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UBC Theses and Dissertations

Continuing education in a professional nursing association Robinson, Diana Janet 1986

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CONTINUING EDUCATION IN A PROFESSIONAL NURSING ASSOCIATION By Diana J a n e t Robinson B.Sc.N., University of B r i t i s h Columbia, 1976 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n THE FACULTY OF GRADUATE STUDIES (The Department of Administrative, Adult and Higher Education) We accept this Thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA September, 1986 (2) Diana Janet Robinson AUTHORIZATION In presenting t h i s thesis i n p a r t i a l f u l f i l l m e n t of the requirements for an advanced degree at the University of B r i t i s h Columbia, I agree that the Library s h a l l make i t freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the Head of my department or by his or her repre-sentative. It i s understood that copying or publication of this thesis for f i n a n c i a l gain s h a l l not be allowed without my written permission. Diana J. Robinson Department of Administrative, Adult and Higher Education The University of B r i t i s h Columbia 1956 Main Mall Vancouver, B r i t i s h Columbia Canada V6T 1Y3 Date: September 18, 1986. i i CONTINUING EDUCATION IN A PROFESSIONAL NURSING ASSOCIATION ABSTRACT Continuing education for health professionals i s a f i e l d of adult education that has emerged since World War I I . The need for continuing education for Registered Nurses (RNs) has arisen l a r g e l y as a r e s u l t of concern over competence. Because of the changes i n the nature of nursing p r a c t i c e , the ever increasing amount of knowledge required, and the impact of technology, RNs are required to continue t h e i r learning i f they are to remain competent. As a r e s u l t of the increasing demand for continuing education, the number of providers and i n s t i t u t i o n s o f f e r i n g continuing nursing education has expanded. Currently, the professional nursing association i s the second largest provider of continuing education, second to educational i n s t i t u t i o n s . This paper describes the development of the continuing educ-ation program within a professional association, the Registered Nurses' Association of B r i t i s h Columbia (RNABC). Four questions were used to guide the examination of the h i s t o r i c a l record of the RNABC from 1912 to the present. Three periods of development were i d e n t i f i e d , from 1912 to 1940, from 1941 to 1967, and from 1968 to the present. Within each period, three areas were ident-i f i e d , to a s s i s t in presentation of events or a c t i v i t i e s that occurred during each time period: major developments, po l i c y development and governance, and educational a c t i v i t i e s and services. i i i In Chapter IV, the study q u e s t i o n s were used to analyze the development o f the RNABC c o n t i n u i n g e d u c a t i o n program i n each o f the t h r e e p e r i o d s . In Chapter V, a summary of the paper i s gi v e n , and c o n c l u s i o n s and i m p l i c a t i o n s o f the study a re d e s c r i b e d . C o n c l u s i o n s reached were that the RNABC has always been a c t i v e l y i n v o l v e d i n c o n t i n u i n g n u r s i n g e d u c a t i o n , however the nature o f i t s involvement has changed over time; t h a t the RNABC has changed and adapted to i n t e r n a l and e x t e r n a l events and trends t h a t have i n f l u e n c e d i t s e d u c a t i o n a l program; t h a t the A s s o c i a t i o n has been both p r o a c t i v e and r e a c t i v e i n response to trend s and events t h a t a f f e c t e d i t s e d u c a t i o n a l program; and that the RNABC views c o n t i n u i n g e d u c a t i o n as an i n t e g r a l p a r t o f i t s a c t i v i t i e s and uses c o n t i n u i n g e d u c a t i o n to achieve i t s primary purpose, t o ensure safe n u r s i n g care to the people o f B r i t i s h Columbia. i v TABLE OF CONTENTS ABSTRACT Page i i ACKNOWLEDGEMENTS Page v i CHAPTER I: INTRODUCTION Page 1 CHAPTER I I : REVIEW OF THE LITERATURE Page 8 CONTINUING PROFESSIONAL EDUCATION Page 8 Professional Associations Page 13 Continuing Education A c t i v i t i e s of a Professional Association Page 15 CONTINUING NURSING EDUCATION Page 20 Continuing Education i n a Professional Nursing Association Page 22 CHAPTER I I I : DEVELOPMENT OF CONTINUING EDUCATION AT RNABC Page 25 THREE STAGES OF DEVELOPMENT Page 26 1912 to 1940: THE FORMATIVE YEARS Page 28 Major Developments Page 28 Pol i c y Development and Governance Page 30 Educational A c t i v i t i e s and Services Page 32 1941 to 1967: EXPANSION OF CONTINUING EDUCATION ACTIVITIES Page 37 Major Developments Page 37 Policy Development and Governance Page 41 Educational A c t i v i t i e s and Services Page 47 1968 TO THE PRESENT: CHANGING ROLES Page 56 Major Developments Page 56 Policy Development and Governance Page 59 Educational A c t i v i t i e s and Services Page 65 V CHAPTER IV: ANALYSIS OF THE HISTORICAL INVOLVEMENT OF THE RNABC IN CONTINUING EDUCATION Page 81 ANALYSIS Page 81 Nature of RNABC Involvement in Continuing Education Page 81 Reaction to Events Influencing the RNABC Educational Program Page 83 Proactive or Reactive? Page 85 Commitment to Continuing Education Page 87 CHAPTER V: SUMMARY, CONCLUSIONS AND IMPLICATIONS Page 88 Summary Page 88 Conclusions Page 92 Implications of the Study Page 93 REFERENCES Page 96 v i ACKNOWLEDGEMENTS I would l i k e to acknowledge and thank a l l those who provided support and encouragement i n the pr o d u c t i o n of t h i s paper; to my a d v i s o r s f o r t h e i r input and graci o u s a s s i s t a n c e ; to my co l l e a g u e s f o r t h e i r i n t e r e s t and saying that I should get on wi t h i t ; to my f a m i l y and f r i e n d s , e s p e c i a l l y R i c h a r d , f o r t h e i r p a t i e n c e and t e n a c i t y ; to the R e g i s t e r e d Nurses' A s s o c i a t i o n o f B r i t i s h Columbia and i t s members, f o r w r i t i n g i t a l l down and g i v i n g p e r m i s s i o n f o r access to the r e c o r d s . Without t h e i r h e l p , t h i s paper would not be. A s p e c i a l thanks to my a s s i s t a n t , C l a i r e McCallum, f o r the p r e p a r a t i o n o f the paper and f o r going t h a t e x t r a m i l e . 1 CHAPTER I INTRODUCTION The Registered Nurses' Association of B r i t i s h Columbia (RNABC), formed by p r o v i n c i a l statute i n 1918, i s a voluntary professional organization with over 27,500 members. The RNABC's main goal i s to ensure that safe nursing care i s provided to the people of B r i t i s h Columbia. In order to achieve this goal, the Association engages i n programs and a c t i v i t i e s which promote improvement in nursing education and practice. In this paper, the focus w i l l be on a c t i v i t i e s and programs related to continu-ing nursing education of Association members which promote improvements i n nursing education and practice. The educational program operated by the RNABC w i l l be described in terms of i t s development over time. Trends and events external to nursing and within the nursing profession that have influenced the evolution of the RNABC continuing education program w i l l be discussed. Four questions w i l l be used to guide examination of h i s t o r i c a l materials related to continuing nursing education within the Association. F i n a l l y , some observations w i l l be made about the impact of the RNABC on continuing nursing education for Registered Nurses (RNs) in B r i t i s h Columbia. The f i r s t section of this Chapter w i l l b r i e f l y discuss the major concepts which were used to develop the paper, namely, con-tinuing professional education, professional associations, and the educational program of a professional association. 2 The p r o f e s s i o n a l s e c t o r has been c a l l e d t h e l a r g e s t g r o w t h a r e a o f c o n t i n u i n g e d u c a t i o n i n r e c e n t y e a r s ( S t e r n , 1983:5). The t e r m c o n t i n u i n g p r o f e s s i o n a l e d u c a t i o n (CPE) came i n t o g e n e r a l u s a g e i n t h e l a t e 1960's as a b r o a d c o n c e p t t h a t i n c l u d e d a l l e f f o r t s t o p r o v i d e l e a r n i n g o p p o r t u n i t i e s f o r p r o f e s s i o n a l s ( H o u l e , 1980:7). CPE i s d e s c r i b e d as a m u l t i - b i l l i o n d o l l a r a c t i v i t y t h a t has no e d u c a t i o n a l p r e c e d e n t and as a f i e l d t h a t i s e m e r g i n g and y e t t o be d e f i n e d ( S t e r n , 1983:5). The f i e l d o f o p e r a t i o n s i n CPE, as i n a d u l t e d u c a t i o n as a w h o l e , c an be d e s c r i b e d i n i t s f i v e d i m e n s i o n s , i n s t i t u t i o n a l , m o r p h o l o g i c a l o r f o r m o f a c t i v i t y , g e o g r a p h i c a l , p e r s o n n e l , and c o n t e n t ( K n o w l e s , 1964:41). T h i s p a p e r w i l l f o c u s on t h e f i r s t two o f t h e s e d i m e n s i o n s , as t h e y a p p l y t o R e g i s t e r e d N u r s e s , t h a t i s , t h e form o f a c t i v i t y t h a t t h e e d u c a t i o n a l p r o g r a m has t a k e n w i t h i n one t y p e o f i n s t i t u t i o n i n a d u l t e d u c a t i o n , t h e p r o f e s s i o n a l a s s o c i a t i o n . S c h r o e d e r d e s c r i b e s f o u r t y p e s o f i n s t i t u t i o n s i n a d u l t edu-c a t i o n , on t h e b a s i s o f t h e r e l a t i o n s h i p o f a d u l t e d u c a t i o n t o t h e main p u r p o s e s o f t h e i n s t i t u t i o n i n w h i c h i t t a k e s p l a c e (1970:37). A p r o f e s s i o n a l a s s o c i a t i o n i s c l a s s i f i e d as a Type I I I i n s t i t u t i o n , s i n c e i t u s e s a d u l t e d u c a t i o n as a means o f a c h -i e v i n g i t s m a j o r p u r p o s e . A p r o f e s s i o n a l a s s o c i a t i o n i s d e f i n e d as "a s t r u c t u r e d body o f members who j o i n t o g e t h e r , more o r l e s s f r e e l y , b e c a u s e o f a s h a r e d i n t e r e s t , a c t i v i t y o r p u r p o s e , and who, by t h e a c t o f j o i n i n g , assume t h e same b a s i c powers and r e s p o n s i b i l i t i e s h e l d b y o t h e r members" ( H o u l e , 1976:229). M e r t o n s a y s t h a t p r o f e s s i o n a l a s s o c i a t i o n s a r e composed o f 3 individu a l s who j o i n together to perform certain functions which they cannot perform i n t h e i r capacity as individuals (1958:50). Program, as i t is used in the context of this paper, i s described as having several elements: i t i s an a c t i v i t y , which has order and continuity; i t includes more than one event and events within the a c t i v i t y are related to every other event; and i t includes educational objectives (Long, 1983:11). The educational program of a professional association i s described by Houle as having to do with "the accreditation of professional schools or other t r a i n i n g programs, the issuance of publications, the sponsorship of conventions and conferences, and the operation of special training programs, such as courses, conferences, workshops, and other a c t i v i t i e s c l e a r l y defined as i n s t r u c t i o n a l " (1980:172). Knowles i d e n t i f i e d two forms of educational a c t i v i t y t y p i c a l l y found within the educational program in a professional association: member directed a c t i v i t i e s , and a c t i v i t i e s directed to other groups. Educational a c t i v i t i e s directed to members may include issuance of journals, annual conferences, and i n s t r u c t i o n a l sessions. Educational a c t i v i t i e s directed to other groups and the general public may include the use of mass media to provide information to the public, and stimulating development of educational events by other groups (1964:60). The educational program of a professional association encompasses a d i v e r s i t y of a c t i v i t i e s . How i s the nature and extent of an association's educational program determined? Authors suggest that trends and events that occur i n both the larger society and within a profession i t s e l f may affect the 4 p r a c t i c e o f t h a t p r o f e s s i o n and i n t u r n l e a d t o new e d u c a t i o n a l p r a c t i c e s . E d u c a t i o n and l e a r n i n g a r e s o c i a l l y b a s e d and a r e t h e r e f o r e l i k e l y t o r e f l e c t changes i n t h e l a r g e r s o c i e t y ( L o n g , 1983:3). Mauksch p r o p o s e s t h a t an u n d e r s t a n d i n g o f t h e h i s t o r i c a l b a c k g r o u n d o f c o n t e m p o r a r y i s s u e s , how t r e n d s and e v e n t s h a v e a f f e c t e d them, and t h e p r o f e s s i o n ' s a t t i t u d e t o w a r d them, i s n e c e s s a r y i n o r d e r t o u n d e r s t a n d t h e i r r e l a t i o n s h i p t o t h e p r o f e s s i o n (1984:5). B r o a d s o c i a l i s s u e s , e v e n t s and t r e n d s a f f e c t t h e p r a c t i c e o f a p r o f e s s i o n and may g i v e r i s e t o l e a r n i n g n e e d s , w h i c h i n t u r n a f f e c t t h e c o n t e n t , l o c a t i o n , t e a c h i n g methods u s e d , and o r g a n i z a t i o n and a d m i n i s t r a t i o n o f an e d u c a t i o n a l p r o g r a m ( L o n g , 1983:24). E v e n t s o c c u r r i n g w i t h i n s o c i e t y , s u c h as t e c h n o l o g i c a l c h a n g e , c h a n g e s i n l e g i s l a t i o n g o v e r n i n g p r o f e s s i o n a l p r a c t i c e , o r g l o b a l c o n f l i c t a f f e c t t h e p r a c t i c e o f p r o f e s s i o n a l s . S o c i a l d e v e l o p m e n t s s u c h as t h e r i s i n g e d u c a t i o n a l l e v e l o f a d u l t s , c h a n g i n g a t t i t u d e s t o w a r d work, p r o f e s s i o n a l o b s o l e s c e n c e , e x p a n s i o n o f n o n - t r a d i t i o n a l a p p r o a c h e s t o e d u c a t i o n , and d e v e l o p m e n t o f new media i m p a c t on p r o f e s s i o n a l p r a c t i c e and e d u c a t i o n ( L o n g , 1983:31). T h i s p a p e r w i l l examine how s e l e c t e d s o c i a l i s s u e s , t r e n d s and e v e n t s o c c u r r i n g o v e r t i m e have a f f e c t e d t h e d e v e l o p m e n t o f t h e e d u c a t i o n a l p r o g r a m i n one p r o f e s s i o n a l n u r s i n g a s s o c i a t i o n , t h e RNABC. F o u r q u e s t i o n s w i l l be u s e d t o g u i d e t h e s t u d y o f t h e h i s t o r i c a l r e c o r d o f t h e RNABC i n r e l a t i o n t o i t s e d u c a t i o n a l p r o g r a m f o r i t s members: 5 1. What has been the nature of RNABC's involvement i n c o n t i n u i n g education? 2. How has the RNABC changed and adapted to i n t e r n a l and e x t e r n a l events and trends that have i n f l u e n c e d the e d u c a t i o n a l program of the A s s o c i a t i o n ? 3 . How has the RNABC been p r o a c t i v e or r e a c t i v e i n response to trends and events that have a f f e c t e d the e d u c a t i o n a l program of the A s s o c i a t i o n ? 4. What i s RNABC's commitment to c o n t i n u i n g education? Chapter I I o f t h i s paper begins w i t h a d e s c r i p t i o n o f c o n t i n u i n g p r o f e s s i o n a l e d u c a t i o n , i n c l u d i n g i t s development s i n c e World War I I . The l i n k between CPE and p r o f e s s i o n a l competence w i l l be explored, as w e l l as reasons f o r engaging i n CPE. P r o f e s s i o n a l e d u c a t i o n f o r R e g i s t e r e d Nurses w i l l be d i s c u s s e d , i n c l u d i n g f a c t o r s which generate a need f o r c o n t i n u i n g e d u c a t i o n . P r o f e s s i o n a l a s s o c i a t i o n s w i l l be d e s c r i b e d i n terms o f s o c i a l f u n c t i o n s , and v a r i o u s r o l e s of a p r o f e s s i o n a l a s s o c i a t i o n i n r e l a t i o n to c o n t i n u i n g education w i l l be e x p l a i n e d . Three o r g a n i z a t i o n a l models f o r a p r o f e s s i o n a l a s s o c i a t i o n ' s c o n t i n u i n g e d u c a t i o n program w i l l be presented. In Chapter I I I , the h i s t o r i c a l r e c o r d of the RNABC w i l l be examined t o d e s c r i b e how e d u c a t i o n a l a c t i v i t i e s have evolved over time. Three time pe r i o d s have been s e l e c t e d to provide a framework f o r p r e s e n t a t i o n and a n a l y s i s o f data. W i t h i n each time p e r i o d , major developments w i l l be i d e n t i f i e d , and s p e c i f i c 6 a c t i v i t i e s concerned with p o l i c y development and governance and e d u c a t i o n a l a c t i v i t i e s / s e r v i c e s w i l l be d e s c r i b e d . The h i s t o r i c a l r e c o r d of the RNABC, i n c l u d i n g p e r i o d i c a l s , annual r e p o r t s , committee r e p o r t s , i n s t i t u t i o n a l f i l e s , and p u b l i c documents prepared by the RNABC as o f f i c i a l statements, w i l l a l s o be used to address the study q u e s t i o n s . The m a j o r i t y o f these documents are primary sources. Since l i t t l e has been w r i t t e n about c o n t i n u i n g n u r s i n g education i n e i t h e r B r i t i s h Columbia or Canada, few secondary sources are a v a i l a b l e . S u p p o r t i v e m a t e r i a l s from Canadian and American n u r s i n g , n u r s i n g h i s t o r y , and s o c i a l p o l i c y w i l l be i n c l u d e d as a p p r o p r i a t e . To a s s i s t the reader i n i d e n t i f y i n g the source o f i n f o r m a t i o n , the f o l l o w i n g key w i l l be used. A.M. - Annual Meeting A.R. - Annual Report Board - Board o f D i r e c t o r s Cmtee Ed. Loans - Committee on Bursary/Loans Cmtee Ed. P o l . - Committee on E d u c a t i o n a l P o l i c y Cmtee Nr. Ed. - Committee on Nursing Education Coun. - C o u n c i l Exec. - Ex e c u t i v e Committee, RNABC GNABC - Graduate Nurses A s s o c i a t i o n o f B r i t i s h Columbia (from 1912 to 1935) RNABC - R e g i s t e r e d Nurses' A s s o c i a t i o n o f B r i t i s h Columbia (from 1935 to present) In Chapter IV, the four study questions w i l l guide a n a l y s i s of the m a t e r i a l presented i n Chapter I I I . Chapter V w i l l present a summary o f the paper, c o n c l u s i o n s o f the study and suggested 7 i m p l i c a t i o n s o f t h e s t u d y f o r c o n t i n u i n g n u r s i n g e d u c a t i o n . 