO). She also is a frequent presenter at conferences and conventions devoted to
the specialty of continuing education and staff development. Avillion is the vice president of the
board of directors of NNSDO and holds a master’s degree in nursing and a doctorate in adult
education from Penn State University.

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CHAPTER

1

T HE

EVOLUTION OF
STAFF DEVELOPMENT :
R ESPONSE TO A CHANGING
HEALTHCARE ENVIRONMENT

Competency: The staff development specialist identifies evolving staff development trends and uses
this information to plan inservice and continuing education programs.

OBJECTIVES
At the conclusion of this chapter, the learner will be able to
1. describe historical events that influenced the evolution of staff development
2. analyze historical trends and use data to plan education programs
3. identify specific historical milestones in the history of nursing and staff development response
to these events

Introduction
In this context, staff development is the process of providing continuing education and training
for people working in organizations that specialize in the delivery of healthcare products and
services. Historical analysis of the evolution of nursing staff development shows that explicit,
repetitive trends indicate the need for specific types of training and continuing education for
healthcare professionals. This chapter traces the history of staff development and identifies
strategies for program planning based on past trends and predictions for the future.

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CHAPTER 1

Origin through World War II (WWII)
Nursing staff development began with the efforts of Florence Nightingale during the Crimean
War (1854–1856), a bitter struggle between Russian troops and an alliance of soldiers from
Turkey, Britain, and France. The horrific numbers of ill and injured men lead to a desperate
need for care provided by reputable nurses. Nightingale worked tirelessly to improve the efficiency and adequacy of nursing care for allied troops.
After the war, Nightingale established standards for the nurses’ training schools that she founded, and she worked to improve efficiency and care delivery in hospitals. She championed the
importance of education and, thus, advised nurses to embark on a course of lifelong learning
and to use the acquired knowledge to improve patient care.
Impact on staff development: A major event that threatens geographic or world-wide safety and
causes illness and injury increases the demand for good patient care. Such a demand increases
the need for qualified nurses, which elicits a need for more training and education at the undergraduate level and for the newly licensed nurse as well.
Throughout the late 1800s and early 1900s, emphasis fell on creating training schools for nurses,
not facilitating lifelong learning. Formal staff development programs for nurses were practically
nonexistent. Hospitals were primarily staffed by nursing students, and the majority of trained
nurses earned their living as private-duty nurses in private practice. However, some early advocates of formal staff development programs began to publish articles in nursing journals describing the need for ongoing continuing education. In 1912, Edna L. Foley, superintendent of the
Visiting Nurses’ Association in Chicago, proposed that graduate nurses attend inservices and
continuing education programs. In 1928, Blanche Pfefferkorn, executive secretary for the
National League for Nursing, wrote a historical review of nursing inservice education, encouraging its expansion.
Then one major event triggered a dramatic change in the way nurses earned their living: the
Great Depression of the late 1920s and 1930s. The number of patients who could afford privateduty nurses sharply decreased, forcing many nurses back into the hospital setting for the first
time since their initial training. Equally surprised were the hospital administrators, who found

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themselves in the position of hiring graduate nurses in significant numbers. This shift in practice
setting created several education needs. Newly hired nurses required orientation to the hospital
setting and inservice training for on-the-job skills. They also needed to learn to work as part of
a team that provided care to large numbers of patients rather than as solo practitioners who
were rarely responsible for more than one patient at a time.
Impact on staff development: Newly hired graduate nurses required orientation and inservice
education pertaining to on-the-job skills. They also needed training in teamwork and organizational skills. Because there were no staff development departments to coordinate these programs,
head nurses and nursing supervisors usually were responsible for training and education activities. Economic and political trends affect healthcare, so staff development specialists had to be
able to anticipate and meet subsequent educational needs.
World War II brought even more changes to the nursing profession. Nurses left hospitals in
large numbers to join the armed forces, which caused a shortage of registered nurses at home.
In an effort to combat the shortage, inactive nurses were encouraged to return to work in the
hospital setting. The number of nonprofessional staff increased in an attempt to compensate for
the lack of registered nurses.
Impact on staff development: Nurses returning to the work force needed refresher courses. Nonprofessional staff required training, inservice, and continuing education. These issues sharply
increased the need for staff development services. Today, educators are expected to meet at least
some of these needs via self-learning modules, computer-based learning, etc., to avoid making
nurses leave their units and sit in a classroom.

1940s–1960s
The decades following WWII were periods of great advances in medical technology and treatment and of corresponding opportunities for the advancement of nursing practice. These
advances and opportunities helped to promote staff development as a distinct, viable nursing
specialty because of the educational needs accompanying these trends.

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This era was also a period of self-analysis for the profession. During the 1940s and 1950s, nurses
and other healthcare personnel began to evaluate their responsibilities and mandatory qualifications against standards set by various professional organizations. Orientation, inservice, and
continuing education needs began to be viewed as priorities by healthcare organizations. In
1953, the Joint Commission for the Improvement of Care of the Patient (a precursor of the Joint
Commission on Accreditation of Healthcare Organizations, or the JCAHO) proposed the establishment of a distinct department devoted to the training and continuing education needs of the
nursing department.
Impact on staff development: For the first time in its history, the nursing profession was advised
by an accrediting organization to establish a department devoted to meeting the continuing education and training needs of nurses. Today, staff development specialists must be aware of new
standards established by accrediting bodies that influence education delivery.
Charge nurses and supervisors began to assume more administrative responsibilities in the
1960s, which sparked a need for leadership and management training. In addition, scientific
inquiry became more important during this decade. The need for an objective, scientific evaluation of nursing care delivery against documented standards of quality became important not
only for the well-being of patients but also to determine how and why nursing is practiced.
Staff development specialists had to deal with the multiple orientation needs that became quite
apparent during the 1960s. Three entry levels of educational preparation—the diploma, the associate degree, and the baccalaureate degree—offered varying amounts of clinical exposure for
nursing students. These differences affected the amount and type of orientation required by
newly licensed nurses.
Finally, the advent of critical care units created a need for nurses with highly specialized technical skills and accurate performance in an atmosphere of extreme pressure.
Impact on staff development: The following continuing education needs became apparent: leadership and management skills, the nursing research process, flexible orientation programs, and
critical care skills. Changes in basic preparation and care delivery alert staff development specialists to changes in their own practice areas.

4

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EVOLUTION OF STAFF DEVELOPMENT :

R ESPONSE

TO A CHANGING HEALTHCARE ENVIRONMENT

Then, a special event occurred in 1969, one that helped to promote staff development as a
viable nursing specialty: The Medical College of Virginia’s Health Sciences Division of Virginia
Commonwealth University sponsored the first national conference on continuing education
for nurses.

1970s–1990s
The 1970s and 1980s were periods of great change in the staff development specialty as well as
in the nursing profession. In the 1970s, the following events helped to establish staff development as a distinct healthcare specialty:
• 1970: The Journal of Continuing Education in Nursing was first published
• 1973: The American Nurses’ Association (ANA) established the Council on Continuing
Education
• 1974: The book, The Process of Staff Development: Components of Change was published.
It defined the practice of staff development until the 1980s
• 1978: The ANA published Guidelines for Staff Development
• 1978: The Joint Commission on Accreditation of Hospitals mandated that a position to
oversee and coordinate staff development activities be established in its affiliated hospitals
The 1970s also saw an expansion of the women’s movement, including a broadening of career
opportunities for women. As women took advantage of these changes, enrollment in nursing
programs decreased, as did the number of licensed, working nurses.
Impact on staff development: Writing skills emerged as an educational need because of the advent
of staff development publications. An increase in the number and variety of career options for
women resulted in decreased enrollment in schools of nursing and a decrease in the number of
working RNs. A shortage of RNs required staff development specialists to prepare and implement
refresher courses for RNs, to offer more training and continuing education for nonprofessional

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CHAPTER 1

nursing department personnel, and to think of ways to make learning more convenient as it
became increasingly difficult for staff members to leave their units to attend programs in classroom settings.
The realization that healthcare truly is a business was acknowledged by both healthcare personnel and consumers during the 1980s. Nurses—particularly nurse managers—needed to acquire
business acumen as the healthcare industry took on the characteristics of the for-profit sector.
The initiation of diagnostic-related groups (DRG) resulted in rapidly decreasing lengths of stays
for patients.
Impact on staff development: The need for education pertaining to financial management and
the business aspects of healthcare drove staff development specialists not only to arrange for such
programming but also to improve their own business skills. Financial management skills continue to grow in importance for nurses.
In 1985, The Journal of Nursing Staff Development (now known as the Journal for Nurses in
Staff Development) began publication. In 1989, the first professional association for nurses in
staff development, the National Nursing Staff Development Organization (NNSDO), was established. Additionally, books devoted to the practice of nursing staff development were published
by major healthcare publishing companies.

1990s
The 1990s were years of rapid advances in technology and in the prevention and treatment of
disease. It was also the decade during which the world became widely aware of devastating
“new” diseases such as AIDS (Acquired Immune Deficiency Syndrome). The ’90s also saw the
creation of large health systems as hospitals, outpatient facilities, and long-term care facilities
merged in efforts to reduce competition and to provide “one-stop shopping” for persons needing a variety of healthcare services.
The increasing effects of DRGs, the growing influence of health maintenance organizations
(HMO), and health insurance companies’ restrictions on types of treatments and lengths of stay
combined to make cost reduction a necessary survival mechanism for newly created health

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systems. For the first time in decades, healthcare personnel, including nurses, faced layoffs.
“Downsizing” was added to the vocabulary of nearly every American.
Impact on staff development: Distance learning—including computer-based learning (CBL),
self-learning modules, and e-learning—became an important way of providing education to
nurses who were unable to leave their units. Staff development specialists also faced the downsizing phenomenon, as the first “cuts” were often made in education-related departments. Staff
development specialists were called upon to prove their value to the organization by measuring
education’s impact on organizational effectiveness and by demonstrating a return on investment (ROI). They also assumed broader responsibilities such as providing housewide education
instead of department-based education and taking on additional roles, including consultant,
researcher, and performance coach. This prompted many organizations to remove the word
“nursing” from staff development and refer to the department simply as staff development.
Additional significant events directly affecting staff development specialists in the 1990s are
summarized below:
• 1992: The ANA published Roles and Responsibilities for Nursing Continuing Education
and Staff Development Across All Settings
• 1992: The American Nurses Credentialing Center (ANCC) offered the first certification
examination for nursing continuing education and staff development
• 1995: The first Core Curriculum for Nursing Staff Development was published
• Emphasis shifted from provision of services to evaluating what impact education had on
organizational effectiveness
• The term “staff development” was replaced in some organizations with other terms such
as “organizational development,” “corporate university,” “education department,” and
“professional development department”
• Qualifications for leadership in staff development focused on education and managerial
experience rather than clinical expertise

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The 2000s
As the healthcare community confronts the challenges of the initial years of the 21st century,
the responsibilities and accountability of staff development specialists continue to grow.
Government regulations such as the Health Insurance Portability and Accountability Act of 1996
(HIPAA) increased the need for mandatory training. Cyclical nursing shortages affected the
delivery of care. But an event that forever changed educational needs, as well as how the
United States functions as a member of the world community, was September 11, 2001 (9/11).
The horrific attacks on the World Trade Center and the Pentagon and the hijacking and subsequent crash in Pennsylvania of an airplane, triggered an immediate, ongoing need for rigid
emergency preparedness. This event also made healthcare professionals aware of a need for
knowledge about bioterrorism and the effects of weapons of mass destruction, including radiation and germ warfare. These types of educational needs were not anticipated by many, but
now they are regarded as necessities.
Impact on staff development: In addition to emergency preparedness training and education
concerning bioterrorism and other weapons of mass destruction, staff development specialists
must be aware of new threats, particularly in the germ warfare arena, and plan education
accordingly.

Conclusion
Staff development has changed drastically since the days of the Crimean War, when Nightingale
first advocated lifelong learning. Staff development specialists must learn from their history by
analyzing trends and events that affect staff development and plan educational endeavors
accordingly. The following table summarizes the evolution of staff development, highlighting
significant events and their impact on the practice of staff development.

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The evolution of staff development

Time period

Event

Impact on staff development

From nursing’s origin Crimean War

Increased demand for formalized, high-quality

to WWII

training for nurses. Nurses were encouraged to
pursue lifelong continuing education. The numbers of “training” schools for nurses increased,
as well as the need for instructors to staff
these schools. Nurses needed opportunities
for lifelong learning.

Great Depression

Nurses moved from private practice to the hospital setting. These nurses needed orientation
to the hospital setting and training in organizing
care for large numbers of patients. Training
was generally provided by head nurses and
supervisors.

WWII

RNs joined the armed forces, causing a severe
nursing shortage. Inactive nurses were recruited
to return to work, and the number of nonprofessional staff increased. Refresher courses for
inactive nurses, training, inservices, and continuing education for nonprofessional staff increased
the need for staff development services.

1940s–1960s

Decades following WWII

Advances in medical technology and treatment
and expanded roles for nurses increased the
need for continuing education.

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FIGURE

1.1

The evolution of staff development (cont.)

Time period

Event

Impact on staff development
The numbers of nonprofessional nursing staff
grew, requiring training and continuing education for that particular population.

1953: The Joint Commission for the Improvement of Care of the Patient proposed the
establishment of a distinct department devoted
to the training and continuing education needs
of nurses.

1990s

Nurses recognized the

1960s: Nursing research assumed greater

need to define and pro-

importance, critical care units opened, varying

mote nursing as a pro-

basic preparation programs triggered a need for

fessional discipline in

flexible orientation, and head nurses required

the 1960s

more management and leadership skills.

New, virulent disease

Continuing education grew in importance due,

processes affected the

in part, to rapid medical advances and new dis-

worldwide population

ease entities.

Mergers and downsizing

Staff development specialists had to prove

became common events

their value to the organization by demonstrating
education’s impact on organizational effectiveness. They also assumed broader role responsibilities such as providing continuing education
to an entire organization instead of just nursing

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The evolution of staff development (cont.)

Time period

Event

Impact on staff development
staff and acting as consultants, researchers,
and performance coaches.

Thanks in part to expand- ANCC offered a certification exam for nursing
ing responsibilities, staff

continuing education and staff development.

development assumes a
housewide role

Staff development specialists were expected to
prove their value to the organization by demonstrating education’s impact on organizational
effectiveness and measuring ROI.

First Core Curriculum for Nursing Staff

Development was published.
2000s

September 11, 2001

Emergency preparedness became an education
priority, as did the effects of weapons of mass
destruction.

HIPAA and other govern-

Types of mandatory training increased.

ment regulations are
enacted

Cyclical nursing

Education must be delivered at the conven-

shortages

ience of staff members. Refresher courses
must be implemented for inactive RNs returning to the work force.

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Bibliography
Avillion, A.E. The redesign of nursing staff development. Pensacola, FL: National Nursing Staff
Development Organization, 1996.
Avillion, A.E. A practical guide to staff development: Tools and techniques for effective education.
Marblehead, MA: HCPro, Inc, 2004.
Brunt, B.A., J.T. Pack, and P. Parr. “The history of staff development.” In A.E. Avillion (Ed.),
Core curriculum for staff development. 2nd ed. Pensacola, FL: National Nursing Staff
Development Organization, 2001. 3–17.
DeSilets, L.D., and S.E. Pinkerton. “Looking back on 25 years of continuing education.” The
Journal of Continuing Education in Nursing 35, no. 1 (2004): 12–13.
Nightingale, F. Notes on nursing. London: Harrison and Sons, 1859.
Tobin, H.M., P.S. Yoder-Wise, P.K. Hull, B.C. Scott, and B.C. Clark. The process of staff development: Components for change. St. Louis: Mosby, 1974.

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EXAM

1. The event that triggered the beginning of staff development was:
a. The Great Depression
b. The Crimean War
c. World War I
d. World War II

2. The Great Depression’s impact on staff development was to cause a significant need for:
a. orientation to the hospital setting
b. training schools of nursing
c. a distinct department devoted to staff development
d. specialty certification

3. Expanded use of nonprofessional healthcare workers was one of the results of:
a. The Great Depression
b. Florence Nightingale’s nurses’ training schools
c. World War II
d. advances in medical technology

4. Staff development specialists should realize that, in the event of a shortage of active registered
nurses, they must be prepared to:
a. offer fewer education programs for unlicensed personnel
b. offer more continuing education programs in the classroom setting for RNs
c. spend less time orienting inactive nurses who are returning to work
d. develop and implement refresher courses

5. What milestone in the evolution of staff development occurred in 1953?
a. Training needs for nonprofessional staff were first identified
b. The Joint Commission proposed that a distinct department devoted to nursing education
needed be established
c. Nursing research became a mandatory activity within healthcare organizations
d. Journals written specifically for nurse educators and staff development specialists were
published

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6. Amanda is the vice president for staff development in a large, multihospital healthcare system.
One of the organization’s strategic goals is to assume a leadership position in the field of longterm care within the next five years. Historically, the organization’s emphasis has been on women’s
health issues. Amanda is asked to submit her long-term goals for review by the CEO and his administrative team. Which of the following goals is the highest priority for long-term planning?
a. Decrease the time spent orienting new employees by 5%
b. Increase the hours of labor and delivery education offered by 10%
c. Facilitate the certification of nurses as geriatric specialists by developing and offering certification preparation courses at least quarterly
d. Facilitate the transition from LPN to RN by offering state board preparation courses to
LPNs enrolled in RN programs

7. Recognizing that women have more career options suggests that staff development specialists
should make all of the following priorities EXCEPT:
a. refresher courses
b. distance learning programs
c. more training for nonprofessional staff
d. more education programs presented in the classroom setting

8. An increase in continuing education pertaining to financial management was due to:
a. acknowledgment that the healthcare industry is a business
b. the healthcare industry’s movement toward a not-for-profit outlook
c. expansion of the women’s movement
d. a decrease in the number of nurse managers

9. The 1990s were characterized by which of the following?
a. The start of management training for nurse leaders
b. The proposal that staff development should be a distinct department within an organization
c. Downsizing of hospital personnel, including nurses
d. A decrease in the roles of staff development specialists because of budget cuts

10. In the 2000s, which of the following types of education assumed a new, critical importance?
a. Writing skills
b. Inservice training
c. Performance coaching
d. Emergency preparedness

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CHAPTER

2

C ORRELATING

VALUES , VISION ,

AND MISSION STATEMENTS WITH
EDUCATIONAL PROGRAMMING

Competency: The staff development specialist will plan, implement, and evaluate education programs that reflect the values, vision, and mission of the staff development department.

OBJECTIVES
At the conclusion of this chapter, the learner will be able to
1. define the mission, vision, and values of his or her organization/department
2. describe the components of staff development mission, vision, and values statements
3. plan educational activities that support the mission, vision, and values of the organization and
the staff development department

Introduction
The staff development department’s values, vision, and mission statements establish a foundation for the delivery of its products and services. These statements must not only guide the way
education is planned and implemented but also coincide with the organization’s value, vision,
and mission statements.
Staff development specialists are evaluated, in part, on how effectively their programs support
these statements and facilitate the achievement of organizational goals.

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Values
A values statement, sometimes referred to as a philosophy, reflects the beliefs and principles
that direct departmental activities. Values must be stated clearly and succinctly and direct the
department’s response to organizational needs. The staff development specialists must support
these values and fulfill their responsibilities accordingly.
Staff development scenario: Victoria is the director of staff development at Mason Health System.
This system consists of two 500-bed hospitals, two hospices, and four long-term care facilities.
Historically, the organization has focused on its oncology and hospice services. However, there
are plans to purchase five outpatient clinics and build two more. The outpatient surgery centers
located within each of the existing three hospitals are marked for significant expansion. Mason
Health System’s values statement has been rewritten to emphasize both the provision of outpatient
services and the meeting of patient and family needs on an outpatient basis. The system also is
giving distance learning new prominence. Due to the extensive education and training needed
for the various outpatient settings, Mason’s administrative team wants the education delivered in
ways that do not require nurses and other staff members to leave their units and sit in classrooms
for long periods of time. Victoria and her staff must review their department’s values statement
and revise it to reflect changes in organizational priorities.
The following values statement reflects organizational changes described in the preceding scenario. In addition to revising the values statement, Victoria must make sure that her staff understand and support the changes affecting Mason Health System and the professional development
department.

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FIGURE

Sample values statement

2.1

Mason Health System staff development department
Mason Health System’s staff development department’s primary responsibility is to offer employees
education programs that enhance their job performances and improve the delivery of high-quality
patient/family care.

In order to fulfill this responsibility, the staff development department adheres to the following principles:

• Learning is a lifelong process
• Teaching/learning is an interactive process between the learner and the staff development
specialist, and it is conducted with mutual respect and regard
• Adults are self-directed learners who bring extensive life experiences to any teaching/
learning activity
• Education activities must be offered in ways that make attendance/participation convenient to
the learner, including but not limited to classroom learning, self-learning activities, computerbased learning, and other forms of distance learning

The staff development specialist adheres to the values of the organization and the staff development
department. He or she is responsible for

• identifying the educational needs of the organization based on learner feedback and organizational goals
• providing educational programs that improve organizational effectiveness, meet learner needs,
and enhance job performance
• evaluating the effectiveness of education programs as measured by their impact on organizational effectiveness and using data obtained to improve educational activities

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FIGURE

2.1

Sample values statement (cont.)

Learners are responsible for

• identifying their education needs and achieving their educational goals
• participating in relevant educational activities and contributing to the success of those activities
• maintaining competence
• evaluating the effectiveness of educational activities
• assuming responsibility for their lifelong learning
• using knowledge and skills acquired from educational activities to enhance job performance,
improve patient care, and support the mission, vision, and values of the organization

Organizational leadership is responsible for

• clearly identifying the mission, vision, and values of the organization
• supporting an environment that encourages lifelong learning
• Attending relevant or necessary education programs
• facilitating learners’ ability to participate in educational activities
• participating in the evaluation of education’s impact on organizational effectiveness

Staff development scenario: In the sample values statement, Victoria and her staff write that the
staff development specialist adheres to organizational values, making it clear that they support
Mason Health System’s goals. It is clearly stated that educational needs are identified based not
only on learner feedback but on organizational values as well and that programs are planned to
improve organizational effectiveness, meet learner needs, and enhance job performance.
Incorporating “convenient” ways of acquiring education is part of the organization’s values and
part of the staff development department’s values as well. Learners are responsible for acquiring
education that improves patient care and their job performance. The emphasis is on fulfilling
organizational needs. These needs are further clarified in the department’s vision and mission
statements.

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Vision
A vision is an image of the staff development department’s future. Staff development specialists
rely on this vision to build a cohesive team that crafts a common identity and future. A vision
motivates employees to work to their maximum abilities. It inspires but remains realistic and
achievable. The following figure offers recommendations for writing a vision statement.

Recommendations for writing a vision statement
When writing your department’s vision statement, keep in mind the following:
1. Recognize that a vision statement is






value-driven
future-oriented
realistic
inspiring
concise

2. Identify the department’s strengths and weaknesses
3. Determine what is inspirational and what is realistic
4. Complement the organization’s value statement with the staff development department’s
vision statement
5. Determine what education and training are expected to accomplish within the
organization
6. Incorporate the staff development department’s vision statement in all departmental activities, including but not limited to
• needs assessment
• program planning
• program implementation
• program evaluation
• quality improvement activities
7. Review and revise the vision statement based on changes in the organization’s vision

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Staff development scenario: Victoria and her staff need to write a vision statement that reflects the
organization’s new emphasis on outpatient products and services. The following vision statement
meets this requirement.

FIGURE

2.2

Sample vision statement
Mason Health System staff development department

It is the vision of the staff development department of Mason Health System to be a tri-state leader in
the provision of education that focuses on performance improvement and excellence in the development of outpatient services and the delivery of distance education.

Mission
A mission statement clearly communicates the purpose and direction of staff development activities to persons within and outside of the organization. It describes essential functions as well as
the overall reason for the department’s existence. A mission statement must
• reflect and support departmental and organizational values and vision
• specify essential functions and the reason for the department’s existence
• identify what the staff development department does for the organization
• serve as the foundation for departmental goals and objectives
• be reviewed and revised as the organization’s mission evolves and changes
Staff development scenario: The staff development department of Mason Health System must have
a vision that reflects organizational priorities. The sample mission statement in Figure 2.3 supports the health system’s new emphasis on outpatient services.

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FIGURE

Sample mission statement

2.3

Mason Health System staff development department
The staff development department of Mason Health System upholds the mission, vision, and values
of the organization by developing and offering educational activities designed to improve the quality
and appropriateness of patient care.

This department’s purpose is to enhance organizational effectiveness by implementing educational
programs that increase the knowledge and skills of all employees. The staff development department
facilitates the development and accreditation of a broad spectrum of outpatient services by offering
education that helps employees to function effectively in outpatient settings.

Education is delivered in ways convenient for the learner, such as self-learning modules, computerbased learning, and e-learning.

Use mission, vision, and values to design and
implement education
After writing appropriate mission, vision, and values statements, staff development specialists
must identify goals for program planning based on these statements.
Staff development scenario: Victoria and her staff are planning education priorities based on
needs assessment data that are focused on mission, vision, and values statements. Emily is a
member of the department. She is an excellent educator and a skilled oncology nurse. Emily plans
and implements many of the oncology continuing education courses for Mason Health System.
Based on Mason Health System’s new focus on outpatient services, Emily is asked to plan some of
the educational activities needed for outpatient care provision. Considering Emily’s background
and the department’s mission, vision, and values, what are some appropriate responsibilities to
assign to Emily?

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Emily’s experience as an oncology nurse is invaluable. Some of her responsibilities may include
• revising current oncology courses so that they are offered via distance learning methods
• adapting existing oncology courses to meet the needs of staff working in outpatient
oncology settings
• adapting existing oncology orientation programs to meet the needs of staff working in
outpatient oncology settings
The preceding suggestions allow Emily to make use of her expertise while meeting department
and organization needs, but the transition may not be as easy for some of Emily’s colleagues.
Staff development scenario: Jeff is a staff development specialist who works primarily with critical care
departments. His background is in emergency room and trauma critical care. He sometimes resists
distance learning activities, believing that teacher–learner personal interaction is necessary for the
provision of quality education. Furthermore, he dislikes the outpatient setting, describing it as “boring.” Are there problems ahead for Jeff? How can Victoria help defuse a potentially difficult situation?
Jeff will not be able to stop the organization’s foray into outpatient services, but that doesn’t
mean he will not try to do so. His feelings may interfere with the staff development department’s ability to function effectively if he indulges in disruptive behavior and negativity. Jeff has
some of the same options as Emily. Here are some suggestions for dealing with Jeff:
• He can continue to work with the critical-care areas but needs to adapt some of his programs to a distance-learning format.
• The outpatient clinics associated with follow-up trauma care and critical care may be an
appropriate focus for Jeff.
• Jeff may require some help learning to make distance learning more interesting and
challenging. Some of his own continuing education needs involve distance learning
development.

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• Jeff may benefit from a frank discussion concerning organizational goals and the staff
development department’s obligation to support those goals reflected in the mission,
vision, and value statements.
• According to the staff development competency identified at the beginning of this
chapter, “The staff development specialist will plan, implement, and evaluate education
programs that reflect the values, vision, and mission of the staff development department.” This competency should be part of Jeff’s job description and reiterated in his
performance evaluations. Ultimately, it is up to Jeff to fulfill his job responsibilities.
• Victoria’s responsibility is to help Jeff adapt to organizational changes and facilitate his
ability to acquire necessary continuing education. However, it is also Victoria’s responsibility to ensure that the staff development department meets the needs of the organization. If Jeff is not able to demonstrate competency in this particular area, disciplinary
action may be necessary.

Conclusion
The mission, vision, and values statements are the foundations of the staff development department’s practice. These statements must reflect the mission, vision, and values of the organization
and serve as the foundation of all departmental activities.