8 CHAPTER II REVIEW OF THE LITERATURE Continuing professional education is an emerging f i e l d which has gained prominence since the mid 1940's (Houle, 1983:256). However, continuing nursing education opportunities only began to expand i n the 1960's (The Scope of Continuing Nursing Education, 1982:13). Although several groups have an interest in continuing education for RNs, the focus of this paper i s the professional nursing association. In this Chapter, information from the l i t e r a t u r e w i l l be used to describe the purpose and development of continuing professional education and continuing nursing educ-ation, various roles and a c t i v i t i e s of professional associations and, more s p e c i f i c a l l y , the roles that a professional nursing association can have in r e l a t i o n to a continuing education program for i t s members. CONTINUING PROFESSIONAL EDUCATION Continuing professional education, broadly defined, refers to any and a l l methods, formal and informal, used to promote the growth and development of professionals, through learning (Grabowski, 1981:85). CPE has become one of the central aims of adult education since the 1960's (Apps, 1985:116). Houle describes four stages of development of CPE, from post-World War II to the present (1983:256). 9 Development of Continuing Professional Education In the f i r s t stage of development of CPE, from post-World War II to the mid 1960's, i t was believed that professionals would take r e s p o n s i b i l i t y for the i r own continuing education and for remaining competent. This expectation continued u n t i l the mid 1960's, when attitudes toward professionals began to change, as a resu l t of a growing concern about the competence of profes-sionals. The goals of CPE in the second stage, from the mid 1960's to the present, have been to establish a minimum l e v e l of performance for a l l p r a c t i t i o n e r s and to strengthen the emphasis on l i f e l o n g learning. CPE is viewed as remedial in nature. The s h i f t i n emphasis occurred when both the public and professionals themselves began to become d i s i l l u s i o n e d with the a b i l i t y of professionals to keep up to date with changes in practice, caused by the rapid p r o l i f e r a t i o n of technology and other changes in professional practice. There has been an increased emphasis on l i f e l o n g learning, and on voluntary or compulsory p a r t i c i p a t i o n i n continuing education. As a r e s u l t , there has been an increase i n the number of providers, programs offered, and types of i n s t r u c t i o n a l methods used, as well as development of ways to measure either the extent of p a r t i c i p a t i o n of individual p r a c t i t i o n e r s , or the impact of p a r t i c i p a t i o n on practice (Houle, 1983:254). Houle predicts that i n the t h i r d stage of development, many of the i n s t i t u t i o n s and programs that evolved in the second stage w i l l no longer be v i a b l e . The central aim of CPE w i l l s h i f t to a focus on increasing the optimal l e v e l of performance of a l l 10 p r a c t i t i o n e r s so that in addition to meeting minimum standards, p r a c t i t i o n e r s w i l l be expected to improve beyond that l e v e l . Individuals w i l l want to be recognized for meeting higher stand-ards, as a measure of status, and development of s e l f - a p p r a i s a l examinations w i l l increase as one way for practitioners to demonstrate an improved l e v e l of practice. As professionals become more specialized, Houle predicts a s h i f t i n the fourth stage of development of CPE, to a focus on meeting the specialized needs of diverse groups within a profes-sion. He also suggests that there i s a movement to increase the importance of both employers and professional associations as providers of CPE (Houle, 1983:260). Purpose of Continuing Professional Education Houle describes a need for the professional to "establish mastery of the new concepts of his own profession, to grow as a person as well as a professional" (1967:263). As well, he i d e n t i f i e s a need for professionals to maintain a fresh outlook on work, to r e t a i n the power to learn, and to carry out society's expectations for members of a profession (1976:48). Caplan iden-t i f i e s philosophical, s o c i a l and economic changes such as the knowledge explosion, r i s i n g consumer expectations for profes-sional accountability, and increased regulation and monitoring by government as reasons why continuing education i s necessary for professionals (1983:319). The pressure for CPE stems from a widespread concern about competency (Williams and Huntley, 1979:32). Competency is defined as the possession of required 11 s k i l l , knowledge, q u a l i f i c a t i o n or capacity to carry out professional r e s p o n s i b i l i t i e s (Stein, 1979). A p r a c t i t i o n e r need not be exceptional in his practice, however he must be adequate in order to be considered competent. Professional competence i s related to preservice education, knowledge obsolescence and r i s i n g consumer expectations for professional practice. Argyris and Schon raise the question of professional competence upon graduation from preservice educational programs (1974:143). T r a d i t i o n a l l y , preservice educational programs for professionals have been based upon a c l a s s i c model, described by Houle as a linear model which consists of three parts: general education, preservice specialized education, and continuing educ-ation (1980:4). This model is being questioned by the public, and by professionals themselves, as the issue of professional competence gains attention. Houle suggests that preservice educational programs should prepare practitioners to be l i f e l o n g learners, that continuing education programs should be individua-l i z e d , and designed to f a c i l i t a t e changes in l i f e patterns or career goals (1980:13). Grabowski suggests that because there is a l i m i t e d amount of time available for preservice education, professionals can only learn basic knowledge and s k i l l s , and must master further knowledge and s k i l l after preservice education i s completed, in order to become and remain competent (1981:86). Manning describes the t r a d i t i o n a l medical school program which emphasizes transfer of information rather than teaching p r a c t i t i o n e r s how to determine their own learning needs, or how to organize their practice to f a c i l i t a t e continuing 12 education (1982:5). M i l l e r suggests that a process model rather than a content model would be more appropriate in continuing health education (1967:326). Continuing health education should emphasize competence and performance rather than knowledge a c q u i s i t i o n , and continued learning rather than continued i n s t r u c t i o n . Houle relates CPE to quality control. He says that basic levels of competency have been established through control of entry into practice and the focus has now switched to developing controls to monitor a l i f e t i m e of practice (1980:273). The issue of professional competence is related to what Grabowski c a l l s professional obsolescence (1981:85). He describes two kinds of professional obsolescence: that r e s u l t i n g from lack of proper use of professional knowledge, and the r e s u l t of f a i l u r e to keep up with new developments. Lack of proper use of professional knowledge may include repeating patterns of behaviour rather than seeking out new strategies, or lacking s e n s i t i v i t y to changes that have occurred i n practice. F a i l u r e to keep up with new developments in the f i e l d may reduce the effectiveness of the p r a c t i t i o n e r , since professional knowledge i s said to become obsolete within f i v e to seven years after i n i t i a l learning (Grabowski, 1981:85). Obsolete knowledge may be due to the p r o l i f e r a t i o n of s c i e n t i f i c discoveries and resultant technological advances or to changing so c i e t a l expectations (Selden, 1981:64). Society expects that professionals w i l l be accountable to the public for safe practice. Accountability is described by Caplan 13 as a " s o c i a l phenomenon t h a t has mushroomed i n t h e p a s t t w enty y e a r s and o b t a i n s n u r t u r a n c e f r o m s u c h r e l a t e d d e v e l o p m e n t s as co n s u m e r i s m , b a c k t o b a s i c s , b e h a v i o u r a l i s m , management by o b j e c t i v e s , and w i d e s p r e a d d i s a f f e c t i o n w i t h , o r e v e n d i s t r u s t o f , a l l p r o f e s s i o n a l s " ( 1 9 8 3 : 3 2 3 ) . He a l s o s t a t e s t h a t t h e p u b l i c c l a m o r f o r a c c o u n t a b i l i t y o f p r o f e s s i o n a l s i s s i m i l a r t o t h e c l a m o r f o r a c c o u n t a b i l i t y o f e v e r y member o f o u r s o c i e t y t o e v e r y o t h e r member. S o c i e t y p e r c e i v e s t h a t t h e r e i s a gap betwe e n what p r o f e s s i o n a l s can do, and what t h e y say t h a t t h e y c a n do, w h i c h has r e s u l t e d i n a l o s s o f p u b l i c f a i t h ( L o r i n g , 1 9 8 0 : 1 2 ) . C o n c e r n o v e r p r o f e s s i o n a l competence has l e d t o i n c r e a s e d r e g u l a t i o n o f p r o f e s s i o n a l p r a c t i c e . I n summary, t h e need f o r c o n t i n u i n g p r o f e s s i o n a l e d u c a t i o n h a s a r i s e n due t o c o n c e r n b y p r o f e s s i o n a l s and t h e p u b l i c a b o u t c ompetence. CPE i s v i e w e d as one way t h a t p r o f e s s i o n a l s c a n become and r e m a i n c o m p e t e n t . The n a t u r e o f t h e p r e p a r a t o r y e d u c a t i o n program, t h e knowledge e x p l o s i o n , and r i s i n g consumer e x p e c t a t i o n s f o r p r o f e s s i o n a l a c c o u n t a b i l i t y a l l i n f l u e n c e t h e nee d f o r CPE. In t h e n e x t s e c t i o n , p r o f e s s i o n a l a s s o c i a t i o n s w i l l be d e s c r i b e d i n terms o f p o s s i b l e r o l e s . P r o f e s s i o n a l A s s o c i a t i o n s P r o f e s s i o n a l a s s o c i a t i o n s a r e composed o f i n d i v i d u a l p r a c -t i t i o n e r s who j o i n t o g e t h e r t o p e r f o r m c e r t a i n f u n c t i o n s w h i c h t h e y c a n n o t p e r f o r m i n t h e i r c a p a c i t y as i n d i v i d u a l s ( M e r t o n , 1 9 5 8 : 5 0 ) . Modern p r o f e s s i o n a l a s s o c i a t i o n s have been i n 14 existence for over a hundred years (Gross, 1983:183). They are t y p i c a l l y voluntary associations although the degree to which they are voluntary may vary (Merton, 1958:50). A professional association exists because of i t s s o c i a l functions. Merton describes the professional association as having three main s o c i a l functions, based upon the services provided to the i n d i v i d u a l p r a c t i t i o n e r , the profession as a whole, and the society at large (1958:51). The professional association pro-vides s o c i a l and moral support to individual members to enable them to function as professionals more e f f e c t i v e l y , to the further benefit of c l i e n t s . In addition, by establishing l e g a l l y enforceable standards of competence, encouraging prac t i t i o n e r s to develop knowledge and s k i l l s , and promoting l i f e l o n g learning, the professional association helps the p r a c t i t i o n e r to carry out professional r e s p o n s i b i l i t i e s competently. For the profession, the professional association sets and helps enforce standards of practice, education, administration, and research. It must also try to anticipate future events and ensure that professionals are available to carry out future r e s p o n s i b i l i t i e s . Dissemination of information about changes that a f f e c t nursing i s also a function of the professional association. An i n d i r e c t function that occurs as a r e s u l t of other a c t i v i t i e s i s the enhancement of the p r o f i l e and status of the profession i n the eyes of the public. The association also has a role in the relationship between the p r a c t i t i o n e r and the society at large. Maintaining a l i a i s o n between the profession and government, and relations with other 15 rela t e d occupations, are part of this function. The overriding object i s to create and present a unity of purpose among profes-sionals and to safeguard the profession against incursion by other occupational groups. In r e l a t i o n to government, the ro l e of the professional association is to formulate p o l i c i e s for government consideration and monitor government and l e g i s l a t i v e a c t i v i t y which may impact on the profession. The professional association must "create a concert of purpose", that i s , develop a c o l l e c t i v e viewpoint among members (Merton, 1958:53). Continuing Education A c t i v i t i e s of a Professional Association Continuing education of members i s described as an overt function of professional associations (Grabowski, 1981:88). The educational role of the professional association i s taken for granted by members and the general public (Hohmann, 1979:84). Associations tend to stress the s o c i e t a l context of the practice of professionals, pragmatic issues, and their status in the sponsorship of continuing education (Grabowski, 1981:88). Professional associations have become more interested in CPE as a re s u l t of s o c i a l , p o l i t i c a l and economic changes which have affected t h e i r membership, programs and finances (Hohmann, 1980:83). Self-examination has occurred which has allowed professional associations to survive, to set new p r i o r i t i e s and, in some cases, has led to increased a c t i v i t y i n CPE. Authors have suggested various roles for a professional association with respect to continuing education. Knowles views a professional society as a learning community and suggests six 16 areas of r e s p o n s i b i l i t y (1979:40). These areas are: development of competencies for various roles within the profession; provid-ing learning opportunities for members; operation of delivery systems that make resources available to working professionals; r a i s i n g the consciousness of members regarding the need for con-tinuing professional development and rewarding self-development e f f o r t s ; assuring that members are continuing their professional development; and informing members about concepts of adult learn-ing and using these concepts in i t s own educational program. Houle suggests that professional associations should consider education as a major element in shaping the p o l i c i e s and practices of the profession, use instruction to inform and influence i t s members, for example, through publications and conventions, and ensure that members have an opportunity to pa r t i c i p a t e i n the planning and delivery of educational programs (1980:173). He also suggests that a professional association should use in s t r u c t i o n to enlighten and influence i t s members and to contribute to pro f e s s i o n a l i z a t i o n of the vocation (1980:165). An association can enhance i t s image in the eyes of i t s members and the public through i t s continuing education program. The public has a posit i v e perception of the image of nurses as individuals concerned about the quality of educational a c t i v i t i e s i n which they p a r t i c i p a t e (Continuing Education, 1982:21). Continuing education i s viewed p o s i t i v e l y by association members. Since the only contact that members may have is with the continuing education program of the association, their view of the association can be favourably influenced by the continuing 17 education program. Professional associations can be both providers and purchasers of educational services (Hohmann, (1979:84). Houle i d e n t i f i e s seven dominant forms of providers: autonomous groups, professional associations, professional schools, the non-professional school sector of a university, places of employment, independent providers, and purveyors of professional supplies and equipment (1980:166). Apps describes providers as mass media, employers and work settings, proprietary schools, higher education, cooperative extension, public schools and other agencies, such as l i b r a r i e s , museums, health and welfare agencies (1979:71) . Puetz describes the professional association as the second largest group of continuing education sponsors, after educational i n s t i t u t i o n s (1985:93). Professional associations can sponsor continuing education d i r e c t l y or i n d i r e c t l y . As a sponsor, a d i r e c t relationship exists between the professional association and the learner; the association provides i n s t r u c t i o n a l sessions, sponsors conventions, and issues journals. The association can sponsor continuing education i n d i r e c t l y by providing resources to enable a direct provider to undertake or enhance i t s works, for example, by providing assistance i n program development or p u b l i c i z i n g upcoming events. An association may operate a continuing education program to protect i t s e l f from incursion by others into i t s sphere of professional j u r i s d i c t i o n (Seldon, 1981:64). With increased s p e c i a l i z a t i o n in the health care f i e l d , there has been a major 18 increase in the number of related professions and a b l u r r i n g of l i n e s between them. Professional associations may view continu-ing education as one way to promote the profession, increase i t s v i s i b i l i t y v i s - a - v i s other workers, and therefore more c l e a r l y define the professional t u r f that is claimed by i t s members. The professional association can also act as a quality control measure in r e l a t i o n to continuing education (Grabowski, 1981:88). Quality control may relate to the i n d i v i d u a l p r a c t i -tioner, the educational program, the sponsoring i n s t i t u t i o n , or some combination. In r e l a t i o n to the individual p r a c t i t i o n e r , the professional association may require evidence of p a r t i c i -pation i n continuing education on either a voluntary or mandatory basis. Continuing education programs and sponsors may be required to meet standards established by the professional association before they can e n r o l l participants (Williams and Huntley, 1979:38). Selden i d e n t i f i e s three alternative roles for a professional association to pursue with regard to control of continuing educ-ation (1976:66). The profession can maintain autonomous control, the government can regulate and l e g i s l a t e CPE, or the profession and government can assume shared r e s p o n s i b i l i t y . U n i l a t e r a l control i n issues of professional competence and continuing education i s the goal of most professional associations, since control gives the professional association power and authority in the society at large. There may be an inherent c o n f l i c t between the goals of the members of a professional group and the profession's commitment to the public good. Governmental control over professional practice is feared by professionals, some of whom believe that service quality w i l l f a l l below standard under government regulation. Selden says i t is c hauvinistic to believe that only professionals can control professional practice and that this stance by professionals may act as an "emotional o u t l e t " that may lead to an eventual reduction i n professional influence rather than an increase (1976:67). Shared r e s p o n s i b i l i t y , or "constructive compromise" i s d i f f i c u l t for professionals to accept, especially i f the professional group has valued i t s autonomy and believes that only peers have the a b i l i t y to evaluate th e i r practice. Selden suggests that i t is the best interests of professional associations to move toward a broadening of involvement by interested others in control over professional practice and continuing education. Hohmann suggests that professional associations have d i f f i c -u l t y i n operating a CPE program, and that a major problem in CPE i s organizational in nature, related to d i f f i c u l t i e s with defin-ing goals, conducting long-range planning, coordinating i n t e r n a l r e l a t i o n s and providing educational programs that address issues important to members (1980:87). The major problem i d e n t i f i e d by Hohmann i s deli v e r i n g quality programs to learners. She suggests that cooperation among providers i s one answer. A cooperative endeavour may be structured in one of three suggested organiza-t i o n a l models of program delivery: the service model, the marketing model, or the performance model (1980:90). 20 In the service model, organizations are reactive to member needs; they view CPE as successful simply because i t e x i s t s . Hohmann says that t h i s is the c l a s s i c operational form (1980:90). A flaw i n this model i s that the program planner la r g e l y determines the content and dir e c t i o n of the program, and there i s no guarantee that the planner can deliver a quality program. In the marketing model, the use of product marketing allows the association to be proactive. Techniques such as "eye appeal" and "targeting the market" are u t i l i z e d . The bottom l i n e i s geared toward ensuring that there are enough participants and programs to keep the operation viable. These two models are sim i l a r since they depend upon what works and changes are made due to experience or feedback from participants' s a t i s f a c t i o n with an event or a c t i v i t y . Impact of the learning a c t i v i t y on practice i s not assessed. The performance model, concerned with learner performance, i s described as an "emerging orientation". Participants are encouraged to become self-learners and associations should assume a supportive r o l e . Hohmann suggests that professional associations should operate on a performance model. However, the heavy investment of resources needed to operate along these lines often precludes using the performance model (1980:91). CONTINUING NURSING EDUCATION Continuing education within the nursing profession has been defined by the American Nurses Association as "planned, organized 21 learning experiences designed to augment the knowledge, s k i l l s and attitudes of registered nurses for the enhancement of nursing p r a c t i c e , education, administration and research, to the end of improving health care for the public" (Cooper, 1983:6). The purpose of continuing nursing education (CNE) i s to update professionals' knowledge and s k i l l s or to prepare them to practice in a d i f f e r e n t setting or a di f f e r e n t area of expertise (Puetz and Peters, 1981:1). Cooper and Hornback suggest that continuing education contributes not only to "professional practice but also to the development of the person as an individual and a responsible c i t i z e n " (1973:2). The main objective of continuing nursing education, however, is described as the improvement of professional practice (The Scope of Continuing Nursing Education, 1982:13). The need for continuing education, according to Puetz and Peters (1981:2), arises out of the nature of preparatory nursing programs as well as changes in the delivery of health care and changes in the role of the RN within the health care system. Preparatory nursing programs vary i n length and content, and Clark suggests that continuing education is one way to make up for the differences in knowledge and s k i l l s of beginning p r a c t i t i o n e r s (1979:4). Socioeconomic changes, p o l i c y developments i n the p o l i t i c a l arena and technological advances in health care have been i d e n t i -f i e d as influences on nursing (Puetz and Peters, 1983:2). Socio-economic changes, such as the changing age of the population, 22 h a v e h a d i m p a c t on t h e number o f p e r s o n s s e e k i n g h e a l t h c a r e , w h i c h i n t u r n a f f e c t s t h e number o f RNs r e q u i r e d and t h e kn o w l e d g e and s k i l l s t h e y need. P o l i c i e s d e v e l o p e d b o t h by g o v e r n m e n t a l and n o n - g o v e r n m e n t a l a g e n c i e s s u c h as r e i m b u r s e m e n t p o l i c i e s and a d m i s s i o n p o l i c i e s t o c e r t a i n t y p e s o f c a r e have had an i m p a c t on t h e knowledge and s k i l l s r e q u i r e d b y RNs. A c c r e d i t a t i o n s t a n d a r d s f o r h e a l t h f a c i l i t i e s a l s o i m p a c t on n u r s i n g p r a c t i c e . More and i n c r e a s i n g l y complex t e c h n o l o g y i s b e i n g u s e d i n n u r s i n g w h i c h n e c e s s i t a t e s a d v a n c e d p r e p a r a t i o n f o r RNs w o r k i n g i n s p e c i a l i z e d a r e a s . C o o p e r s u g g e s t s t h a t s o c i a l t r e n d s , t h e c h a n g i n g n a t u r e o f n u r s i n g , s t a n d a r d s o f p r a c t i c e , and p r o f e s s i o n a l c e r t i f i c a t i o n a r e f a c t o r s t h a t h e l p c r e a t e l e a r n i n g needs f o r RNs ( 1 9 8 3 : 6 - 9 ) . A g r e a t e r a c c e p t a n c e b y RNs o f i n d i v i d u a l a c c o u n t a b i l i t y and r e s p o n s i b i l i t y f o r p r a c t i c e , c o n t i n u e d d e l i n e a t i o n o f n u r s i n g p r a c t i c e f r o m t h e p r a c t i c e o f o t h e r h e a l t h p r o f e s s i o n s , and i n c r e a s i n g consumer demand f o r a s s u r a n c e t h a t RNs a r e p r o v i d i n g s a f e c a r e a r e i d e n t i f i e d by C l a r k as f a c t o r s t h a t l e a d t o t h e need f o r c o n t i n u i n g e d u c a t i o n f o r RNs ( 1 9 7 9 : 4 ) . C o n t i n u i n g E d u c a t i o n i n a P r o f e s s i o n a l N u r s i n g A s s o c i a t i o n The p r o f e s s i o n a l n u r s i n g a s s o c i a t i o n may have v a r i o u s r o l e s i n r e l a t i o n t o c o n t i n u i n g e d u c a t i o n f o r i t s members. Weldy s u g g e s t s t h a t t h e p r o f e s s i o n a l a s s o c i a t i o n h as a r e s p o n s i b i l i t y t o " s u p p o r t members i n p u r s u i t o f a c h o s e n g o a l " ( 1 9 7 0 : 3 6 ) . The e x t e n t o f i n v o l v e m e n t o f a p r o f e s s i o n a l a s s o c i a t i o n depends somewhat on t h e e d u c a t i o n a l o p p o r t u n i t i e s a v a i l a b l e t o n u r s e s 23 through other educational resources. Weldy describes educational a c t i v i t i e s of various state nurses' associations i n the United States; such as, providing resource people to discuss issues and problems of practice, acting as a coordinating body, giving assistance i n program planning, and developing guidelines to a s s i s t RNs to plan for the i r own continuing education (1970:37). The annual convention i s also i d e n t i f i e d as part of the educational a c t i v i t i e s of a professional nursing association, and may include topics of special interest to members in addition to the business section. Puetz describes the continuing education program of a professional nursing association as having three elements consis-t i n g of inputs, throughputs and outputs (1985:89). Inputs of a continuing education program include resources provided for the e f f e c t i v e functioning of the program, such as adequate s t a f f , s u f f i c i e n t p a r t i c i p a n t s , i n s t r u c t i o n a l personnel, p o l i c i e s and procedures which impact on program delivery, f i n a n c i a l support, and f a c i l i t i e s and equipment available. Throughputs are described as the development and implementation of the products of the continuing education program, i t s financing and i t s coordination with other programs within the association. Products may include provision of continuing education offerings, approval of continuing education offerings sponsored within i t s j u r i s d i c t i o n , and c e r t i f i c a t i o n of i t s members. Coordination of continuing education a c t i v i t i e s within a s p e c i f i c geographic area may sometimes be a product of a professional association. The primary outcome of the continuing education program should 24 involve a change in professional practice of participants. Other outcomes may include increased income, additional members and improved public r e l a t i o n s . In t h i s Chapter, continuing professional education has been described by looking at i t s stages of development. The second stage, which exists at the current time, was explored by looking at factors which suggest the need for CPE. Continuing education i n nursing was then described i n terms of i t s purpose and factors which impact on the need for RNs to continue to learn. Since the educational program of a professional association is being studied in the next Chapter, l i t e r a t u r e related to the goals, purpose and role of professional associations generally, and s p e c i f i c a l l y in r e l a t i o n to CNE, was presented. In the next Chapter, the h i s t o r i c a l record of the RNABC w i l l be examined in r e l a t i o n to three stages of development, and a c t i v i t i e s within each stage w i l l be described. 25 CHAPTER III DEVELOPMENT OF CONTINUING EDUCATION AT THE RNABC It is the intention to describe, in this Chapter, the development of the continuing education program of the RNABC from 1912 to the present. Three stages of development w i l l be described, from 1912 to 1940, from 1941 to 1967, and from 1968 to the present. F i r s t , a b r i e f overview of each stage w i l l be given, with a c t i v i t i e s highlighted that make each period unique. Next, each stage of development w i l l be described in more d e t a i l , giving major developments f i r s t , and then s p e c i f i c a c t i v i t i e s i n the area of po l i c y development and governance and educational a c t i v i t i e s / s e r v i c e s . P o l i c y development and governance w i l l include statements made by the Association concerning i t s role in continuing education as well as po l i c y statements concerning s p e c i f i c issues or areas such as continuing education requirements for r e - r e g i s t r a t i o n and the position of the Association v i s - a - v i s the need for post-basic specialty t r a i n i n g . Educational a c t i v i t i e s and services w i l l describe s p e c i f i c roles of the Association such as provider of continuing education, providing support and information services, the influencing/advocacy r o l e , and the quali t y monitoring r o l e . 26 THREE STAGES OF DEVELOPMENT In the f i r s t stage of development, from 1912 to 1940, continuing education a c t i v i t i e s of the RNABC were limited i n nature, since the Association's main goals were to achieve nurse r e g i s t r a t i o n and to e s t a b l i s h a system for quality control i n preparatory nursing education programs. Continuing education was provided mainly by volunteers since the single employee of the Association was concerned mainly with r e g i s t r a t i o n and schools of nursing. By 1936, requests for continuing education were being made by nurses throughout the province, and Association s t a f f were authorized to respond to these requests by arranging v i s i t s to discuss nursing issues. With the formation of d i s t r i c t s in 1938, a formal communication mechanism with members was established. This network was used to disseminate information on nursing from the p r o v i n c i a l and national l e v e l as well as to encourage l o c a l a c t i v i t i e s , e s p e c i a l l y to help keep nurses up to date with changes i n nursing. In 1940, the Association sponsored a refresher course for inactive nurses, a need which arose due to the number of nurses leaving the province to j o i n the war e f f o r t . With the advent of World War I I , the Association's r o l e i n continuing education became a more v i s i b l e part of Association a c t i v i t i e s . Over the time period 1941 to 1967, Association a c t i v i t i e s as a provider increased to such an extent that the RNABC was the major provider of continuing education for RNs i n B r i t i s h Columbia. Many Association a c t i v i t i e s such as the Placement Service, RNABC News, l i b r a r y , 27 and educational funds were established during this time. Continuing education became a v i t a l part of Association a c t i v i t i e s and additional s t a f f positions were established within the Association to service this a c t i v i t y . In 1965, the Association produced a five-year plan which calle d for a gradual decentralization of r e s p o n s i b i l i t y for providing continuing educ-ation so that RNABC chapters would take more r e s p o n s i b i l i t y for planning and conducting l o c a l continuing education a c t i v i t i e s , with assistance from RNABC provided, i f needed. Also at this time, the RNABC supported the ef f o r t s of the University of B r i t i s h Columbia to esta b l i s h a Continuing Nursing Education Di v i s i o n . The role of the Association shifted at the end of this period, from being the major provider of continuing education to promotion of the development of continuing education a c t i v i t i e s by others, with advice and consultation available from the RNABC. This r o l e was further elaborated i n the second and t h i r d parts of a comprehensive study on nursing education, i n i t i a t e d by the RNABC i n 1967, which was to provide d i r e c t i o n for future Association a c t i v i t i e s . From 1968 to the present, the Association has focused on a c t i v i t i e s and services that support the professional practice of RNs, such as the Safety To Practice Program, development of post-basic specialty programs and l i b r a r y services. In addition, services to members, such as career counselling, educational loans, and information services have been provided. In the next section of the paper, each of the three stages of development w i l l be described i n d e t a i l . 28 1912 to 1940: THE FORMATIVE YEARS Major Developments At the f i r s t Annual Meeting of the Graduate Nurses Associat-ion of B r i t i s h Columbia (GNABC) i n 1913, three educational papers were presented by Association members (GNABC. A.M., 1913). In the early years, most of the energy of the Association was dir e c -ted toward achieving a B i l l for nurse r e g i s t r a t i o n , however, the GNABC established a l i n k with the Canadian Nurse magazine with items of interest from B.C. nurses forwarded by the Association for i nclusion i n the magazine (GNABC. Coun., 23/02/15). The Association supported the establishment of a Red Cross Chair in Public Health at the University of B r i t i s h Columbia (UBC) and the f i r s t baccalaureate program in nursing in the B r i t i s h Empire, started at UBC i n 1919 (Green, 1984:9). In 1920, UBC offered the f i r s t fourteen-week course in public health nursing, which had been developed with the support of the Public Health Nursing Section of the GNABC. Also in that year, the Association established i t s f i r s t scholarship to support a nurse engaging in post-basic study at the university l e v e l . GNABC also supported a scholarship at McGill University for the same purpose. In 1922, the Nursing Education Committee was established as a Standing Committee of the Association and embarked upon the preparation of lesson plans to ass i s t teachers i n small schools of nursing. The committee also established an eight-week course 29 i n teaching and administration, the f i r s t of i t s kind in B.C. (GNABC. A.M., 1923). Refresher courses for practicing nurses, c a l l e d " i n s t i t u t e s " , were arranged for public health nurses and private duty nurses s t a r t i n g in 1923 (GNABC. Coun., 02/04/23). These courses were designed to bring p r a c t i c i n g nurses up to date with changes in nursing practice. In 1925, GNABC endorsed a two week course i n x-ray technique, sponsored by a commercial company (GNABC. Coun., 10/10/25). At the Annual Meeting in 1926, the establishment of a l i b r a r y was suggested, however, a committee to study the issue was not formed u n t i l 1930. Instead, the Association accepted the of f e r of the Provincial Public Library Commission to have an "open shelf" at the pr o v i n c i a l l i b r a r y . Books were purchased for the "open shelf" as a project by the Public Health Nursing Section of the GNABC in 1929. A refresher course for i n s t i t u t i o n a l nurses was f i r s t offered through UBC in 1931, along with courses offered for public health and private duty nurses. In 1934, the scope of refresher courses was broadened to include a l l nurses ir r e s p e c t i v e of th e i r f i e l d of nursing practice. L i b r a r y services were appearing in hospitals, and in 1931, the Association urged the continued development of l i b r a r i e s , both i n hospitals and nursing organizations. In 1935, the "open shelf" was moved to the pr o v i n c i a l o f f i c e s of the Registered Nurses' Association of B r i t i s h Columbia (RNABC). In 1936, budget was allocated to add to the l i b r a r y holdings of the Association. Funds were allocated in 1936 to allow Association s t a f f to 30 t r a v e l t o meet w i t h n u r s e s t o b r i n g m a t t e r s p e r t a i n i n g t o n u r s i n g t o t h e i r a t t e n t i o n , n o t j u s t t o t r a v e l i n c o n j u n c t i o n w i t h s c h o o l s o f n u r s i n g work. The f i r s t e d u c a t i o n a l t o u r o f t h e p r o v i n c e o c c u r r e d i n 1 9 3 7 , and was c a r r i e d o u t by two RNs em p l o y e d by t h e A s s o c i a t i o n . The p u r p o s e o f t h e t o u r was t o t a k e i n f o r m a t i o n t o n u r s e s a b o u t c u r r e n t n u r s i n g i s s u e s . D i s c u s s i o n a b o u t d i v i s i o n o f t h e p r o v i n c e i n t o c h a p t e r s and d i s t r i c t s b e g a n i n 1 9 3 8 and was one t o p i c o f t h e e d u c a t i o n a l t o u r i n t h a t y e a r . A s s i s t a n c e was p r o v i d e d t o c e n t r e s t o form c h a p t e r s , a t f i r s t on a v o l u n t a r y b a s i s , and t h e n , i n 1 9 4 0 , an o r g a n i z e r was a p p o i n t e d on a h a l f - t i m e b a s i s t o p r o v i d e a s s i s t a n c e t o c h a p t e r s . P o l i c y Development and G o v e r n a n c e RNABC R o l e i n C o n t i n u i n g E d u c a t i o n I t a p p e a r s t h a t t h e A s s o c i a t i o n d i d n o t have an o f f i c i a l s t a t e m e n t a b o u t t h e r o l e o f t h e A s s o c i a t i o n i n c o n t i n u i n g e d u c a t i o n d u r i n g t h i s p e r i o d . C o n t i n u i n g e d u c a t i o n was n o t m e n t i o n e d i n t h e N u r s e s ( R e g i s t e r e d ) A c t as a s t a t u t o r y o b l i g a t i o n , and h e n c e , was n o t a f o c u s f o r A s s o c i a t i o n a c t i v i t y u n t i l 1 9 3 6 . I n t h a t y e a r , t h e RNABC a c k n o w l e d g e d t h e r e q u e s t s o f members i n o u t l y i n g c o m m u n i t i e s when a sum o f money was a l l o c a t e d t o a l l o w A s s o c i a t i o n s t a f f t o t r a v e l t o c e n t r e s , o t h e r t h a n t h o s e where a s c h o o l o f n u r s i n g was l o c a t e d , t o " b r i n g m a t t e r s p e r t a i n -i n g t o n u r s i n g " t o t h e a t t e n t i o n o f RNs (RNABC. Coun., 2 3 / 1 0 / 3 6 ) . 