Bibliography
Avillion, A.E. The redesign of nursing staff development. Pensacola, FL: National Nursing Staff
Development Organization, 1996.
Avillion, A.E. A practical guide to staff development: Tools and techniques for effective education.
Marblehead, MA: HCPro, Inc, 2004.
Brunt, B.A. “Philosophy, mission, and goals.” In A.E. Avillion (Ed.), Core curriculum for staff
development. 2nd ed. Pensacola, FL: National Nursing Staff Development Organization, 2001.
19–30.

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F INAL

EXAM

1. Mark is writing a first draft of a values statement for the staff development department. It is
important that this statement:
a. concentrates on the individual preferences of the staff development specialists
b. identifies essential functions of the department
c. reflects the philosophy of the organization
d. focuses on the future

2. The administrative team at Community Hospital has announced that the hospital will expand its
services to include physical medicine and rehabilitation, with an emphasis on neurological rehabilitation. Due to Community Hospital’s recent merger with a pediatric facility, pediatric services
at Community Hospital will be phased out. This may lead to downsizing of nurses currently working on the pediatric unit of Community Hospital. Based on these issues, all of the following programs are appropriate priorities EXCEPT:
a. care of the spinal cord patient
b. job interviewing skills
c. stroke rehabilitation
d. developmental characteristics of the toddler

3. An inspiring, future-oriented statement about the staff development department is a:
a. vision
b. mission
c. value
d. principle

4. Which of the following statements qualifies as a vision?
a. Learning is a lifelong process
b. Learners are responsible for identifying their education needs
c. The staff development department of Maplewood Health System strives to be a statewide
leader in pediatric oncology
d. The staff development department of Maplewood Health System is responsible for the
provision of education that enhances organizational effectiveness

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5. The statement that describes essential functions as well as the reason for the staff development
department’s existence is the:
a. vision
b. values
c. principles
d. mission

6. Which of the following statements qualifies as part of a mission statement?
a. The staff development department desires to be a national leader in the provision of education services that focus on excellence in mental health services
b. Staff development specialists realize that adults are self-directed learners
c. The staff development exists to enhance organizational effectiveness by providing education offerings designed to improve the knowledge and skills of all employees
d. Staff development specialists are responsible for identifying their own education needs

7. Samantha is the sole staff development specialist in a 300-bed community hospital located in rural
Montana. Which of the following is a realistic/appropriate vision for her department?
a. The staff development department exists to provide education and training that enhances
job performance
b. It is the vision of the staff development department to assume a national leadership position in the delivery of continuing education
c. It is the vision of the staff development department to develop distance learning programs
appropriate for healthcare professionals within the organization and throughout rural
Montana
d. The staff development department supports the concept that learning is a lifelong process

8. Dixon Hospital is purchased by a large, for-profit healthcare corporation. Which of the following
might be stressed as part of the hospital’s staff development mission considering the new for-profit
status?
a. Developing free blood pressure screening education
b. Designing education activities that generate income
c. Offering education to nonlicensed personnel
d. Developing programming that supports lifelong learning

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9. Lucas P. Simpson Memorial Medical Center’s management team has the reputation of adhering to
an autocratic, directive management style. Managers generally believe that they must exert strict
control over their employees. Which of the following statements coincide with these types of values?
a. Adults are self-directed learners
b. Teaching/learning is a dynamic, interactive process between teacher and learner
c. Employees adhere to the direction of management when participating in education activities
d. Learners participate in evaluating the effectiveness of education

10. Which of the following statements accurately describe the importance of mission, vision, and values
statements?
a. A vision must be practical and oriented to the present healthcare environment
b. A mission describes the purpose of the staff development department
c. Values have little to do with basic organizational philosophy
d. Staff development mission, vision, and values are independent of those of the organization

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Competency: The staff development specialist will fulfill the roles and responsibilities identified in
his or her job description.

OBJECTIVES
At the conclusion of this chapter, the learner will be able to
1. describe qualifications for the staff development specialist
2. write competency-based job descriptions for the staff development specialist

Introduction
Qualifications of the staff development specialist vary depending on specific roles and responsibilities. Some may be full-time employees within the department, while others may fulfill dual
roles of educator and direct patient care provider, each on a part-time basis. A common requirement for all such specialists is that they be highly skilled educators.
This chapter provides guidelines for writing staff development department job descriptions and
identifying necessary qualifications for those who assume the role of staff development specialist.

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Qualifications
Qualifications for the staff development specialist depend on the role that he or she fulfills within an organization. Regardless of the role assumed, however, the most important qualification
for a staff development specialist is excellence in program planning and implementation.
Consider the following questions when writing or revising job descriptions:
• Is the staff development department responsible for education throughout the organization or for a specific department(s)?
• Is the staff development department a centralized or decentralized department?
• Do staff development specialists represent one or various clinical disciplines?
• Do staff development specialists have clinical backgrounds, or are some of them coming
from nondirect patient care backgrounds?
• To whom does the director/manager of staff development report?
The preceding questions help to clarify the responsibilities and organizational structure of the
staff development department. There is no single way of structuring a staff development department because there is no single delivery mechanism for training and continuing education.
However, guidelines do exist for the identification of qualifications that meet the needs of individual departments and adhere to legal standards. Such guidelines include the following:
1. Qualifications for the same role and responsibilities are identical regardless of
whether the individual works full-time or part-time. Managers still make the mistake
of holding full-time employees to higher standards/qualifications than part-time employees. If an employee is hired to fulfill the role and responsibilities of a staff development
specialist, qualifications are the same regardless of hours worked per pay period.
2. Qualifications should reflect the standards of the profession. Most professionals in
staff development possess a minimum of a bachelor of science degree. This is changing

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rapidly, however, and many organizations require a master’s degree in a clinical or nonclinical area of specialization. But as educational expertise and knowledge become the
benchmark for staff development specialists, a graduate degree in adult education is
often desirable, if not required.

Caution: Remember that staff development specialists are not necessarily nurses (unless
the department is solely responsible for the nursing department). Staff development
specialists working in departments within large hospitals or health systems may come
from a variety of clinical backgrounds. Some may come from nonclinical backgrounds as
well and are responsible for training and continuing education activities in nonclinical
departments.
3. Qualifications should reflect the standards of the organization. For example, if the
director/manager of staff development in a large organization has responsibilities and
accountability equal to that of the vice presidents of the organization, his or her title
should also be vice president (VP) (e.g., vice president of education) and should possess
similar educational credentials. In fact, staff development specialists at the VP level often
are expected to hold doctoral degrees.
Suppose the leader of staff development is at the middle manager level. If the usual standard of
educational preparation for middle managers within an organization is a master’s degree, the
manager of staff development must also possess a master’s degree.
Staff development specialists holding positions at the staff level (nonmanagement level) should,
at least, possess a baccalaureate degree. This is especially important because most staff development specialists plan and implement educational activities for employees from various disciplines, most of which require a bachelor’s degree at entry practice level (e.g., PT, OT, computer
specialists). Holding similar degrees lends credibility to individuals responsible for the training
and educational activities of an organization.
Caution: Preparation at the master’s level is rapidly becoming standard for staff development specialists. Geographic location is no longer an obstacle to obtaining a graduate
degree—it is possible to earn a graduate degree from an accredited university online without ever setting foot on campus.

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4. Minimum qualifications should be upheld impartially. If the standard for staff development specialists within an organization is preparation at the master’s level, that standard should be upheld when hiring or promoting staff members. If the organization is
willing to hire someone without such preparation, the job description must identify a
specific period of time (e.g., 18 months) within which the employee must earn the specified degree.
Staff development scenario: Samantha and Denise are part-time employees in a large staff development department. They work part time as direct patient care providers and part time as “clinical educators” within the staff development department. Both hold baccalaureate degrees and
are working to earn master’s degrees in adult education—a requirement for promotion to fulltime staff development specialists. Because of their exceptional job performances, Samantha and
Denise are promoted under the condition that they earn their graduate degrees within 12
months, according to written policy.
At the end of the 12 months, Samantha is in the process of completing her thesis and will earn
her degree in another six months. Samantha is demoted to the position of clinical educator until
her degree is successfully earned. Denise needs another year to complete her degree. She is given
an extension and is allowed to remain in the position of staff development specialist.
Both Samantha and Denise have performed well in the role of staff development specialist.
Neither has received any disciplinary action, and their performance evaluations have been
excellent. Samantha is single, without children. Denise is married and has two children, ages
two and six. Samantha asks her manager why she has been demoted but Denise has not.
Samantha is told that Denise has a family and children and more responsibilities at home.
Denise is single and, therefore, should have been able to complete her degree in the allotted
time period.
Was this situation handled appropriately? What are the potential consequences from these events?
Samantha has good reason to file a grievance based on discrimination. Unfortunately, some
managers still fail to understand that preference cannot be given solely on the basis of family
responsibilities. Standards must be upheld consistently and without partiality. The manager also

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may be subject to disciplinary action because she has failed to perform her management duties
appropriately.
The potential consequences of these events also are significant. Other staff members who must
earn degrees based on this written policy will investigate whether they have been unfairly held
to standards that are not upheld impartially. It is likely that more grievances will be filed.
The lesson learned from this scenario: Adhere to written policies without partiality or discriminatory actions.
5. Mandatory qualifications include demonstrated ability and experience in the
adult education field. Staff nurses—and professionals from other disciplines at the staff
level—are often promoted to management positions based on their clinical expertise.
They often have little or no management experience, however, so this is a disservice to
both the person promoted and to the organization in which he or she works. Instead,
staff nurses should be groomed for management positions with leadership and management training, as well as with gradual involvement in management activities before an
actual promotion occurs.
The same holds true for persons assuming the role of staff development specialist. Employees
who demonstrate exceptional clinical skill or expertise within a nonclinical discipline are sometimes promoted to staff development positions based on these skills and not on their ability to
plan, implement, and evaluate educational activities. This is unfair to the new staff development
specialist as well as the organization. Staff development specialists need to be groomed, just as
new managers do. Therefore, persons interested in assuming an educator role should be given
opportunities to plan and implement training and continuing education with the assistance of
staff development specialists and the approval of their managers. Of particular importance is
their ability to facilitate knowledge acquisition using a variety of teaching methods. Persons who
are interested in successfully pursuing the role of staff development specialist must demonstrate
interest in the continuing education process and actively seek out opportunities to participate in
the planning and delivery of continuing education.
Staff development scenario: Brittany is a registered nurse with extensive critical care experience.

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She currently works in the emergency room of a large metropolitan hospital and has the reputation of being “tough” but the best nurse in the emergency department. She has written several
self-learning modules in conjunction with the staff development department. Brittany applies for
and is hired as one of the staff development specialists for the critical care areas within the
organization. After a few weeks, her staff development preceptor, Morgan, asks to talk to the
director of staff development. It seems that Brittany is alienating the employees who work on the
various critical care units. She is abrasive and impatient with staff members who do not have her
level of expertise. Her teaching style is autocratic, and she makes her colleagues so uncomfortable
that they have trouble demonstrating successful knowledge acquisition and are starting to avoid
continuing education activities that involve her. Morgan tries to help Brittany improve her interactive skills and teaching style, but Brittany says to Morgan, “You don’t understand how the critical care mind works. You were only a med-surg nurse and wouldn’t be able to do my job or
teach what I can teach.”
What were some actions that should have been taken prior to hiring Brittany as a staff development specialist?
Brittany was hired primarily due to her clinical expertise. Although she did participate in the
development of self-learning modules, her ability to interact as a staff development specialist was
not assessed. The ability to facilitate learning—the most important skill—was not evaluated.
Brittany had the reputation for being the best emergency department nurse, but she also is considered “tough” to work with by her colleagues. The development of self-learning modules
required clinical expertise, but it did not give Brittany much opportunity to fulfill the educator
role using the principles of adult education. Did Brittany understand the qualifications necessary
for a staff development specialist? Given Brittany’s behavior, it is doubtful that the qualifications
were explained to her.
When considering persons for a staff development specialist role, remember the following key points:
• Do not rely primarily on clinical or specialty expertise
• Teaching ability and the ability to facilitate knowledge acquisition are of primary importance

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• The candidates should have the opportunity to interact with and deliver education to
colleagues in person, as well as via distance-learning methods
• The candidates should have the opportunity to review and discuss competency-based
job descriptions and qualifications for the staff development specialist role before applying for the position
Figure 3.1 summarizes important guidelines for determining staff development specialist qualifications.

FIGURE

3.1

Guidelines for determining qualifications

1. Qualifications for the same role and responsibilities are identical regardless of whether the individual is a full-time or part-time employee.

2. Qualifications should reflect the standards of the profession.

3. Qualifications should reflect the standards of the organization.

4. Minimum qualifications should be upheld impartially.

5. Mandatory qualifications include demonstrated ability and experience in the adult education field.

Job descriptions
Job descriptions must contain certain types of information. The following sections offer some
recommendations to follow when writing job descriptions for staff development specialists.

Title
Titles are consistent for persons fulfilling the same role. Suppose a staff development department hires part-time employees to act as clinical educators (orienting new employees to the

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clinical setting, providing inservices, etc.) who work under the direction of persons who have
experience in and possess graduate degrees in adult education. These are two distinct levels of
staff and should not hold the same title or function under the same job description. Titles
should reflect qualifications and job responsibilities.

Overview of responsibilities
An overview of responsibilities is a one-paragraph description of essential duties. For example,
an overview of responsibilities may read as follows: “The staff development specialist is responsible for planning, implementing, and evaluating continuing education activities incorporating
the principles of adult education. He or she must demonstrate competency in each of the critical competencies identified in this job description. The staff development specialist is responsible for delivering services that are consistent with the mission, vision, and values of the organization and the staff development department.”

Qualifications
Qualifications must be explicit and consistently enforced. Examples of qualifications include
• necessary licensure or certification
• necessary educational preparation
Caution: If someone is hired with a provision to complete education requirements within a
specified time frame, this condition must be in writing and enforced consistently. Include the
following information:
• Amount (in years) and type of experience needed
• Any specific requirement or condition (e.g., an emergency flight nurse must be able to
arrive at the emergency department within 20 minutes of receiving notification that his or
her presence is required)

Reporting mechanism
Briefly but clearly identify to whom this position reports. If this particular job description has supervisory responsibilities, it must delineate what types of staff are supervised by someone in this role.

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Working conditions
Identify the following factors:
• Working hours (e.g., whether flexible hours including weekends, holidays, and shift
work are required)
• Any lifting or moving requirements (e.g., patients, desks, AV equipment) including the
minimum amount of weight the employee must be able to lift or move (e.g., 50 pounds
on a regular basis)
• Any potential exposure to infectious diseases or injury

Competencies
A process of measuring a professional’s ability to perform or demonstrate explicit behaviors
according to established, specific criteria is competency-based evaluation. These behaviors are
delineated in job descriptions. Competency-based job descriptions should be developed for all
employees within the organization, for clinical and nonclinical departments alike.
Sample staff development competencies are identified at the beginning of each chapter in this manual
and serve as a guideline for competency development within healthcare organizations. Remember
that competency statements should be explicit. For example, consider the following competency:
The staff development specialist plans, implements, and evaluates training and continuing education according to the principles of adult education. These principles are that
• adults are self-directed learners
• adults bring a variety of valuable life experiences to any learning situation
• adults focus on acquiring knowledge and skills that will benefit them as they conduct
their activities of daily living

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• adults are responsive to both intrinsic and extrinsic motivators
Why is it necessary to specify the principles of adult learning? Because not all staff development
specialists (or potential staff development specialists) focus on—or are even aware of—the same
principles. By clearly identifying these principles, confusion and doubt as to the competency
requirements are reduced. Consider the second principle: Adults bring a variety of valuable life
experiences to any learning situation. This statement helps educators acknowledge that various
life experiences are valuable, enhance learning situations, and command respect.

Signatures
Job descriptions must be approved, signed, and dated by the department manager and the
human resources director. Additionally, the employee should sign and date two copies of his or
her job description. One copy is maintained in the employee’s personnel file, and the other
copy is given to the employee.
Figure 3.2 contains a suggested template for job descriptions.

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Job description template

3.2
Title: Accurately reflects qualifications and responsibilities

Overview of responsibilities: General summary of responsibilities

Qualifications: Explicit and consistently enforced

Reporting mechanism: Clearly identify to whom this position reports. If this is a job description for
someone who has supervisory responsibilities, identify the roles this position supervises.

Working conditions: Include work hours, the minimum weight the employee must be capable of lifting
and the frequency with which objects must be lifted or moved, and any potential exposure to infectious diseases.

Competencies: Specific behaviors the employee must demonstrate in order to successfully fulfill roles
and responsibilities. Be as explicit as possible to reduce confusion and doubt.

Signatures: Job descriptions are signed and dated by the responsible manger and human resources
representative. The employee signs and dates two copies of his or her job description. One copy is
maintained in the employee’s personnel file, and the other copy is given to the employee.

Conclusion
Qualifications and job descriptions must be developed and administered fairly and consistently.
These issues are subject to legal scrutiny, and it is necessary that managers and employees be
aware of the implications of proper administration and the consequences of failure to implement
their responsibilities appropriately and legally.

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Bibliography
Avillion, A.E. A practical guide to staff development: Tools and techniques for effective education. Marblehead, MA: HCPro, Inc, 2004.
Bradely, D., and S. Huseman. “Validating competency at the bedside.” Journal for Nurses in
Staff Development 19, no. 4 (2003): 165–175.

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EXAM

1. Which of the following statements concerning staff development specialist qualifications is accurate?
a. Minimum education requirements vary depending on the role fulfilled
b. The most important qualification is clinical expertise
c. Persons who work full-time must possess different qualifications than those who work
part-time, even though they fulfill the same role
d. Responsibilities are the same for all staff development specialists even though they fulfill
different roles

2. Dominic is the manager of staff development in a 700-bed teaching hospital. His peers hold master’s
degrees. Which of the following statements about Dominic is most likely to true in this situation?
a. Dominic’s job description mandates that he possess a doctorate in adult education
b. Dominic is qualified to manage the staff development department because of his excellence in clinical practice
c. Dominic demonstrates expertise in management skills
d. Dominic is required to possess a graduate degree only if he works a minimum of 40
hours per week

3. Which of the following actions violates legal principles concerning job performance?
a. Requiring the manager of staff development to possess a master’s degree because this is
the standard for all middle managers within the organization
b. Establishing criteria that give preferential treatment to staff members who have children
c. Requiring staff development specialists to have experience in adult education instead of
clinical expertise
d. Establishing criteria that mandate the baccalaureate degree as the minimum educational
preparation for nurses working in staff development

4. Which of the following persons is best qualified to fulfill the role of staff development specialist?
a. David, who has a master’s degree in business administration and extensive patient education experience
b. Lisa, who is a certified critical care nurse and a recognized leader on her unit
c. Brian, who is a computer specialist and successfully assists with the delivery of continuing education for various nonclinical departments
d. Emily, who is pursuing a bachelor’s degree in adult education but has no practical experience in the planning and delivery of continuing education

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5. Paula is a staff development specialist with a master’s degree in adult education. She is responsible for the design, implementation, and evaluation of continuing education activities, as well as the
supervision of part-time employees who help with inservice and orientation on clinical units. Ron is
one of these part-time employees. Based on this scenario, which of the following statements is
most accurate?
a. Paula and Ron have the same title within the staff development department
b. Paula holds a higher position within the staff development department
c. Ron must possess the same qualifications as Paula
d. Ron is able to fulfill the same role as Paula

6. “A minimum of five years of successful healthcare management experience and the demonstration
of effective leadership skills” is an example of a:
a. title
b. competency
c. qualification
d. responsibility

7. All of the following factors must be included under “working conditions” EXCEPT:
a. working hours
b. specific moving and lifting requirements
c. potential exposure to infectious diseases
d. minimal educational preparation

8. Which of the following statements about competencies is accurate?
a. Competency statements explicitly describe behaviors that must be demonstrated
b. Competency statements provide a general guide for behavior
c. Competency statements are primarily useful for clinical job descriptions
d. Competency statements describe minimal education preparation requirements

10. When identifying qualifications and writing job descriptions, remember that:
a. lifting and moving requirements are essential for direct patient care providers but are not
mandatory for staff development specialists
b. educational preparation should reflect the standards of the profession
c. qualifications are based on professional requirements not on organizational standards
d. managers can be flexible when applying standards to staff members depending on individual circumstances

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Competency: The staff development specialist plans, implements, and evaluates training and continuing education according to the principles of adult education. These principles are that
• adults are self-directed learners
• adults bring a variety of valuable life experiences to any learning situation
• adults focus on acquiring knowledge and skills that will benefit them as they conduct
their activities of daily living
• adults are responsive to both intrinsic and extrinsic motivators

OBJECTIVES
At the conclusion of this chapter, the learner will be able to
1. identify the principles of adult learning
2. apply the principles of adult learning to his or her staff development practice

Introduction
It is assumed that any educator responsible for the training and continuing education of adults
is familiar with the principles of adult learning. However, identifying these principles is very different from actually applying them in staff development practice. The purpose of this chapter is
to assist the staff development specialist in the application of the principles of adult learning as
he or she plans, implements, and evaluates training and continuing education.

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Identification and application of adult learning principles
1. Adults are self-directed learners. Adults determine what they want to learn and how
they want to learn it. They also want to be respected as both adults and learners. Thus,
adults may attend a mandatory program, but if they feel it is a waste of their time, they
probably will not acquire much new knowledge. Adults know that their time is valuable
and expect education to be offered at times and in ways that are convenient for them.
Adult learners also like to know why it is important for them to participate in an educational
activity. Developing measurable learning objectives does not necessarily explain why a program
is important, so staff development specialists also must be able to explain why an educational
activity is important to employees and to the organization. Consider the following example:
Staff development scenario: County Hospital’s patient satisfaction surveys and quality improvement data show a significant decrease in patient satisfaction. Among the complaints are
• “Nurses act as though I am stupid if I ask a question.”
• “My physical therapist talks and laughs with the other therapists when he or she is giving me therapy. I never have a chance to ask about my progress. If I interrupt them,
they ignore me.”
• “My mother’s call light was on for 20 minutes before anyone answered it. When the nursing assistant came in, she rudely told us that she was very busy and had gotten there as
fast as she could. I know she was busy. But she could have been polite about saying so.”
The preceding comments are part of a trend at County Hospital. The staff development department is asked to plan and implement a series of mandatory customer satisfaction programs, with
an emphasis on communication skills. Staff members are overhead making comments such as,
“These programs will be a real waste of time. I already know how to talk to patients!”
What can the staff development specialists do to help promote the importance of this program to
self-directed learners?

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Consider doing the following:
• Publicize the program by explaining the rationale. Use statements such as “customer satisfaction is our business,” and identify a target percentage for customer satisfaction (e.g.,
98%, 100%). If programs are advertised on bulletin boards and in areas accessible to
patients and families, do not use examples of risk management data or survey results.
However, at the beginning of the program, such data can be presented, as long as confidentiality of staff and patients involved is maintained. Ask the marketing or public relations department for help in writing good promotional materials. Answer questions from
staff members honestly and openly—they may not realize the seriousness of the problem.
• Explain the consequences of poor customer satisfaction. Relate these consequences to
patient outcomes, organizational effectiveness, and job security. Poor patient satisfaction
may lead to a decrease in admissions and even downsizing. Staff members need to
understand that their actions influence the financial solvency of the organization.
• Offer the program at times and in ways convenient for the learners. Acknowledge that
employees’ time is valuable.
• Identify program objectives clearly. Adults need to know what is expected of them and
why.
• Measure the impact of education, and share results with employees. If patient satisfaction increases following the educational program, make sure that the employees are
notified. They need to know that education makes a difference.
2. Adults bring a variety of valuable life experiences to any learning situation.
Learners’ life experiences can enhance any learning situation and should be treated with
respect. Such experiences may not directly relate to the specific topic of the program,
but they can still complement learning. For example, nearly everyone has received both
good and bad customer service in various settings. Allow participants to share their
experiences from both the customer and provider perspectives, and incorporate these

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experiences into the educational activity. If the education is provided via a distance
learning method, solicit relevant anecdotes from staff and use the stories to illustrate
good and bad customer service. You may wish to acknowledge learners’ assistance by
including a statement such as, “The staff development department would like to thank
Tracey Stevens, RN, and David Weber, PT, for their assistance in developing this program.” This gives credit to employees but does not violate confidentiality by identifying
exactly what anecdotes, stories, or feelings are theirs. Encourage the sharing of relevant
experiences, but do not allow any one participant to dominate the discussion in a public
setting.
Caution: Do not publicly acknowledge staff members by name in any educational setting or delivery method without their permission.
3. Adults focus on acquiring knowledge and skills that will benefit them as they conduct their activities of daily living. Adults want to know how the acquisition of skills
and knowledge will benefit them. These benefits can be work-related or related to their
personal lives. Adults are task-oriented, problem-centered, or life-oriented in their approach
to learning. Remember that adults are self-directed and are more likely to go through the
learning process enthusiastically if they believe that it will improve some aspect of their
lives. For example, classes on retirement programs and benefits offered by the organization
will help employees to prepare for living a comfortable retirement. The bottom line is that
adult learners need to know how to apply information to their own lives.
Consider the preceding customer safety scenario. Staff development specialists must explain how
customer service education will help them. Such factors might include the following:
• Enhanced communication skills can be used with colleagues as well as with patients and
can help improve workplace communication, interpersonal interactions, and patient outcomes because information is transferred more quickly and more accurately.
• Better communication with patients and families improves patient outcomes because it
encourages efficient gathering of information and better transfer of such information to
other members of the healthcare team.

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• Customer service is an issue of great importance to accrediting agencies. The hospital’s
continued existence depends on maintaining accreditation and the quality of patient
outcomes.
Adults are also impatient with learning activities that they believe waste their time. Consider the
following example:
All pediatric nurses must demonstrate ongoing competency in their ability to insert intravenous
(IV) lines. Some organizations require that these nurses attend a review course and demonstrate
acceptable technique in a skills lab, but doing so is a waste of time for experienced nurses who
frequently insert IVs without difficulty. Instead, why not offer a time-saving alternative that
acknowledges the expertise of these nurses? Develop a “challenge” exam that measures didactic
knowledge. If nurses successfully pass this test, they are exempt from attending the course. A skills
lab demonstration may be necessary for nurses who have had little or no opportunity to insert IV
lines or who are having difficulty with this task. If nurses have had no problem with this skill,
establish a minimum number of successful “starts” per year, and ask preceptors to observe colleagues insert an IV as part of competency demonstration. This approach avoids asking competent nurses to waste time sitting in classrooms or completing self-learning modules.
4. Adults are responsive to both intrinsic and extrinsic motivators. All principles of
adult learning complement each other. As mentioned earlier, adults are motivated by factors that improve some aspect of their lives. This supports the principle that adults focus
on acquiring knowledge and skills that help them improve their lives.
Examples of extrinsic motivators include promotions, salary increases, better job opportunities,
and better working conditions. Intrinsic motivators include enhanced self-esteem, increased ability to manage stress, and enhanced job satisfaction.
Learners benefit from the incorporation of such motivators as part of the teaching/learning
process. Scenarios that illustrate how education can help learners achieve goals triggered by
motivators enhance learning activities.
Figure 4.1 explains the ways in which the principles of adult learning can be incorporated as
part of education planning and delivery.