31 P o l i c y Statements In 1923, the Council of the GNABC authorized funds to advertise the summer i n s t i t u t e to be held at UBC (GNABC. Coun., 2/04/23). A course i n x-ray technique offered by the Victor X-Ray Company was endorsed by the Association in 1925 (GNABC. Coun., 10/10/25). In 1930, the RNABC supported the new bac-calaureate program at UBC, which consisted of a combined course of Arts and Sciences which was six years in length (GNABC. Coun., 26/09/30). At the Annual Meet ing in 1932, a decision was made to off e r refresher courses "as frequently as the Association can af f o r d " (GNABC. A.M. 29/03/32). In 1934, a decision was made to broaden the scope of the refresher course so that a l l groups, public health, private duty, and i n s t i t u t i o n a l nurses, could be included (GNABC. Coun., 6/10/34). The Council, i n 1935, c a l l e d for post-graduate o b s t e t r i c a l t r a i n i n g for RNs working in iso l a t e d d i s t r i c t s (GNABC. Coun., 22/04/35). In summary, the role of the RNABC in continuing education was limited i n the p o l i c y development and governance area. How-ever, by 1936, the Association's role in continuing education was formally acknowledged by the a l l o c a t i o n of funds and d i r e c t i o n given to Association s t a f f to provide this service. Specific p o l i c y decisions related to advertising courses, endorsation of courses, support for baccalaureate education for RNs, the need for refresher and post-basic t r a i n i n g also were made. 32 Educational A c t i v i t i e s and Services During this time period, the RNABC provided continuing education programs for i t s members, f i n a n c i a l assistance to indiv i d u a l s and educational programs, support to members in forming chapters, l i b r a r y services and a communication news-l e t t e r . Each of these a c t i v i t i e s are described in d e t a i l below. Provider of Continuing Education Programs At the 1922 Annual Meeting of the GNABC, the Nursing Education Committee was established as a standing committee, with Ethel Johns as i t s f i r s t Convener. In i t s report to the Annual Meeting in 1923, the Committee reported i t had "prepared lesson plans and other material l i k e l y to be of assistance to teachers i n small t r a i n i n g schools" and had established a short course in teaching and administration, with the teaching portion being six weeks and the administrative component l a s t i n g two weeks. A committee of the Association worked with UBC to arrange a Public Health Institute in 1924 and, as well, to arrange Public Health meetings during the year. These i n s t i t u t e s were held at UBC annually u n t i l 1939, with input of Association members in the planning of each i n s t i t u t e (Green, 1984:48). Miss Randall, Registrar at GNABC, was invited to conduct a round table conference at an i n s t i t u t e i n Seattle in 1926 (GNABC. Coun., 2/06/26). Two nurses, Miss. K.I. Sanderson and Mrs. C. Thompson, were hired i n 1937 to conduct an educational tour of B.C. "for the 33 p u r p o s e o f i n t e r e s t i n g and e d u c a t i n g a l l n u r s e s .. . r e g a r d i n g p r e s e n t day p r o b l e m s f a c i n g t h e n u r s i n g p r o f e s s i o n ; so t h a t t h e y w i l l be a b l e t o t a k e a more a c t i v e p a r t i n t h e d i s c u s s i o n s a r i s i n g c o n c e r n i n g t h e s e p r o b l e m s " (RNABC. A.M., 3/04/37). The e d u c a t i o n a l t o u r o r I n s t i t u t e o f 1938 i n c l u d e d a p r e s e n t a t i o n o f a p l a n t o d i v i d e t h e p r o v i n c e i n t o c h a p t e r s and d i s t r i c t s (RNABC. Coun., 23/04/38). A l s o i n 1938, t h e i t i n e r a n t o r t r a v e l l i n g i n s t r u c t o r s , as t h e y were c a l l e d , were a s k e d t o u n d e r t a k e a t r a v e l l i n g r e f r e s h e r c o u r s e , w h i c h o c c u r r e d i n O c t o b e r o f t h a t y e a r (RNABC. Coun., 16/09/38), as w e l l , m e n t i o n i s made o f a 1940 t o u r o f V a n c o u v e r I s l a n d o f one week i n d u r a t i o n (RNABC. Coun., 19/01/40). I n 1940, t h e RNABC s p o n s o r e d a r e f r e s h e r c o u r s e i n s u p e r -v i s i o n . The need f o r t h i s c o u r s e a r o s e s i n c e RNs were now r e q u i r e d t o s u p e r v i s e a u x i l i a r y w o r k e r s , who were i n c r e a s i n g i n number i n h o s p i t a l s , s i n c e t h e y were r e p l a c i n g RNs who were s h o r t i n number, as a r e s u l t o f t h e need f o r n u r s e s t o j o i n t h e war e f f o r t . R e f r e s h e r c o u r s e s f o r p r i v a t e d u t y n u r s e s were j o i n t l y s p o n s o r e d by UBC and RNABC, b e g i n n i n g i n 1924 (GNABC. Coun., 21/04/24). I n s t i t u t i o n a l n u r s e s had t h e i r own r e f r e s h e r c o u r s e as o f 1931,also s p o n s o r e d by t h e A s s o c i a t i o n (GNABC. Coun., 12/09/31). 34 Support and Information Services F i n a n c i a l Assistance In 1920, the RNABC established a scholarship for a course of a year's length in any aspect of nursing at a Canadian University to be given to a member of the GNABC (GNABC. Coun., 15/10/20). The f i r s t scholarship of $1,000 was given in 1921 to Mary Campbell (GNABC. Coun., 28/01/21). Scholarships were again granted i n 1930 (two in the amount of $500 each), 1931 (one $500 scholarship), and i n 1936 ($400 for a scholarship for UBC for t r a i n i n g in public health, teaching and supervision and hospital administration). On two occasions, the GNABC contributed money to McGill University. In 1921, $0.10 per GNABC member was donated to the McGill Scholarship Fund to a s s i s t nurses to take an educational program (GNABC. Coun., 28/01/21). In 1933, $500 was sent to allow the McGill program to continue when f i n a n c i a l circumstances threatened to cause i t to close (GNABC. Coun., 26/05/33). RNABC Chapters In 1938, the RNABC established a committee to determine the f e a s i b i l i t y of forming chapters and d i s t r i c t s , to allow for l o c a l p a r t i c i p a t i o n in Association a c t i v i t i e s and provide a means of communication between members and the p r o v i n c i a l organization. At the Annual Meeting in 1939, in p r i n c i p l e support was given to go ahead. RNABC members provided assistance on a voluntary basis to chapters wishing to form. The RNABC developed guidelines to 35 a s s i s t centres to organize and provided sample constitution and bylaws (RNABC. Coun., 24/11/39). In 1940, Miss K. Sanderson was appointed on a part-time basis to a s s i s t chapters and d i s t r i c t s to organize. Port Alberni and Nelson requested assistance, and the f i r s t meeting of the Vancouver Island D i s t r i c t occurred on November 29, 1940. At least two chapters were needed to form a d i s t r i c t , presumably, V i c t o r i a and Port Alberni were the two chapters i n the Vancouver Island D i s t r i c t . Major a c t i v i t i e s of Chapters included maintaining a communi-cation l i n k between l o c a l nurses and the p r o v i n c i a l association, p a r t i c i p a t i n g in decision making as members of the RNABC Council, and providing educational opportunities for Chapter members. Annual Meeting Education of members attending the Annual Meeting of the Association was provided through discussion of nursing issues within the business section of the meeting and a presentation of an educational topic. At the f i r s t Annual Meeting, three papers were read (GNABC. A.M. 13/06/13). At subsequent Annual Meetings, demonstrations of newer nursing measures occurred and experts on p a r t i c u l a r topics were invited to share their knowledge with the group. Educational sessions varied i n length and method, from a one hour lecture or reading, to demonstrations, workshops, s k i t s , and discussion groups. 36 Newsletters When the Nurses Act was passed in 1935, a Press Committee was established as a Standing Committee of the Association. Prior to this date, however, there i s evidence that the Association communicated with i t s members v i a a c i r c u l a r i z e d l e t t e r , at least annually, p r i o r to the Annual Meeting, beginning i n 1913. In addition, as early as 1915, papers were s o l i c i t e d from members to be sent to the Canadian Nurse magazine (GNABC. Coun., 23/02/15). The Press Committee had r e s p o n s i b i l i t y in two areas, forwarding material for inclusion in the Canadian Nurse and providing information about Association a c t i v i t i e s to newspapers and government representatives. Library A f t e r a survey of schools of nursing, the GNABC considered the establishment of a c i r c u l a t i n g l i b r a r y (GNABC. A.M., 5/04/26). In 1927, a Library Committee was established, with Mary Campbell as i t s Convener (GNABC. Coun., 29/10/27). The Library Committee was asked to "go into the question of a l i b r a r y , i t s location, the l i b r a r i a n , the l i s t of books". The l i b r a r y was f i r s t established under the auspices of the Pr o v i n c i a l Public Library Commission which offered to provide a special section of i t s "open shelf" c o l l e c t i o n for nursing references (GNABC. Coun., 22/09/28). The Association was responsible for purchasing and maintaining the references on the "open shelf". In 1929, the Public Health Nursing Section 37 purchased books f o r the "open s h e l f " as a p r o j e c t ; i n 1930 s u b s c r i p t i o n s to the Canadian Nurse and the I n t e r n a t i o n a l Nursing magazine were purchased. In 1935, books from the "open s h e l f " were t r a n s f e r r e d to the RNABC p r o v i n c i a l o f f i c e (RNABC. Coun., 21/06/35). In 1936, funds were f i r s t set aside i n the budget of the A s s o c i a t i o n to add books and magazines to the l i b r a r y c o l l e c t i o n (RNABC. Coun., 18/09/36). In summary, du r i n g the time p e r i o d 1912 to 1941, e d u c a t i o n a l a c t i v i t i e s and s e r v i c e s were i n the beginning stage. An i n t e g r a l component o f the Annual Meeting was the education s e s s i o n s ; as w e l l , r e f r e s h e r courses were i d e n t i f i e d as a need as e a r l y as 1919, and were p r o v i d e d a n n u a l l y t h e r e a f t e r . In the mid 1930's, the l i b r a r y was being developed as a s e r v i c e to A s s o c i a t i o n com-mi t t e e s and s t a f f . F i n a n c i a l a s s i s t a n c e was pro v i d e d to i n d i v i d u a l s and i n s t i t u t i o n s i n order to support c o n t i n u i n g e d u c a t i o n . Communication l i n k s were being e s t a b l i s h e d through the Chapter s t r u c t u r e , the n e w s l e t t e r , and the Canadian Nurse  J o u r n a l . 1941 to 1967: EXPANSION OF CONTINUING EDUCATION ACTIVITIES Major Developments An A s s i s t a n t R e g i s t r a r was appointed to RNABC s t a f f i n 1943 and e d u c a t i o n a l a c t i v i t i e s of the A s s o c i a t i o n i n c r e a s e d g r e a t l y . With the begin n i n g o f World War I I , RNABC sponsored r e f r e s h e r courses f o r nurses i n response to a n u r s i n g shortage 38 p r e c i p i t a t e d b y n u r s e s ' p a r t i c i p a t i o n i n t h e war. Over t h e d e c a d e , 1940 t o 1949, t h e RNABC s p o n s o r e d s i x i n s t i t u t e s i n V a n c o u v e r , and a s e r i e s o f r e g i o n a l programs w i t h an e s t i m a t e d 300-400 p a r t i c i p a n t s . I n d u s t r i a l n u r s i n g d e v e l o p e d i n r e s p o n s e t o i n c r e a s i n g numbers o f p e o p l e i n v o l v e d i n f a c t o r y work, and e d u c a t i o n a l p rograms were g e a r e d t o t h e l e a r n i n g needs o f i n d u s t r i a l n u r s e s . As w e l l , w i t h t h e n u r s i n g s h o r t a g e , a u x i l i a r y p e r s o n n e l were em p l o y e d b y h o s p i t a l s , and t h e A s s o c i a t i o n p r o v i d e d e d u c a t i o n a l p rograms f o r n u r s e managers t o meet new l e a r n i n g n e e d s . RNABC c o o p e r a t e d t o p r o v i d e e d u c a t i o n r e l a t e d t o t h e war e f f o r t , f o r example, s e s s i o n s on a i r r a i d p r e c a u t i o n s f o r RNs. I n 1946, c o u r s e s on i n s e r v i c e e d u c a t i o n and c l i n i c a l i n s t r u c t i o n began t o be o f f e r e d by RNABC. T h i s f o l l o w e d a 1944 A n n u a l M e e t i n g r e s o l u t i o n c a l l i n g f o r i n c r e a s e d s u p p o r t f o r i n s e r v i c e e d u c a t i o n w i t h a g o a l t o a c h i e v e a g r e a t e r amount o f s t a b i l i t y i n n u r s i n g s t a f f . I n t h e R e p o r t o f t h e P l a c e m e n t S e r v i c e i n 1946, a c a l l was made f o r an i n s e r v i c e e d u c a t i o n p r o g r a m i n a l l i n s t i t u t i o n s and o r g a n i z a t i o n s e m p l o y i n g n u r s e s . C h a p t e r s and D i s t r i c t s were a c t i v e l y f o r m i n g . I n 1943, D i s t r i c t s g a i n e d r e p r e s e n t a t i o n on t h e p r o v i n c i a l C o u n c i l . The d e s i r e f o r b e t t e r c o m m u n i c a t i o n w i t h members r e s u l t e d i n t h e p u b l i s h i n g o f a B u l l e t i n , p r e p a r e d b y t h e E x e c u t i v e s e c r e t a r y . By 1967, t h e B u l l e t i n was p u b l i s h e d e v e r y two months. The RNABC e s t a b l i s h e d a l o a n f u n d i n 1942, w i t h a t o t a l amount o f $800 and p r e f e r e n c e was g i v e n t o s t u d e n t s e n r o l l e d i n u n i v e r s i t y p o s t - b a s i c s t u d y . The A s s o c i a t i o n p a r t i c i p a t e d i n t h e N a t i o n a l H e a l t h G r a n t s p r o g r a m f r o m 1948 t o 1961, w h i c h p r o v i d e d 39 funds for the preparation of health personnel. Salary of an it i n e r a n t instructor and costs of a workshop on tests and measurements (1952) were both covered by this program. The Placement Service, planned i n 1941, began operations on a p r o v i n c i a l basis in 1943, to provide vocational counselling and meet the need for nursing service within the province. This was the beginning of labour relations a c t i v i t y for the Association, including education of members regarding rights and r e s p o n s i b i l i t i e s as union members. During the decade 1950 to 1959, sponsorship of educational programs by the RNABC increased s i g n i f i c a n t l y . Delegates at the 1950 Annual Meeting i d e n t i f i e d a need for more programs in small communities and programs expanded as a r e s u l t . Over a hundred programs were held, with over 2,700 registrants. In 1958, the RNABC requested and received funds from government to finance an i n s t i t u t e on operating room nursing and one on inservice education. The Association recognized a need to evaluate post-basic courses and set up a committee to establish c r i t e r i a , f i r s t in 1950 and again i n 1955. Approval was granted by the RNABC to a Red Cross Accelerated F i r s t Aid Course in 1950. Interest was expressed by the Association i n 1950 and 1955 in nurses being able to obtain university credit for courses taken i n c l i n i c a l topics. Also, i n r e l a t i o n to the UBC School of Nursing, the RNABC opposed inclusion of the School under the Faculty of Medicine, which had been proposed. At the f i r s t meeting of the Committee on Nursing Education 40 i n 1955, one of i t s functions was stated as "to plan and direct educational projects for members of the Association" (19/12/55). The Association decided in 1957 to employ an educational consult-ant and the p o s i t i o n was f i l l e d i n 1959. Her duties included o v e r a l l r e s p o n s i b i l i t y for the educational a c t i v i t i e s of the Association, including supervision of the Itinerant Instructor. A Bursary/Loan Fund, in the amount of $10,000, was established i n 1959 to a s s i s t members studying at both the u n i v e r s i t y and c l i n i c a l l e v e l . The assistance was to be 50% bursary and 50% loan. In the decade of the 1960's, Association a c t i v i t y in the area of continuing education expanded to the extent that a second s t a f f member, whose only r e s p o n s i b i l i t y was continuing education, was added to the s t a f f i n 1964. Regional courses expanded greatly, to over eighty during the decade, and there was also an increase i n co-sponsorship arrange-ments with government, educational i n s t i t u t i o n s and health care agencies. The 1960's saw the beginning of a close and ongoing rel a t i o n s h i p between the Association and at f i r s t , the Division of Continuing Medical Education, and, a f t e r i t was established, Continuing Nursing Education at UBC. In the l a t t e r 60's and several years i n the 1970's, the Association made a s i g n i f i c a n t f i n a n c i a l contribution to UBC to support the Continuing Nursing Education Division. A comprehensive statement of the Association's role in continuing education was developed i n 1961, which resulted in an increase i n educational programming. The f i r s t comprehensive, 41 public statement on the Association's role in continuing educa-t i o n was made i n 1964 by Miss F.A. Kennedy, the RNABC Educational Consultant, to the Fraser Valley D i s t r i c t of the RNABC. In 1966, a fi v e year plan for continuing education was developed by the Association, urging the appointment of a nurse instr u c t o r at UBC to assess needs and plan programs for RNs. In addition, a decision was made to decentralize r e s p o n s i b i l i t y for i n s t i t u t e s , so that l o c a l areas could start to plan and conduct programs, with advice and support from the RNABC. On several occasions i n the 1960's, the RNABC engaged i n discussions with the University of V i c t o r i a to encourage development of a BSN program. In addition, the Association c a l l e d for a Master's program in nursing at UBC. Polic y Development and Governance RNABC Role i n Continuing Education In a review of the role of the Association, carried out i n 1941, the expansion of educational a c t i v i t i e s over previous years was recognized and a decision was made to continue the educational work of the Association, including sponsorship of discussion groups and preparation of outlines for them (RNABC. A.M., 26/04/41). At the Annual Meeting in 1942, i t was recommended "that educational questions be given special consideration by the Council and that they formulate plans at the e a r l i e s t moment for t h e i r implementation." In 1943, a new s t a f f position of Assistant Registrar was 42 established, with Miss F. McQuarrie as the f i r s t incumbent. Her duties were "to a s s i s t with the organization of an extension program for the education of RNs throughout the province, and to conduct or to a s s i s t with such classes or meetings as may be developed" (RNABC. Coun., 20/10/43). In 1955, at the f i r s t meeting of the Committee on Nursing Education, constituted under a newly revised Act, the Terms of Reference of the Committee were "to recommend to the Council studies and p o l i c i e s which w i l l promote a high standard of nurs-ing education and a s s i s t the nursing profession to meet changing demands i n respect to nursing service and to plan and direct educational projects for members" (Cmtee Nr. Ed., 19/12/55). In 1959, a full - t i m e Educational Consultant, Miss F.A. Kennedy, was appointed (RNABC. E x e c , 20/05/59). It i s l i k e l y that t h i s decision was made as a resu l t of the increase in requests for continuing education programs as well as an increase i n the size of the membership which necessitated adding to the Association s t a f f . By 1961, duties of the Educational Consultant included o v e r a l l r e s p o n s i b i l i t y for the educational a c t i v i t i e s of the Association, including the itine r a n t or t r a v e l l i n g programs, which continued to be carried out by an instructor. Also i n 1961, the f i r s t comprehensive statement on continuing education was developed by the Committee on Educational Needs of Graduate Nurses. The Committee recommended that the RNABC give p r i o r i t y to the educational needs of a c t i v e l y p r a c t i c i n g nurses and those 43 nurses wishing to return to active practice; that the need for refresher courses be assessed; that the RNABC sponsor a refresher course for Head Nurses; that the RNABC continue to stress the need for and importance of inservice education programs; and that the RNABC consider arranging programs for special interest groups. It was also recommended that the RNABC move toward gradual decentralization of regional i n s t i t u t e s and that consultation services should be provided i n connection with the i n s t i t u t e s (Committee on Educational Needs, 4/11/61). In 1963, a decision was made to es t a b l i s h a second education p o s i t i o n , the Educational Secretary, to report to the newly renamed Director of Education Services. Florence Fleming was appointed to this p o sition in February, 1964; her primary r e s p o n s i b i l i t i e s were i n r e l a t i o n to educational programs for members (RNABC. Coun., 9/03/63). In a ta l k delivered by Miss Kennedy, probably i n 1964, to the Fraser Valley D i s t r i c t of the RNABC, she said that "the RNABC i s not primarily an educational agency. We look upon many of our educational a c t i v i t i e s for members as a stop-gap measure u n t i l such time as the educational agencies can assume r e s p o n s i b i l i t y for continuing educational a c t i v i t i e s for nurses". She stated that the goals of the Association i n r e l a t i o n to continuing education were assessing educational needs; informing members about e x i s t i n g educational resources; pressing for development and expansion of adequate educational resources within the framework of educational i n s t i t u t i o n s ; giving guidance to educational agencies i n r e l a t i o n to p r i o r i t i e s in program 44 o f f e r i n g s ; encouraging and stimulating s e l f - d i r e c t e d study; and sponsoring and conducting educational a c t i v i t i e s toward the achievement of professional status (Kennedy, Undated: 1). Miss Kennedy noted i n her speech that this occasion was the f i r s t time that discussion of RNABC goals in continuing education had been undertaken at the D i s t r i c t l e v e l . At a j o i n t meeting of the Committees on Nursing Service and Nursing Education, held in 1966, an educational plan for the subsequent 6 years was developed. Three major thrusts were i d e n t i f ied: to work with UBC to arrange educational sessions for RNs (through the Department of Continuing Medical Education), to urge the appointment of a full - t i m e nurse instructor in the UBC School of Nursing to "assess needs and resources for continuing education for nurses and to plan, develop and implement and coordinate projects for the continuing education of nurses" (RNABC. Resume of some RNABC A c t i v i t i e s 10/67). In the mean-time, the RNABC would offer to coordinate continuing education projects for B.C. nurses. Policy Statements In t h i s period, p o l i c y statements were made by the RNABC on a v a r i e t y of issues and topics related to continuing education. In 1942, the Association urged UBC to establish post-graduate and refresher courses, p a r t i c u l a r l y i n teaching, supervision and hos p i t a l administration (RNABC. A.M., 04/42). The RNABC supported a recommendation made by the Canadian Nurses Association i n a study of the needs of RNs returning from the 45 war. It urged that less stringent entrance requirements be set for these nurses: RNABC contacted UBC to indicate i t s support for this recommendation (RNABC. A.M., 1945). In 1946, the Association stated it's pos i t i o n on s t a f f education programs, "that i n a l l i n s t i t u t i o n s and organizations employing nurses, a s t a f f education program be i n s t i t u t e d , i n the development of which nurses in a l l levels of positions p a r t i c i p a t e " (RNABC. A.R. , 1946). The RNABC recommended to the B.C. government, i n 1947, that post-graduate opportunities at the university l e v e l be increased to increase the supply of head nurses, supervisors and administrators (RNABC. A.R., 1947). In a 1949 statement, the RNABC said that the education of nurses should be regarded i n the same l i g h t as education for other public service workers, and that, therefore, the government should accept f i n a n c i a l r e s p o n s i b i l i t y for nursing education (RNABC. Coun., 19/02/49). The statement concluded by saying that se t t i n g standards should continue to be the r e s p o n s i b i l i t y of the professional association. In 1950, the Association c a l l e d for the development of uni v e r s i t y courses for i n d u s t r i a l nurses that would carry c r e d i t (RNABC. Exec. 3/02/50). Also in 1950, discussion occurred about placing the UBC School of Nursing under the Faculty of Medicine. The RNABC was not in support of this action and informed the UBC Senate of i t s po s i t i o n (RNABC. Exec. 13/11/50). When the Senate met on November 16, a decision was made to keep nursing under the Faculty of Applied Science. In 1955, a general statement was made supporting the need for credit for advanced preparation 46 c o u r s e s t a k e n b y n u r s e s " e s p e c i a l l y w i t h t h e p r e s e n t i m p e t u s t o w a r d u n i v e r s i t y p r e p a r a t i o n o f s t a f f i n r e s p o n s i b l e p o s i t i o n s " (Cmtee Ed. P o l . 13/01/55). The A s s o c i a t i o n a g r e e d t o t a k e r e s p o n s i b i l i t y f o r e v a l u a t i o n o f p o s t - g r a d u a t e c l i n i c a l c o u r s e s i n 1950 and a s k e d t h a t c r i t e r i a be d e v e l o p e d (RNABC. E x e c . 18/12/50). In 1955, t h e A s s o c i a t i o n " a g r e e d t h a t t h e r e i s a need f o r s o m e t h i n g more t h a n t h e n u r s e r e c e i v e s i n h e r u n d e r g r a d u a t e c o u r s e , p a r t i c u l a r l y i n t h e u s u a l s p e c i a l t i e s o f o p e r a t i n g room, o b s t e t r i c s and p e d i a t r i c s (Cmtee Ed. P o l . , 13/01/55). On t h e i s s u e o f s p e c i a l i z a t i o n , t h e RNABC s t a t e d , i n 1966, s u p p o r t f o r t h e p r i n c i p l e o f s p e c i a l i z a t i o n f o l l o w i n g a g e n e r a l b a s i c n u r s i n g e d u c a t i o n . I n 1967, t h e A s s o c i a t i o n d e v e l o p e d a c o m p r e h e n s i v e s t a t e m e n t on i n s e r v i c e e d u c a t i o n w h i c h o u t l i n e d f o u r components: o r i e n t a t i o n , s k i l l t r a i n i n g , c o n t i n u i n g e d u c a t i o n and l e a d e r s h i p and management (RNABC. E x e c . 15/12/67). I n summary, p o l i c y s t a t e m e n t s were made on numerous o c c a s i o n s d u r i n g t h i s p e r i o d r e l a t i v e t o t h e r o l e o f t h e RNABC i n c o n t i n u i n g e d u c a t i o n . The A s s o c i a t i o n was t h e major p r o v i d e r o f c o n t i n u i n g e d u c a t i o n u n t i l t h e mid 1960's when a d e c i s i o n was made b y t h e A s s o c i a t i o n t o e n c o u r a g e t h e de v e l o p m e n t o f programs and a c t i v i t i e s by e x t e r n a l g r o u p s . The RNABC was moving i n t o more o f a c o n s u l t a t i v e r o l e ; t o members, e d u c a t i o n a l i n s t i t u t i o n s , h e a l t h c a r e a g e n c i e s and government. S p e c i f i c p o l i c y s t a t e m e n t s were made by t h e A s s o c i a t i o n i n r e g a r d t o t h e n e e d f o r c l i n i c a l and d e g r e e p r o g r a m s , t h e need f o r s t a f f 47 development, the r e s p o n s i b i l i t y of government to fund continuing nursing education, and the need for specialty t r a i n i n g . Educational A c t i v i t i e s and Services Educational a c t i v i t i e s and services expanded during t h i s stage, e s p e c i a l l y in r e l a t i o n to provision of continuing education programs for RNs. In the early 1960's the focus of Association a c t i v i t y shifted, as increased emphasis was placed on supporting the development of educational a c t i v i t i e s of others, such as the university. There was also an increase in f i n a n c i a l assistance to indi v i d u a l s , development of a vocational counselling service, RNABC News, strengthening of the Chapter network, and expansion of the l i b r a r y . Also i n this period, the Association acknowledged i t s role in quality control of continuing education programs and developed a new role i n influencing events that affected continuing nursing education. Provider of Continuing Education Programs The Association began to sponsor refresher courses for married nurses in 1942, to as s i s t these individuals to return to the work force i n response to wartime needs (RNABC. Coun., 10/04/42). Short courses in teaching and administration were offered with UBC and the B r i t i s h Columbia Hospital Association (BCHA) i n 1943 and 1944 (RNABC. Coun., 21/01/43; 22/03/44). The RNABC hired an i t i n e r a n t instructor on a contract basis to teach a v a r i e t y of topics. From 1940 to 1949, six i n s t i t u t e s were held 48 i n V a n c o u v e r and a s e r i e s o f r e g i o n a l programs were h e l d , w i t h b e t w e e n 3 0 0 - 4 0 0 n u r s e s p a r t i c i p a t i n g . From 1 9 5 0 t o 1 9 5 9 , t h i r t y p r o g r a m s were h e l d i n t h e V a n c o u v e r / V i c t o r i a a r e a and s e v e n t y r e g i o n a l i n s t i t u t e s were h e l d , w i t h a p p r o x i m a t e l y 2 , 7 0 0 p a r t i c i -p a n t s . I n t h e n e x t d e c a d e , t h i r t y - t w o p rograms were o f f e r e d i n V a n c o u v e r / V i c t o r i a and a p p r o x i m a t e l y e i g h t y r e g i o n a l i n s t i t u t e s w i t h an e s t i m a t e d 6 , 5 0 0 p a r t i c i p a n t s (Du Gas, 1 9 6 8 : 2 3 ) . The i n s t i t u t e s were p l a n n e d c e n t r a l l y , w i t h t h e RNABC t a k i n g r e s p o n s i b i l i t y f o r d e v e l o p i n g , o f f e r i n g and f u n d i n g them. T o p i c s f o r t h e i n s t i t u t e s i n t h e 1 9 4 0's r e f l e c t e d c h a n g e s t h a t were o c c u r r i n g i n n u r s i n g . F o r example, c o u r s e s on h e a d n u r s e s h i p were o f f e r e d s e v e r a l y e a r s c o n s e c u t i v e l y , s i n c e few n u r s e s h a d e x p e r i e n c e i n t h i s n ewly d e v e l o p i n g r o l e . I n 1 9 4 8 , a c o n f e r e n c e on c u r r i c u l u m d e v e l o p m e n t was h e l d , t o a s s i s t n u r s e e d u c a t o r s t o u p g r a d e t h e i r s c h o o l c u r r i c u l a . C o u r s e s were a l s o h e l d f o r i n d u s t r i a l n u r s e s , a r o l e t h a t e v o l v e d d u r i n g t h e war y e a r s t o p r o v i d e n u r s i n g c a r e t o f a c t o r y w o r k e r s (RNABC. E x e c . 1 3 / 0 1 / 4 9 ) . I n t h e e a r l y 1 9 5 0's, t h e RNABC s p o n s o r e d e d u c a t i o n a l p r o g r a m s w h i c h d e a l t w i t h n u r s i n g a s p e c t s o f c i v i l d e f e n c e and A t o m i c , B a c t e r i a l , and C h e m i c a l w a r f a r e (RNABC. E x e c . 6 / 0 4 / 5 1 ) . P r o g r a m s f o r n u r s e e d u c a t o r s and a d m i n i s t r a t o r s on s u c h t o p i c s as ward a d m i n i s t r a t i o n and c u r r i c u l u m d e v e l o p m e n t c o n t i n u e d t h r o u g h o u t t h e 1 9 5 0's w i t h c l i n i c a l t o p i c s s u c h as o p e r a t i n g room and p s y c h i a t r i c n u r s i n g o f f e r e d o c c a s i o n a l l y i n t h e l a t e r 1 9 5 0's. I n 1 9 6 2 , a p l a n f o r g r a d u a l d e c e n t r a l i z a t i o n o f r e s p o n s i b i l i t y f o r i n s t i t u t e s was p r o p o s e d so t h a t l o c a l a r e a s w o u l d assume i n c r e a s e d r e s p o n s i b i l i t y f o r p l a n n i n g and c o n d u c t i n g 49 programs. Consultation would continue to be available from the RNABC (Du Gas, 1968:24). In the 1960's, with the development of continuing nursing education at UBC, emphasis shifted from provision of educational opportunities solely by RNABC to encouraging development of com-munity resources to meet continuing education needs for members. For example, a series of programs on c l i n i c a l topics was j o i n t l y planned and conducted by RNABC and UBC Continuing Medical Education from 1962 to 1968, u n t i l the establishment of the Continuing Nursing Education Department (RNABC. Exec. 26/06/65). Support and Information Services Financial Assistance In 1942, a revolving loan fund of a maximum of $800 was established. Each loan could be up to a maximum of $200 and students pursuing university post-graduate study were given preference (RNABC. A.M., 11/04/42). Loans were given annually. In 1959, a Bursary/Loan Committee was established to administer a bursary/loan fund of $10,000 (RNABC. Exec. 7/05/59). The purpose of t h i s fund was to as s i s t nurses in furthering their education i n the f i e l d of nursing and to increase the number of nurses with preparation beyond a basic course (RNABC. A.M., 1959). Assistance was to be i n the form of 50% bursary and 50% loan. This educational fund was increased in 1960 to $57,500, and ten awards of $4,000 each were given (RNABC. Exec. 10/09/60). Money was allocated to the loan fund on an annual basis, as requested 50 b y t h e B u r s a r y / L o a n Committee. I t was n o t e d i n 1968 t h a t t h e need f o r f u n d s t o a s s i s t i n t h e c o s t o f n u r s i n g e d u c a t i o n f a r e x c e e d e d t h e t o t a l o f a v a i l a b l e f u n d s (RNABC. Coun., 3/07/68). F e d e r a l H e a l t h T r a i n i n g G r a n t s , w h i c h o p e r a t e d f r o m 1948 t o 1961, p r o v i d e d f u n d s f o r t h e p r e p a r a t i o n o f h e a l t h p e r s o n n e l and t h e p u r c h a s e o f e q u i p m e n t and s u p p l i e s . RNABC a c c e s s e d f u n d s t h r o u g h t h i s p r o g r a m t o f u n d t h e t r a v e l s o f t h e i t i n e r a n t i n s t r u c t o r , t o p u t on a workshop on t e s t s and measurement, and t o s p o n s o r RNABC members who were a t t e n d i n g u n i v e r s i t y . T h i s p r o g r a m a s s i s t e d o v e r 30,000 i n d i v i d u a l s n a t i o n w i d e t o o b t a i n a d v a n c e d p r e p a r a t i o n i n h e a l t h s e r v i c e s . N e a r l y 50% o f t h i s number were n u r s e s ( M u s s a l l e m , 1964:53). RNABC s p o n s o r e d i n d i v i d u a l s and g u a r a n t e e d repayment i n c a s e o f d e f a u l t o f t h e te r m s and c o n d i t i o n s o f t h e g r a n t (RNABC. Coun., 1/04/67). V o c a t i o n a l C o u n s e l l i n g The RNABC P l a c e m e n t S e r v i c e was f i r s t e s t a b l i s h e d i n 1941 and b e g a n t o f u n c t i o n on a p r o v i n c i a l b a s i s i n 1943 w i t h two o b j e c t i v e s i n mind: t o meet t h e need f o r n u r s i n g s e r v i c e w i t h i n t h e p r o v i n c e and t o p r o v i d e v o c a t i o n a l c o u n s e l l i n g f o r n u r s e s . T h i s was t h e f i r s t s e r v i c e o f i t s k i n d i n a C a n a d i a n n u r s i n g a s s o c i a t i o n (RNABC. A.R., 1944). E d u c a t i o n a l i n f o r m a t i o n and a d v i c e , c a r e e r o p t i o n s , and a d v i c e t o n u r s e s u n a b l e t o seek employment due t o h e a l t h p r o b l e m s was p r o v i d e d t h r o u g h o u t t h i s p e r i o d . A c t i v i t i e s i n c l u d e d an Employment R e f e r r a l S e r v i c e as w e l l as i n d i v i d u a l c o u n s e l l i n g . A m a j o r a r e a o f a c t i v i t y was r e l a t e d t o c o n d i t i o n s o f employment, s i n c e RNs were n o t u n i o n i z e d 51 (RNABC. A.M., 1945). Educational sessions on employment issues were held to inform members of t h e i r rights and obligations as employees (RNABC. E x e c , 5/04/46). Chapters In 1943, RNABC D i s t r i c t s obtained representation on the Council (RNABC. Coun., 20/10/43). Chapters and D i s t r i c t s continued to evolve during t h i s period, with new chapters being formed where others disbanded due to lack of