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FIGURE

4.1

Tips for incorporating principles
of adult learning

Adult learning principle

Incorporation tips

Adults are self-directed learners

• Promote the program using objective data

Adults bring a variety of life experiences to any

• Answer questions honestly

learning situation

• Provide a specific rationale for learning
activities
• Explain the consequences if education is not
received
• Respect and acknowledge that employees’
time is valuable
• Identify program objectives clearly
• Measure the impact of the education, and
share results with staff

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Adults focus on acquiring knowledge and skills

• Treat adults’ life experiences with respect

that will benefit them as they conduct their

• Acknowledge learners’ contributions to the

activities of daily living

educational activity

Adults are responsive to both intrinsic and

• Explain how the knowledge and skills

extrinsic motivators

acquired will enhance job performance

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FIGURE

4.1

THE PRINCIPLES OF ADULT LEARNING

Tips for incorporating principles
of adult learning (cont.)

Adult learning principle

Incorporation tips

Adults are responsive to both intrinsic and

• Extrinsic motivators include promotions,

extrinsic motivators

salary increases, better job opportunities, and
better working conditions
• Intrinsic motivators include enhanced selfesteem, increased ability to manage stress,
and enhanced job satisfaction
• Incorporate a variety of scenarios into learning activities that help identify these motivators
and how education will help achieve desired
results

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Conclusion
Most staff development specialists can identify the principles of adult learning easily. However,
planning, implementing, and evaluating learning activities in accordance with these principles is
not so easily accomplished. Staff development specialists must analyze these principles and
apply them to all facets of the teaching/learning process.

Bibliography
Avillion, A.E. A practical guide to staff development: Tools and techniques for effective education.
Marblehead, MA: HCPro, Inc, 2004.
Bland, G., and L.C. Hadaway. “Principles of adult learning.” In A.E. Avillion (Ed.) Core curriculum for staff development. 2nd ed. 31–64. Pensacola, FL: National Nursing Staff Development
Organization, 2001.
Merriam, S.B., and R.G. Brockett. The profession and practice of adult education: An introduction. San Francisco: Jossey-Bass, 1997.

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EXAM

1. Adults are self-directed learners. This implies that:
a. adults refuse to participate in education unless they want to
b. adults need to understand why a particular leaning activity is important to them and to
the organization
c. adults want someone else to be responsible for identifying their learning needs
d. adults will learn only if the learning activity is mandatory

2. Ways to incorporate the principle that adults are self-directed learners into program planning
include all of the following EXCEPT:
a. mandate programs that may be unpopular
b. share information that explains why the program is important to staff and the organization
c. use survey and quality improvement data to illustrate the impact of failure to attend the
program
d. respect the learners’ input and answer questions honestly

3. Which of the following is an appropriate strategy to use when meeting the needs of self-directed
learners?
a. Do not share any quality improvement data with employees, as this may make them feel
as though they are not doing a good job
b. Allow them to refuse to participate in mandatory education
c. Measure the impact of education, and share results with learners
d. Avoid answering questions about the need for the program if learners are resentful

4. Rose Ann is a nursing assistant with more than 25 years of experience in pediatrics. She is attending a program on generational learning and shares some of her experiences from her generation’s
viewpoint as well as from a pediatric perspective. The staff development specialist should:
a. thank Rose Ann and attempt to take back control of the program
b. thank Rose Ann and use the anecdotes to help illustrate critical learning activities
c. use Rose Ann’s anecdotes as part of a self-learning module without mentioning her name
d. ask Rose Ann’s supervisor whether her stories about pediatric development are true

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5. Which of the following violates the rights of the employee?
a. Encouraging learners to participate in classroom discussions
b. Asking staff members to assist in the development of a computer-based learning program
c. Using an anecdote that an employee shared in a classroom setting in the development of
a self-learning module without the employee’s permission
d. Asking an employee who has dominated the classroom setting by relaying personal opinions for 10 minutes to allow other learners an opportunity to contribute their thoughts

6. Which of the following adheres to the principle that adults must be able to use acquired knowledge
and skills to benefit their daily living activities?
a. Mandating that emergency room nurses attend a program on chronic neurologic disorders
b. Mandating that a nurse who administers a dose of oral antibiotic an hour late attend a
program on the five rights of medication administration
c. Demonstrating how a mandatory program on improving hospital security can reduce
workplace violence
d. Reducing the amount of mandatory programs employees must attend

7. All of the following statements about adult learning principles are correct EXCEPT:
a. adults respond to external and internal motivators.
b. adults use their life experiences to enhance learning.
c. adults are more responsive to education when they understand the rationale for the education being offered.
d. adults must deal with a variety of responsibilities, which can sometimes be overwhelming.
Therefore, they need educators to identify and direct their leaning needs.

8. Louisa is planning a staff development program and is focusing on intrinsic motivators. Which of
the following qualifies as a program that is an intrinsic motivator?
a. CPR recertification
b. Relaxation training
c. HIPAA training
d. Critical care certification preparation course

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9. Robyn is the preceptor for a new staff development specialist. She is trying to explain why it is
important to incorporate the principles of adult education into learning activities. Which of the following examples should Robyn use to help illustrate this point?
a. Adults benefit from attending all orientation classes, even if they are already competent in
certain skills
b. Adults resent mandatory training because they believe it is a waste of time
c. Adults focus on applying new knowledge and skills to enhance job performance
d. Adults are motivated only by tangible, extrinsic motivators

10. The intensive care unit staff are troubled by stress and are concerned about the increase in the
number of minor illnesses they are experiencing. Classes on stress management and relaxation
breathing are offered and attended enthusiastically. How does this type of programming correlate
with the principles of adult learning?
a. These programs focus on a coping need and will help staff members in their working
lives
b. These programs are offered in response to intrinsic motivators and are not priorities
c. These programs were offered without learner input, and adults will not be motivated to
attend
d. These programs allow the intensive care unit staff to acquire technical skills to improve
patient care

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C OLLECTING

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ANALYZING EDUCATION NEEDS
ASSESSMENTS DATA

Competency: The nursing staff development specialist collects and analyzes education needs
assessment data to help identify and prioritize learning needs.

OBJECTIVES
At the conclusion of this chapter, the learner will be able to
1. identify sources for the identification of learning needs
2. gather data for the identification of learning needs
3. analyze data to prioritize learning needs

Introduction
Conducting needs assessments can become an exercise in futility. For example, endless surveys
or open-ended questions at the end of program evaluations provide a disorganized amount of
data that often has little or no practical use. For that reason, build needs assessments into existing processes—and avoid wasting time and effort developing methods of data collection that
duplicate existing processes.

Preparing for data collection
The purpose of needs assessments is to identify and prioritize learning needs, assess the level of
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problems, and meet accreditation standards. Because data come from so many different sources,
it is essential to gather them in a logical, concise manner. Take the following steps before data
collection:
1. Establish a computerized system of monitoring and documenting education needs.
Most large hospitals and health systems have purchased or developed systems for their
in-house network to track human resource data, including program attendance. These
types of systems may include (or be adapted to include) mechanisms for recording and
tracking needs assessment data.
If such a system is not in place, the staff development department may need to establish its
own system by using departmental computers to record and track data. First do the following:
• Identify who is responsible for recording data and who will have access to such data
• Determine a system of categorizing education topics
• Determine how often data will be reviewed
There is no need for a complicated tracking and retrieval system, especially if the staff development department creates its own system. The system must be accurate, easily accessible,
and swiftly retrievable, but it can be as simple as a spreadsheet that lists topics and data
source (e.g., survey, performance evaluations, etc.) and can calculate the number of responses
per topic.
Caution: Do not attempt to develop a tracking and retrieval system without the assistance of the
information systems department.
2. Identify sources of data collection. Some organizations conduct elaborate needs assessment surveys on an annual basis, using techniques such as advisory groups, brainstorming, focus groups, and the Delphi technique—a technique for obtaining written ideas
from persons considered to be experts in designated areas that involves asking participants to complete three consecutive rounds of questions. There is nothing wrong with
such surveys, but they tend to take considerable time and effort to implement.

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Also, the JCAHO mandates that needs be assessed at least annually, but an ongoing system of
data collection is efficient and more practical than an annual written survey for several reasons:
written surveys are time-consuming to distribute, the return rate for such surveys is historically
low, and such surveys often fail to identify important learning needs that are crucial for performance improvement. Thus, it is more time-efficient and practical to gather data from processes that already exist. When creating an evaluation, remember the following:
• Include specific learning-needs questions at the end of all program evaluations
• Develop a system to identify learning needs based on performance evaluations
• Develop a system to identify learning needs based on risk management and quality
improvement data
• Create a mechanism to identify learning needs based on informal interviews

TIP

Data collection
If the staff development department conducts a housewide needs assessment survey,
look for events that large numbers of employees attend. Events such as Nurses’ Week
activities or employee appreciation days allow the staff development department to reach
large numbers of employees without depending on “return mail” responses. If surveys are
distributed at these events, offer a simple reward when the survey is completed and
returned, such as pens, discount coupons, or mugs. Incorporating the survey as part of a
major event saves time and increases the response rate.

3. Establish a mechanism for the consistent categorization of education topics.
Because needs are collected from so many different sources, develop an easy way of categorizing the education topics. To help with this categorization, consider dividing topics
into the following four main categories: mandatory training, clinical inservice/continuing
education, nonclinical inservice/continuing education, and employee health and wellness.
These topics can then be subdivided further, as follows:

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• Mandatory training: JCAHO mandates, government mandates, and safety and security
(e.g., patient falls, workplace violence, and medical error reduction)
• Clinical inservice/continuing education: This area can be subdivided into specific
specialties, such as neurology/neurosurgery, orthopedics, pediatrics, etc.
• Nonclinical inservice/continuing education: This area can be divided into specific
nonclinical department needs
• Employee health and wellness: Includes topics such as stress management, smoking
cessation, weight reduction, etc.
The preceding suggestions are certainly not all-inclusive. Each organization must categorize
learning needs in a manner appropriate to its products and services. Regardless of how you
organize it, categorizing needs is a more logical means of data collection and documentation.

Data collection
Data from program evaluations
Most (if not all) education activities require learner feedback via a program evaluation tool.
These tools must be incorporated in all settings, whether in the classroom or as part of distance
learning. As programs end, evaluations should be completed and returned to the staff development department. Here are some suggestions to encourage that process:
• The classroom setting: Evaluations are collected by the staff development specialist or
another educator responsible for program facilitation.
• Self-learning modules: Evaluations are part of the written packet. They are completed
and returned to the staff development department either in person or via intraorganization mail.
• Computer-based learning or e-learning: Evaluations are completed, printed out, and
returned/e-mailed to the staff development department.

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• Video or DVD: A supply of evaluations is kept with the video or DVD in use and are
easily accessible to learners. Forms are completed and returned to the staff development
department.
How do you word the questions pertaining to learning needs? Determine what information you
seek. Identify what the learner needs to know v. what he or she would like to know, and in
what setting education should be offered. Consider using or adapting the following statements
as part of program evaluation tools:
• Identify three education programs that would help you improve your job performance
• Identify three education programs that you would enjoy attending
Caution: Each of the two preceding prompts elicits quite different data. These types of statements
help to retrieve information that is “need to know” v. “nice to know.”
• Identify three education programs that would help you improve your personal
health/fitness
Also determine what learning methods are preferred. Most participants state that they prefer to
learn in a classroom setting while interacting with friends and colleagues. However, staff development specialists know that learners are unlikely to be able to leave their units or departments
long enough to attend such programs. Therefore, consider adding/adapting the following questions to program evaluation tools:

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Considering your job responsibilities, which of the following methods is the most convenient way for you to receive education and training?
Classroom setting _____

Skills lab _____

Computer-based learning ______

E-mail updates ______

Video/DVD _____

Self-learning packets ___ Audiotapes or audioconferences _____
On-the-job demonstration _____
Other ___________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Are you able to use the following pieces of equipment to obtain education?
Computer ___Yes ___No
Video/DVD player ___Yes ___No
E-mail ___Yes ___No
If you answered “no” to any of the preceding questions, please list below what you
need to help you use this equipment for educational purposes.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Data from performance evaluations
Staff development specialists do not have access to performance evaluations because those documents are confidential. Therefore, they must depend on managers to inform them of educational
needs identified during the performance evaluation process. Consider the following scenario:
The manager of the physical therapy (PT) department is writing 10 performance evaluations,
which must be discussed with employees this month. During each evaluation session, the employee and manager jointly identify employee learning needs. The PT manager e-mails the needs to
the manager of staff development. However, the PT manager is tired of sending endless e-mails.

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Despite her best intentions, she often forgets to inform the staff development department of the
staff needs identified during performance evaluations. The staff development manager is having
trouble keeping track of similar e-mails sent to him by managers throughout the organization.
How can this problem be solved?
It’s never easy to ask busy managers to remember to communicate additional information on a
regular basis. Thus, here are some suggestions for handling such situations:
• Develop a computerized form that identifies the established categories of education
needs. Explain these categories to managers so that they know how to record data.
This method preserves confidentiality because only needs—not names—are recorded
on the form.
• Ask managers to submit the information to the staff development department on a regular (e.g., quarterly) basis. Identify due dates, and send out a housewide e-mail reminder.
Managers can record needs using their computers and simply forward the form via email. This avoids asking managers to send a constant “flow” of e-mail to staff development and reduces the number of e-mails the staff development department receives.
Caution: Some managers always will be late to or forgetful of educational programs. They
are more likely to cooperate if administration supports the process. Also, don’t forget that
adults need to know why they are learning (or doing) something. Be sure to explain why this
information is needed and how the staff development department is going to use it.
• Share a summary of educational needs with managers. Doing so helps them understand
how the data is being used and how educational priorities are set.

Data from quality improvement and risk management
A member of the staff development department must be a member of the quality improvement
and risk management committees. The information discussed at such committee meetings is an
essential source of education needs data, which is especially important because needs identified
from these sources are often of critical importance.

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For example, trends in the number of falls, employee back injuries, or patient complaints must
be analyzed to determine whether these problems are due to a system flaw or indicate learning
needs. Unless an immediate, urgent training need arises, such data can be summarized quarterly
for planning purposes.
Caution: Data collection is ongoing. However, it cannot be reviewed daily. Instead, set aside
specific days at regular intervals (e.g., quarterly) to analyze data and plan programs.

Informal data
A staff development specialist is eating lunch in the cafeteria. A group of nurses from the neurosurgical unit join her. They share some excellent ideas for education programs and explain why these
programs are important to them. How do these suggestions “fit” into the needs assessment process?
Informal suggestions can be very valuable, as can having a system to track them. Categorize
these ideas, and add them to the database maintained by the staff development department.
Ideas obtained informally should also be discussed during the staff meetings of the staff development department, and the meetings’ minutes should be recorded. Other means of data collection include focus groups, brainstorming sessions, and interviews. Regardless of the source of
data, remember to
• categorize and record all identified needs and their sources in an organized fashion
• maintain confidentiality, as required
• recognize the value of both formal and informal sources of data
• facilitate the collection process as much as possible

TIP

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In addition to categorizing and recording education topics, record the source of the identified education needs (e.g., performance evaluations, informal discussion, quality improvement meeting, etc.).

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Analyzing needs assessment data
Develop a logical, organized method of data analysis that includes differentiating between a
learning need, a performance problem, and a systems flaw; prioritizing needs; and planning
program delivery.

Differentiating learning needs from other issues
Staff development specialists are often asked to provide education to solve problems that are
not true learning needs. They must be able to differentiate learning needs from performance
problems and systems flaws. They also must be able to help managers and colleagues understand that education is not an automatic solution to the organization’s problems.

Performance issue
Bernadette is a registered nurse. She has worked on a surgical oncology unit for the past three years,
and in that time, she has received positive performance evaluations and provided her patients with
excellent care. She had no history of committing medication errors until fairly recently.
Bernadette has committed four errors in the past five months. These errors included administering medications late and failing to initiate a change in a medication order according to the
timetable identified by the physician. There were no adverse patient effects. When discussing these
errors with her manager, Bernadette stated, “I am tired of working so hard and not getting any
recognition. I’m not going to exhaust myself just to give medications at the exact time they are
ordered. The meds were only a little late, and nobody was hurt.” Bernadette’s manager asks the
staff development department to provide Bernadette with remedial education concerning the
proper administration of medications. Is this situation characterized by a learning need? Is education going to solve the problem?
Analyze this situation according to the following questions:
• Is Bernadette aware of performance expectations based on her job description?
• Has Bernadette’s manager made it clear that her current performance fails to meet performance expectations?

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• According to the information provided, does Bernadette have a history of administering
medications correctly prior to the past five months?
If the answer to these questions is “yes,” this situation does not represent a learning need.
Rather, it represents a performance issue that needs to be addressed by Bernadette’s manager.
The situation may also represent an administrative issue if Bernadette’s manager fails to clearly
communicate performance expectations/initiate appropriate counseling when Bernadette fails to
fulfill her job responsibilities appropriately.

Systems flaw
Norah works the evening shift on a neurologic rehabilitation unit. Primary patient populations
include spinal cord-injured, stroke, and traumatic brain-injured patients. These patients require
extensive care, and a great deal of lifting and positioning is required. During the past month,
patient falls have increased significantly on the evening shift, especially during the hours from
4:30 p.m. to 6:30 p.m. These hours are meal times for both staff and patients.
The evening shift also has five vacancies: two RNs, one LPN, and two nursing assistants. Norah
and her peers have suggested having patient supper trays delivered earlier and staff meal breaks
scheduled later to avoid some of the staffing issues, but these suggestions have been ignored. The
nurse manager of the unit asks the staff development department to provide education on fall prevention to staff members working the evening shift. Does this situation represent a learning need?
The answer to the preceding question is “probably not.” Consider the following questions:
• Are staff members initiating patient transfers and positioning appropriately?
• Do the falls occur because of insufficient numbers of staff members available to transfer
and position patients?
• If barriers to performance (e.g., staffing and timing of meals) are removed, would the
number of falls decrease?
• Have new staff members been hired who do not know how to correctly transfer and
position patients?

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• Are there new patient issues pertaining to transfers and positioning that have not been
explained to staff?
If staff members have demonstrated the ability to transfer and position patients correctly and
safely, and if it is determined that barrier removal would decrease the number of falls, then this
is a systems flaw issue not a learning need.

Learning need
Alicia is one of five RNs recently hired to work on the cardiac care unit. The other four nurses
have cardiac care experience, but Alicia does not. Alicia has an extensive background in medical-surgical nursing and is regarded as an excellent clinician. She is having difficulty identifying
the various cardiac arrhythmias. What does this situation represent?
This is a learning need. Alicia is new to the practice of cardiac care and needs education and
training to identify arrhythmias.

Prioritizing needs and planning education
There are several descriptors used when discussing the prioritization of education needs.
However, such needs typically fall into similar broad categories:
1. Life saving. These education needs must be met swiftly; if they are not, patients, visitors,
and employees are in danger of significant harm or even death. Examples of such priorities include fire safety, dealing with workplace violence, and response to a respiratory or
cardiac arrest. These needs are of the highest priority.
2. Basic needs and inservices. These needs are basic to the performance of job duties and
responsibilities (e.g., medication administration, rhythm-strip interpretation) but are not as
time-critical as life-saving needs. Note that some organizations choose to include accrediting agencies’ mandated training in this category rather than classify such training under a
separate category. These needs are essential, but the potential for harm and the rapidity
with which employees must respond to them is less than for life-saving needs.

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3. Continuing education needs. These needs are essential to the professional growth and
development of employees. Education keeps employees abreast of advances and
changes in their respective disciplines, as well as how to respond to particular events. Its
ultimate goal is to improve patient outcomes.
4. Employee health and wellness. These needs pertain to issues of health and wellness,
such as stress reduction, smoking cessation, and relaxation training.
Caution: The priority of an education topic also is influenced by the number of employees in
need of training and education. For example, suppose a large community hospital has one
oncology nurse practitioner on its staff. She may have some important and even life-saving education needs unique to her role. In this case, it would be cost and time effective to have this
nurse attend programs outside the organization that are designed to meet her needs.
Another category of needs might be described as “administrative directives.” All staff development specialists ultimately deal with urgent training and education needs triggered by
administrative directives or changes in the organization’s mission, vision, and values. These
needs generally take precedence over all other needs, with the exception of life-saving
needs. For example, it is doubtful that orientation of critical care nurses would be cancelled
because administration has mandated customer service training. Typically, education that
meets administrative directives must be offered simultaneously with other categories of
needs. Staff development specialists must be experts in flexibility.
Another training need that frustrates most staff development specialists occurs when an issue
arises that is not, in reality, a learning need but is mandated as one by the organization’s
administration.
Consider Norah’s situation on the neurologic rehabilitation unit. She and her colleagues identified a systems flaw as the primary causative factor behind the falls on the unit. Suppose that
Norah’s manager, with the backing of administration, insists that Norah and her colleagues on
the evening shift receive remedial training in fall prevention. Should staff development specialists
design and implement training and education? Is there a way to justify the belief that this is a
systems flaw without alienating Norah’s manager and the administration?

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Develop pretests to assess knowledge during orientation, and use these tests when such
situations arise. For example, the principles of safe medication administration, transfer and
positioning techniques, and fall prevention techniques all can be assessed with pretests and
demonstration. Such tests are useful during orientation because they allow experienced nurses
to omit certain aspects of classroom orientation, thus acknowledging their experience and
making orientation more efficient.
Pretests are also useful when staff development specialists are asked to provide remedial
training for nonlearning needs situations. Having a number of pretests available for common
problem areas (e.g., medication errors) saves staff development specialists time and effort
and eliminates the costs of developing periodic remedial training. Successful completion of
pretests/accurate skill demonstration helps illustrate that the problem is not a learning need.
These findings facilitate analysis of the problem and, hopefully, the accurate cause of adverse
occurrences will be identified and resolved.

Conclusion
After collecting data and prioritizing education needs, the staff development specialists select the
programs that must be offered, developed, or revised during a given period. Data collection
should be incorporated into existing systems to facilitate the process and maximize its value.
Appropriate data analysis allows for the identification of learning needs and program development that will enhance organizational performance.

Bibliography
Avillion, A.E. A practical guide to staff development: Tools and techniques for effective education.
Marblehead, MA: HCPro, Inc., 2004.
Fennel, V. “Learning needs assessment.” In A.E. Avillion (Ed.). Core curriculum for staff development. 2nd ed. pp. 170–197. Pensacola, FL: National Nursing Staff Development
Organization. 2001.

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F INAL

EXAM

1. Prior to data collection, all of the following steps are essential EXCEPT:
a. categorizing education topics
b. identifying sources for data collection
c. arranging to have access to individual employees’ performance evaluations
d. developing a computerized system of documenting educational needs

2. When collecting needs assessment data from program evaluations, it is helpful to:
a. differentiate between “need to know” and “nice to know” education programs
b. inform learners that they must participate in computer-based learning
c. focus solely on programs that will improve job performance
d. include needs assessment questions on program evaluation tools only when the program
is offered in a classroom setting

3. Performance evaluations are important sources when identifying education needs. Anna is the
manager of the surgical pediatric unit and is concerned about maintaining employee confidentiality when she identifies learning needs for the staff development department. Which of the following best helps Anna to preserve confidentiality?
a. Anna meets privately with the manager of staff development and discusses individual
employee performance evaluations with her
b. Anna refuses to share information from performance evaluations with anyone
c. Anna provides education herself in order to maintain confidentiality
d. Anna summarizes employee education needs and relays this information to the staff
development department but does not identify employees by name

4. Which of the following is a “must” when collecting needs assessment data?
a. Establish a computerized system of recording and tracking needs assessment data
b. Distribute a needs assessment survey to all employees annually
c. Ask the quality improvement manager to meet monthly with the staff development director to discuss education needs
d. Organize a yearly survey using the Delphi technique

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5. The most efficient way to collect data from quality improvement and risk management findings is to:
a. have the manager of staff development review all adverse occurrence reports
b. appoint a staff development specialist to act as a member of the quality improvement and
risk management committees
c. ask the organization’s risk manager to summarize education needs based on adverse
occurrence reports, and relay this information to the staff development department
d. implement education only if the need is indicated after analysis of a sentinel event

To answer questions six and seven, review the following scenario:
Amy has made three medication errors this month. Two of the medication errors were errors
of omission (i.e., she forgot to administer two medications), and one occurred as a result of
Amy administering the wrong dose of an oral antibiotic. Prior to this month, Amy has administered medications for two years without error. Amy is not too concerned about these errors,
because she says the unit on which she works is really busy, and no patients were injured due
to the errors.

6. Which of the following phrases best describes this situation?
a. A learning need
b. A systems flaw
c. A performance issue
d. A reason for termination

7. Who is the person best suited to intervene in this situation?
a. The staff development specialist
b. The director of nursing
c. Amy’s peers
d. Amy’s manager

8. David is an RN with five years of experience as an intensive care nurse. He recently accepted a
position on a spinal cord rehabilitation unit. David is having difficulty correlating the degree of
spinal cord injury to the neurological deficit and appropriate nursing interventions, something with
which he has little experience. Which of the following best describes this situation?
a. A learning need
b. A performance issue
c. A systems flaw
d. An administrative issue

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9. Susan accepts a position as charge nurse on an Alzheimer’s disease unit in a long-term care facility.
Her manager, Ms. Cane, tells her that she really does not need much orientation because her background is in intensive care. Susan lacks experience working with Alzheimer’s patients and is having
difficulty providing adequate nursing care. In addition to a learning needs issue, this situation is:
a. a performance issue
b. grounds for Susan’s dismissal
c. an administrative issue
d. a systems flaw

10. A Washington, DC, health system located close to the White House and Capitol building has been
placed on alert as an organization at high risk for a bioterrorism attack. Continuing education must
be developed, implemented swiftly, and regularly updated. This education is best described as:
a. life-saving
b. basic
c. continuing education
d. professional development

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P LANNING

AND
IMPLEMENTATION
OF EDUCATION

Competency #1: The staff development specialist plans training and continuing education based
on needs identified from a variety of sources, including but not limited to needs assessment surveys, performance evaluations, risk management data, quality improvement data, and the mission, vision, and values of the organization.
Competency #2: The staff development specialist implements training and continuing education
by identifying effective program delivery methods, selecting appropriate teaching strategies, and
facilitating learner participation.

OBJECTIVES
At the conclusion of this chapter, the learner will be able to
1.
2.
3.
4.

identify objectives for education activities
identify effective program delivery methods
select appropriate teaching strategies
facilitate learner participation in educational activities

Introduction
Planning includes identifying objectives, selecting teaching strategies, writing content, preparing
the physical learning environment, and establishing a system of program evaluation. Also,
because of advances in distance learning and the urgent need to enhance learning convenience,
the steps of the planning process must incorporate a variety of teaching methods that, until
recently, were not an issue for staff development specialists.

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Identifying objectives
Behavioral objectives must describe the behavior a learner will demonstrate as an outcome of
learning. These objectives also must reflect the manner in which the learner acquires knowledge and skills. For example, a learner cannot demonstrate a psychomotor skill at the conclusion of a distance learning program unless either arrangements have been made for a skills lab
or the organization possesses equipment to allow a virtual, simulated demonstration.
Objectives must tell the participant exactly what he or she must demonstrate to prove that
learning has occurred. They must be written at the level appropriate for the desired outcome.
Most staff development specialists begin with an introduction such as, “At the conclusion of this
program the learner will be able to . . .” This wording informs participants that something is
expected of them at the conclusion of the learning activity. Following this introduction, an
objective contains a measurable action verb and a description of the desired behavior. The following analysis of well-written objectives includes application of distance learning standards:
1. Each objective contains a verb describing the behavior that is to be observed and
measured. These verbs are precise and explicitly describe the behavior expected of the
learner. The verbs measure knowledge, comprehension, application, analysis, synthesis,
and evaluation.
2. Knowledge is the most fundamental type of objective. Verbs that measure knowledge include “define,” “list,” “recall,” and “name.” Knowledge focuses on the memorization of facts. An example of a knowledge objective is, “Define congestive heart failure.”
3. Comprehension includes knowledge plus the ability to interpret that knowledge.
Verbs that measure comprehension include “discuss,” “explain,” “translate,” and “determine.”
An example of a comprehension objective is, “Describe the effects of a narcotic overdose.”
4. Application takes place when knowledge is applied in specific situations. Verbs
that measure application include “demonstrate,” “operate,” “perform,” and “apply.” An
example of an application objective is, “Demonstrate the safe, accurate administration of
medication via intramuscular injection.”