member p a r t i c i p a -t i o n . In 1962, the f i r s t meeting of Chapter Presidents was held at the RNABC "to consider problems of communication and functions at the chapter l e v e l " (RNABC. A.M. 1962). Thirty-four chapter presidents attended the meeting and i t was decided that the meeting should be an annual a c t i v i t y . In addition to discussions about chapter functioning, the meetings had an educational com-ponent. In 1964, for example, the Association's parlimentarian conducted a session on parlimentary procedure (RNABC. A.M. 1964). At the 1965 Annual Meeting, the President noted that "many of the chapters and d i s t r i c t s are undertaking quite extensive educational projects". Annual Meeting Educational sessions continued to be a part of the Annual Meeting during this period. In addition, there is evidence that exhibits were a part of some of the Annual Meetings. These took the form of text and reference book exhibits (1942) and 52 exhibitors representing commercial suppliers of interest to RNs (1949). On some occasions, a t h i r d day was added to the usual two day meeting, and the whole day was educational in nature (RNABC. E x e c , 7/02/59). In 1967, the educational day was j o i n t l y sponsored with the Canadian Tuberculosis Society since the topic was "Tuberculosis Institute for Nurses" (RNABC. E x e c , 18/06/66). A decision was made in 1967 to l i m i t the educational component of the Annual Meeting to one-half day, to intersperse the educational content with the business sessions, and to l i m i t the meeting to two days (RNABC. Coun., 21/10/66). Newsletters With the development of the Chapter and D i s t r i c t structure, i t became important to communicate on a regular basis with members. A newsletter, c a l l e d the B u l l e t i n , was sent to Chapters and D i s t r i c t s , and i n i t i a l l y contained the Annual Report of the Association. Reference i s made in the 1954 Annual Report of the Association to a "regular b u l l e t i n prepared by the Executive Secretary which serves as a medium through which a l l members may be kept informed of the a c t i v i t i e s of the Association". The B u l l e t i n was f i r s t mentioned in f i n a n c i a l statements in 1943, as a D i s t r i c t and Chapter expense (RNABC. Coun., 15/09/43). In 1944, a monthly News B u l l e t i n is mentioned, however, i t appears that possibly two or three major Bu l l e t i n s were issued annually, at least u n t i l 1961. The f i r s t B u l l e t i n , published p r i o r to the Annual Meeting, contained the information about the meeting and the Annual Report. A late f a l l B u l l e t i n contained 53 information about what had occurred at the previous Annual Meeting, including the President's Address, and changes to the Nurses Act or Constitution and By-Laws that had occurred. By 1966, the RNABC re a l i z e d the need for a regular communication vehicle with members and in 1967 a decision was made to publish a news b u l l e t i n every two months (RNABC. E x e c , 25/02/67). In 1968, the RNABC News was f i r s t published in a magazine format. There were 6 issues per year, with approximately 100 pages, including advertisements. Library The l i b r a r y was managed by Association s t a f f , although mention i s made in 1954 of a volunteer, an Association member, who had catalogued the l i b r a r y (RNABC. E x e c , 18/09/54). The l i b r a r y was used by Association s t a f f and committees and was not availab l e to the members at large. Quality Control In 1950, the RNABC approved the Red Cross Accelerated F i r s t Aid Course. However, i t i s not clear what process was used to make thi s decision (Cmtee Ed. Pol., 19/06/50). A committee was struck i n 1950 and again i n 1955 to est a b l i s h c r i t e r i a which would be used to assess programs, but no written record exists and there i s no evidence to suggest that this task was accomplished. The Association did continue to approve courses: i n 1965, a course i n Normal and Therapeutic Nutrition, and i n 54 1967, an o u t l i n e f o r a c o u r s e i n I n d u s t r i a l F i r s t A i d were a p p r o v e d (Cmtee Nr. Ed., 7/05/65; RNABC. E x e c , 21/01/67). I n f l u e n c e / A d v o c a c y R o l e D u r i n g t h e t i m e p e r i o d 1940 t o 1967, t h e RNABC became more a c t i v e i n t r y i n g t o i n f l u e n c e t h e d i r e c t i o n t h a t e x t e r n a l a g e n c i e s were t a k i n g w i t h r e s p e c t t o c o n t i n u i n g e d u c a t i o n f o r RNs and i n s p e a k i n g o u t on c o n t i n u i n g e d u c a t i o n n e e d s . I n p a r t i c u l a r , t h e need f o r p o s t - b a s i c c l i n i c a l s p e c i a l t y c o u r s e s , t h e n e e d f o r e d u c a t i o n a l o p p o r t u n i t i e s a t t h e u n i v e r s i t y l e v e l , and t h e need f o r f i n a n c i a l s u p p o r t f o r n u r s e s s e e k i n g t o f u r t h e r t h e i r e d u c a t i o n were a r e a s i d e n t i f i e d f o r a c t i o n . On many o c c a s i o n s , t h e RNABC a s k e d UBC t o o f f e r c o u r s e s f o r RNs, f o r example, on s u c h t o p i c s as t e a c h i n g and s u p e r v i s i o n (1942), c o u n s e l l i n g (1944), and e f f e c t i v e u t i l i z a t i o n o f n u r s i n g p e r s o n n e l (1953). From 1963 t o 1968, t h e RNABC and C o n t i n u i n g M e d i c a l E d u c a t i o n a t UBC j o i n t l y s p o n s o r e d a s e r i e s o f c o u r s e s on c l i n i c a l t o p i c s (Du Gas, 1968:5). The n e e d f o r e d u c a t i o n a l o p p o r t u n i t i e s a t t h e u n i v e r s i t y l e v e l was d i s c u s s e d w i t h UBC on s e v e r a l o c c a s i o n s . In 1949, RNABC e s t a b l i s h e d a committee t o s t u d y a p r o p o s a l t o s e t up a s c h o o l o f n u r s i n g a t UBC, t h a t i s , a f r e e s t a n d i n g p r o g r a m , s e p a r a t e f r o m t h e j o i n t V a n c o u v e r G e n e r a l H o s p i t a l / U B C p r o g r a m t h a t h a d e x i s t e d s i n c e 1919. RNABC met w i t h UBC i n 1963 " t o s e e k ways i n w h i c h t h e A s s o c i a t i o n m i g h t l e n d e f f e c t i v e s u p p o r t t o e f f o r t s ... t o b r o a d e n t h e programme o f t h e s c h o o l t o i n c l u d e a c t i v i t i e s i n 55 continuing nursing education ... including the provision, at evening and summer school sessions, of courses acceptable for cre d i t toward the BSN degree" (RNABC. E x e c , 19/10/63). In 1965, the RNABC ca l l e d for the expansion of the UBC School of Nursing and the establishment of a school of nursing at the University of V i c t o r i a (RNABC. E x e c , 6/10/65). The RNABC supported the appointment of a nurse at UBC "to assess the needs and resources for continuing education for nurses and to plan, develop and implement and coordinate projects for the continuing education of nurses" (RNABC. E x e c , 16/12/66). At the 1967 Annual Meeting, RNABC members supported the contribution of $5,000 a year for five years to UBC to appoint a fu l l - t i m e faculty member to carry out the above a c t i v i t i e s . The RNABC s o l i c i t e d and received funds from the Department of Health and Welfare i n 1958 to finance an i n s t i t u t e for operating room nurses and one for inservice educators (RNABC. Coun., 25/10/58). The need for f i n a n c i a l support for nurses was i d e n t i f i e d by RNABC and communicated to the Science Council of Canada in 1967 (RNABC. Coun., 18/11/67). In addition, the RNABC supported the Canadian Nurses Foundation (CNF), established to " s o l i c i t and hold funds to provide scholarships for nurses undertaking u n i v e r s i t y studies i n nursing and nursing-related d i s c i p l i n e s , and to provide grants in aid of nursing research" (Canadian Nurses Foundation, 1963). In 1961, the RNABC had given support i n p r i n c i p l e to the formation of the CNF, and an annual donation 56 was given on several occasions during the 1960's (RNABC. E x e c , 18/06/66) . In summary, the end of the 1960's marked a change in the primary role of the Association as the major provider of continuing education. With the development of the univer s i t y d i v i s i o n of continuing education, RNABC began to work cl o s e l y with UBC to develop educational opportunities for RNs in both c l i n i c a l topics and degree c r e d i t . The Association began to develop i t s role as the major authority regarding continuing nursing education i n B.C. The RNABC also acknowledged i t s role i n q u a l i t y control of continuing education programs, but no formal process was as yet developed. 1968 TO THE PRESENT: CHANGING ROLES Major Developments The r o l e of the Association in the 1970's gradually evolved as supportive of chapters as providers of continuing education, and encouraging development of continuing education in the college, i n s t i t u t e and university system, especially in r e l a t i o n to c l i n i c a l topics and career advancement. The focus of the RNABC's a c t i v i t y during the l a t t e r 1970's and 1980's was the development of a c t i v i t i e s and programs that supported the professional practices of members, for example, workshops on le g a l and e t h i c a l issues i n nursing, professionalism, evaluation of nursing performance and the development of print materials 57 such as being a witness at a coroner's inquest. Several p r o v i n c i a l continuing education conferences were sponsored by the RNABC during the f i r s t h a l f of the 1970's, mainly to a s s i s t Chapters and D i s t r i c t s to i d e n t i f y and use l o c a l resources in planning educational programs and a c t i v i t i e s . The RNABC continued to sponsor Federal Health Grant trainees u n t i l 1976 when the program was discontinued, and funded the Canadian Nurses Foundation u n t i l 1974. In 1979, the RNABC established the Registered Nurses Foundation of B.C., a separate society which could receive and administer funds for educational purposes. In 1971 and 1973, plans for the development of post-basic and continuing education were completed. These plans were to set the d i r e c t i o n for Association a c t i v i t y for the next decade. The f i r s t post-basic c l i n i c a l specialty course appeared in 1969; the 1970's saw a major expansion of this type of educational a c t i v i t y i n B.C. The Association provided seed money to a s s i s t eight of these courses to develop, and ongoing support and consultation regarding program development. In 1974, the Association implemented a program to a s s i s t program planners to develop programs and to have the i r programs evaluated. The Continuing Education Approval Program (CEAP) was operated j o i n t l y by the Registered Psychiatric Nurses Association of B r i t i s h Columbia and the RNABC from 1976 to 1981, when RNABC resumed u n i l a t e r a l r e s p o n s i b i l i t y for the program. RNABC participated in discussions regarding the development of the B.C. Medical Centre in 1975 and responded to government 58 commissions on education in 1976. RNABC was active in discussions concerning a province-wide mechanism for coordination of continuing nursing education during the l a t t e r 1970's. As members' interest i n education increased, the RNABC began to c a l l for an external BSN program at UBC that would be accessible to pr a c t i c i n g RNs. The RNABC participated, f i r s t , in a task group to study the f e a s i b i l i t y , and then, on the advisory committee to the UBC program. In 1980, the RNABC funded a project to id e n t i f y competencies necessary for practice i n specialized c l i n i c a l areas. These statements were subsequently used in development of post-basic c l i n i c a l s p e c i a l t y courses and i n a project to determine the need for these types of programs. The RNABC continued to provide loans to members, up to a possible t o t a l of $250,000, u n t i l 1982, when this a c t i v i t y was discontinued. The RNABC continues to provide support to the Registered Nurses Foundation of B.C. and refers members to alternate sources of f i n a n c i a l support. The RNABC developed four "Safety To Practice" conferences in 1980; these conferences were offered on a province-wide basis and were intended to support the professional practice of nurses. Each conference was one day i n length and they were prepared i n such a way that a l l the content was pre-packaged in either print or audiovisual format. The f i r s t conference gave information about professionalism; the second conference was concerned with self-evaluation and assertiveness techniques. The t h i r d conference focussed on documentation of unsafe situations in the 59 nursing practice setting while conference four discussed how nurses might influence changes i n the health care system. Career counselling, which had been started as part of the Placement Service, continued u n t i l 1982. Subsequently, career resources are made available on a self-serve basis through the l i b r a r y . The RNABC continues to c a l l for the need for both c l i n i c a l and degree programs which meet the needs of working nurses. The Association has discussed this need with government, educational i n s t i t u t i o n s and health care agencies. Educational sessions on professional issues have continued, with expansion of topics and new arrangements for co-sponsorship of events with chapters, professional practice groups, educ-ati o n a l i n s t i t u t i o n s , health care agencies and related health groups. Resource material which supports professional practice has been developed, using both p r i n t and media. Library resources have increased with the addition of a career room and a s h i f t i n focus to user s e l f - s u f f i c i e n c y . The RNABC News has increased in the number of pages, and the content has d i v e r s i f i e d , now including c l i n i c a l topics, advice to nurses, association news and continuing education l i s t i n g s . P o l i c y Development and Governance RNABC Role in Continuing Education The Committee on Nursing Education was given authority by the RNABC Council to take action on matters pertaining to 60 continuing nursing education. In 1969, the Committee on Nursing Education stated that the r e s p o n s i b i l i t i e s of the Committee were to i d e n t i f y needs and assess p r i o r i t i e s , plan programs when no other resources existed, refer requests for programs to e x i s t i n g resources, and interpret continuing education to the profession and the public. In addition, p a r t i c i p a t i o n i n research pertinent to continuing education, establishment of a coordinating mechanism and promotion of professional self-development were i d e n t i f i e d as r e s p o n s i b i l i t i e s (Cmtee Nr. Ed., 28/01/69). During the l a t t e r 1960's and early 1970's the Association c a r r i e d out a major study of nursing education in B.C., which re-sulted i n a three part plan. Part II of the study was concerned with post-basic nursing education or "formal study by graduate nurses at a degree-granting i n s t i t u t i o n " (RNABC. A Proposed Plan: Part I I . 1971:2). Part III of the study concerned i t s e l f with continuing nursing education or " a l l planned, systematic approaches to learning geared toward s p e c i f i c educational objectives which occur beyond basic preparation for one's vocation and which do not normally lead to an academic degree" (RNABC. A Proposed Plan: Part I I I . 1973:4). The impetus for the study of the need for university l e v e l preparation for RNs i n 1968 arose p a r t l y out of the recommenda-tions from the Royal Commission on Health Services, which estimated that approximately twenty-five percent of nursing positions required preparation at the baccalaureate l e v e l or higher (RNABC. A Proposed Plan: Part I I . 1971:5). The RNABC post-basic study looked at programs available i n B.C. at the 61 baccalaureate, c e r t i f i c a t e and graduate l e v e l , f i n a n c i a l assistance available to pursue formal study, and the a v a i l a b i l i t y of counselling services (RNABC. A Proposed Plan: Part I I . 1971:5). As a re s u l t of this study, the RNABC called for greater f l e x i b i l i t y on the part of u n i v e r s i t i e s regarding entrance requirements and required courses; increased c l i n i c a l content in the baccalaureate program; f l e x i b l e delivery methods throughout the province; increased a v a i l a b i l i t y of f i n a n c i a l support for RNs taking post-basic programs; and the establishment by RNABC of a career counselling service (RNABC. A Proposed Plan: Part I I . 1971:5). Part III of the study, on continuing education, was based on the premise that "the need for a plan for continuing nursing education i n the 70's has been well documented in nursing l i t e r a -ture" (RNABC. A Proposed Plan: Part I I I . 1973:3). Six broad areas were studied: nurse manpower, chara c t e r i s t i c s of nurses and t h e i r work settings, i d e n t i f i c a t i o n of learning needs, m u l t i p l i c i t y of people and agencies involved, change, and adoption of learning. Recommendations were made for the in d i v i d u a l nurse, the professional association, and educational and health care agencies. Recommendations for the RNABC included development of guidelines for planning C.E. a c t i v i t i e s , development of a system for evaluation of C.E. a c t i v i t i e s , expansion of consultative and counselling service, provision of salary support to the UBC Div i s i o n of Continuing Nursing Education, provision of support to 62 members and p a r t i c i p a t i o n in a c t i v i t i e s which supported the necessity of C.E. i n professional practice and a r t i c u l a t i o n with groups involved in issues related to safe practice (RNABC. A Proposed Plan: Part I I I . 