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5. Analysis involves reducing information into components and explaining the
relationship among these components. Verbs that measure analysis include “differentiate,” “compare,” “contrast,” and “distinguish.” An example of an analysis objective is,
“Compare the side effects of tricyclic antidepressants prescribed for major depressive disorder.”
6. Synthesis focuses on the production of new information by combining and
arranging various facts and knowledge. Verbs that measure synthesis include “design,”
“formulate,” “develop,” and “organize.” An example of a synthesis objective is, “Design a
distance learning program that includes a virtual simulation of a bioterrorist attack.”
7. Evaluation is the judgment of an event based on defined, objective criteria. Verbs
that measure evaluation include “assess,” “evaluate,” “critique,” “measure,” and “validate.”
An example of an evaluation objective is, “Evaluate the impact of patient satisfaction
training as measured by a decrease in patient complaints.”
8. Identify learning objectives based on the needs and levels of participant expertise. For example, newly licensed nurses just beginning their careers are orienting to a
medical oncology unit. It would be appropriate to ask them to describe pain management procedures used on the unit; it would not be appropriate to ask them to evaluate
two distinct pain management strategies for terminally ill patients.
Conversely, it would not be appropriate to ask a group of experienced oncology nurses to simply
identify pain management strategies. This is too basic, and any education program focusing on
that objective would probably bore these nurses. Their objectives should be established at a higher level, and asking them to analyze, synthesize, or evaluate would be much more appropriate.

Selecting and implementing education strategies
Should programs be offered in a classroom setting, as computer-based learning (CBL), as a
DVD/video, as a skills lab, or as a combination of any of the dozens of options available to
staff development specialists? Should the format be lecture/discussion, skill demonstration, or
case study? Consider the following when selecting and implementing education strategies:

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• Match the strategy and the content to the level of the objectives and the expertise of the
audience
• Consider the time and cost of the strategies available
• Determine how many employees need to attend a learning activity
• Assess the ability of learners to have access to and operate equipment necessary for distance learning activities
• Assess the ability of faculty to facilitate learning effectively
Staff development specialists must choose from a variety of strategies. Arguably, the most effective teaching/learning strategy combines two or more methods or settings. The following options
describe some critical aspects of each choice.

Lecture/discussion
Lecture/discussion is probably one of the most common education strategies. It allows for the
presentation of information in an orderly manner, can be used with large groups, and allows for
interaction among participants and the presenter. The presenter must be a highly skilled public
speaker for lecture/discussion to succeed. He or she must encourage participation and must
respect varying points of view. An unskilled lecturer may limit or discourage interaction, fail to
adhere to the principles of adult learning, or actually bore the learners. Others value their ability
to entertain over the effectiveness of the learning activity. A skilled classroom presenter facilitates learning and is both enthusiastic and entertaining.

Group discussions
Group discussions are objective-driven meetings between two or more persons who assemble to
share knowledge, exchange information, develop a process, or critique options regarding specific issues, problems, or other topics of concern. Discussion may be formal or informal and is
generally conducted with the aid of a facilitator.

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Some advantages of group discussion include excellent opportunities for staff input and the ability to interact with members of other departments. Disadvantages include the reluctance of some
persons to express their opinions and others’ attempts to dominate the discussion. Unexpected
hostility or competitiveness may become evident, and minority viewpoints may be suppressed
or ridiculed.

Role play
Role play is the enactment of work-related reality situations. Learners are encouraged to improvise and react as they feel the role they are assuming requires. Role play is especially useful for
interpersonal skills such as communication skills, dealing with angry patients or colleagues, and
interacting with grieving or frightened patients and families. The advantages of role play include
the opportunity to practice skills and behaviors in a risk-free environment, to rehearse responses
to situations that are challenging, and to acquire insight into personal values, beliefs, and attitudes. Disadvantages include adult learners’ reluctance to participate in role-play activities in
front of others. Learners often feel that role play is too contrived. It is not an effective teaching
strategy by itself.

Skill demonstration/simulation
Skill demonstrations and simulations provide opportunities to acquire new skills and behaviors
and to practice them in environments that duplicate specific settings. These education strategies
are especially useful when skills and behaviors require practice and mastery before being performed in the patient environment or when actual work-related experiences are difficult to provide. Learners gain experience without the potential of dangerous consequences to patients or
to themselves. The primary disadvantage to skill demonstration and simulations is that these
experiences demonstrate behavior in a controlled setting and cannot predict staff’s behavior during a live situation.

Distance learning
Many, if not most, learners identify live, interpersonal, face-to-face classroom settings as their
preferred learning environment. Despite this preference for personal interaction, however, staff
development specialists know that it is quite difficult for learners to leave their work settings to
attend programs. Thus, the most logical option for program planning and implementation is to
identify the right mix of classroom, distance, and self-learning strategies. Such a mix is referred

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to as “blended learning.” Blended learning is the combination of many types of learning strategies to best meet learners’ needs.
Consider the following distance learning recommendations as strategies for blended or “standalone” learning:

Determining the appropriateness of distance learning
To help determine whether distance learning is appropriate, answer the following questions:
1. Who are your participants? Do they have the skills necessary to participate in distance
learning (e.g., reading and writing ability, computer skills)? Do they have access to necessary equipment (e.g., computers, video/DVD players)?
2. Can identified objectives be achieved via distance learning? Is distance learning appropriate? For example, demonstration of competency in a psychomotor skill is not usually
appropriate for distance learning.
3. What are the costs associated with distance learning development? Can the organization
afford it? Is the content consistent enough that extensive, expensive revisions will not
need to be made frequently?
4. Have learning objectives been clearly identified at the beginning of the distance learning
activity? The objectives must be stated (e.g., in a video), written, computer-based, etc.
Consider the following distance learning strategies:
• Printed self-learning modules. Often found in professional journals, these articles with
exams can be a cost-effective strategy for specific groups of distance learners. To use
this method, learners must be self-motivated and able to read and write proficiently.
• Audioconferences. Audioconferences are most effective for auditory learners. They
should be accompanied by handouts for clarity of content.

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• Video conferences. They are helpful because the learner can both see and hear speakers. Viewing video conferences requires sophisticated and often expensive equipment.
• Computer-based learning (CBL). CBL can allow for visual stimulation with graphics,
learner interaction, and immediate feedback. CBL facilitates attendance records.
• Web-based courses. Web-based courses are generally provided by universities and
health systems affiliated with universities. They require significant commitments of time
and money.
The following table summarizes the advantages and disadvantages of each education strategy.

FIGURE

Education strategies

6.1
Strategy
Lecture/discussion

Advantages

Disadvantages

• Allows information

• Requires a highly skilled public speaker

to be presented in

• Lecture/discussion format is often evalu-

an orderly manner

ated on the presenter’s ability to entertain rather than the effectiveness of the

• Can be used with

learning activity

large groups of
learners
• Allows for interaction among learners and between
learners and the
presenter

Group discussion

• Excellent opportu-

• Reluctance of some persons to express

nities for staff

their opinions

input

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FIGURE

6.1
Strategy
Group discussion

Education strategies (cont.)
Advantages
• Good opportunities for interaction

Disadvantages
• Potential for one or more persons to
dominate the group

among members

• Expressions of hostility or competitiveness

of different

• Suppression of minority viewpoints

departments

• Useful for acquirRole play

ing/improving
interpersonal
skills and learning
to respond to
challenging

• Learners may be reluctant to participate in
role play
• Learners may feel that role play is too contrived
• Role play is not an effective teaching strategy by itself

situations

• Provides opportu-

• These experiences measure behaviors in a

Skill demonstrations

nities to acquire

controlled setting but do not predict what

and simulations

and demonstrate

behaviors will be applied in the work setting

new skills and
behaviors in riskfree settings

• Convenient; availDistance learning

able 24/7

• Lacks interpersonal interaction
• Does not typically have the opportunity for
immediate feedback from faculty

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Audio-visual aids
Caution: Copyright laws regarding the use of printed materials, audiovisuals, music, etc., govern
your use of these resources as education tools. Classroom use and the use of materials in distance education are considered separate and different by United States copyright law. Access the
U. S. Copyright Office Web site to print guidelines regarding these laws at www.copyright.gov.
Many staff development specialists have limited budgets and rely on flip charts, overhead transparencies, and slides—all of which can be effective. Below are some elements to keep in mind
when developing and using various audio-visual (AV) aids.

Handouts
When creating handouts, remember the following:
• Do not exceed a length of 10 pages
• Write as a content outline with space for note-taking not a verbatim script of a presentation
• Offer relevant tables, charts, etc.
• Include a bibliography
• Type on clean white paper
• Select a font size no smaller than 12 point
• Select a font style that is easy to read, such as Arial or Times New Roman
• Number each page
• Adhere to copyright laws (e.g., don’t duplicate graphics without permission)

Flip charts
When creating flip charts, remember the following:
• Make sure that the flip chart and stand are sturdy
• Use a pad with grid lines to align text
• Put no more than six lines on each page
• Use dark markers to make it easier for participants to read the writing

Transparencies
When creating transparencies, remember the following:
• Do not exceed 10–12 words per transparency

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• Put transparencies in order, and number them
• Keep the transparency clean and uncluttered
• Use half-inch–high bold letters and numbers on transparencies
• Use a light shade for the background color, and use a dark shade of text for contrast

35 mm slides
When creating 35 mm slides, remember the following:
• Do not exceed 10–12 words per slide.
• Keep slides clean and uncluttered.
• Keep information brief and to the point.
• Keep the font size at 14–16 point for 35 mm slides.
• Avoid using a white or light-colored background.
• Colors like green or blue serve as good background colors. Use a dark background
color, and put text and accents in light colors. White text on a dark blue or black background is a good choice.
• Keep a consistent color and style scheme for all slides.
• Use a font such as Arial that is easy to read on screen.

PowerPoint presentations
When creating PowerPoint presentations, remember the following:
• Use a font size of 20–22 point.
• Keep the colors simple.
• Experiment with different fonts and graphics before developing the entire presentation.
• Don’t go overboard with animation or video clips. These techniques are appropriate
when used for emphasis and to add interest. Avoid using them to the extent that they
distract from the content.
• Remember that not all organizations can afford to facilitate the development of numerous PowerPoint presentations.

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Conclusion
The education strategy selected must be the one that best facilitates learning. Strategies must not
only be effective but user-friendly and cost effective. Staff development specialists must plan
and implement their programs by focusing on the needs of the learner and the organization as
well.

Bibliography
Avillion, A.E. A practical guide to staff development: tools and techniques for effective education.
Marblehead, MA: HCPro, Inc, 2004.
DiMauro, N.M. “Integrating technology choices into practice.” In B.E. Puetz and J.W. Aucoin
(Eds.). Conversations in nursing staff development. Pensacola, FL: National Nursing Staff
Development Organization, 2002. 287–302.
Fennimore, L.A. “Delivering distance learning.” In B.E. Puetz and J.W. Aucoin (Eds.).
Conversations in nursing staff development. Pensacola, FL: Pohl Publishing, 2002. 317–328.
O’Connor, M.G., and G. Virgil. “Teaching/learning methodologies.” In A.E. Avillion (Ed.). Core
curriculum for staff development. 2nd ed. Pensacola, FL: National Nursing Staff Development
Organization, 2001. 231–260.
Puetz, L., and S.A. Zuel. “Educational planning.” In A.E. Avillion (Ed.). Core curriculum for staff
development. 2nd ed. Pensacola, FL: National Nursing Staff Development Organization, 2001.
199–229.

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F INAL

EXAM

1. As part of an extensive course on new oncology chemotherapeutic agents, the learner must be
able to distinguish between two drugs (referred to here as Drug A and Drug B) with similar names
and actions but that cause quite different side effects. Which of the following objectives best
explains what the learner must accomplish?
a. Define Drug A and Drug B
b. Discuss Drug A and Drug B
c. Contrast the side effects of Drug A and Drug B
d. Determine the side effects of Drug A and Drug B

2. A group of experienced critical care nurses are updating their pharmacology knowledge. As part
of the education program, these nurses will select and administer these drugs during a mock
code situation. Which of the following objectives is most appropriate for this group of learners?
a. Recall the side effects of new critical care drugs
b. Discuss the action of new critical care drugs
c. Administer new cardiac drugs accurately and safely during a simulated code
d. Identify potentially lethal interactions among the new cardiac drugs

3. Nursing students entering their junior year are learning to assess the respiratory system. They
have just begun to study abnormal breath sounds today. Which of the following objectives is most
appropriate for achievement at the conclusion of their 60-minute class?
a. Describe three different abnormal breath sounds
b. Demonstrate accurate lung auscultation
c. Demonstrate accurate percussion of the lungs
d. Critique the respiratory assessment capabilities of a peer

4. The clinical departments must design and implement a fall prevention program to which all direct
patient care providers adhere. All clinical departments should have input into the program. Which
of the following education formats is most appropriate to accomplish this project?
a. Role play
b. Group discussions
c. Simulation
d. Lecture/discussion

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5. All housekeeping staff must be trained in the use of a new cleaning solution that has the potential
for harm if not used correctly. They also need training to use equipment to dispense the solution
and to protect themselves from harm while using the solution. Which of the following is the best
teaching option?
a. Distance learning
b. Lecture/discussion and return demonstration
c. Role play and self-learning modules
d. Group discussion

6. The orientation of nurses hired to work on the cardiac care unit includes assessment of their ability to interpret rhythm strips and to demonstrate the correct clinical intervention (including psychomotor skills). Because this group includes both experienced and inexperienced cardiac nurses,
what is the best education strategy to use?
a. Lecture/discussion
b. Role play
c. Blended learning
d. Self-learning modules

7. The ability to perform accurately and swiftly during a code is part of advanced cardiac life support
(ACLS) certification. Which of the following strategies is most appropriate to measure this need?
a. Skill demonstration
b. Lecture discussion
c. Group discussion
d. Self-learning module

8. Which of the following is a good recommendation when developing handouts?
a. Do not make handouts more than 20 pages in length
b. Use a minimum font size of 8 point
c. Avoid including charts in handouts
d. Include a bibliography

9. All of the following are appropriate when creating slides EXCEPT:
a. placing a maximum of 10–12 words on each slide
b. keeping the font size to 14–16 point
c. varying styles and color schemes among the slides
d. using a dark background color

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10. Martha works within the limits of a small budget. She is using overhead transparencies for a presentation. Which of the following is a good recommendation for Martha?
a. Use a maximum of 20 words per transparency
b. Use a dark transparency background
c. Copyright laws do not affect information on transparencies
d. Use half-inch–high bold letters and numbers

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7

R ECORDKEEPING

Competency: The staff development specialist establishes and maintains a recordkeeping system.

OBJECTIVES
At the conclusion of this chapter, the learner will be able to
1. discuss the types of records the staff development department must maintain
2. write a policy for the confidentiality of educational records

Introduction
Establishing and maintaining a recordkeeping system allows the staff development specialist to
access attendance records, program evaluation data, and the planning and implementation processes
of learning activities. Accrediting agencies such as the Joint Commission on Accreditation of
Healthcare Organizations (JCAHO), the Occupational Safety and Health Administration (OSHA), and
the American Nurses Credentialing Center (ANCC) also mandate the maintenance of such a system.
Many organizations have established their own password-protected computerized recordkeeping systems, which allow authorized personnel easy access to necessary data. The challenge is in determining the identity of the authorized individuals and ensuring that these same people do not divulge
passwords or share confidential information. This chapter provides information on the development
and maintenance of a recordkeeping system, including how to maintain confidentiality.

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Types of records maintained
The following records are mandatory components of the staff development department’s recordkeeping system:
1. Attendance lists: A record of the learning activity, faculty, teaching/education strategy,
date and time of the activity, number of contact hours (if offered), and the names and
signatures of participants. If the program is offered via distance learning, the date and
time requirement may be met by noting the activity format and the date and time when
the learner engaged in the activity.
2. Competency validation: A record of required competencies, how they were validated,
and the date and time of validation.
3. Orientation checklists (can be combined with competency validation): A record
that provides evidence that essential procedures, policies, routines, and job expectations
were provided to the employee upon hire or transfer to a different unit/department.
4. Individual employee records: Each employee must have a record of his or her education participation, including but not limited to mandatory training, orientation, and attendance at inservices and continuing education events.
5. Meeting minutes: Documentation of what happened at staff development department
meetings. Maintain meeting minutes to show the processes of educational planning,
implementation, and evaluation.
6. Needs assessment process: An explanation of the needs assessment process and maintenance of documentation showing how education was planned and implemented based
on identified needs. Documentation evidence includes surveys, meeting minutes, quality
improvement meeting minutes, and risk management data.
7. Learning activity records: The following items must be included in the records of all
learning activities:

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• How it was determined that a need existed for a particular program
• Education activity calendars
• Evidence of who planned the activity
• Explanation of how faculty were involved in the planning process
• Evidence that the faculty were qualified to teach the program
• Objectives
• Target audience
• Teaching/education strategies
• Content
• Handouts
• Audio-visual aids (e.g., copies of videos, slides)
• Physical facilities (e.g., classroom and computer availability)
• Number of contact hours, if applicable
• Sample of certificate awarded or written verification of participation
• Copy of pre- and post-tests, skill verification, etc.
• Program evaluations
• Any materials used to advertise the program
• Attendance checklists
• Analysis of how the education affected organizational effectiveness, if applicable
These learning activity records may be filed alphabetically, chronologically, or by activity code
number. They are used as permanent files and resources when repeating, updating, or revising
learning activities.

Recordkeeping policy
A recordkeeping policy should look similar to the example in Figure 7.1.

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FIGURE

7.1

Sample recordkeeping policy

The Staff Development Department of Myers Health System maintains education records in accordance with the mission, vision, and values of Myers Health System and according to the standards
of

Joint Commission on Accreditation of Healthcare Organizations

Records are maintained for a period of

two

.

years.

(Note: Base number of years on organizational and certification requirements.)
The following records are maintained:
• Attendance lists
• Competency validation
• Orientation checklists
• Individual employee education records
• Staff development department meeting minutes
• Needs assessment process
• Learning activity records including, but not limited to, the following:
- Needs identification
- Education activity calendars
- Planning committee members
- Faculty, how they were involved in the planning process, and their qualifications
- Objectives
- Target audience
- Teaching/education strategies
- Content
- Handouts
- Audio-visual aids
- Physical facilities
- Number of contact hours, if applicable
- Sample of certificate awarded or written verification of participation

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FIGURE

7.1

Sample recordkeeping policy (cont.)

- Copy of pre- and post-tests, skill verification, etc.
- Program evaluations
- Any materials used to advertise the program
- Attendance checklists
- Analysis of how the learning activity affected organizational effectiveness
Learning activities are filed alphabetically and used as permanent files and resources when repeating, updating, or revising learning activities.
The recordkeeping system is automated and housed in the health systems computer network. Data entered
as part of the recordkeeping system are “backed up” via CDs by the information systems specialists.
Access to the records is limited to protect the confidentiality of the employee and faculty.
Confidentiality is maintained in the following ways:
- All files are password protected.
- Employee records are filed alphabetically by unit/department. Each unit/department’s
records are password protected. The only persons with access to these records are the
respective managers of the units/departments and the staff development specialists.
Sharing confidential information, including sharing passwords with other managers or unauthorized personnel, is forbidden, and persons who do so are subject to disciplinary action.
- The records do not contain performance evaluations, disciplinary actions, grievances filed,
or health data concerning individual employees. Such information is accessible only to the
employee’s managers and the human resource specialists. Staff development specialists
have no access to this type of information.
- Back-up CDs of education records are maintained in a locked, fire-proof file cabinet in the
staff development office. The only persons who have access to the file cabinet are the
staff development specialists.

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Conclusion
Recordkeeping is mandated by various accrediting organizations. Keeping up-to-date records is
one way of tracking program attendance and effectiveness. A written policy that focuses on
records collected and on maintaining confidentiality is necessary. The development of an automated system facilitates record retrieval and saves both time and effort.

Bibliography
Jones, D., and C. Little. “Recordkeeping.” In A.E. Avillion (Ed.). Core curriculum for staff development. 2nd ed. Pensacola, FL: National Nursing Staff Development Organization, 2001.
435–445.

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EXAM

1. Which of the following statements about recordkeeping systems is accurate?
a. Only agencies that deal exclusively with nursing personnel can mandate a recordkeeping
system
b. All managers throughout the organization should have access to the staff development
department’s recordkeeping system.
c. Program evaluation data must be maintained in the recordkeeping system
d. Attendance records are primarily the responsibility of the individual employee’s manager

2. Helen transfers to the pediatric oncology unit after working for five years on an adult oncology
unit. Staff development records maintained must include:
a. orientation to the pediatric oncology unit
b. rationale for transferring to the pediatric oncology unit
c. Helen’s most recent performance evaluation
d. any disciplinary action that affected Helen’s performance record

3. Which of the following is an accurate statement concerning recordkeeping?
a. Minutes of the staff development department are not considered essential to the recordkeeping system unless they refer to mandatory training activities
b. Each employee must have a record of his or her participation in learning activities
c. Dates of participation in distance learning activities are not essential
d. Competency validation is under the jurisdiction of middle management, and staff development specialists generally are not involved in the process

4. Which of the following is NOT an acceptable way to file learning activity records?
a. Alphabetically
b. Chronologically
c. Per activity code number
d. According to evaluation results

5. A written policy governing recordkeeping should include:
a. the length of time for which records must be maintained
b. disciplinary action taken for employees who fail to attend mandatory training
c. personnel files of staff members who serve as faculty
d. qualifications of staff development specialists

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6. Melanie is the manger of the intensive care unit. She allows one of her senior primary nurses,
Bonnie, to access the confidential education records of all her colleagues so Bonnie can help
Melanie write performance evaluations. Which of the following statements is correct about
Melanie’s actions?
a. Melanie has the authority to delegate this type of responsibility
b. Bonnie has the authority to share this information with her colleagues in Melanie’s
absence
c. Melanie is subject to disciplinary action for violating confidentiality standards
d. Bonnie needs to have access to this information in the event that Melanie is ill or unable
to work

7. The rationales for keeping education include all of the following EXCEPT:
a. adherence to accrediting standards
b. revision of learning activities
c. tracking disciplinary action taken against employees
d. recording orientation of new employees

8. It is imperative that records concerning the faculty member include:
a. his or her date of birth
b. his or her qualifications to teach
c. the length of time he or she has worked for the organization
d. his or her performance evaluations

9. Which of the following helps maintain confidentiality of education records?
a. Password-protected automated system
b. Maintaining back-up CDs of records in the organization’s education library
c. Decentralized written records maintained on individual units/departments
d. Written files accessible to departmental secretaries

10. A JCAHO surveyor is reviewing the education record of a nurse who recently transferred from the
medical intensive care unit to the emergency room. Which of the following must be part of this
nurse’s education record?
a. Most recent performance evaluation
b. Any disciplinary actions taken against this nurse
c. Evidence of orientation to the emergency room
d. The nurse’s reasons for transferring to the emergency room

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STYLES

Competency: The staff development specialist will plan and implement programs in accordance
with the various learning styles of the participants.

OBJECTIVES
At the conclusion of this chapter, the learner will be able to
1. differentiate between the three basic learning styles, which are visual, auditory, and kinesthetic
2. incorporate teaching methods that facilitate learning for persons of each learning style

Introduction
Most experts recognize three distinct styles of learning: auditory, visual, and kinesthetic. Some
staff development specialists develop and implement programs by focusing—often unconsciously—on their own preferred learning style, but they must recognize the characteristics of the others as well and incorporate strategies that meet the needs of all participants.

Auditory learners
Auditory learners learn by relating sounds to knowledge. They learn predominantly by hearing
and respond best to verbal instructions. Auditory learners hum or talk to themselves or others

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(even in classroom settings) when they are bored or restless, and they often read aloud to
acquire knowledge. Such verbalization helps them remember important facts—as they speak,
their brains are stimulated to assimilate knowledge and skills.
Auditory learners position themselves wherever they best can hear (but not necessarily see) the
person presenting information. Many even use auditory words, such as “I hear what you’re saying” or “That sounds good to me,” in their everyday speech. Also, their emotions can be
revealed from the tones of their voices.
Because they learn by hearing or speaking, auditory learners learn best from lecture/discussion
formats, audiotapes, audioconferences, and discussion groups. They do not enjoy visual aids or
written handouts.

Staff development

TIP

Consider these factors when facilitating the auditory learners’ education experience:
• Allow auditory learners to talk through problems and procedures and to express their
solutions verbally whenever possible.
• Provide excellent verbal explanations.
• Assess learner satisfaction by listening to tone of voice. Auditory learners may say that
everything is “fine,” but their tones of voice may indicate otherwise.

Visual learners
Visual learning is the predominant learning style for adults. Those who learn in this way prefer
to position themselves where they can see the presenter or visual aids. They take detailed, copious notes, like verbal discussions to contain lots of imagery, and like handouts and visual aids
that are colorful, contain graphics, and are visually stimulating. Visual learners may close their
eyes to visualize what they are learning. They express their emotions via facial expressions.

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Staff development
Consider these factors when facilitating visual learners’ education experience:
• Provide handouts or other visual aids that are illustrated and colorful
• Ensure that these learners can see the presenter or visual aids easily
• Make sure that written materials are easy to read

Staff development scenario: Sheila is a nurse new to the staff development specialty. She is facilitating a course on advanced respiratory pathophysiology. During the lecture/discussion portion
of the course, Shelia notices that Maxine seldom looks at her and often appears to be muttering
under her breath. However, Maxine frequently contributes to the discussion. Michael sits quietly
in the front of the classroom, takes detailed notes, and seldom contributes to verbal discussions.
However, both of these participants score well on the post-test. Shelia asks her manager for help in
understanding the behaviors of these participants. What is the manager likely to say?
Shelia does not recognize the characteristics of the various learning styles. Maxine, the auditory
learner, prefers auditory stimulation and often repeats facts aloud to memorize them. Michael,
the visual learner, dislikes auditory stimulation and prefers visual stimulation. Their behaviors
are typical of these two learning styles.

Kinesthetic learners
Kinesthetic learners, sometimes called “hands-on” learners, acquire knowledge and skill by
direct, physical involvement. They learn best by doing, so they must be active participants in
the session, and they require frequent breaks. Kinesthetic learners speak with their hands and
display feelings through body language. Their favorite phrases include, “Keep in touch,” “We
need to touch base,” or “I can’t grasp this information.” They may struggle to remember information that is relayed visually or verbally, but they remember activities performed physically
without difficulty.

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Staff development

TIP

Consider these factors when facilitating kinesthetic learners’ education experience:
• Provide opportunities for skill demonstration
• Allow time for breaks at regular intervals
• Use demonstration (whether in person, on DVDs, or during computer-based learning) as much as possible
• Learners may say that everything is “fine,” but their tones of voice may indicate
otherwise.

Staff development scenario: Teresa is an experienced staff development specialist. She knows that
the participants in her pain management pharmacology course represent three different learning
styles. In order to meet the needs of visual, auditory, and kinesthetic learners, what concepts
should she incorporate into her program?
To meet the needs of visual learners, Teresa uses visual aids such as handouts, videos, and
graphics because they are colorful, and explicit, and easy to see. She also positions herself during lectures/discussions so participants can see her.
For the auditory learners, Teresa facilitates discussion, encourages participant input, and gives all
directions clearly and concisely. She also avoids an overabundance of auditory stimulation and
visual distraction, which helps to maintain a comfortable learning environment for visual learners, who are distracted by too much noise, and for auditory learners, who may find too much
visual stimulation distracting.
For the kinesthetic learners, Teresa builds frequent breaks into the program. She also displays
equipment used to administer pain medication, as well as outdated samples of the drugs being
discussed. These learners appreciate the chance to move around and to handle the equipment
and drug samples.

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Conclusion
Experienced staff development specialists recognize their own learning styles as well as the
styles preferred by participants in their learning activities. Acknowledging learner characteristics
and incorporating a variety of teaching strategies into learning activities makes education enjoyable and effective for all types of learners.
Figure 8.1 summarizes learning style characteristics and preferred teaching strategies.

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FIGURE

8.1
Learning style
Auditory

Summary of learning styles
Learner characteristics

Preferred teaching strategies
• Lecture/discussion

• Learn best from verbal
instruction

• Audio tapes
• Need to hear but not
• Audioconferences

necessarily see the
presenter

• Group discussions
• Read aloud to acquire
knowledge

• Hum or talk to themselves
when bored

• Remember by verbalizing
facts

• Use auditory words in their
every day speech, such as,
“I hear what you mean” or
“That sounds good to me”

• Conduct business effectively via telephone or audioconference

• Reveal emotions through
tone of voice

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8.1
Learning style
Visual

STYLES

Summary of learning styles (cont.)
Learner characteristics

Preferred teaching strategies

• Sit where they can best

• Handouts that are well-illustrated

see the presenter or

and colorful

observe visual aids
• Visibility of presenter or visual aids
• Often close their eyes to
visualize or remember

• Written materials that are easy to

something

read

• Respond to visual aids

• Give the opportunity to read

such as slides, graphics,

through learning materials

and written handouts

• Prefer written or spoken
language filled with
imagery

• Find auditory and kinesthetic stimuli distracting

• Prefer passive
environments

• Take copious notes

• Reveal emotions through
facial expressions

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FIGURE

8.1
Learning style
Kinesthetic

Summary of learning styles (cont.)
Learner characteristics

Preferred teaching strategies
• Direct, hands-on involvement

• Sometimes referred to as
“hands-on” learners

• Return demonstrations
• Display emotion through
• The opportunity to move around at

body language

frequent intervals
• Remember what activities
• Directions accompanied by demon-

are performed but have

stration

trouble remembering what
was said or seen

• Use phrases such as,
“Keep in touch” and
“I can’t grasp this
information”

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Bibliography
Avillion, A.E. A practical guide to staff development: Tools and techniques for effective education.
Marblehead, MA: HCPro, Inc, 2004.
Miller, S. “Three different learning styles.” The University of South Dakota,
www.usd.edu/trio/tut/ts/style.html (Accessed on April 28, 2003).

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F INAL

EXAM

1. Mark is a staff development specialist responsible for facilitating a lecture/discussion group on
cardiac pathophysiology. One participant, Miranda, seldom looks at Mark and often repeats
important facts softly after Mark presents them. Mark believes that she is uninterested in the
topic. To his astonishment, however, she scores 100% on the post-test and compliments Mark on
his teaching ability. It is probable that Miranda is:
a. a visual learner
b. a kinesthetic learner
c. an auditory learner
d. a learner who is already familiar with the program content

2. Lauren is having trouble grasping the basics of physical assessment of the respiratory system.
During a lecture presentation, she hears about the various lung sounds and the techniques of
auscultation, percussion, and palpation. During a return demonstration skills lab, Lauren suddenly recognizes what she needs to do and accurately demonstrates the necessary physical assessment skills. What type of learner is Lauren?
a. Auditory
b. Kinesthetic
c. Visual
d. Verbalizing

3. Scott is an RN who has recently transferred from the neurosurgical unit to the spinal cord injury
rehabilitation unit. He successfully completes a computer-based learning program on the rehabilitation of the spinal cord patient. The program contained a significant amount of graphics, charts,
and patient illustrations. Scott is probably:
a. a visual learner
b. a kinesthetic learner
c. an auditory learner
d. a verbalizing learner

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4. Donna is a staff development specialist who prepares colorful, well-illustrated handouts. Which of
the following learners will best appreciate these handouts?
a. Dan, who learns a new procedure by reading the steps aloud
b. Josephine, who prefers return demonstration as an education strategy
c. Adam, who is easily distracted by auditory stimuli
d. Laura, whose favorite phrase is, “That sounds good to me!”

5. Deborah has created a distance learning activity via a series of audio tapes. Which of the following
learners will most enjoy this format?
a. Marie, who reads textbooks aloud when studying
b. Jeremy, who prefers to take detailed notes
c. Ray, who likes to participate in role play and simulations
d. Adrian, who prefers to sit where he can easily see the presenter

6. Allison likes to sit in the front of the classroom. She learns best when handouts are detailed, colorful, and contain graphics. Allison is:
a. a kinesthetic learner
b. a visual learner
c. an auditory learner
d. a hands-on learner

7. Amy likes to talk through new procedures and verbalize solutions. Amy is:
a. a visual learner
b. an auditory learner
c. a kinesthetic learner
d. a hands-on learner

8. Maxine notices that one of the participants attending her critical care course often closes her eyes
for a moment when an important point is made. This participant sits in the front of the classroom
and takes copious notes. Maxine is afraid that the participant is bored. In reality, the participant’s
learning style is probably:
a. auditory
b. kinesthetic
c. visual
d. hands-on

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9. Ben is responsible for facilitating the code simulation portion of advanced cardiac life support
recertification. He should keep in mind that simulations and demonstrations are the preferred
learning strategy for which of the following people?
a. Ray, who prefers a quiet learning environment
b. Pat, who likes group discussions
c. Hailey, who thinks of herself as a kinesthetic learner
d. Kelly, who thinks of herself as a visual learner

10. Anticipate that emotions are expressed through body language with what type of learner?
a. Kinesthetic
b. Visual
c. Auditory
d. Verbal

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EDUCATION
FOR MULTICULTURAL
AND MULTIGENERATIONAL
PARTICIPANTS

Competency: The staff development specialist plans and implements learning activities in accordance with the needs of multicultural and multigeneration participants.

OBJECTIVES
At the conclusion of this chapter, the learner will be able to
1.
2.
3.
4.

incorporate cultural diversity into learning activities
identify common cultural factors that influence participants’ behaviors
describe the common characteristics among specific generations of learners
plan and implement learning activities that meet the needs of multi-generational learners

Introduction
For the first time in the history of the United States, four different generations of Americans are
working alongside each other in various work settings. Each generation has specific values, attitudes, and expectations that sometimes enhance, but often disturb, the workplace. The staff
development specialist must meet the learning needs of these four generations simultaneously.
In addition to recognizing differences among generations, the staff development specialist must
provide learning activities that account for the diverse cultural backgrounds of employees.
Likewise, these employees must be able to work together and serve patients and families from
many cultures.

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This chapter offers suggestions to enhance the learning environment of employees from different generational perspectives and cultural backgrounds.

Cultural diversity and the practice of staff development
Knowledge of cultural customs can help to avoid misconceptions and misunderstandings and,
ultimately, can enhance both patient care and the workplace environment. However, there is a
danger of stereotyping persons of the same cultural background. To believe that “all Muslims do
this” or “all Catholics believe that” is impractical, incorrect, and often offensive. Therefore, the
staff development specialist must distinguish between stereotyping and generalizing cultures.
For example, suppose a nurse is assigned to provide postoperative care for an Italian man. The
nurse assumes that he will be excitable, will want pain medication, and will have many emotional family members at his bedside. Making such assumptions is stereotyping. On the other
hand, suppose the nurse recognizes that Italians may be emotionally expressive and rely on the
overt emotional support of family members. She is prepared to help both the patient and his
family as needs arise. This nurse recognizes certain possible behaviors but does not make automatic assumptions about how the patient and his family will behave. This is referred to as making a generalization. The difference between stereotyping and generalizing may seem slight, but
it is in fact quite significant.
Staff development scenario: Gayle is a staff development specialist who recently accepted a position at an organization with a large Chinese and Chinese-American population. Gayle meets
with a 65-year old nurse manager of Chinese descent to discuss learning needs for the manager’s
unit. The manager has the reputation of being one of the best managers in the hospital, and
Gayle looks forward to working with her. Throughout the meeting, Gayle attempts to make eye
contact with the manager, who consistently avoids doing so. Gayle is offended and thinks that the
manager is not interested in discussing educational needs. Later, Gayle learns that her attempt to
make eye contact was offensive to the nurse manager, because for her, refusal to make eye contact is a sign of respect.
Gayle vows never to make the same mistake again. During one of her group discussion learning
activities, Gayle interacts with all of the participants but avoids making eye contact with Kevin, a

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young intensive care nurse of Chinese ancestry. After the discussion ends, Kevin approaches
Gayle and asks what he has done to offend her. “You looked at everyone else when you talked to
them, but not to me!” Gayle learns that Kevin is a fourth-generation Chinese-American, does not
speak a word of Chinese, and has an American cultural perspective.
Despite her best intentions, Gayle has stereotyped Kevin based on her experience with the
nurse manager and based on Kevin’s appearance. If Gayle had actively observed Kevin’s interactions with the rest of the group, however, she would have noticed that he did not avoid eye
contact with others. Recognizing the possibility that eye contact might be offensive was appropriate. Behaving as if that was automatically true for all persons of Chinese descent was not.
The previous example shows how easy it is to mistake stereotyping for cultural sensitivity. Staff
development specialists not only must deliver education to help employees care for patients of
various cultures but also must meet the needs of culturally diverse staff members. Here are
some suggestions for meeting this challenge:
1. Identify predominant cultures among the patient and employee population. It is
impossible to educate staff about all cultures. Therefore, begin by identifying those that
are most common in the populations you serve and focusing on these cultures during
diversity education and training.
2. Consider offering a course in English for speakers of other languages. It may be to
an organization’s benefit to offer such a course: Employees whose native language is not
English are at a disadvantage when communicating with their English-speaking colleagues and patients. In addition, it is impossible to understand diverse cultures if
healthcare providers and patients are unable to speak with each other. Many colleges
and universities offer this type of course, so consider negotiating with them to have a
course brought on-site to your organization.
3. Consider offering a course about the language(s) other than English that are most
common among patients and staff. For example, if Spanish-speaking patients make
up a significant portion of an organization’s patient population, negotiate with a local
college or university to provide a conversational Spanish course for employees.

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4. Include American culture as part of diversity training. Although Americans span a
variety of ethnic and racial backgrounds, there are cultural distinctions that are typically
American. For example, most Americans value eye contact as an indicator of attention
and concentration. Members of Asian and Middle Eastern cultures often avoid eye contact, considering it to be rude or an indication of sexual promiscuity. Therefore, a nurse
who has just arrived from Japan must learn the significance of eye contact to Americans.
Another example is that Americans are often perceived by other cultures as being loud and
boisterous, while Americans view their behavior as enthusiastic and friendly. Consider this
scenario:
An American is dining in a Parisian restaurant with her husband, a Frenchman. At the next
table, a group of Americans are talking about the upcoming Super Bowl. The woman introduces
herself as a fellow American, and she is soon engaged with them in animated conversation. The
American notices that her husband is becoming increasingly uncomfortable and a bit embarrassed. When asked, her husband explains that in France, people do not have conversations simply because they are from the same country. It just isn’t done.
When planning cultural diversity learning activities, discuss American characteristics as well as
the characteristics of other cultures.
5. Include cultural diversity training in the orientation of all employees. Most organizations include some type of cultural diversity education when orienting direct patientcare providers. All employees from all departments can benefit from such training. At
one time or another, most employees interact with patients, visitors, and colleagues, so
they all should receive cultural diversity education.
6. Incorporate cultural sensitivity into the organization’s competency education and
training. A combination of written pre- and post-tests, role play, and on-the-job behaviors can help you assess cultural competency.

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Staff development
Use work-related case studies and scenarios to teach cultural diversity. Present the study
or scenario from two distinct cultural viewpoints. For example, write a case study about
pain management for a Mexican patient and then present the same case study with a
patient who is a native of Vietnam. This excercise allows participants to consider care
provision for the same problem (i.e., pain) but from two distinct cultural viewpoints.

Identifying topics in cultural diversity
What facets of a culture are important to include in cultural diversity training and education?
The following diversity education planner identifies important topics to include in learning activities. The form is a template that you can complete and use to compare and contrast two or
more cultures.

FIGURE

9.1

Cultural diversity education planner

Characteristics

Culture

Culture

Culture

Family and gender roles
• Head of household/family
• Role of women
• Role of elderly
• Role of extended family
• Family structure
• Decision-maker regarding
care, if other than patient
• Role of children
• Importance of children,
including gender value

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FIGURE

9.1

Cultural diversity education planner (cont.)

Characteristics

Culture

Culture

Culture

Communication
• Body language
• Tone of voice
• Facial expression
• Eye contact
• Gestures
• Posture
• Spokesperson, if other
than patient
Sexuality
• Gender roles
• Sex outside of marriage
• Homosexual relationships
• Celibacy
• Male circumcision
• Female circumcision
• Menstruation
• Birth control
• The birth process
Pain
• How pain is expressed
• How pain is perceived
(e.g., punishment, divine
will, etc.)
• Accepted measures to
relieve pain
Diet/nutrition
• Preparation
• Restrictions
• Religious mandates

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EDUCATION FOR MULTI - CULTURAL AND MULTI - GENERATIONAL PARTICIPANTS

Cultural diversity education planner (cont.)

Characteristics

Culture

Culture

Culture

Religion
• Role in daily life
• Specific practices
• Clergy representation
• Influence on perceptions
of illness and injury
• Treatment issues (e.g.,
blood transfusions, need
for same-sex caregivers)
Health practices
• View of illness (e.g., punishment, divine will, etc.)
• Home remedies
• Herbal remedies
• Cultural remedies
• Trust or lack of trust in
medical technology
• End-of-life issues (e.g.,
organ donation, whether
the patient is informed of
his or her terminal status)
Work ethic
• Gender issues
• Financial needs
• Respectability of specific
occupations
Other

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Conclusion
Ongoing cultural diversity training and education is necessary. An excellent resource for up-todate information about numerous cultures is Geri-Ann Galanti’s Web site, www.ggalanti.com/
articles.html. It is updated frequently and offers information about diverse cultural healthcare
issues.

Education planning for multigenerational learners
Consider the following example of generational differences: If asked to identify a significant
national event that occurred during their lifetimes, how will members of different generations
respond? “Veterans” (born between 1922 and 1945) may talk about the death of President
Franklin D. Roosevelt, the president who was elected to an unprecedented four terms and led
the country during the Great Depression and World War II. Later generations are unlikely to
think of Roosevelt’s death when asked this question. For example, most “Baby Boomers” (born
between 1946 and 1960) are likely to discuss the assassination of President John F. Kennedy.
However, if the name Kennedy is brought up in the presence of “Generation Xers” (born
between 1961 and 1980), the death of John F. Kennedy, Jr. may come to mind. Xers and
“Generation Yers” (born between 1981 and 2000) (as well as the two previous generations) may
cite the horrific events of September 11, 2001, in New York and Washington, DC, as the national
events having the greatest impact on their lives. This example shows the wide gap in experiences that affect the generations.
Staff development specialists must recognize the general characteristics of each generation, how
these characteristics affect the learning process, and what implications these characteristics have
for education planning and implementation.
Caution: As with cultural diversity, it is important to generalize, not stereotype. The characteristics presented in this chapter are generalities and may not be displayed by all members of a given generation.

Veterans (1922–1945)
Veterans experienced first-hand two of the most critical events of the 20th century: the Great
Depression and World War II. These events have shaped how they view themselves and the world
in which they live. To better understand the Veteran learner, consider the following characteristics:

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• Veterans have vivid memories of parents and grandparents who came to the United
States as immigrants. They value cultural traditions and the wisdom and wit of their
remembered elders.
• Veterans prefer formal learning environments and dislike sharing experiences that they
deem to be too personal.
• Veterans treat authority figures with respect.
• Veterans view educators as authority figures.
• Veterans are the least likely of all learners to confront you directly if they disagree with
you. Staff development specialists may not be aware that Veterans are dissatisfied with a
learning experience until program evaluations are completed.
The following recommendations to facilitate learning for Veterans are based on the preceding
characteristics:
• Because Veterans prefer a formal learning environment, allow for lecture/discussion time.
Do not ask personal questions, and do not force Veterans to share personal experiences.
Show that their life experiences are valued, and provide a nonthreatening environment
for the sharing of those experiences if they so desire.
• Veterans view educators as authority figures. They expect educators to both be dressed
in and behave in a business-like fashion. Avoid profanity and the extensive use of slang.
• Veterans like organized structured activities. Make sure that objectives are clearly stated
and understood. Provide organized handouts that summarize key points of the education
activity.
• When developing written materials and visual aids, avoid small print. Use at least 14point font and a style, such as Arial, that is easy to read.

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• Distance learning is not a favorite with Veterans. If distance learning is the teaching
strategy, make sure that Veterans have contact information for the staff development
specialist facilitating the distance learning activity (which is a good idea regardless of
the participant’s generation but may be especially important for veterans). Veterans and
Baby Boomers may prefer face-to-face clarification, while Xers and the Generation Y
members may rely more heavily on e-mail communication.
• Treat Veterans with respect at all times.
• Never presume that Veterans are computer illiterate.
• Veterans dislike activities that may show their lack of skill or knowledge in front of
younger colleagues. Therefore, establish nonthreatening learning environments.

Baby Boomers (1946–1960)
Baby Boomers, generally raised by doting Veteran parents, grew up believing that they were
entitled to the best the world had to offer. They also believe that they must change the world
for the better. Here are some common Baby Boomer characteristics:
• Baby Boomers have a passionate work ethic
• Financial success is of great importance to Baby Boomers
• Baby Boomers invented the phrase, “Thank God it’s Monday,” and the 60-hour work week
• Baby Boomers value teamwork
• Baby Boomers value personal gratification in the workplace
• Baby Boomers are dedicated learners and initiated the self-help book craze
• Baby Boomers do not respond well to authority figures
• Baby Boomers are often perceived to have a “know it all” attitude
The following are teaching considerations for Baby Boomers:
• Baby Boomers respond best to educators who treat them as equals and share personal
accounts of their own knowledge
• Baby Boomers want to know how learning activities will enhance job performance

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• Baby Boomers enjoy team learning activities, icebreakers, and group discussions
• Baby Boomers do not like role play
• Baby Boomers do not like to display a lack of knowledge or skill in front of others
• Baby Boomers are the first generation to use the Internet and to make information easily
accessible

Generation X (Xers) (1961–1980)
Xers are known as the latchkey generation. They are the first generation to predominantly experience single-parent families or families with two working parents. Computers are considered a
part of their daily lives. Here are some common Xers characteristics:
• Xers value a reasonable balance between work and personal time.
• Xers value flexibility.
• Xers dislike close supervision and prefer self-directed activities.
• Xers are comfortable with change and view it as normal.
• Xers are accustomed to changes in their family structures.
• Xers know about downsizing through their parents’ experiences and are not motivated to
work for one organization throughout their careers.
• Xers are not loyal to an employer; rather, they are loyal to themselves. Having seen the
ramifications of downsizing, they are concerned about protecting themselves.
• Xers are motivated to save money and secure their financial futures.
Teaching considerations are plentiful for Xers. Baby Boomers and Xers view the world quite

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differently. There are often interpersonal conflicts between these generations due to differences
in work ethics and world views.
When teaching Xers, consider the following:
• Xers prefer self-directed learning. They are born distance learners. They prefer to participate in learning activities at a time and place convenient for them.
• Xers dislike having to be in a specific place at a specific time to participate in education.
• Xers like to have fun during learning activities.
• Xers enjoy role playing and simulations. They are not as worried as Baby Boomers and
Veterans are about making mistakes in front of others.
• Xers enjoy discussion. They are enthusiastic learners and ask lots of questions. If distance learning is the teaching method, clearly identify how questions should be
answered (e.g., e-mail, office appointments, etc.)
• Xers prefer immediate feedback and reward.
• Xers do not automatically respect authority figures. Their respect must be earned by
demonstrating knowledge, expertise, and enthusiasm.
• Xers generally prefer lots of visual stimulation, such as pictures, graphics, and tables.
They prefer these types of visual aids to the printed word.

Generation Y (Yers) (1981–2000)
Generation Y will replace the Baby Boomers in the workplace and redefine the working environment. Some characteristics common to Yers include the following:
• Yers have grown up in the age of technology and, therefore, take computers and the
Internet for granted.

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• Yers grew up with DVD players, CD players, and cell phones.
• Yers value diversity.
• Yers are accustomed to sharing the workload and usually held part-time jobs in high
school and college.
• Yers are globally oriented. They do not assume geographic isolation or geographic
protection.
• Most Yers are comfortable with single-parent families, families with stepparents and
stepsiblings, and same-sex unions. Grandparents are often the primary parent figures.
• Yers have even less company loyalty than Xers. They view downsizing as typical of business and have witnessed a constant stream of mergers, takeovers, and closings.
• Yers focus more on what they do than on where they work.
• Yers respect persons who demonstrate knowledge and skill. They generally respect
Veterans and value their life experiences.
When teaching learners from Generation Y, consider the following:
• Yers are comfortable with the tools associated with distance learning
• Yers enjoy the opportunity for interaction with colleagues during learning activities
• Yers look for fun as well as structure in the workplace and during learning activities
• Yers are comfortable with the technology of distance learning but prefer interactive
opportunities
• Yers benefit from mentor programs and often admire Veterans
• Yers have a strong work ethic and share many of the values of Veterans
• Yers value education
• Yers enjoy reading

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Conclusion
Meeting the needs of the various generations is an ongoing challenge. The apparent differences can lead to conflict, especially between the Veterans and the Baby Boomers, as well as
between the Xers and Yers. Therefore, incorporate a variety of teaching methods and flexibility into education planning. Staff development specialists must also be aware of their own generational characteristics and avoid allowing them to interfere with helping members of other
generations learn.

Bibliography
Alch, M.L. “Get ready for the Net Generation.” Training & Development 37, no. 2 (2000): 32–33.
Avillion, A.E. A practical guide to staff development: Tools and techniques for effective education.
Marblehead, MA: HCPro, Inc, 2004.
Galanti, G.A. “An introduction to cultural differences.” Culture and Medicine 172, no. 5 (2000):
335–336. www.ggalanti.com/articles/Intro.pdf
Galanti, G.A. “Filipino attitudes toward pain medication.” Culture and Medicine 173, no. 10
(2000): 278–279.
Hammill, G. “Mixing and managing four generations of employees.” FDU Magazine Online.
www.fdu.edu/newspubs/magazine/05ws/generations.htm (Accessed on May 17, 2005).
News Digest. 2001. “Baby boomers.” Training. (Electronic version) (Accessed on August 24,
2002.)
News Digest. 2001. “Generation Xers.” Training. (Electronic version) (Accessed on August 24,
2002.)

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EXAM

1. Filipinos are often stoic when dealing with pain. They may not express that they are suffering considerably. Janet, an RN working on a surgical unit, recognizes this characteristic. She is taking
care of a middle-aged Filipino man who has had surgery because of a bowel obstruction. Which of
the following actions indicates a generalization of his cultural characteristics?
a. Janet assumes that he is hiding his suffering and insists that he take his pain medication
b. Janet asks him whether he is in pain
c. Janet recognizes that he may not verbally complain of pain and assesses both verbal and
nonverbal indications of pain
d. Janet assumes that all Filipinos hide their suffering

2. Vicki is planning to teach a pain management course for a group of culturally diverse participants. Which of the following statements indicates that Vicki is sensitive to cultural differences?
a. Vicki assumes that all of the Italian-American participants believe that all patients need
maximum amounts of pain medication
b. Vicki plans to ask a British nurse to explain to the class why patients of British descent
are too reserved to ask for pain medication
c. Vicki believes that all of the participants will agree that pain medication should be given
as often as possible
d. Vicki plans to share generalized beliefs about pain and suffering among various cultures

3. Nicole is in charge of planning cultural diversity training for her organization. All of the following
are appropriate steps to take EXCEPT:
a. avoiding teaching about American culture because doing so may offend some participants
b. offering a course on English for speakers of other languages for employees whose native
language is not English
c. identifying predominant cultures of the patient and staff populations
d. making cultural diversity part of the organization’s competency training program

4. Ashley is responsible for the general orientation of all new employees. Today’s group of orientees
includes persons from physical therapy, nursing, maintenance, and information systems. Which of
the following actions is appropriate?
a. Allow maintenance and information systems employees to report to their departments
when offering cultural diversity training
b. Incorporate cultural diversity training throughout the orientation program for all orientees

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c. Confine cultural diversity training to a brief lecture about tolerance
d. Make cultural diversity training optional for those persons who do not provide direct
patient care

5. Jack is a staff development specialist responsible for customer satisfaction training. Elizabeth, an
outpatient surgery nurse, is extremely polite and appears interested throughout the program. She
treats Jack with respect and appears comfortable with the lecture format. After the program concludes, Jack reads Elizabeth’s program evaluation comments with surprise. She found the program
a waste of time and was generally dissatisfied with the experience. Based on this scenario,
Elizabeth is most likely a member of which generation?
a. Generation Y
b. Generation X
c. Baby Boomer
d. Veteran

6. Cassie has planned a learning activity that requires a great deal of teamwork and discussion.
Participants from which of the following generations are most likely to like this approach?
a. Baby Boomer
b. Veteran
c. Generation X
d. Generation Y

7. Mark is a member of the Veteran generation. Which of the following learning activities will he most
likely prefer?
a. Computer-based learning
b. Role play
c. Lecture/discussion
d. Simulation

8. Jennifer designs a handout with a great deal of visual stimulation. She has kept the number of
printed words to a minimum and prefers to teach via graphs, tables, and pictures. Jennifer is probably a member of which generation?
a. Baby Boomer
b. Generation X
c. Veteran
d. Generation Y

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9. The generation that has come to view downsizing as normal is:
a. Generation Y
b. Generation X
c. Veteran
d. Baby Boomer

10. Sandra is a newly licensed RN. She has a strong work ethic and enjoys participating in mentoring
activities. She accepts computer technology as the norm and is comfortable with all types of distance learning. However, she prefers the opportunity to interact with her colleagues. A member of
which of the following generations is best suited to mentor Sandra?
a. Baby Boomers
b. Xers
c. Yers
d. Veterans

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DEALING WITH THE
RESISTANT LEARNER

Competency: The staff development specialist identifies coping strategies to use when dealing with
the resistant learner.

OBJECTIVES
At the conclusion of this chapter, the learner will be able to
1. discuss issues that trigger resistance to learning
2. evaluate education offerings during which resistance is evident
3. describe ways to defuse the resistant learner

Introduction
Nancy is teaching the return skills demonstration portion of an education program designed to
reduce workplace violence. As part of the program, various codes are discussed (i.e., Code 44
indicates a violent patient or family outburst). Lisa, a long-time employee of the labor and delivery unit, is obviously bored. She rolls her eyes, loudly whispers derogatory comments to colleagues, and frequently interrupts Nancy and other participants during discussions to ask questions or to complain about the procedures being taught. Finally, she asks Nancy, “Why do we
need all these stupid code numbers? It’s just one more thing to worry about and wastes our time
learning pointless facts.”