1973:3). These recommendations have formed the basis for RNABC a c t i v i t y in continuing education during the 1970's and early 1980's. At a j o i n t meeting of the Committees on Nursing Education and Nursing Practice i n 1977, a query was raised about the role of the RNABC i n providing educational programs. Concern was espressed about the appropriateness of the RNABC providing courses when educational i n s t i t u t i o n s also offered nursing education. Support was expressed for continued a c t i v i t y in the area of professional offerings and the suggestion was made that the RNABC should be involved i n professional offerings. The outcome of the meeting was to suggest to the RNABC that a review of the ro l e of the Association i n providing continuing education courses for i t s members be undertaken (RNABC. Joint Meeting, 14/04/77). In a 1978 review of r e s p o n s i b i l i t i e s of Association s t a f f , prepared by Helen Sabin, i t was recommended that continuing education consultation continue, both i n r e l a t i o n to CEAP, and also "where such consultation contributes to the development of an e f f e c t i v e continuing nursing education delivery system in B.C." (Board Motion, 78-11-37). In 1984, after a series of i n s t r u c t i o n a l sessions on a number of professional topics were offered to members on a co-sponsorship basis, the RNABC was asked to reconsider t h e i r p o l i c y regarding involvement as providers. The RNABC stated 63 " t h a t as a m a t t e r o f p o l i c y RNABC w i l l c o n t i n u e t o p r o v i d e C.E. programs ... and w i l l l i m i t c o n t e n t t o t h o s e a r e a s w h i c h d i r e c t l y s u p p o r t RNABC a c t i v i t i e s a nd p r o j e c t s o r w h i c h c o n t r i b u t e t o t h e p r o f e s s i o n a l d e v e l o p m e n t o f members by a d d r e s s i n g m a t t e r s o f b r o a d p r o f e s s i o n a l c o n c e r n " ( B o a r d M o t i o n , 84-11-5). I n 1985, as a r e s u l t o f an A n n u a l M e e t i n g r e s o l u t i o n , A s s o c i a t i o n s t a f f were a s k e d t o r e v i e w t h e r o l e o f t h e RNABC v i s - a - v i s c o n t i n u i n g e d u c a t i o n . A r e p o r t , p r e p a r e d f o r t h e B o a r d i n November, 1985, recommended t h a t t h e RNABC d e v e l o p and p u r s u e t h r e e r o l e s i n c o n t i n u i n g e d u c a t i o n f o r members -- as a f a c i l i t a t o r , m o n i t o r and p r o v i d e r -- and t h a t s p e c i f i c a c t i v i t i e s u n d e r e a c h r o l e w ould be d e v e l o p e d a n n u a l l y as p a r t o f t h e u s u a l b u d g e t i n g p r o c e s s ( B o a r d M o t i o n , 85-11-84). The r e p o r t a l s o n o t e d t h a t c o n t i n u i n g e d u c a t i o n a c t i v i t i e s o f t h e A s s o c i a t i o n a r e p e r v a s i v e , t h a t i s , c a n be f o u n d i n a l m o s t a l l o f t h e s e r v i c e a r e a s p r o v i d e d t o members. P o l i c y S t a t e m e n t s I n 1974, as p a r t o f t h e r e v i e w o f c o n t i n u i n g n u r s i n g e d u c a t -i o n , a P o s i t i o n P a p e r on C o n t i n u i n g E d u c a t i o n f o r R e - r e g i s t r a t i o n was d e v e l o p e d , w h i c h s u p p o r t e d t h e need f o r v o l u n t a r y p a r t i c i p a t i o n r a t h e r t h a n m andatory c o n t i n u i n g e d u c a t i o n ( B o a r d M o t i o n , 74-09-11). A t t h e same t i m e , t h e RNABC made a d e c i s i o n n o t t o d e v e l o p a s y s t e m o f r e c o r d i n g members' p a r t i c i p a t i o n i n c o n t i n u i n g e d u c a t i o n ( B o a r d M o t i o n , 74-09-33). I n a d d i t i o n , t h e B o a r d s t a t e d " t h a t n u r s i n g e d u c a t i o n b e l o n g s w i t h t h e g e n e r a l e d u c a t i o n s y s t e m " ( B o a r d M o t i o n , 74-10-7). I n a b r i e f t o t h e W i n e g a r d Commission i n 1976, w h i c h s t u d i e d t h e d e l i v e r y o f u n i v e r s i t y programs t o n o n - m e t r o p o l i t a n a r e a s , 64 t h e RNABC s t a t e d t h a t t h e r e i s "a need f o r r e c o g n i t i o n o f c o n -t i n u i n g e d u c a t i o n , b o t h a c a d e m i c and n o n - d e g r e e , as an e s s e n t i a l component o f p r o f e s s i o n a l e d u c a t i o n f o r t h e d e v e l o p m e n t and m a i n t e n a n c e o f competence i n n u r s i n g p r a c t i c e " (RNABC. B r i e f t o W i n e g a r d C o m m i s s i o n , 1976:2). In 1979, RNABC c a l l e d f o r t h e d e v e l o p m e n t o f a n a t i o n a l a c c r e d i t a t i o n p r o g r a m f o r n u r s i n g e d u c a t i o n programs ( B o a r d M o t i o n , 79-3-11). The RNABC i s i n s u p p o r t o f a c o o r d i n a t e d s y s t e m o f p o s t -b a s i c e d u c a t i o n i n B.C. ( B o a r d M o t i o n , 79-6-33) and has c a l l e d f o r t h e d e v e l o p m e n t o f a BSN p r o g r a m w h i c h o f f e r s RNs a v a r i e t y o f o p p o r t u n i t i e s t o a c c e s s t h e p r o g r a m t h r o u g h o u t t h e p r o v i n c e ( B o a r d M o t i o n , 79-6-22). I n 1981, t h e A s s o c i a t i o n r e q u e s t e d t h a t t h e B.C. government e n s u r e a d e q u a t e f u n d s t o s u p p o r t a c c e s s i b l e BSN programs ( B o a r d M o t i o n , 81-6-99 and 83-3-14). T h i s s t a t e m e n t has a l s o b e en made i n r e l a t i o n t o p o s t - b a s i c c l i n i c a l s p e c i a l t y programs ( B o a r d M o t i o n , 82-6-86). I n 1982, t h e RNABC t o o k t h e p o s i t i o n t h a t d e v e l o p m e n t o f c e r t i f i c a t i o n programs i n s p e c i a l i z e d a r e a s o f n u r s i n g s h o u l d o c c u r a t t h e n a t i o n a l l e v e l ( B o a r d M o t i o n , 82-6-128). I n summary, t h e r e has been an e v o l u t i o n and s h i f t o f t h e A s s o c i a t i o n ' s r o l e f r o m t h a t o f t h e s o l e p r o v i d e r o f a l l c o n t i n u i n g e d u c a t i o n f o r n u r s e s t o t h e c u r r e n t s i t u a t i o n where t h e RNABC has r e d e f i n e d i t s a r e a o f r e s p o n s i b i l i t y t o t h r e e major r o l e s . A l s o , e d u c a t i o n i s a component o f n e a r l y a l l A s s o c i a t i o n a c t i v i t i e s . S p e c i f i c p o l i c y s t a t e m e n t s have been made i n 65 r e l a t i o n to voluntary versus accreditation of CNE programs, BSN programs and development nursing s p e c i a l t i e s . mandatory continuing education, coordination of CNE, accessible of c e r t i f i c a t i o n programs for Educational A c t i v i t i e s and Services From 1968 to the present, educational a c t i v i t i e s and services have shifted and expanded. In addition to a role as provider of CNE, and providing support and information to members, the Association's role as a f a c i l i t a t o r and advocate has grown. The focus of the Association's role as a provider is on professional development topics and as a co-sponsor of education-a l events. In terms of support, educational loans and career counselling were discontinued in 1982. Increased support to Chapters and an expansion of the l i b r a r y have been implemented. The Association f a c i l i t a t e d the development of the Continuing Nursing Education Division at UBC, the development of post-basic c l i n i c a l specialty courses, and the BSN program at the University of V i c t o r i a . In addition, the RNABC has developed nursing practice standards which can be used as a guide in development of CNE programs, and has participated i n ef f o r t s to develop a coordinating mechanism for CNE. In i t s monitoring/ influencing/advocacy r o l e , the Association has taken action to influence various other groups who have an interest in CNE to provide f i n a n c i a l assistance, sponsor programs and to support RNABC views on CNE. 66 P r o v i d e r o f C o n t i n u i n g E d u c a t i o n Programs In 1969, t h e RNABC j o i n t l y s p o n s o r e d , w i t h t h e B r i t i s h C o l u m b i a H o s p i t a l A s s o c i a t i o n , (BCHA) and V a n c o u v e r G e n e r a l H o s p i t a l , an e i g h t - w e e k c o u r s e i n i n t e n s i v e c a r e . T h i s c o u r s e a r o s e as a r e s u l t o f an A n n u a l M e e t i n g r e s o l u t i o n t h a t s t a t e d , "due t o t h e i n c r e a s i n g number o f i n t e n s i v e c a r e u n i t s i n t h e p r o v i n c e and i n c r e a s e d demands on n u r s e s f o r a d e q u a t e t r a i n i n g t o p r o v i d e s a f e n u r s i n g c a r e " a need f o r s u c h a c o u r s e e x i s t e d . I n 1973, a m a j o r s h i f t o c c u r r e d i n RNABC a c t i v i t i e s i n c o n t i n u i n g e d u c a t i o n . Much more e m p h a s i s was p l a c e d on w o r k i n g c o o p e r a t i v e l y w i t h o t h e r g r o u p s t o e n c o u r a g e d e v e l o p m e n t o f r e s o u c e s / a c t i v i t i e s by o t h e r s and t h e A s s o c i a t i o n r o l e was d e s c r i b e d as p l a n n i n g and c o o r d i n a t i n g r a t h e r t h a n as a p r o v i d e r , e s p e c i a l l y i n r e l a t i o n t o c l i n i c a l t o p i c s . The f o c u s s h i f t e d t o p r o v i s i o n o f s e r v i c e s t o s u p p o r t p r o f e s s i o n a l p r a c t i c e , e s p e c i a l -l y w i t h t h e r e p o r t on S a f e t y To P r a c t i c e ( S T P ) , r e l e a s e d i n 1976. The Committee on A s s e s s m e n t o f S a f e t y To P r a c t i c e was s t r u c k i n 1974. I t s p u r p o s e was t o " s t u d y mechanisms t o m o n i t o r t h e c o n t i n u i n g n u r s i n g competence o f members and t o p r o p o s e r e c o m m e n d a t i o n s t o a s s u r e t h e i r c o n t i n u i n g s a f e t y t o p r a c t i c e " (RNABC. Committee on A s s e s s m e n t , 1976). A number o f re c o m m e n d a t i o n s f r o m t h e STP r e p o r t gave r i s e t o e d u c a t i o n a l a c t i v i t i e s . A q u a l i t y a s s u r a n c e p r o g r a m t o a s s i s t n u r s e s t o a s s e s s w h e t h e r c a r e p r o v i d e d met s t a n d a r d s was d e v e l o p e d w i t h b o t h a u d i o v i s u a l and p r i n t r e s o u r c e s . The c o u n s e l l i n g and c o n s u l t a t i o n s e r v i c e s were c o n t i n u e d w h i c h a s s i s t e d n u r s e s t o g a i n i n f o r m a t i o n a b o u t e d u c a t i o n a l and c a r e e r 67 opportunities and assisted with development of learning a c t i v i t i e s . A recommendation related to development of materials by the RNABC on performance appraisal and promotion of programs on t h i s topic was also made. An informational program, c a l l e d Safety To Practice Conferences, was developed "to acquaint members and poten t i a l members with the professional p r i v i l e g e s and obligations of RNABC membership" (RNABC. Committee on Assessment, 1976). These four one-day conferences included p r i n t and audiovisual materials. Conferences were led by RNABC members knowledgeable about the Association. Over a five-year period (1976 to 1981), over 260 agency Administrators and Directors of Nursing and 1,500 RNs attended these conferences. These confer-ences continued u n t i l 1982, subsequently s e l f - i n s t r u c t i o n a l modu-les on some of the same topics were developed for use by members. In the 1980's, workshops continue to be provided related to topics that support nursing practice. In addition, educational sessions which a s s i s t Chapters to function more e f f e c t i v e l y have been implemented on such topics as leadership and budgeting. Workshops on e f f e c t i v e lobbying have been presented for Chapters and elected RNABC o f f i c i a l s . Educational support has been given when new or changed Association services have been introduced. A major a c t i v i t y of the early 1980's has been the proposal to make changes to the Nurses Act: audiovisual resources and a speaker's bureau have been used to provide information to members about the proposed changes and how they can help make the changes happen. The Association has also produced four thirty-minute tapes on ethics which are shown over the Knowledge Network. 68 S u p p o r t and I n f o r m a t i o n S e r v i c e s F i n a n c i a l A s s i s t a n c e A l l o c a t i o n o f f u n d s f o r t h e e d u c a t i o n a l f u n d was made by t h e B o a r d on an a n n u a l b a s i s u n t i l 1 9 8 0 . A t t h a t t i m e , t h e f u n d was t o p p e d up t o t h e amount o f $ 2 5 0 , 0 0 0 , i n c l u d i n g t h e o u t s t a n d i n g l o a n s ( B o a r d M o t i o n , 8 0 - 1 - 5 4 ) . T h e r e had been a g r a d u a l i n c r e a s e i n t h e a l l o c a t i o n i n t h e 1 9 7 0's, as more n u r s e s were r e t u r n i n g t o s c h o o l t o t a k e b o t h c l i n i c a l p r ograms and u n i v e r s i t y d e g r e e p r o g r a m s . R e c o r d s show t h a t , i n 1 9 7 3 , l o a n s t o t a l l e d $ 6 , 9 4 6 , i n 1 9 7 5 $ 1 0 , 0 0 0 was b u d g e t e d , $ 2 5 , 0 0 0 i n 1 9 7 6 , $ 3 5 , 0 0 0 i n 1 9 7 7 , $ 7 5 , 0 0 0 i n 1 9 7 8 and $ 1 0 0 , 0 0 0 i n 1 9 7 9 . I n 1 9 8 2 , t h e RNABC d e c i d e d t o d i s c o n t i n u e o f f e r i n g l o a n s t o i n d i v i d u a l s i n f a v o u r o f e n c o u r a g i n g d e v e l o p m e n t o f o t h e r f i n a n c i a l s o u r c e s ( B o a r d M o t i o n , 8 2 - 6 - 5 1 ) . F e d e r a l H e a l t h T r a i n i n g G r a n t s were a g a i n a v a i l a b l e t h r o u g h t h e p r o v i n c i a l government from 1968 t o 1 9 7 6 . The RNABC s p o n s o r e d i n d i v i d u a l s f o r t h e s e G r a n t s i n o r d e r " t o promote t h e f u l l u t i l i z a t i o n o f a v a i l a b l e government f u n d s f o r t h e improvement o f h e a l t h s e r v i c e s t h r o u g h t r a i n i n g b u r s a r i e s , b y s p o n s o r i n g s e l e c t -e d members f o r a d d i t i o n a l s t u d y " (Cmtee Ed. L o a n s , 1 5 / 0 2 / 6 8 ) . I n o r d e r f o r i n d i v i d u a l s t o a c c e s s t h e s e g r a n t s , t h e RNABC had t o s p o n s o r i n d i v i d u a l s and g u a r a n t e e t h e r e t u r n o f t h e f u n d s i f t h e i n d i v i d u a l d e f a u l t e d on t h e terms o f t h e agreement w i t h t h e go v e r n m e n t . E a c h y e a r , t h e RNABC r e q u e s t e d an amount o f money f r o m t h e gove r n m e n t , u s u a l l y $ 2 5 , 0 0 0 t o $ 4 5 , 0 0 0 p e r y e a r , and 69 screened and recommended applicants for the Grant (RNABC. E x e c , 7/06/74) . Canadian Nurses Foundation F i n a n c i a l assistance to the Canadian Nurses Foundation (CNF) was provided i n 1964 with the a l l o c a t i o n of $1,000; from 1966 u n t i l 1973 the Association gave a per capita donation to CNF, which varied from $22,554 i n 1968 to $12,231 i n 1972. In 1974, the Association decided to discontinue f i n a n c i a l support for CNF on an organizational basis and encourage individual membership. Registered Nurses Foundation of B.C. The Registered Nurses Foundation of B.C. (RNF) was established by the RNABC i n 1979 to provide bursaries to post-basic nursing students pursuing degree, specialty or refresher programs. The RNABC continues to provide o f f i c e and s t a f f support to the RNF. Also, in 1985, funds o r i g i n a l l y allocated by the RNABC to develop post-basic c l i n i c a l courses were reallocated to a baccalaureate scholarship program. The RNABC plans a donation to RNF i n 1987 as part of i t s 75th Anniversary celebrations. Career Counselling Career counselling services were established subsequent to a recommendation from the 1973 study on continuing education. Both career and educational information were available to members, either on a one-to-one basis or through use of printed material. 70 In 1982, the Board discontinued this service due to a change in p r i o r i t i e s . Today, a career room as been set up i n the l i b r a r y . Information about educational opportunities, funds for education, and career options are provided on a self-help basis. Telephone information continues to be provided on a limited basis. Chapters The Chapter President's meeting continues to be held once or twice yearly. At present, i t is held in conjunction with spring and f a l l meetings of the Board of Directors. The main purpose of th i s meeting i s to provide an opportunity for Chapter Presidents to share ideas and concerns with one another, to gain information about RNABC programs and a c t i v i t i e s , and to discuss issues and ideas of mutual interest and concerns with elected members of the Board of Directors. Newsletters Continuing Education B u l l e t i n From 1972 u n t i l 1982, Association s t a f f prepared a l i s t i n g of courses available i n B r i t i s h Columbia, Western Canada and the Western United States which would be of interest to nurses. The Continuing Education B u l l e t i n was c i r c u l a t e d free of charge to over 500 health care agencies and educational i n s t i t u t i o n s i n B.C. Every six weeks or so, 1,500-2,000 copies of the C.E. B u l l e t i n were sent out. The B u l l e t i n was discontinued i n 1982. 71 RNABC News In 1986, the RNABC News w i l l p u b l i s h s i x i s s u e s w i t h approximately 240 pages i n t o t a l . I t s c i r c u l a t i o n i s approximately 30,000 per i s s u e , which i n c l u d e s RNABC members, r e l a t e d h e a l t h care o r g a n i z a t i o n s and o t h e r s . The RNABC News a l s o p u b l i c i z e s s e l e c t e d c o n t i n u i n g education o f f e r i n g s i n each i s s u e o f the magazine. L i b r a r y At the 1968 Annual Meeting, a r e s o l u t i o n was made to examine the l i b r a r y s e r v i c e . A Committee on L i b r a r y P o l i c y was sub-sequent l y e s t a b l i s h e d i n 1969 to develop a b l u e - p r i n t f o r province-wide l i b r a r y s e r v i c e s and to estimate the f i n a n c i a l i m p l i c a t i o n s o f a province-wide l i b r a r y s e r v i c e (Cmtee on L i b r a r y , 19/03/69). Recommendations made by the L i b r a r y Committee were to h i r e a l i b r a r i a n on a par t - t i m e b a s i s and th a t the l i b r a r y "should continue to be used c h i e f l y to promote the work o f the RNABC Committees, and be a v a i l a b l e to RNABC o f f i c e r s , committee members and p r o f e s s i o n a l s t a f f " . The l i b r a r y was expanded to p r o v i d e member access i n 1970 (RNABC. A.M. 1970). In 1983, a major review of l i b r a r y s e r v i c e s was undertaken. The l i b r a r y i s a r e f e r e n c e and r e s e a r c h l i b r a r y which emphasizes user s e l f - s u f f i c i e n c y (Board Motion, 84-11-97). In 1984, a p i l o t p r o j e c t was conducted to man the l i b r a r y w i t h v o l u n t e e r s on Saturdays d u r i n g the academic term. As a r e s u l t of the success o f the p i l o t p r o j e c t , Saturday openings, s t a f f e d by v o l u n t e e r s , have become a r e g u l a r s e r v i c e . 72 Lib r a r y c i r c u l a t i o n in 1985 was 9,816 items with 8,969 inq u i r i e s (RNABC. Report of the Executive Director, January, 1986). Saturday l i b r a r y users t o t a l l e d 193. RNABC As F a c i l i t a t o r Post-Basic Specialty Courses With changes i n nursing practice leading to delineation of nursing into s p e c i a l t i e s , the RNABC, starting in the l a t t e r part of the 1960's, became active in promoting the development of post-basic c l i n i c a l specialty courses. A 1968 Annual Meeting resolution c a l l e d for an intensive care course, and the Committee on Nursing Education c a l l e d for a post-basic course in obstetrics (10/12/69). RNABC was a member of the B.C. Council on Post-Basic C l i n i c a l Specialty Courses which aimed to promote the development of courses, coordinate the planning, and seek f i n a n c i a l support (B.C. Council. Minutes. 