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Nancy has had enough. She asks Lisa, “If you were an ill or injured patient confined to bed,
what would you rather hear paged, ‘Code 44, labor and delivery unit,’ or ‘There’s a violent visitor
throwing things at nurses in the labor and delivery area?’ And wouldn’t you want to get help
quickly if you were the nurse he was throwing things at?” The rest of the class applauds, and Lisa
is quiet for the remainder of the learning activity.
Does this scenario sound familiar? All staff development specialists face the challenge of dealing
with learners who do not want to participate in specific learning activities. These learners are
restless, sometimes rebellious, and often sullen. Their verbal comments and body language let
everyone involved in a classroom, discussion group, or skills demonstration know that they definitely do not want to be there. Learners resistant to certain distance learning programs do their
best to spread negative comments about the activities, sometimes derailing what could have
been a highly effective education experience. The attitudes and behaviors of such learners affect
others, making it difficult to establish and maintain a positive learning environment.
Staff development specialists must recognize and accept that resistant learners aren’t going to go
away. There are always employees who seem to make it their vocation to complain and disrupt
learning activities. This chapter discusses the issues that often trigger resistant learners and ways
to defuse them.

Why learners are resistant
No one can make someone else want to learn. Staff development specialists are responsible for
planning learning activities that benefit employees and the organizations in which they work—
they are not responsible for an adult’s refusal to learn.
Staff development specialists must not blame themselves for a learner’s lack of motivation.
There are times when learning activities are ineffectively designed or conducted, but in most
cases, educators are not to blame for a colleague’s unwillingness to learn.
What should staff development specialists do when confronted with resistant learners? Ignoring
or accepting the resistant learners’ attitudes and behaviors is not an option. Doing so will only
encourage inappropriate behaviors, interfere with the other participants’ abilities to learn, and

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TIP

Staff development
Remember that personal problems affect both attitudes and behaviors. Resistance to
learning may have nothing to do with the learning activity or the staff development specialist responsible for the initiation of the activity. The staff development specialist may be the
target of misplaced anger, so avoid taking a learner’s resistance personally.

hamper the staff development specialist’s ability to lead learning activities effectively. The following suggestions for dealing with resistant learners are not always easy to perform, and
they are not 100% effective, but they can help to diffuse the negative atmosphere created by
resistant learners.

Important questions to answer about the learning activity
Learners may be resistant due to the nature or presentation of a learning activity. However,
this reason for resistance does not mean that the program is poorly planned and implemented
or that the staff development specialist is ineffective. Rather, it means that some important factors may not have been addressed or adequately investigated. For that reason, the staff development specialist should evaluate the effectiveness of learning activities by asking the following questions:
1. Do learners understand why they are participating in the learning activity?
Resistance is sometimes due to a lack of understanding about the importance of education. No matter how effectively the program is advertised or its purpose explained, not
all employees have equal access to information. Part-time employees, prn employees,
and employees who generally work only weekends are often out of the communication
loop. Therefore, determine how thoroughly the program’s purpose has been disseminated and how clearly the objectives have been identified.

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2. Is the learning activity offered in response to a learning need or a systems flaw?
Most staff development specialists have been asked to use education to correct a problem that is a systems flaw rather than a learning need. Mandating that employees attend
such a program almost always guarantees a great deal of resistance. If, despite the staff
development department’s best efforts, this type of program is still mandated, try to make
the training as concise and convenient as possible. Consider developing pre- and posttest options. If employees successfully pass a pretest, proof exists that knowledge deficit
is not the problem. The same concept can be used with skill demonstration. If employees accurately demonstrate a particular skill, further training is unnecessary, and knowledge deficit is not the problem.
3. Is the program designed to meet the needs of diverse groups of learners?
Staff development specialists must do their best to get to know their learners. They can
do so in several ways:
• Establish a friendly rapport with colleagues. Observe their learning styles, and get to
know them in a nonlearning environment. For example, have lunch with different
groups of employees and talk with them about topics other than education. Learners
are more likely to provide honest feedback and to cooperate during learning activities if they know and respect educators.
• Pay particular attention to learning styles, cultural characteristics, and generational
characteristics.
• Offer education in formats that are convenient and effective. For example, don’t
expect employees who have little or no access to computers to be enthusiastic about
computer-based learning.
4. Are learners afraid of repercussions if the learning activity is not completed
successfully?
Most organizations have certain knowledge requirements that employees must meet to
keep their jobs or receive promotions. Fear of adverse consequences often makes learners behave negatively. Staff development specialists cannot alter the consequences, but
they can ensure that learning activities are designed for maximum effectiveness.

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5. Do the staff development specialists responsible for implementing learning
activities have credibility in the minds of the learners?
A staff development specialist who plans and implements leadership and management
training must have a record of successful managerial experience if he or she wants the
respect and cooperation of learners. All learners need to believe that the person teaching
them possesses practical experience as well as theoretical knowledge.
6. Will learners have the opportunity to apply the new knowledge and skills in
their work settings?
Acquiring new knowledge and skills without the opportunity to apply them in the workplace violates one of the basic principles of adult learning. Learners resent devoting time
and effort to pursue knowledge they cannot apply. Therefore, an organization must not
only support training and continuing education but also help employees apply the
acquired knowledge and skills.
7. Do learners feel comfortable in the learning environment?
Is the learning environment appropriate for the activity and for the needs of the learners?
The environment is easier to control in a classroom or demonstration setting than it is
for distance learning. Do learners have access to and the ability to operate necessary
equipment? If not, why not? Whatever the format, learners must not feel threatened, and
both the physical and emotional learning environments must be comfortable.
8. Is the staff development specialist enthusiastic about the learning activity?
The staff development specialist facilitates (or inhibits) learning through tone of voice,
body language, and enthusiasm. An upbeat, positive attitude is usually contagious.

Dealing with overt hostility
Staff development scenario: Emergency preparedness training is mandatory for all nurses working in a large medical center in downtown Washington, DC. Wendy is responsible for planning
and leading this training. She adheres to principles of adult learning, uses a variety of teaching
methods, and is enthusiastic and knowledgeable.

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Most participants are interested and attentive throughout the training. However, Amanda and
Rachel, two nurses from the respiratory care unit, are overtly hostile. They whisper and giggle
and roll their eyes at comments made by colleagues during group discussions. Immediately
before a scheduled break, Amanda says, “We don’t have to sit through this. Francis will get us
out of here.”
Francis is the vice president of nursing. She is also Amanda’s cousin and a close friend of
Rachel’s, and rumor has it that these two nurses are treated with considerable favoritism because
of their friendship with Francis. How does the staff development specialist respond?
This type of situation is frustrating and not all that uncommon. However, two people can not be
allowed to disrupt the learning experience for the rest of the participants. The staff development
specialist calls for a break or initiates a small group activity in order to speak privately with
Amanda and Rachel. Privacy is important to avoid embarrassment to Wendy or the two other
nurses. Wendy tells them that obviously they are upset and don’t want to participate. She asks
them if there is anything she can do to improve the learning experience for them. They
respond, “Sure there is. Just let us leave!”
Wendy tells them that the choice is theirs to make: They can either stop disrupting the class and
show some consideration for their colleagues or they can return to their work setting. They must
take responsibility for their actions.
The nurses choose to return to their work setting. The next day Wendy is summoned to the
Francis’s office and asked to explain why she asked Rachel and Amanda to leave the training
session. Wendy is prepared for this question, and she explains as objectively as possible what
happened. She makes it clear that she gave the women a choice and that the decision to leave
was theirs.
Staff development scenario: Orthopedic nursing staff members are required to participate in a
computer-based learning course about pain management for the surgical amputee patient.
Participants routinely enjoy the course, and it has proven to be quite effective. Jeremy, a newly
hired orthopedic nurse, has been making derogatory comments about distance learning in
general and about this course in particular. His frequent comments are starting to affect his

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colleagues. Some who have yet to take the course are beginning to respond negatively to the idea
of distance learning. What should be done to rectify this situation?

Several questions to answer:
1. Does Jeremy know how to participate in computer-based learning? If he does not, he may
be reluctant to admit to his lack of knowledge about it.
2. Are there consequences for failing to complete this course successfully? Jeremy may be
fearful of disciplinary action if he performs poorly.
3. Does Jeremy understand the importance of the course and how the knowledge he gains
will be applied in the work setting?
4. Has the staff development specialist talked to Jeremy about Jeremy’s concerns?
The answers to these questions will help to identify the reasons for Jeremy’s resistance and will
help the staff development specialist help Jeremy learn.
Staff development scenario: Diane is a staff development specialist with a background in rehabilitation nursing. She is waiting for Pauline, a staff nurse on the spinal cord injury rehabilitation unit,
to arrive. Pauline has been having difficulty applying her knowledge of spinal cord pathophysiology
to the rehabilitation setting, and her manager has asked Diane to design some self-learning modules for her. Such modules have been a great help to other nurses with similar difficulties.
Pauline arrives 15 minutes late and is obviously angry. She refuses to sit down and says, “I’ve
been a nurse for seven years and never had any problems before. It’s the way this stupid hospital
is run. You don’t have any right to tell me how to be a nurse!” Diane asks Pauline to sit down
and tries to explain that she wants to make this experience less frustrating for Pauline and to help
her use her rehabilitation skills. Pauline responds by reaching across the desk, grabbing both of
Diane’s arms, and shouting, “I don’t need you to interfere in my business!”
Dealing with violence is frightening. Whether the hostility is expressed verbally or physically,

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the staff development specialist must take steps to protect himself or herself and to help the
violently resistant learner. Here are some suggestions when dealing with violent learners:
• Ask them to sit down. Assuming a sitting posture often has a calming effect. The staff
development specialist should sit down as well. Doing so puts the two at equal eye
level and helps defuse anger.
• Never allow an angry person to block the exit from the room. Always make sure
that the exit is easily accessible. If the staff development specialist feels that he or she is
in danger, the angry learner is asked to leave. If the learner does not comply, the staff
development specialist should leave the area at once.
• Never make a threatening gesture (e.g., grabbing the angry person’s arms). Doing
so causes the situation to escalate, may cause an outburst of physical violence, or may
trigger an accusation of assault and battery against the staff development specialist.
• Use a calm, measured tone of voice. Do not speak loudly or let body language indicate fear or anger.
• Do not take anger personally. In such situations, the staff development specialist is
generally the target of displaced anger. This knowledge doesn’t make the situation any
less frightening, but it does make it easier to maintain self-control.
• Listen actively. Maintain eye contact. Explain that the purpose of the meeting is to help
him or her but that shouting or threats will not be tolerated. Learners need to know that
they are free to express concerns and that they will receive all available help as long as
they treat others with respect.
• Know how to get help quickly. Don’t be afraid to call for help if the threat of danger
exists. Know how to summon security personnel. If it is anticipated that a meeting has
the potential for violence, ask another colleague to be present or a security officer to
remain nearby.

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• Report all incidents of violence, whether verbal or physical. Never allow violence
to go unreported. Follow organizational policies and procedures for reporting these
incidents.

Conclusion
Resistant learners are an ongoing issue for most, if not all, staff development specialists. The
staff development specialist must do everything possible to help such learners acquire knowledge; however, he or she must not allow disruptive behaviors to compromise the learning experience for others. Although the staff development specialist cannot make someone want to learn,
he or she can facilitate learning as best as possible. To do so, rely on the principles of adult
learning and respect differences of learning style, culture, and generational perspectives to promote enthusiasm for the learning process.

Bibliography
Avillion, A.E. A practical guide to staff development: tools and techniques for effective education.
Marblehead, MA: HCPro, Inc, 2004.
Dickerson, P.S. “Ten tips to help learning.” Journal for Nurses in Staff Development, 9/10 (2003):
244–250.
Hequet, M. “Training no one wants.” Training, 41, no. 1 (2004): 22–28.
Mulvihill, C. “Dealing with the difficult patient.” University of Pittsburg, www.pitt.edu/
~cjm6diff.html. (Accessed on August 6, 2002.)
Trainingmag.com (1998) “Stand up: Defusing the hostile trainee.” Training (Electronic version),
August 6, 2002.

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F INAL

EXAM

1. Which of the following statements about resistant learners is accurate?
a. It is up to the staff development specialist to successfully motivate resistant learners
b. A learner’s resistance may actually have little or nothing to do with the staff development
specialist
c. Learners usually are resistant because the learning activity is poorly planned or implemented
d. The problem of resistant learners will decrease as distance learning opportunities
increase

2. Carolyn is a nursing assistant on the orthopedic unit of a small community hospital, and she is
scheduled to attend mandatory classroom training today. She is in the midst of divorce proceedings. Before she leaves for work, her lawyer informs her that her husband is suing for full custody
of their children. Carolyn is frightened and angry. She arrives at work feeling upset and longs to
express her fears and frustration. Throughout the training, she is restless and frequently makes
derogatory comments about the instructor and the learning activity. Carolyn is most likely
expressing:
a. dissatisfaction with an unqualified instructor
b. frustration with a poorly planned learning activity
c. misplaced anger
d. fear of failure

3. The nurse managers at Metropolitan Hospital want medication administration training to be mandated for all nurses due to an increase in the number of medication errors. The nurses say that
the errors are due to changes in pharmacy policies and the timing of meals and treatments that
conflict with medication times. What does this situation best indicate?
a. A systems flaw
b. A learning need
c. Insubordinate nurses
d. Misplaced anger

4. Which of the following situations is most likely to trigger learner resistance?
a. Mandatory ACLS certification for critical care nurses
b. Emergency preparedness training for military healthcare personnel

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c. A staff development specialist who asks to work part-time on the pediatric unit before
planning pediatric continuing education
d. A staff development specialist with a background in orthopedic nursing is assigned to
develop and implement orientation programs for emergency department personnel

5. Maxine is attending a program on the prevention of workplace violence. She is obviously angry
about having to attend this program. She whispers to the person sitting near her and is overheard
making comments such as, “This is such a waste of time!” and “We should all walk out!” Which
of the following is an appropriate action for the staff development specialist to take?
a. Stop the lecture/discussion and tell Maxine to be quiet
b. Call for a break, privately tell Maxine that her behavior is distracting to the other participants, and say that if she is unable to participate appropriately, she should return to her
work area
c. Ask to speak to Maxine privately, and ask her to please stop complaining
d. Ignore Maxine’s behavior, and continue with the program

6. Serena is facilitating a skills demonstration lab that requires her to certify employees after they
have mastered the skill. One of the participants is the CEO’s daughter-in-law, Shelly. Shelly performs poorly and does not seem to care whether she demonstrates skills accurately. She tells the
staff development specialist, “You just better not make me do this over and over. It doesn’t matter
anyway. My father-in-law will make you certify me. If you don’t, I’ll see that you get fired!” What
should the staff development specialist do?
a. Explain to Shelly why it is important to master this skill and that she will not be certified
until she achieves competency
b. Privately ask Shelly not to discuss education issues with the CEO
c. Ask Shelly to leave the skills demonstration
d. Report Shelly to the CEO and file a grievance with her immediate supervisor

7. Matthew storms into Cindy’s office in the staff development department. He has failed a distance
learning pharmacology update course and must now attend additional educational programs. He is
angry and blames Cindy for his failure. What should Cindy do?
a. Ask Mark to sit while she remains standing. Doing so gives her a position of authority.
b. Realize that Mark dislikes her and is using the course failure as an excuse to verbally
abuse her.
c. Make sure that Mark does not position himself between her and the exit to the office.
d. Avoid telling anyone else that Mark is angry.

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8. All of the following statements about dealing with angry colleagues are accurate EXCEPT:
a. do not take anger personally
b. speak in calm, measured tones
c. report all incidents of violence, whether verbal or physical
d. be sure to meet with the angry person privately to respect his or her confidentiality

9. Pediatric nurses in a small community hospital must participate in continuing education that deals
with pain management for pediatric patients. The unit is short-staffed, and every bed is continuously occupied. The nurses are enthusiastic learners and are eager to participate in this learning
activity. There is one computer available for the purpose of computer-based learning. To avoid
resistance, what learning strategy is best suited in this situation?
a. Classroom learning
b. Self-learning modules
c. Computer-based learning
d. Audioconferences

10. Jason is confronted in his office by a nursing assistant who is angry because she has failed the
written CPR recertification exam. The nursing assistant is verbally abusive and is clenching and
unclenching her fists. What is an appropriate action for Jason to take?
a. Grasp the nursing assistant gently by the arm and ask her to leave
b. Tell the nursing assistant that she is out of control and that he is calling security
c. Move behind his desk so that the nursing assistant is between Jason and the doorway
d. Speak in calm, measured tones; maintain eye contact; and attempt to calm the nursing
assistant

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11

T IPS FOR PLANNING
ORIENTATION , INSERVICE , AND
CONTINUING EDUCATION

Competency: The staff development specialist will plan and implement orientation, inservice,
and continuing education using time-saving strategies that enhance the efficiency of education delivery.

OBJECTIVES
At the conclusion of the chapter, the learner will be able to
1. develop orientation strategies that reduce the time and number of staff required to orient
employees
2. implement a mechanism for inservice training that facilitates the delivery of “just in time”
training
3. design continuing education programs that meet learner needs and adhere to accrediting
agency standards

Introduction
Staff development specialists are constantly asked to deliver education in ways that are faster,
more efficient, take less work time, and improve job performance. It is often an overwhelming task. This chapter offers the experienced staff development specialist tips for meeting
these challenges.

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Orientation
One of the few certainties of staff development practice is that orientation is in a state of constant review and revision. There is no such thing as a “perfect” orientation program. However,
an orientation program can be flexible and can complement existing processes.
1. Assign responsibility for orientation to specific staff development specialists.
Someone must be in charge of the project, but that does not mean that only these individuals deliver orientation. To the contrary, in most organizations, the entire staff development department participates to some extent. However, assigning primary responsibility for orientation ensures that orientation efforts are scrutinized constantly.
2. Arrange orientation activities in conjunction with other programs as often as possible. For example, if rhythm-strip interpretation is a component of orientation as well as
a competency for critical care nurses, arrange to offer competency assessment/reassessment on a regular basis and have it coincide with orientation. Depending on the number
of nurses involved, offer the pretests/posttests twice a month on the same day that new
critical care orientees perform this task. Distinct learning opportunities (e.g., orientation
and ongoing competency assessment) are offered simultaneously, thus saving time and
money. This method is a huge time-saving strategy when it comes to mandatory training
and skill demonstration, so combine education efforts whenever possible.
3. Establish preceptor programs for all departments, not just those involved in direct
patient care. A manager should not assume the role of primary preceptor. Rather, staff
members who show an interest and aptitude for the role should be groomed as preceptors. The role of preceptor should be accompanied by a salary differential when preceptor duties are performed. Offering all employees such an opportunity enhances morale.
Here are some specific tips for a preceptor program:
• Identify specific qualifications for the preceptor role, including education and length
of job experience.
• Avoid assigning the role of preceptor to all employees. This role requires special
skills and strengths.

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• Do not force anyone to become a preceptor. Candidates for this role must want to
assume the accompanying responsibilities.
• Select individuals who demonstrate not only job expertise but a genuine desire to
help colleagues excel at their jobs, as well as a flair for teaching.
• All candidates for the preceptor role must attend training and education programs
designed to groom employees as preceptors. The following topics should be included in any preceptor curriculum:
- Principles of adult education
- Learning styles
- Generational differences
- How to offer constructive criticism
- How to deal with a resistant learner
- How to evaluate job performance objectively
- Leadership principles
- Communication skills
4. Incorporate the organization’s competency requirements into orientation. Initial or
ongoing competency assessment generally requires some time set aside for taking preand posttests and for skill demonstration. Offer all three for both orientees and established employees within the same period. Doing so provides an option for both groups
to avoid classroom or distance learning hours if they demonstrate competency successfully right away. Persons who need additional education and training may then attend
classroom or other means of instruction to achieve competency. Avoid setting up separate competency assessment mechanisms and teaching sessions for orientees alone;
doing so is often an inefficient use of time.

Inservice education
Inservice education generally refers to training delivered to meet an immediate need. Also
known as on-the-job or “just in time” training, such education must be delivered swiftly,
accurately, and concisely. Typically, inservices must be delivered around the clock so that

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employees working different shifts receive adequate training. Most organizations do not have
enough staff development specialists to deliver inservice training to all employees without
assistance. Here are some suggestions to meet inservice needs efficiently:
• Use distance learning techniques whenever possible. For example, the implementation of
a revised policy may require proof that employees have read and accepted the revisions.
Do not waste time and money setting up classroom training for such simple inservices.
E-mail distribution is an efficient way to disseminate such information quickly, and e-signatures are acceptable as proof that the policy has been read and accepted. If employees
do not have access to unit/department e-mail, their managers can post a copy of the policy, along with a sign-in sheet indicating acceptance.
• Note that some managers of small departments may choose to present new information
during a staff meeting. Regardless of methodology, training must be documented. A simple template that can be customized and distributed quickly saves time when training
must be quick and concise. Consider using such a template for all inservices that consist
primarily of reading information. Another example is reviewing background information
on a rarely seen illness affecting a recently admitted patient.
• Use available resources outside the staff development department. For example, suppose
staff on a particular unit need to learn quickly how to use a new piece of equipment.
Contact the vendor leasing or selling this equipment. Most vendors have preprinted
guidelines for equipment use and often are willing to provide inservice training.
Preceptors should be among the first to be trained and to demonstrate accurate use of
such equipment. In turn, because preceptors have already demonstrated their ability to
facilitate learning, they can help train their colleagues.
Such inservice training must be documented and maintained. If questions arise about the proper
use of equipment (e.g., family complaint, patient injury, accreditation review), such documentation is essential. Again, develop and maintain a template for such training to allow for swift customization and distribution.

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FIGURE

11.1

FOR PLANNING ORIENTATION , INSERVICE , AND CONTINUING EDUCATION

Inservice documentation form
for review of written materials

Date:_____________________________

Department/unit: __________________

Information distributed: __________________________________________________________________
(e.g., new/revised policy, update on evolving health hazards, background information on a rarely
seen illness, etc.)

The attached document(s) indicate a change or a new way of providing products and services to our
patients, families, visitors, and/or employees. After you have read these document(s), indicate that
you comprehend and accept changes in policies, organizational directives, and relevant new patient
information by dating and signing below. If you have any questions, please contact your department
manager.

It is required that all employees read the attached documents and sign their names by the following
date: _________________

Date: _______________Signature: _____________________________Title: ________________________

________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

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FIGURE

11.2

Inservice documentation
form for skill training

Date: ___________
Time: ___________
Objective: __________________________________
Skill acquired: ______________________________
Trainer:_____________________________________
After observing accurate demonstration of __________________________________________________,
the following learners demonstrated competence in __________________________________________
________________________________________________________________________________________

________________________________________________________________________________________
(Trainer’s signature, time, and date)
Date: _________ Time: _________ Learner’s signature and title: ________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

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Clinical staff members are often expected to learn basic information about a disease process or
treatment when patients are admitted with unusual or rarely seen illnesses. Here are some useful Web sites to use when confronted by these types of challenges:

Centers for Disease Control: www.cdc.gov
According to the CDC’s Web site, “The Centers for Disease Control and Prevention (CDC) is
recognized as the lead federal agency for protecting the health and safety of people—at home
and abroad, providing credible information to enhance health decisions, and promoting health
through strong partnerships. CDC serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and education activities designed to improve the health of the people of the United States.”

National Institutes of Health: www.nih.gov
According to NIH’s mission statement, “The National Institutes of Health is the steward of medical and behavioral research for the Nation. It is an Agency under the U.S. Department of Health
and Human Services.”

American Association for Clinical Chemistry: www.labtestsonline.org
The American Association for Clinical Chemistry’s Web site offers information on a wide variety
of lab tests (including rarely ordered tests) and how to interpret findings.

Federal Food and Drug Administration: www.fda.gov
The Federal Food and Drug Administration’s Web site offers a wealth of information about drug
trials, approvals, warnings, and cautions.

PubMed: www.pubmed.gov
According its Web site, PubMed is a service of the National Library of Medicine and includes
millions of citations for biomedical articles—dating back to the 1950s. The citations are from life
science journals.

Continuing education
Continuing education is defined as a learning activity designed to enhance an employee’s

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professional growth and development. Experienced staff development specialists have
planned and implemented many such programs. However, offering continuing education
programs that also allow professionals to obtain specific numbers of contact hours or continuing education credits is increasingly important. Many states and healthcare organizations
mandate that certain types of professionals obtain a specific number of continuing education
credits annually. Many licensed professionals must earn such credits in order to maintain
licensure/specialty certification. Here are some suggestions when applying for continuing
education credit from a professional association or other accrediting body:
1. Obtain instructions for completing the application and follow them exactly. If
there are questions or concerns about any facet of the process, call the accrediting
agency and follow its directives. Some parts of the application may appear to be redundant, but do not attempt to avoid repetition by using such statements as “Refer to page
55 for this answer” or “This information has already been presented on page two.” Make
it as easy as possible for the people reviewing the application. These reviewers do not
want to (nor will they) flip through an application searching for information. If you are
asked to do so, repeat information accordingly.
2. Meet deadlines. All accrediting agencies ask that applications be submitted within a specific period before offering the program. If the accrediting agency wants the application
in six weeks before program implementation, you must submit it then.
3. Meet the accrediting agency’s qualifications guidelines. If two RNs, one of whom
must hold a graduate degree in nursing, is the standard for the committee planning the
program, then it is necessary to meet that standard. When identifying faculty, whether
for classroom or distance learning activities, make sure that they are qualified experts in
the content field. It’s generally required that a brief résumé be submitted by all members
of the planning committee, including faculty.
4. Avoid conflicts of interest. Most accrediting agencies frown on a program that is implemented to advertise or promote specific products or businesses, such as a pharmaceutical agency or physician practice. Follow all standards concerning this issue carefully.

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5. Make sure that objectives are explicit and measurable. The objectives also must coincide with content offered—some staff development specialists write wonderful objectives
that have little or nothing to do with actual or relevant program content. Instead, objectives should help the learner identify the important aspects of the program. For example,
an objective that mandates that learners identify anatomical structures in the lungs is not
of primary importance when the content focuses on the pathophysiology of myocardial
infarction. That doesn’t mean participants should ignore the lungs—it just means that the
lungs are not the focus of this program.
6. Content must allow for the achievement of objectives. The content must reflect the
objectives, and the objectives must reflect the content. If the content presented does not
provide adequate information to achieve the objectives, the focus of the program is misdirected.
7. Participant attendance must be verified. Verification options include sign-in sheets, esignatures, completion of pre- and posttests, etc.
8. Achievement of objectives must be evaluated. Evaluation strategies include posttests,
skill demonstration, role play, simulation, etc.
9. Participants must have an opportunity to evaluate the program. These evaluations
must be kept on file, and the information obtained must be used to enhance future
learning activities.

Conclusion
Staff development specialists are required to offer and evaluate many different types of programming. Emphasize ease of delivery, attendance, and facilitating maximum competency in a short
amount of time. Practical, creative use of resources can help you fulfill staff development
responsibilities in an efficient, constructive manner.

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Bibliography
Avillion, A.E. A practical guide to staff development: tools and techniques for effective education.
Marblehead, MA: HCPro, Inc, 2004.
Ellis, K. “Top training strategies.” Training, 7/8 (2003): 31–35.
Fennimore, L.A. “Delivering distance learning.” In B. E. Puetz and J.
W. Aucoin (Eds.) Conversations in nursing professional development. Sudbury, MA: Jones and
Bartlett Publishers, 2002. 317–328.
Gloe, D. 2001. “Implementation of learning activities.” In A.E. Avillion (Ed.) Core curriculum for
staff development. 2nd ed. Pensacola, FL: National Nursing Staff Development Organization,
2001. 261–302.
Puetz, L., and S.A. Zuel. “Educational planning.” In A.E. Avillion (Ed.) Core curriculum for staff
development. 2nd ed. Pensacola, FL: National Nursing Staff Development Organization, 2001.
199–229.

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EXAM

1. Simone is responsible for the orientation program at Kane Health System. She believes that a preceptor program will benefit new employees and enhance the efficiency of orientation. Which of
the following actions should Simone take?
a. Facilitate the development of preceptorships within all departments
b. Arrange for the managers of housekeeping and maintenance to act as the preceptors for
all new employees
c. Avoid associating monetary rewards with the role of preceptor
d. Note that job expertise is the only important requirement for the preceptor role

2. It is essential that all of the following be included in a preceptor curriculum EXCEPT:
a. learning styles
b. communication skills
c. return demonstration of clinical skills
d. how to evaluate job performance

3. Cardiac care nurses at Community Hospital must demonstrate ongoing competency in the interpretation of cardiac arrhythmias. A logical way to do so is to:
a. develop a self-learning module that all nurses must complete annually
b. mandate classroom instruction on this topic for all nurses orienting to the cardiac care
unit
c. mandate that both orientees and established employees attend the same classroom
instruction concerning interpretation of cardiac arrhythmias
d. develop pre- and posttests that, if successfully completed, validate competency for both
new employees and established employees and that allow them to bypass classroom
instruction

4. A new policy concerning workplace security must be disseminated and reviewed by all employees
as soon as possible. Which of the following is the most efficient, appropriate strategy for this type
of “just in time” training?
a. E-mail will be distributed, with electronic signature indicating that employees have read
and accepted the new policy
b. Staff development specialists will review the policy with staff members on designated
units/departments during all shifts

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c. Classroom training will be planned and implemented
d. Staff development specialists will videotape a reading of the policy highlighting essential
changes and make the video available to all department managers

5. A newly admitted patient requires the use of an IV pump never seen by the majority of the nursing
staff on the admitting unit. They need inservice training. Which of the following approaches is most
efficient and ensures the highest degree of competency?
a. Formal classroom inservice
b. Inservices provided by the equipment vendor around the clock on the unit
c. Mandatory inservice training for all nurses in the organization
d. Mandate that all nurses watch a video about the new IV pump

6. Mrs. Temple is admitted to Metropolitan Hospital. She is receiving an innovative treatment that
requires the use of equipment rarely seen in this facility. All of the following statements pertaining
to inservice training in this situation are accurate EXCEPT:
a. vendors leasing or selling this equipment may be of valuable assistance in the training
process
b. this is a good example of “just in time” training and, as such, formal documentation of
training is not an important issue
c. preceptors are often able to facilitate inservice training
d. distance learning is not appropriate for immediate skill demonstration

7. Which of the following is an example of inservice training?
a. Instruction regarding the use of a new patient-lifting device
b. Pathophysiology of spinal cord injury and its treatment
c. Oncology pharmacology course focusing on new chemotherapeutic agents
d. Staff development course focusing on innovative teaching techniques

8. Which of the following is an example of continuing education?
a. CPR certification
b. Review of new patient care policy
c. Identification and discussion of professional liability issues
d. Demonstration of accurate use of new type of patient restraints

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9. Miranda is planning a continuing education program focusing on the pathophysiology of breast cancer. Which of the following is an appropriate goal?
a. Participants will understand the manifestations of invasive breast cancer
b. Participants will describe the pathophysiology of invasive ductal breast cancer
c. Participants will identify structures of the female reproductive tract
d. Participants will discuss the impact of breast surgery on breast feeding

10. The most effective evaluation strategy for a continuing education program focusing on pharmacological advances in pain management is:
a. discussion
b. role play
c. pre- and posttests
d. e-signature

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Q UALITY

IMPROVEMENT
AND EVALUATION OF
EDUCATIONAL EFFECTIVENESS

Competency: The staff development specialist will evaluate the success of learning activities by
measuring their impact on learner behavior and organizational effectiveness.

OBJECTIVES
At the conclusion of this chapter, the learner will be able to
1.
2.
3.
4.
5.

identify learner satisfaction
measure knowledge acquired as a result of a specific learning activity
evaluate changes in job performance as a result of a specific learning activity
assess the impact of education on organizational effectiveness
measure return on investment (ROI) from specific learning activities

Introduction
Staff development specialists are responsible for the quality and effectiveness of their learning
activities. There must be documented evidence that education improves job performance,
enhances patient outcomes, and contributes to the financial solvency of the organization. To collect this evidence, an objective system of data collection and analysis must be part of the quality
improvement efforts of the staff development department.

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If a staff development specialist is consistently rated as “highly qualified” and an “excellent”
presenter, those ratings are nice but do not prove that education increased organizational effectiveness. On the other hand, a 40% decrease in patient falls following fall prevention training
shows that education has improved patient safety. This chapter concentrates on various evaluation strategies that are useful as quality improvement monitors and that help demonstrate the
worth of the staff development department.

Level I evaluation: Reaction and learner satisfaction
Level I evaluation is used to describe the learner’s reaction to and satisfaction with a learning
activity. It includes the learner’s response to the presenter and to the learning environment.
Sometimes referred to as the “happiness” index, Level I evaluations generally are forms that participants complete at the end of learning activities. Not long ago, such evaluations dealt almost
exclusively with classroom learning, but today, Level I evaluations must address the distance
learning environment as well. The following templates (featured in Figures 12.1 and 12.2) offer
suggestions for Level I evaluations from classroom and distance learning formats.
Such reaction data are always useful. They help identify presenter strengths and weaknesses,
environmental problems, and learner satisfaction. However, Level I evaluation alone is insufficient—the staff development department must be able to determine, at the very least, whether
knowledge gain occurred.

Level II: Knowledge acquisition (learning)
Level II measures whether learning actually occurred. Its evaluation mechanism is based on program objectives. In most cases, for example, simple knowledge acquisition is measured via a
pre- and posttest or skills demonstrated in a controlled setting, such as a skills lab. Comparison
of pre- and posttest scores, or appraisal of skill proficiency before and after training, can help
measure knowledge gained.
Remember that pre-testing, whether in written or demonstration form, must be conducted tactfully. That is, emphasize that assessment of the learner’s level of knowledge prior to the learning activity is simply a way to demonstrate and measure knowledge gained by comparing its

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FIGURE

12.1

IMPROVEMENT AND EVALUATION OF EDUCATION EFFECTIVENESS

Classroom evaluation form
Date: _________
Time: _________

Name (optional): ___________________________
Profession: ________________________________
Department/unit:___________________________
Program title: ______________________________
Instructor(s): _______________________________
Objectives: 1._____________________________
2._____________________________
3._____________________________

Please answer the following questions: (Note: N/A stands for not applicable.)
1. How well did the program content meet the stated objectives?
__Excellent __Very Good __Good __Fair __Poor __N/A
2. Based on the program content, how well were you able to achieve the objectives?
a. Objective #1___________________________________________
__Excellent __Very Good __Good __Fair __Poor __N/A
b. Objective #2___________________________________________
__Excellent __Very Good __Good __Fair __Poor __N/A
c. Objective #3____________________________________________
__Excellent __Very Good __Good __Fair __Poor __N/A

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FIGURE

12.1

Classroom evaluation form (cont.)

3. Was the instructor(s) an effective teacher?
__Excellent __Very Good __Good __Fair __Poor __N/A
4. Was the instructor(s) knowledgeable and well-prepared to teach this program?
__Excellent __Very Good __Good __Fair __Poor __N/A
5. Was there enough time for discussion and to ask questions?
__Excellent __Very Good __Good __Fair __Poor __N/A
6. Did the instructor show respect for the participants?
__Excellent __Very Good __Good __Fair __Poor __N/A
7. Were the handouts useful?
__Excellent __Very Good __Good

__Fair __Poor __N/A

8. Were you able to read the handouts without difficulty?
__Excellent __Very Good __Good __Fair __Poor __N/A
9. Were the audio-visuals useful?
__Excellent __Very Good __Good

__Fair __Poor __N/A

10. Was the temperature of the classroom comfortable?
__Excellent __Very Good __Good __Fair __Poor __N/A
11. Were the seating arrangements comfortable?
__Excellent __Very Good __Good __Fair __Poor __N/A
12. Were you able to see and hear the instructor without difficulty?
__Excellent __Very Good __Good __Fair __Poor __N/A
13. Were you able to see and hear the A/Vs used without difficulty?
__Excellent __Very Good __Good __Fair __Poor __N/A

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IMPROVEMENT AND EVALUATION OF EDUCATION EFFECTIVENESS

Classroom evaluation form (cont.)

14. Would you like to make any other comments?
________________________________________________________________________________________
________________________________________________________________________________________
15. For future program planning purposes, please identify three specific education topics that would
improve your ability to do your job.
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
16. What would be the easiest, most efficient way for you to attend programs focusing on the topics you identified in #15 above?
Classroom ______
Self-learning modules ___________
Video or DVD _____________
Audioconference ______________
Computer-based learning ________________
Other: (Please identify) ___________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

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FIGURE

12.2

Distance learning evaluation form

Date:_________

Time: ________

Name (optional): ___________________

Profession: ________________________

Department/unit:___________________

Program title: ______________________

Teaching method (Please check all that apply):
__Computer-based learning __Video __Self-learning packet
__Audiotape __Teleconference

Objectives:

1._____________________________
2._____________________________
3._____________________________

Please answer the following questions: (Note: N/A stands for not applicable)

1. How well did the program content meet the stated objectives?
__Excellent __Very Good __Good __Fair __Poor __N/A

2. Based on the program content, how well were you able to achieve the objectives?
a. Objective # 1_________________________________________________
__Excellent __Very Good __Good

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__Fair __Poor __N/A

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IMPROVEMENT AND EVALUATION OF EDUCATION EFFECTIVENESS

Distance learning evaluation form (cont.)

b. Objective #2______________________________________________
__Excellent __Very Good __Good __Fair __Poor __N/A

c. Objective #3______________________________________________
__Excellent __Very Good __Good __Fair __Poor __N/A

3. Was the teaching method effective?
__Excellent __Very Good __Good __Fair __Poor __N/A

4. How well were you able to use the equipment for this distance learning experience?
__Excellent __Very Good __Good __Fair __Poor __N/A

5. How well did the program explain how to receive help or to ask questions if you need to do so?
__Excellent __Very Good __Good __Fair __Poor __N/A

6. Were the handouts useful?
__Excellent __Very Good __Good __Fair __Poor __N/A

7. Were you able to read the handouts without difficulty?
__Excellent __Very Good __Good __Fair __Poor __N/A

8. Was the location of this distance learning experience comfortable? In other words, was it quiet
and comfortable?
__Excellent __Very Good __Good __Fair __Poor __N/A

9. Did the quality of the graphics, videos, or audiotapes help you to learn?
__Excellent __Very Good __Good __Fair __Poor __N/A

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FIGURE

12.2

Distance learning evaluation form (cont.)

10. Would you like to make any other comments? ___________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
11. For future program planning, please identify three specific education topics that would improve
your ability to do your job. ________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
12. What would be the easiest, most efficient way for you to attend programs focusing on the topics you identified in #11 above?
Classroom ______
Self-learning modules ___________
Video or DVD _____________
Audioconference ______________
Computer-based learning ________________
Other: (Please identify) __________________________________

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results to those achieved after receiving the education. Assure participants that pre-education
performance will not be shared with anyone other than the learner and the staff development

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specialist. No penalties are associated with pre-education performance.

Staff development
Remember that successful completion of a pre-test or accurate skill demonstration prior to
education may indicate that the learner is already competent in certain skills and does not
need additional education and training.

When using written pre- and posttests, consider the following questions:
1. Are instructions for completing pre- and posttests clear and learning objectives understood? It is particularly important that they be so for distance-learning activities, for
which the staff development specialist is not present.
2. Are tests appropriate for the participant’s reading level?
3. Are written materials appropriate for participants whose native language is not English?
4. Can employees whose native language is not English follow verbal instructions during
psychomotor demonstrations?
5. If staff members other than staff development specialists observe skill demonstration in the
controlled setting, how do you ensure that evaluation and documentation are consistent?
Evidence of learning in addition to the reaction data demonstrate program value to a certain
extent, but it is more important to obtain evidence that the learner applied knowledge gained in

TIP

the work setting.

Staff development
Persons evaluating skill demonstration in the controlled setting should follow a consistent
template for documentation, such as the sample shown in Figure 12.3. This template provides consistency and may be adapted for competency assessment.

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FIGURE

12.3

Skill demonstration form

Date: ________
Objectives: ____________________________________
____________________________________
____________________________________
Skill demonstration:
Step 1 _______________________________________________________
Step 2 _______________________________________________________
Step 3 _______________________________________________________
Step 4 _______________________________________________________

Observer comments:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Skill was successfully demonstrated: ________________________________________
Observer’s signature
________________________________________
Learner’s signature
Skill was not successfully demonstrated : ____________________________________
Observer’s signature
The following steps will be taken by the learner to achieve successful skill demonstration:
________________________________________________________________________________________
________________________________________________________________________________________
_____________________________
Learner’s signature

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Level III: Behavior
Level III involves assessing the learner’s behavior (i.e., the actual use of new knowledge/skills)
during the performance of job-related duties. Application of new knowledge and skills requires
the support of managers and administrators. When evaluating behavior, consider the following
questions:
• How has performance of job-related duties been affected by new knowledge or skills
acquired during a learning activity?
• Has the impact of the learning activity on job performance been clearly communicated
to learners, management, and administration?
• Does the work environment encourage the application of new knowledge and skills
acquired during a learning activity?
Behavior may be evaluated by direct observation, documentation review, and assessment of the
appropriateness of patient care interventions. Regardless of the method chosen, however, evaluation must be performed consistently. The template in Figure 12.4 may be adapted as a tool for
Level III evaluation.

Level IV: Results/impact
Level IV assesses the actual impact education has on the organization. Doing so takes considerable effort, so programs evaluated at Level IV should be selected carefully. Examples of impact
findings include the following:
• Improvement of patient outcomes
• Decreased lengths of stay
• Decrease in hospital-acquired infections
• Increase in health insurance reimbursement
• Decrease in staff turnover
• Decrease in employee injuries

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FIGURE

12.4

Evaluation of behavior
(application of new knowledge and skills)

Date: _____________
Time: _____________
Objectives: _______________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

Evaluation
Medical record review:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Use of equipment:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Direct observation: ______________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Evaluator’s comments:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
____________________________________
Evaluator’s signature

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Level IV data must be presented to the organization’s leadership and staff to demonstrate education’s impact on the organization. The following example is based on an employee health and
wellness course that includes such components as stress reduction, smoking cessation, exercise,
and nutrition:
1. Calculate the number of employee sick days and work-related injuries
2. Create a course on health and wellness for employees
3. Perform Level I, II, and III evaluations on this course
4. Compare the number of employee sick days and work-related injuries at three months,
six months, and 12 months after course implementation (which helps measure long-term
impact)
5. Present findings to the organization

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Staff development
Do not use the word “proof” when presenting findings. This word is too easily challenged
by persons who say that it is impossible to remove all other variables that may have lead
to the Level IV results. To “prove” an exact cause-and-effect relationship between education and results, you must eliminate all other factors that might influence findings, which is
a nearly impossible task. Therefore, use the word “evidence” instead.

Level V: Return on investment
The purpose of Level V evaluation is to demonstrate education’s effect on the organization’s bottom line. Because a return on investment (ROI) requires a cost-benefit analysis, which is timeconsuming, ROI should be calculated only for programs that have a significant financial impact
on the organization.
The following example demonstrates how to perform a Level V evaluation:
Employee orientation has been reviewed and revised for the purpose of decreasing the length of
orientation, the turnover rate for new employees, and the dollars spent to orient staff. First,

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determine the cost of orientation under the “old” system.
• How long did orientation take?
• How much overtime was needed to pay the employees who had to work additional
hours until new employees successfully completed orientation?
• How much staff development and preceptor time was spent orienting new employees?
(Use hourly wages to determine costs.)
• How much preparation time did it take to plan and implement orientation? (Determine
costs in salary for preparation time.)
• How much did the supplies, equipment, etc., used for orientation cost?
• What was the turnover rate for employees within the first six months of their employment?
Next, answer the same questions based on the findings from the “new” orientation program.
Calculate ROI as a percentage for both the old and new orientation programs and compare the
findings. Divide the dollar value of the program (net program benefits) by the total cost of training. Net program benefits are the program benefits minus the program costs.
ROI (%) = Net program benefits
Program costs X 100

Conclusion
All five levels of evaluation are important to the survival of the staff development department.
Judicious use of evaluation techniques can demonstrate education’s impact on organizational
effectiveness and justify the existence of the staff development department.

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Bibliography
Abdulhadi, L., and E. Hull. “Program evaluation and return on investment.” In A.E. Avillion (Ed.)
Core curriculum for staff development. Pensacola, FL: National Nursing Staff Development
Organization, 2001. 343–360.
Avillion, A.E. The redesign of nursing staff development. Pensacola, FL: National Nursing Staff
Development Organization,1998.
Avillion, A.E. A practical guide to staff development: tools and techniques for effective education.
Marblehead, MA: HCPro, Inc, 2004.
Kirkpatrick, D.L. “Great ideas revisited.” In D.L. Kirkpatric (Compiler) Another look at evaluating
training programs. Alexandria, VA: ASTD, 1998. 3–8.
Kirkpatrick, D.L. “Evaluating training programs: Evidence vs. proof.” In D.L. Kirkpatrick
(Compiler) Another look at evaluating training programs. Alexandria, VA: ASTD, 1998. 9–11.

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F INAL

EXAM

1. Hannah is reviewing evaluation data from a particular learning activity. Data focus on ability to
achieve objectives, the effectiveness of the presenter, and the physical environment of the classroom. What type of evaluation data is Hannah reviewing?
a. Reaction
b. Behavior
c. Learning
d. Impact

2. Jean scores 70% on a pharmacology pretest. After participating in a pharmacology course, Jean
scores 98% on the same test. This situation can be used as part of which level of evaluation?
a. Level I
b. Level II
c. Level III
d. Level IV

3. Marjorie enjoys computer-based learning (CBL) and participates in a CBL course that focuses on
stroke rehabilitation. Which of the following feedback is part of Level I evaluation?
a. Return demonstration of patient transfer techniques
b. Using new patient positional skills on the stroke unit
c. Stating that there were insufficient numbers of computers available
d. Calculating that the cost of the program outweighed the benefits

4. Following a course on pain management initiatives, nurses are observed as they interact and
intervene with patients suffering from chronic pain prior to the course and after its completion.
What type of evaluation is this?
a. Behavior
b. ROI
c. Reaction
d. Learning

5. Which of the following demonstrates Level II evaluation?
a. Reviewing adverse occurrence data to determine whether there has been a decrease in
patient falls following a fall prevention course

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b. Reading learners’ comments about the physical comfort of the classroom
c. Comparing the cost of a learning activity to its effect on the finances of the organization
d. Observing demonstration of a skill in a controlled setting before and after participating in
a learning activity

6. Health insurance reimbursement has increased following a course on documentation of patient
outcomes. Reimbursement and documentation were analyzed prior to and after the program. This
is an example of:
a. Level I evaluation
b. Level II evaluation
c. Level III evaluation
d. Level IV evaluation

7.

Level III evaluation is performed by which of the following?
a. Implementing pre- and posttests
b. Reviewing medical records to assess the documentation of infection control interventions
before and after a course on preventing hospital-acquired infections
c. Analyzing the impact of an education program on patients’ lengths of stay
d. Calculating return on investment

8.

Level V evaluation requires:
a. calculating ROI
b. assessing learning satisfaction
c. observing behavior
d. evaluating impact on the organization

9.

Which of the following illustrates Level IV evaluation?
a. Observing that the number of hospital-acquired infections decreases after a course on
infection control is implemented
b. Comparing scores on pre- and posttests during a pharmacology course
c. Demonstrating safe use of new equipment during a skills lab
d. Calculating the cost of a learning activity and comparing it to monetary impact on the
organization

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10. Marjorie calculates the cost of hospital-acquired infections in terms of additional patient days and
interventions used to treat the infections. She compares these findings before and after a course
that focuses on preventing hospital-acquired infections. Marjorie has assessed:
a. knowledge
b. behavior
c. ROI
d. learning

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13

W RITING

TEST ITEMS

Competency: The staff development specialist will write test items that measure knowledge, comprehension, application, and analysis.

OBJECTIVES
At the conclusion of the chapter, learners will be able to
1. identify the components of a well-written test question
2. discuss tactics to avoid when writing test questions
3. write test questions that measure knowledge, comprehension, application, and analysis

Introduction
It is not easy to write “good” test questions. The staff development specialist must write questions that measure achievement of objectives and avoid tactics that do not measure knowledge.

Components of well-written test questions
A multiple-choice test can be an effective assessment of knowledge, provided that the test questions are based on the course objectives and are well-constructed. Here are some tips for writing test questions:

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• The stem of a test question is the partial statement (incomplete stem), brief scenario, or
question that must be addressed in order to correctly answer it. When writing a stem,
always give enough information that the student can choose a reasonable option from
the answers provided.
• An incomplete stem is always punctuated with a colon. For example:
Learners born between 1922–1945 are referred to as:
A. Veterans
B. Baby Boomers
C. Generation Xers
D. Generation Y
• If the statement is a direct question, make sure that a question mark appears at the end
of the stem. For example, “Which generation of learners was born between 1922–1945?”
• Ask questions that require more than knowledge of facts whenever possible. Instead of
asking which generation was born between 1922 and 1945, describe a learning strategy
and ask learners to identify which generation would most prefer that strategy.
• A correctly written test item consists of a well-written stem and four choices. Make sure
that the best choice is the correct answer. The remaining three distractors should be
plausible but clearly incorrect. For example:
If drug Y is administered to a patient with kidney failure, that patient’s potassium level will:
A. increase
B. decrease
C. stay about the same
D. fluctuate erratically

Tactics to avoid when writing test questions
When writing test questions, keep the following in mind:
• Don’t include unnecessary information in the stem of a test question. For example,
“Differences among generations affect learning. Which of the following strategies is best
suited for Generation Xers?” Although differences among generation do affect learning,

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this statement does not provide information essential to the test question. Therefore, cut
the sentence.
• Avoid writing true/false items. They do not provide opportunities to assess high levels of
learning.
• Avoid the use of “multiple multiples.” Examples of multiple multiples include “all of the
above,” “none of the above,” and combinations of choices such as “c and d.”

Measuring objective achievement
Knowledge
Test items that measure knowledge include terms that represent basic levels of knowledge
acquisition. Therefore, if a program objective is “Define Level I evaluation,” then an appropriate
test item might be as follows.
Level I evaluation is defined as:
a. assessment of learner satisfaction
b. measurement of knowledge acquisition
c. calculation of ROI
d. evaluation of behavioral change in the work setting

Comprehension
Comprehension involves translation and interpretation of knowledge. An objective that requires
demonstration of comprehension is, “Describe learning styles that best meet the needs of Baby
Boomers.” The corresponding test question might read as follows:
Which of the following learning styles best meets the needs of Baby Boomers?
a. Role-play
b. Lecture
c. Self-learning modules
d. Team activities

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Application
You apply knowledge when you use it in concrete situations. Verbs such as “apply” and
“demonstrate” indicate application. Suppose a learning objective requires the learner to
“Demonstrate safe and accurate intramuscular injection (IM) technique.” A test item might be
written as follows.
When administering IM injections in the buttocks, insert the needle:
a. slowly and remove it rapidly
b. using the deltoid muscle as a guide
c. using the sacrum as an anatomical landmark
d. in the abdominal rectus

Analysis
Analysis involves explaining the relationships between the components of a situation. Words
such as “analyze,” “distinguish,” and “compare” measure analysis. An objective that requires the
leaner to “distinguish between Stage III and Stage IV breast cancer” is analytical. A test item
might be written as follows.
A major difference between Stage III and Stage IV breast cancer is:
a. the presence of cancer in the ducts of the breast
b. the presence of cancer in the lymph nodes
c. bone metastasis
d. sites and degree of metastasis

Bibliography
Aucoin, J.W. “Writing better test items.” Journal for Nurses in Staff Development, 21, no. 1 (2005):
6–9.

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EXAM

1. An incomplete stem is always followed by a:
a. colon
b. period
c. question mark
d. exclamation point

2. Which of the following is a well-written stem?
a. Cultural sensitivity is influenced by personal values. Which of the following statements
describes dietary practices of Muslims?
b. Are all of the following choices accurate?
c. Generation Xers prefer to learn by:
d. Which is (are) characteristics of Baby Boomers?

3. Distractors are:
a. poorly written choice options
b. written in negative terms
c. designed to confuse the learner
d. incorrect options offered along with the single correct option

4. Which of the following choices may appropriately be used as a distractor?
a. All of the above
b. d and c
c. None of the above
d. Distance learning

5. True/false items are:
a. appropriate when assessing application
b. poor examples of test items
c. used to evaluate critical thinking
d. useful only for assessing skill demonstration

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6. Which of the following stems helps to measure knowledge?
a. Major depressive episode is defined as:
b. Which of the following distinguishes drug X from drug Y?
c. Which of the following evaluation levels measures organizational impact?
d. Administering lidocaine in the presence of premature atrial contractions demonstrates:

7. “Which of the following statements describes the action of drug A when administering during the
manic phase of bipolar disorder?” This stem measures:
a. knowledge
b. comprehension
c. application
d. analysis

8. Application is measured by which of the following objectives?
a. Recall the side effects of Zoloft
b. Discuss the characteristics of Generation Xers
c. Define multiple sclerosis
d. Demonstrate safe administration of IV Lasix

9. Consider this stem: “Drug X and drug Y are both administered to bipolar disorder patients. Which
of the following is more appropriate for a patient under the age of 15?” It measures:
a. analysis
b. application
c. comprehension
d. knowledge

10. The choice “all of the above” represents:
a. comprehension
b. multiple multiples
c. knowledge
d. an incomplete stem

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14

O VERVIEW

OF A
STAFF DEVELOPMENT
BUSINESS PLAN

Competency: The staff development specialist will write (or contribute to) a business plan that
coincides with the organization’s strategic plan and upholds the mission, vision, and values of
the organization.

OBJECTIVES
At the conclusion of the chapter, the learner will be able to
1. discuss the components of a business plan
2. identify specific elements of the business plan that demonstrate the value of staff development to the organization

Introduction
A strategic plan is a long-range guide that forecasts fiscal and operational objectives for an
organization for a period of no less than three years and as long as 10 years or more. The organization’s strategic plan is the foundation for the staff development’s business plan and reflects
the organization’s mission, vision, and values; its goals and objectives; its allocation of resources;
and its marketing strategies. Therefore, when writing or revising the staff development department’s business plan, keep a copy of the organization’s strategic plan nearby, and use it to forecast the future of the department. A well-written plan should be no longer than 20 pages. It

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should allow the reader to grasp both the essentials of the staff development department and
how the department contributes to organizational effectiveness.

Components of the business plan
Executive summary
The executive summary is a concise overview of the business plan and is the first component
presented to the reader. It is arguably the most important part of the plan. The executive summary should be no more than two pages long and should “grab” the reader’s attention.
The easiest way to write an executive summary is do so after the rest of the plan is complete.
Write summary or opening paragraphs of all the plan’s components and compile them as your
executive summary.
The executive summary is often the only portion of a business plan read by executive level staff
so it must be concise, effective, and impressive.

Departmental description
The department description describes the organization of the department and why the organizational structure enhances the delivery of products and services. Include the following in the
department description:
• Mission, vision, and values statements
• Description of the department’s customers
• The setting of the staff development department (e.g., centralized, decentralized, within
a health system, in a community hospital)
• Departmental responsibilities
• A brief overview of the department’s products and services (details are provided in
another component of the business plan)

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• Some recent, major accomplishments supported by objective evaluation data (e.g., 40%
decrease in sick days following implementation of employee health and wellness course)

Departmental structure
The departmental structure includes
• the department’s organizational chart
• reporting mechanism
• job descriptions
• qualifications
• Roles and responsibilities

Products and services
This section of the plan describes, in detail, the products and services that are provided and to
whom. Include not only current but also potential products and services. Consider the following
types of products and services that the staff development department offers or may plan to offer:
• Orientation
• Inservice education
• Continuing education
• Student affiliations
• Patient education
• Seminars and conferences
• Research
• Performance coaching
• Consultative services
• Publishing
• Employee health and wellness

Marketing strategies
Marketing strategies focus on customer and competitor identification, how products and services
are developed and promoted, and the costs of marketing the department and the products and
services it provides. Consider the following questions when writing the marketing component of
a staff development business plan:
• Who are the department’s internal and external customers?

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• Who are the department’s “best” customers?
• What are the department’s most popular products and services?
• What are the department’s least popular products and services?
• What marketing strategies have increased use of or purchase of products and services?
• What marketing strategies have failed to increase the use of products and services?
• What are the costs of marketing the department’s products and services?
The answers to these questions form the basis of the marketing component of the business
plan. They guide the department’s efforts to promote its products and services, and they predict
the need for future products and services

Action plan
The action plan identifies objectives, actions taken to achieve them, and evaluation of objective
achievement from previous fiscal years. Consider the following when preparing the action plan:
• Objectives must be written in measurable terms
• Objectives must include target achievement dates
• Persons responsible for objective achievement must be identified specifically
• Objectives must be quantifiable
• Objectives must be evaluated, achievement documented, or corrective actions identified
if objectives are not achieved
See Figure 14.1 to view a sample action plan.

Actions include
1. consulting with employee health department
2. identifying percentage of employee sick days within the past six months
3. planning education based on employee demographics (e.g., number of smokers)
4. implementing education using a variety of education strategies

Budget overview
The budget is generally a separate component. It can be attached in its entirety to the plan or
maintained as a separate document according to organization policy. If it is maintained as a
separate document, provide an overview of the budget in the business plan. Include the following in such an overview:

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FIGURE

14.1
Objective

Employee sick

OF A STAFF DEVELOPMENT BUSINESS PLAN

Sample action statement
Target
achievement date
June 30, 2005

days will decrease

Responsible party

S. Keller, RN
J. Kane, RN

Status

Course planned and
implementation starts
January 7, 2005

by 10% within six
months of implementation of
employee health
and wellness
course

• Personnel budget
• Capital budget
• Operating budget
• Profit and loss statements
• Summarize major sources of income and expense
• Include examples of programs that had a significant ROI

Conclusion
Most organizations have their own format of business plan development. This chapter offers
general guidelines for the development of such a plan and specific components to include.

Bibliography
Avillion, A.E. Writing a staff development plan: Business strategies for the 21st century. Pensacola,
FL: National Nursing Staff Development Organization, 2003.

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F INAL

EXAM

1. The executive summary is:
a. written before the rest of the business plan
b. composed of summary or opening paragraphs from the plan’s other components
c. seldom read by executive level staff
d. a concise summary of the financial statement

2. A guide that forecasts objectives for a period of no less than three years and for as many as 10
years is the:
a. executive summary
b. departmental description
c. action plan
d. strategic plan

3. Mission, vision, and values statements are part of the:
a. departmental description
b. marketing strategies
c. goals and objectives
d. budget

4. When writing the departmental structure component of the business plan, include:
a. an action plan
b. goals and objectives
c. a reporting mechanism
d. a budget

5. The foundation for the staff development plan is:
a. the department’s goals and objectives
b. the organization’s strategic plan
c. the organization’s financial forecast
d. the department’s roles and responsibilities

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6. It is important to include which of the following in a departmental description?
a. Goals and objectives
b. Marketing strategies
c. Mission, vision, and values
d. Job descriptions

7. Include job descriptions as part of the:
a. action plan
b. organizational structure
c. marketing strategies
d. financial component

8. When developing a marketing plan, identify all of the following EXCEPT:
a. external customers
b. competitors
c. most popular products and services
d. roles of staff development specialists

9. Which of the following is an appropriately written action plan objective?
a. Number of falls will decrease by 10% within one month of the implementation of a fall
prevention training course
b. Increase participation in distance learning activities
c. Decrease number of hospital-acquired infections by 15%
d. Number of certified critical care nurses will increase after implementation of a critical care
certification review course

10. Significant ROI examples are part of:
a. goals and objectives
b. action plan
c. budget overview
d. strategic plan

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E THICAL

SCENARIOS IN
STAFF DEVELOPMENT

Competency: The staff development specialist will identify staff development ethical dilemmas and
possible solutions to those dilemmas.

OBJECTIVES
At the conclusion of the chapter, the learner will be able to
1. describe staff development ethical dilemmas
2. propose solutions to staff development ethical dilemmas

Introduction
Ethical dilemmas occur frequently in the healthcare arena, and such dilemmas also confront staff
development specialists. This chapter focuses on common staff development dilemmas and
potential solutions to them.
The term “ethics” indicates a formal process for making logical and consistent decisions based
upon moral beliefs. An “ethical dilemma,” therefore, occurs when conflicts exist among various
moral value claims. Moral values are internal beliefs about the nature of good and bad and right

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and wrong. Conflicts arise when one person is asked to participate in an action that is at odds
with moral beliefs. The following scenarios illustrate some common staff development dilemmas.

Scenarios
Staff development scenario: A JCAHO surveyor arrives at Memorial Medical Center to conduct an
announced survey. Janice, the manager of staff development, is summoned to the director of
nursing’s office. The director of nursing has not attended mandatory training and education for
more than three years. He asks Janice to falsify attendance records to make it look as though he
complied with organizational standards. Janice believes that such an action would be immoral
and compromise her own professionalism. What should she do?
Janice has several options. To refuse outright may affect Janice’s continued employment status.
At the very least, it may make working at Memorial Medical Center an unpleasant experience
and compromise its accreditation status.
However, to agree to a blatant falsification of records is wrong and possibly illegal.
One compromise may be to offer to conduct essential training immediately and record attendance date and time honestly.
None of these solutions is completely free of risk or deception. Regardless of Janice’s ultimate
decision, her interaction with and feelings about the director of nursing are probably tainted for
the foreseeable future.
Staff development scenario: In order to complete orientation, all RNs must pass a pharmacology
exam. Hospital policy dictates that failure results in the termination of the orientee. Two RNs fail
the examination. One of these nurses, Ann, is single, without family obligations, and the other,
Kay, is a single mother of three children. The staff development specialist feels sorry for Kay and
allows her to take the exam numerous times until she achieves a passing score. Anne is terminated. Ann discovers that Kay was allowed to repeat the exam numerous times. She files a discrimination lawsuit, citing both the hospital and the staff development specialist. The staff development
specialist is consequently fired. Was this fair?

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Yes. The staff development specialist chose to discriminate against Anne in favor of Kay because
Kay is a single mother. Although the staff development specialist may indeed have been justified
in her concern for the single mother of three, that did not give her the right to violate legal standards and hospital policy.
Angela is a staff development specialist in charge of emergency preparedness training. Randy
and Joyce are RNs participating in the course. Angela and Randy are good friends, but Angela
does not get along with Joyce. The nurse who earns the highest score in emergency preparedness
training will be awarded a prestigious critical care award. Joyce has commented publicly that she
will file a grievance if Randy wins because, “Angela will help Randy and make sure I look bad.”
What should Angela do?
Angela has several options to avoid facing an ethical dilemma. She can ask to have another staff
development specialist assume responsibility for training. If no one else is qualified, Angela can
ask that her manager or a staff development peer observe and monitor the class and evaluation
of the learner’s achievements. Angela could also choose to take no additional action but to evaluate both nurses objectively. She must identify the tactic that best reduces the potential for an
ethical dilemma to occur.

Conclusion
The preceding scenarios are only a few of the ethical dilemmas a staff development specialist
may face. When confronted by such problems, he or she must identify options for the resolution
of the dilemma and choose the one that best adheres to legal, professional, and personal standards of professional behavior.

Bibliography
Burkhardt, M.A. Ethics and issues in contemporary nursing. 2nd ed. Clifton Park, NY: Delmar
Thomson Learning, 2002.

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F INAL

EXAM

1. Jordan believes that the death penalty is wrong. Allison does not agree. The women’s views are
examples of:
a. ethics
b. moral values
c. dilemmas
d. prejudice

2.

An ethical decision is characterized by:
a. logic and consistency
b. prejudice
c. irregularities
d. unfounded beliefs

3. Terry is the critical care staff development specialist. Her best friend fails to achieve advanced
cardiac life support certification, which is a job requirement. The friend asks Terry not to report
the results to administration and to give her time to take the test again. Such an action is against
hospital policy and would put Terry’s job at risk. What should Terry do?
a. Agree to her friend’s request
b. Allow Terry to take the certification exam again in private
c. Report the results to administration
d. Ask the CEO to change the hospital policy

4. Two nurses apply for the position of charge nurse. The ultimate deciding factor for earning the
promotion is the successful completion of a management and leadership course. Kate is the staff
development specialist in charge of the course. Her best friend is one of the nurses applying for
promotion. The other nurse and Kate have never gotten along. What is the best course of action
for Kate to take?
a. Refuse to implement the course
b. Recommend her friend for the promotion
c. Report the behavior of the nurse with whom Kate doesn’t get along to the director of
nursing
d. Ask for an objective observer to monitor course implementation and evaluation

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hcPro
NURSING

EDUCATION

INSTRUCTIONAL GUIDE

Nursing education instructional guide

Target audience:
Staff development specialists, directors of education, and nurse managers

Statement of need:
This manual offers busy staff development specialists off-the-shelf, ready-to-use tools and templates for
assessing staff ’s learning needs, planning curricula, and creating, marketing, leading, and evaluating their
education programs.The advice and tools within the manual help educators adapt education programs/inservices to the new challenges associated with their role, incorporate new technology, and
use evidence-based teaching strategies.
The American Nurses Credentialing Center (ANCC) is recognizing the importance of the staff educator role and stressing the need for qualified experienced clinicians to fill this position.Therefore, this
manual prepares the staff educator for certification and also counts as credit toward it.

Educational objectives:
Upon completion of this activity, participants should be able to
• describe historical events that influenced the evolution of staff development
• analyze historical trends and use data to plan education programs
• identify specific historical milestones in the history of nursing and staff development’s response to
these events
• define mission, vision, and values
• describe the components of staff development’s mission, vision, and values statements
• plan educational activities that support the mission, vision, and values of the organization and the
staff development department
• describe qualifications for the staff development specialist

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• write competency-based job descriptions for the staff development specialist
• identify the principles of adult learning
• apply the principles of adult learning to his or her staff development practice
• identify sources for the identification of learning needs
• gather data for the identification of learning needs
• analyze data to prioritize learning needs
• identify objectives for education activities
• identify effective program delivery methods
• select appropriate teaching strategies
• facilitate learner participation in educational activities
• discuss the types of records the staff development department must maintain
• write a policy for the confidentiality of educational records
• differentiate among the three basic learning styles: visual, auditory, and kinesthetic
• incorporate teaching methods that facilitate learning for persons of each learning style
• incorporate cultural diversity into learning activities
• identify common cultural factors that influence participants’ behaviors
• describe the common characteristics among specific generations of learners
• plan and implement learning activities that meet the needs of multigenerational learners

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• discuss issues that trigger resistance to learning
• evaluate education offerings during which resistance is evident
• describe ways to defuse the resistant learner
• develop orientation strategies that reduce the time and number of staff required to orient employees
• implement a mechanism for inservice training that facilitates the delivery of “just in time” training
• design continuing education programs that meet learner needs and adhere to accrediting agency
standards
• identify learner satisfaction
• measure knowledge acquired as a result of a specific learning activity
• evaluate changes in job performance as a result of a specific learning activity
• assess the impact of education on organizational effectiveness
• measure return on investment (ROI) from specific learning activities.
• identify the components of a well-written test question
• discuss tactics to avoid when writing test questions
• write test questions that measure knowledge, comprehension, application, and analysis
• discuss the components of a business plan
• identify specific elements of the business plan that demonstrate the value of staff development to
the organization
• describe staff development ethical dilemmas
• propose solutions to staff development ethical dilemmas
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Nursing education instructional guide

Author
Adrianne E. Avillion, DEd, RN

Accreditation/designation statement:
This educational activity for 10 contact hours is provided by HCPro, Inc. HCPro is accredited as a
provider of continuing nursing education by the American Nurses Credentialing Center’s Commission
on Accreditation.

Disclosure statements
Adrianne E. Avillion, DEd, RN, has declared that she has no commercial/financial vested interest in
this activity.

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Instructions for obtaining your nursing contact hours

In order to be eligible to receive your nursing contact hour(s) for this activity, you are required to do
the following:
1. Read the book
2. Complete the exam
3. Complete the evaluation
4. Provide your contact information in the space provided on the exam and evaluation
5. Submit the exam and evaluation to HCPro, Inc.
Please provide all of the information requested above and mail or fax your completed exam, program
evaluation, and contact information to
Robin L. Flynn
Manager, Continuing Education
HCPro, Inc.
200 Hoods Lane
P.O. Box 1168
Marblehead, MA 01945
Fax: 781/639-0179
If you have any questions, please contact Robin Flynn at 781/639-1872 or [email protected].

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Nursing education exam

Name: _________________________________________________________________________
Title: __________________________________________________________________________
Facility name: ___________________________________________________________________
Address: _______________________________________________________________________
Address: _______________________________________________________________________
City: _________________________________ State: __________________ ZIP: ____________
Phone number: ________________________ Fax number: _____________________________
E-mail: __________________________________________________________________________
Nursing license number: ________________________________________________________
(ANCC requires a unique identifier for each learner)

1.

2.

The event that triggered the beginning of staff development was:
a.The Great Depression

c. World War I

b.The Crimean War

d. World War II

The Great Depression’s impact on staff development was to cause a significant need for:
a. orientation to the hospital setting
b. training schools of nursing
c. a distinct department devoted to staff development
d. specialty certification

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3.

Mark is writing a first draft of a values statement for the staff development department. It is important that this statement:
a. concentrates on the individual preferences of the staff development specialists
b. identifies essential functions of the department
c. reflects the philosophy of the organization
d. focuses on the future

4.

The administrative team at Community Hospital has announced that the hospital will expand its
services to include physical medicine and rehabilitation, with an emphasis on neurological rehabilitation. Due to the Community Hospital’s recent merger with a pediatric facility, pediatric services at
Community Hospital will be phased out. This may lead to downsizing of nurses currently working on
the pediatric unit of Community Hospital. Based on these issues, all of the following programs are
appropriate priorities EXCEPT:
a. care of the spinal cord patient
b. job interviewing skills
c. stroke rehabilitation
d. developmental characteristics of the toddler

5.

Which of the following statements concerning staff development specialist qualifications is accurate?
a. Minimum education requirements vary depending on the role fulfilled
b.The most important qualification is clinical expertise
c. Persons who work full-time must possess different qualifications than those who work part-time, even though
they fulfill the same role
d. Responsibilities are the same for all staff development specialists even though they fulfill different roles

6.

Dixon Hospital is purchased by a large, for-profit healthcare corporation. Which of the following
might be stressed as part of hospital’s staff development mission considering the new for-profit
status?
a. Developing free blood pressure screening education
b. Designing education activities that generate income
c. Offering education to nonlicensed personnel
d. Developing programming that supports life-long learning

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7.

Adults are self-directed learners. This implies that:
a. adults refuse to participate in education unless they want to
b. adults need to understand why a particular learning activity is important to them and to the organization
c. adults want someone else to be responsible for identifying their learning needs
d. adults will learn only if the learning activity is mandatory

8.

Ways to incorporate the principle that adults are self-directed learners into program planning include
all of the following EXCEPT:
a. mandate programs that may be unpopular
b. share information that explains why the program is important to staff and the organization
c. use survey and quality improvement data to illustrate the impact of failure to offer the program
d. respect the learners’ input and answer questions honestly

9.

Amy has made three medication errors this month. Two of the medication errors were errors of omission (i.e., she forgot to administer two medications) and one occurred as a result of Amy administering the wrong dose of an oral antibiotic. Prior to this month, Amy has administered medications for
two years without error. Amy is not too concerned about these errors because she says the unit on
which she works is really busy and no patients were injured due to the errors. Which of the following
phrases best describes this situation?
a. A learning need

c. A performance issue

b. A systems flaw

d. A reason for termination

10. Performance evaluations are important sources when identifying education needs. Anna is the manager of the surgical pediatric unit and is concerned about maintaining employee confidentiality when
she identifies learning needs for the staff development department. Which of the following best helps
Anna to preserve confidentiality?
a. Anna meets privately with the manager of staff development and discusses individual employee performance
evaluations with her
b. Anna refuses to share information from performance evaluations with anyone
c. Anna provides education herself in order to maintain confidentiality
d. Anna summarizes employee education needs and relays this information to the staff development department,
but does not identify employees by name

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11. As part of an extensive course on new oncology chemotherapeutic agents, the learner must be able
to distinguish between two drugs (referred to here as Drug A and Drug B) with similar names and
actions, but that cause quite different side effects. Which of the following objectives best explains
what the learner must accomplish?
a. Define Drug A and Drug B
b. Discuss Drug A and Drug B
c. Contrast the side effects of Drug A and Drug B
d. Determine the side effects of Drug A and Drug B

12. A group of experienced critical care nurses are updating their pharmacology knowledge. As part of
the education program, these nurses will select and administer these drugs during a mock code situation. Which of the following objectives is most appropriate for this group of learners?
a. Recall the side effects of new critical care drugs
b. Discuss the action of new critical care drugs
c. Administer new cardiac drugs accurately and safely during a simulated code
d. Identify potentially lethal interactions among the new cardiac drugs

13. Which of the following statements about recordkeeping systems is accurate?
a. Only agencies that deal exclusively with nursing personnel can mandate a recordkeeping system
b. All managers throughout the organization should have access to the staff development department’s recordkeeping system.
c. Program evaluation data must be maintained in the recordkeeping system
d. Attendance records are primarily the responsibility of the individual employee’s manager.

14. Which of the following helps maintain confidentiality of education records?
a. Password-protected automated system
b. Maintaining back-up CDs of records in the organization’s education library
c. Decentralized written records maintained on individual units/departments
d. Written files accessible to departmental secretaries

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(
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15. Mark is a staff development specialist responsible for facilitating a lecture/discussion group on cardiac pathophysiology. One participant, Miranda, seldom looks at Mark and often repeats important

2

facts softly after Mark presents them. Mark believes that she is uninterested in the topic. To his
astonishment, however, she scores 100% on the post-test and compliments Mark on his teaching
ability. It is probable that Miranda is:
a. a visual learner

c. an auditory learner

b. a kinesthetic learner

d. a learner who is already familiar with the program content

16. Donna is a staff development specialist who prepares colorful, well-illustrated handouts. Which of
the following learners will best appreciate these handouts?
a. Dan, who learns a new procedure by reading the steps aloud
b. Josephine, who prefers return demonstration as an education strategy
c. Adam, who is easily distracted by auditory stimuli
d. Laura, whose favorite phrase is, “That sounds good to me!”

17. Filipinos are often stoic when dealing with pain. They may not express that they are suffering considerably. Janet, an RN working on a surgical unit, recognizes this characteristic. She is taking care of
a middle-aged Filipino man who has had surgery because of a bowel obstruction. Which of the following actions indicates a generalization of his cultural characteristics?
a. Janet assumes that he is hiding his suffering and insists that he take his pain medication
b. Janet asks him whether he is in pain
c. Janet recognizes that he may not verbally complain of pain and assesses both verbal and nonverbal indications
of pain
d. Janet assumes that all Filipinos hide their suffering

18. Cassie has planned a learning activity that requires a great deal of teamwork and discussion.
Participants from which of the following generations are most likely to like this approach?
a. Baby Boomer
b.Veteran
c. Generation X
d. Generation Y

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19. Which of the following statements about resistant learners is accurate?
a. It is up to the staff development specialist to successfully motivate resistant learners
b. A learner’s resistance may actually have little or nothing to do with the staff development specialist
c. Learners are usually resistant because the learning activity is poorly planned or implemented
d.The problem of resistant learners will decrease as distance learning opportunities increase

20. Pediatric nurses in a small community hospital must participate in continuing education that deals
with pain management for pediatric patients. The unit is short-staffed, and every bed is continuously
occupied. The nurses are enthusiastic learners and are eager to participate in this learning activity.
There is one computer available for the purpose of computer-based learning. To avoid resistance,
what learning strategy is best suited in this situation?
a. Classroom learning
b. Self-learning modules
c. Computer-based learning
d. Audioconferences

21. Simone is responsible for the orientation program at Kane Health System. She believes that a preceptor program will benefit new employees and enhance the efficiency of orientation. Which of the
following actions should Simone take?
a. Facilitate the development of preceptorships within all departments
b. Arrange for the managers of housekeeping and maintenance to act as the preceptors for all new employees
c. Avoid associating monetary rewards with the role of preceptor
d. Note that job expertise is the only important requirement for the preceptor role

22. A new policy concerning workplace security must be disseminated and reviewed by all employees as
soon as possible. Which of the following is the most efficient, appropriate strategy for this type of
“just in time” training?
a. E-mail will be distributed, with electronic signature indicating that employees have read and accepted the new
policy
b. Staff development specialists will review the policy with staff members on designated units/departments during all shifts

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c. Classroom training will be planned and implemented
d. Staff development specialists will videotape a reading of the policy highlighting essential changes and make the
video available to all department managers

23. Marjorie enjoys computer-based learning (CBL) and participates in a CBL course that focuses on
stroke rehabilitation. Which of the following feedback is part of Level I evaluation?

a. Return demonstration of patient transfer techniques
b. Using new patient positional skills on the stroke unit
c. Stating that there were insufficient numbers of computers available
d. Calculating that the cost of the program outweighed the benefits
24. Following a course on pain management initiatives, nurses are observed as they interact and
intervene with patients suffering from chronic pain prior to the course and after its completion.
What type of evaluation is this?
a. Behavior
b. ROI
c. Reaction
d. Learning

25. An incomplete stem is always followed by a:
a. colon
b. period
c. question mark
d. exclamation point

26. The choice “all of the above” represents:
a. comprehension
b. multiple multiples
c. knowledge
d. an incomplete stem

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27. The executive summary is:
a. written before the rest of the business plan
b. composed of summary or opening paragraphs from the plan’s other components
c. seldom read by executive level staff
d. a concise summary of the financial statement

28. Significant ROI examples are part of:
a. goals and objectives
b. action plan
c. budget overview
d. strategic plan

29. Terry is the critical care staff development specialist. Her best friend fails to achieve advanced cardiac life support certification, which is a job requirement. The friend asks Terry not to report the
results to administration and to give her time to take the test again. Such an action is against hospital policy and would put Terry’s job at risk. What should Terry do?
a. Agree to her friend’s request
b. Allow Terry to take the certification exam again in private
c. Report the results to administration
d. Ask the CEO to change the hospital policy

30. Two nurses apply for the position of charge nurse. The ultimate deciding factor for earning the promotion is the successful completion of a management and leadership course. Kate is the staff development specialist in charge of the course. Her best friend is one of the nurses applying for promotion. The other nurse and Kate have never gotten along. What is the best course of action for Kate
to take?
a. Refuse to implement the course
b. Recommend her friend for the promotion
c. Report the behavior of the nurse with whom Kate doesn’t get along to the director of nursing
d. Ask for an objective observer to monitor course implementation and evaluation

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Nursing education evaluation

Name: _________________________________________________________________________
Title: __________________________________________________________________________
Facility name: __________________________________________________________________
Address: _______________________________________________________________________
Address: _______________________________________________________________________
City: _________________________________ State: __________________ ZIP: ____________
Phone number: __________________________ Fax number: __________________________
E-mail: __________________________________________________________________________
Nursing license number: ________________________________________________________
(ANCC requires a unique identifier for each learner)

1. This activity met the following learning objectives:

Strongly

Strongly

disagree

agree

• Describe historical events that influenced the

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evolution of staff development
• Analyze historical trends and use data to plan education
programs
• Identify specific historical milestones in the history of nursing and staff development response to these events
• Define mission, vision, and values
• Describe the components of staff development mission,
vision, and values statements
• Plan educational activities that support the mission, vision,
and values of the organization and the staff development
department

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Strongly

Strongly

disagree

agree

• Describe qualifications for the staff development

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specialist
• Write competency-based job descriptions for the staff
development specialist
• Identify the principles of adult learning
• Apply the principles of adult learning to his or her staff
development practice
• Identify sources for the identification of learning needs
• Gather data for the identification of learning needs
• Analyzes data to prioritize learning needs
• Identify objectives for education activities
• Identify effective program delivery methods
• Select appropriate teaching strategies
• Facilitate learner participation in educational activities
• Define “negative pressure wound therapy,” and list two
factors to consider about the patient before administering this therapy
• Discuss the types of records the staff development
department must maintain
• Write a policy for the confidentiality of educational
records
• Differentiate among the three basic learning styles:
visual, auditory, and kinesthetic
• Incorporate teaching methods that facilitate learning
for persons of each learning style
• Incorporate cultural diversity into learning activities
• Identify common cultural factors that influence participants’ behaviors
• Describe the common characteristics among specific
generations of learners
• Plan and implement learning activities that meet the
needs of multigenerational learners
• Discuss issues that trigger resistance to learning
• Evaluate education offerings during which resistance is
evident

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Strongly

Strongly

disagree

agree

• Describe ways to defuse the resistant learner
• Develop orientation strategies that reduce the time

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and number of staff required to orient employees
• Implement a mechanism for inservice training that facilitates the delivery of “just in time” training
• Design continuing education programs that meet
learner needs and adhere to accrediting agency standards
• Identify learner satisfaction
• Measure knowledge acquired as a result of a specific
learning activity
• Evaluate changes in job performance as a result of a
specific learning activity
• Assess the impact of education on organizational
effectiveness
• Measure return on investment (ROI) from specific
learning activities
• Identify the components of a well-written test question
• Discuss tactics to avoid when writing test questions
• Write test questions that measure knowledge, comprehension, application, and analysis
• Discuss the components of a business plan
• Identify specific elements of the business plan that
demonstrate the value of staff development to the
organization
• Describe staff development ethical dilemmas
• Propose solutions to staff development ethical
dilemmas

2.

Objectives were related to the overall purpose/goal
of the activity

1

2

3

4

5

3.

This activity was related to my nursing activity
needs

1

2

3

4

5

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Nursing education instructional guide

Strongly

Strongly

disagree

agree

4.

The exam for the activity was an accurate test of the
knowledge gained

1

2

3

4

5

5.

The activity avoided commercial bias or influence

1

2

3

4

5

6.

This activity met my expectations

1

2

3

4

5

7.

Will this learning activity enhance your professional nursing practice?
Yes

No

8.

This educational method was an appropriate delivery tool for the nursing/clinical audience

9.

How committed are you to making the behavioral changes suggested in this activity?
a. Very committed
b. Somewhat committed
c. Not committed

10. Please provide us with your degree
a. ADN

b. BSN

c. MSN

d. Other, please state _____________________________

11. Please provide us with your credentials
a. LVN

b. LPN

c. RN

d. NP

e. Other, please state _____________________________

12. The fact that this product provides nursing contact hours influenced my decision to buy it
Strongly disagree 1

200

2

3

4

5

Strongly agree

N URSE E DUCATOR M ANUAL : E SSENTIAL S KILLS

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13. I found the process of obtaining my continuing education credits for this activity easy to complete
Strongly disagree 1

2

3

4

5

Strongly agree

14. If you did not find the process easy to complete, which of the following areas did you find the most
difficult?
a. Understanding the content of the activity
b. Understanding the instructions
c. Completing the exam
d. Completing the evaluation
e. Other, please state:

15. How much time did it take for you to complete this activity (including reading the book and completing the exam and the evaluation)? _______
16. If you have any comments on this activity, process, or selection of topics for nursing CE, please note
them below.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

17. Would you be interested in participating as a pilot tester for the development of future HCPro nursing education activities?
Yes

No

Thank you for completing this evaluation of our nursing CE activity.

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