13/12/72). This Council was disbanded i n 197 3, when they decided that they could not achieve th e i r goal (B.C. Council. Minutes. 28/03/73). In 1979, the RNABC set aside a fund of $100,000 to be used i n the development of post-basic specialty courses, "such courses to be directed towards improving the participant's knowledge and s k i l l s i n an area of direct nursing practice" (Board Motion, 79-1-49). Eight post-basic courses were developed using seed money from this fund. In 1980, the balance of the money in this fund was donated to the Registered Nurses Foundation of B.C., with the same c r i t e r i a to be used as had been developed by the 73 RNABC. In 1984, the RNF requested that funds remaining be reallocated to a Baccalaureate Scholarship Assistance Fund. The RNABC was represented on the advisory committees of many of the post-basic c l i n i c a l specialty courses during t h e i r development and ongoing operation. University of B r i t i s h Columbia The RNABC has provided f i n a n c i a l assistance to UBC i n developing resource f a c i l i t i e s and materials. In 1971, $2,000 was given to UBC to fund a c a r r e l i n the P.A. Woodward Mobile Instru c t i o n a l Resources Centre (MIRC) (RNABC. Board. 5/03/71). A sum of money was granted for several years, probably 1971 to 1973, for the purchase and production of audiovisual materials to be assembled into i n s t r u c t i o n a l packages, to be available to RNABC members, v i a the MIRC (RNABC. Board. 5/03/71). Between 1968 and 1977, the RNABC provided funds to UBC to develop the Divis i o n of Continuing Nursing Education. From 1968 to 1972, the amount was $5,000 annually, and from 1973 to 1977, the amount was increased to $10,000 annually. These funds were to be used to a s s i s t i n the establishment of an ongoing viable continuing nursing education d i v i s i o n (RNABC. Brief to Faris Commission, 1976:12). University of V i c t o r i a On January 19, 1965, the RNABC met with Dr. Taylor, President of the University of V i c t o r i a , to discuss the p o s s i b i l i t y of establishing a School of Nursing. RNABC 74 p a r t i c i p a t e d i n a survey of nursing resources in V i c t o r i a to determine the f e a s i b i l i t y of a School of Nursing i n late 1960. A decision was made not to fund the School at that time. In 1973, the University Senate again considered the establishment of a nursing program i n V i c t o r i a and RNABC was represented on an advisory committee set up to consider i t . In a 1975 Task Committee on Access of Nurses to University Level Study, the RNABC reite r a t e d i t s support for a BSN program open to Registered Nurses at the University of V i c t o r i a . Development of Standards for Nursing Practice In the 1970's, the Association developed a number of state-ments about competencies expected of RNs. A series of standard care plans i n nursing s p e c i a l t i e s were prepared; these standards could be used by nurses to id e n t i f y learning needs. Three other documents, "Competencies And S k i l l s Required For Nurse Registration For A Graduate Of A Basic Program", "Essential Manual S k i l l s For A New Graduate" and "Roles and Functions" were used to describe expectations of RNs, and as such, gave guidance to the development of post-basic specialty programs. A study on competencies required by nurses working in specialized areas of nursing practice, completed in 1981, has been used to develop post-basic c l i n i c a l programs (Kermacks. 1981). Standards for Nursing Practice, developed in 1985, can be used by ind i v i d u a l nurses to do a self-assessment of nursing practice and may help to i d e n t i f y learning needs. In addition, these standards are useful both to preparatory and post-basic 75 programs since they can be used as guidelines for outcome statements for the program. It i s planned that these standards w i l l be incorporated into an accreditation program, currently under development, for post-basic c l i n i c a l specialty courses. Coordination of Continuing Education The RNABC has been involved in a number of continuing education conferences which served as a vehicle to discuss the issue of coordination of continuing education a c t i v i t i e s . The RNABC sponsored or was involved i n p r o v i n c i a l continuing education conferences in 1970, 1971, 1972, 1974, 1976, and 1983. The f i r s t three conferences were i n i t i a t e d by RNABC, although UBC planned and conducted at least the f i r s t one in 1970. The 1970 conference was ca l l e d to provide an opportunity to discuss i n t e r -professional education, to provide assistance in developing short courses i n the RNABC D i s t r i c t s , and to provide information on educational resources available in l o c a l communities. Repre-sentatives attended from each RNABC D i s t r i c t , UBC, RNABC, the p r o v i n c i a l government and other associations. The same repre-sentation occurred i n 1971 when issues and trends in nursing education, regional concerns, and evaluation methods were discussed. Participants i d e n t i f i e d problems such as how to plan c l i n i c a l sessions, how to establish co-sponsorship arrangements between D i s t r i c t s and l o c a l educational i n s t i t u t i o n s , and e f f e c t i v e planning at the Chapter and D i s t r i c t l e v e l . In 1972, topics discussed included proposed curriculum changes at the UBC School of Nursing, manpower needs in nursing, 76 and reports of l o c a l Chapter a c t i v i t i e s . In 1974, the RNABC held an evening meeting to discuss how the Association could best a s s i s t l o c a l regions with continuing education. The nature of the conference changed i n 1976, to expand beyond the RNABC Chapter and D i s t r i c t structure, to include other organizations concerned with continuing education. Twenty-nine participants took part in the province-wide CNE conference which was t i t l e d "Communication - Cooperation Coordination in C.N.E. Can We Achieve I t ? " Its purpose was to bring together individuals and organizations i n the Lower Main-land interested in CNE to exchange information about a c t i v i t i e s , pose action to f a c i l i t a t e cooperative and coordinated a c t i v i t y i n the Lower Mainland (RNABC. Board. 02/76). As a result of the conference, the RNABC invi t e d a small group of providers to an October meeting to plan a coordination strategy. An Ad Hoc Committee on Province-Wide Coordination of C.N.E. was established. Several meetings were held, however, the group was unable to accomplish i t s task and the group gradually disbanded, although formal steps were not taken to disband the Committee. At another conference i n 1983, sponsored by Vancouver Community College and RNABC, individuals administratively respon-s i b l e for post-basic nursing programs met to collaborate about issues and concerns, to consider solutions and develop action plans for implementing solutions to problems i d e n t i f i e d . Subsequent to the conference, the Post-Basic Nursing Group was established to carry on with the work of the conference. 77 Monitoring/Influencing/Advocacy The RNABC has taken action to influence various other groups who have an interest in the continuing education of RNs. Govern-ments, both p r o v i n c i a l and federal, educational i n s t i t u t i o n s and health related groups have been influenced by RNABC to provide f i n a n c i a l assistance, to sponsor programs, or to support RNABC views on a variety of issues. RNABC has been active i n monitor-ing the quality of continuing education programs through a Continuing Education Approval Program. Government RNABC was represented on an advisory committee to B.C. Hospital Insurance Services which discussed training needs of RNs working i n Coronary Care Units i n 1969-1970. RNABC met with Canada Manpower i n 1973 to request funding for a post-basic operating room course to be held i n V i c t o r i a . With the advent of planning for the B.C. Medical Centre in 1975, the RNABC was active on several committees to develop administrative structure and p o l i c i e s for BCMC and especially the proposed Division of Continuing Education. In 1976, there were three government commissions, F a r i s , Goard, and Winegard, to study various aspects of tr a i n i n g and education i n the province. The RNABC made i t s views known in b r i e f s presented to each of these commissions. In 1979, the government prepared a paper on nursing education i n B.C. (Ministry of Education). The report received 78 wide attention from Association members, and RNABC was active in preparing a comprehensive response. When the Health Manpower Working Group of the Ministry of Health commissioned a study on the need for post-basic c l i n i c a l courses i n 1980, the RNABC made i t s views known. A Ministry of Education study, released in 1985, which proposed curriculum guidelines for post-basic nursing education programs, was greatly influenced by RNABC p a r t i c i p a t i o n . Educational Institutions In 1972, the Association c a l l e d for the development of a post-diploma course i n respiratory disease and requested that UBC consider development of the course. Also at UBC, RNABC participated on a task force to develop an external BSN program in 1980 and continued on the advisory committee to the program. Continuing Education Approval Program In 1973, the RNABC supported the establishment of a Committee on Approval of Continuing Education Programs (CEAP) as recommended i n the study on continuing education. In July, 1974, the committee was appointed, with i t s terms of reference "to examine continuing nursing education programs submitted to the Association for i t s endorsement and to approve those which, i n i t s opinion, meet the c r i t e r i a ; to recommend revisions in the p o l i c i e s , procedures and c r i t e r i a for the approval of continuing nursing education programs as, in i t s experience, seem necessary" 79 (RNABC. Exec. 19/04/74). CEAP reviewed two types of programs: short courses or workshops and continuing education programs. The c r i t e r i a used to assess programs were based on a program planning model. From 1976 to 1981, the Registered Psychiatric Nurses Association j o i n t l y sponsored CEAP with RNABC since many of the programs being reviewed were appropriate for both groups. In 1979, funds were obtained from the Canada Manpower for Training Improvement Project (T.I.P.) to report on the effectiveness of CEAP i n terms of i t s stated purposes and provide information about i t s l i a b i l i t i e s . This research study was designed to evaluate the impact of CEAP on the planning of continuing education courses for RNs. Recommendations from this study were made i n r e l a t i o n to the types of programs that should be reviewed, c l a r i f i c a t ion of the purpose of the review process, application of the approval standard, and committee membership and functioning. As a resu l t of actions taken subsequent to this study, a decision was made by the RNABC, i n 1981, to resume u n i l a t e r a l sponsorship of CEAP and to focus on evaluation of post-basic c l i n i c a l courses that were over 400 hours in length. Currently, the RNABC is in the process of developing an accreditation system that would be applicable to continuing nursing education programs. In summary, educational services and a c t i v i t i e s have expanded since 1969 to include additional roles as a f a c i l i t a t o r and monitor/influence/advocacy r o l e . The RNABC continues to provide CNE, s p e c i f i c a l l y in support of Association a c t i v i t i e s 80 and services, and, as well, to support the professional practice of i t s members. In Chapter IV, the continuing nursing education a c t i v i t i e s of the Association w i l l be examined in r e l a t i o n to the four study questions. 81 CHAPTER IV ANALYSIS OF THE HISTORICAL INVOLVEMENT BY THE RNABC IN CONTINUING EDUCATION It i s the intention, i n this Chapter, to use the study questions as a guide to analyze the h i s t o r i c a l data presented in Chapter I I I . For each of the four study questions, examples w i l l be drawn from the h i s t o r i c a l record to discuss the nature of RNABC's involvement i n continuing education, the nature of the Association's reaction to internal and external events and the nature of i t s commitment to continuing nursing education. ANALYSIS Nature of RNABC Involvement i n Continuing Education The RNABC has been involved in continuing education for i t s members since the beginning of the GNABC i n 1912. In addition to conducting the business of the Association at Council and Annual Meetings, members spent time discussing nursing issues and exchanging information about nursing practice. Over the years 1912 to 1940, the Association was involved i n program planning and i n s t r u c t i o n ; the issuance of publications, including a newsletter and l i b r a r y service; and providing f i n a n c i a l and other support to individuals and educational programs. During the period 1941 to 1967, the i n s t r u c t i o n a l programs offered by the Association increased markedly, with programs offered for nurse 82 managers, nurse educators, both in preparatory programs and inservice education programs, and programs to as s i s t members and the general public to cope with changes occurring as a result of World War II and the Korean War. Also during this time, the ro l e of the Association in continuing education was described and defined on several occasions. As a resu l t of a 1961 review of Association a c t i v i t y in continuing education, the RNABC began to modify i t s r o l e as the major provider of CNE i n B r i t i s h Columbia, i n favour of supporting the development of educational offerings by RNABC Chapters, educational i n s t i t u t i o n s and health care agencies. Also during this period, the Association became more active i n speaking out about the learning needs of RNs i n re-l a t i o n to post-basic c l i n i c a l specialty education and accessible u n i v e r s i t y education at the baccalaureate and master's l e v e l . During the period 1968 to the present, the RNABC has been active i n providing consultation to providers and consumers of continuing education programs in program development and imple-mentation, establishing standards for continuing education programs and providing a mechanism for program evaluation. RNABC has also participated i n e f f o r t s to coordinate CNE i n B r i t i s h Columbia, monitored the action of government and others interested and involved in CNE, supported the development of f i n a n c i a l assistance to RNs seeking further education, developed p o l i c y and po s i t i o n statements on CNE issues, expanded support services to members such as l i b r a r y and the RNABC News, and provided i n s t r u c t i o n a l sessions on topics that support the professional practice of RNs, for example, legal and e t h i c a l 83 issues i n nursing practice. In 1985, the Board of Directors supported the RNABC1s involvement i n CNE i n three major r o l e s : as a f a c i l i t a t o r , a monitor and a provider. Currently, programs are being developed or refined to explicate s p e c i f i c a c t i v i t i e s under each r o l e . These a c t i v i t i e s w i l l be revised annually, as part of the annual review of Association a c t i v i t i e s . In summary, the RNABC has always been a c t i v e l y involved in CNE, but the nature of i t s involvement has changed over time. Currently, i t i s recognized that educational a c t i v i t i e s of the RNABC are an in t e g r a l part of the majority of services provided by the Association, and that the Association uses continuing education to a s s i s t i n achievement of i t s primary purpose, to ensure safe nursing care to the people of B r i t i s h Columbia. Reaction to Events Influencing the RNABC Educational Program The RNABC has changed and adapted to internal and external events and trends that have influenced i t s educational program by adding or deleting a c t i v i t i e s and expanding or changing i t s focus of a c t i v i t i e s . During the time period 1912 to 1940, the Association recognized a need for refresher courses for i t s members and assisted UBC i n the planning and implementation of a course for public health nurses. The need for a course of this nature arose due to the creation of new positions for RNs i n public health and the expansion of the public health service in the 1920's. The Association provided f i n a n c i a l support to university schools of nursing, such as McGill University, since i t was recognized that 84 there was a need for university prepared nurses to function as teachers. In the mid 1930's, the Association responded to requests of members to provide educational opportunities in their l o c a l areas by developing the t r a v e l l i n g i n s t i t u t e . The focus of the Association role s h i f t e d , with the addition of the i n s t i -tutes, to include an acknowledged role as a provider of CNE. During the time period 1941 to 1967, educational a c t i v i t i e s of the Association expanded i n response to member requests, changes i n nursing, and external world events. Due to the i n f l u -ence of World War I I , programs were developed s p e c i f i c a l l y for nurse administrators to as s i s t them to learn to manage a nursing unit and to supervise s t a f f . The nurse manager role evolved at least in part as a re s u l t of the addition of the a u x i l i a r y worker to h o s p i t a l s t a f f . During this time, the Association was active i n working for better employment conditions and wages for RNs. In addition, the Association provided educational sessions to inform i t s members about the rights and r e s p o n s i b i l i t i e s of emp-loyees. With the evolution of the i n d u s t r i a l nurse, as a r e s u l t of the need for health care in i n d u s t r i a l plants during World War I I , came the need for c l i n i c a l courses for these nurses. In addition to providing the courses, the RNABC lobbied the univers-i t i e s to request that the courses be acceptable for univer s i t y c r e d i t . In the mid 1960's, the Association recognized that there was a need to review i t s role as a provider of CNE, espe c i a l l y with the expected development of the community college system. It was decided that the Association should gradually decentralize i t s educational a c t i v i t i e s and encourage the Chapters and 85 educational i n s t i t u t i o n s to develop and take r e s p o n s i b i l i t y for providing CNE. For example, the RNABC was involved i n a j o i n t project to provide CNE with the UBC Division of Continuing Medical Education from 1963 to 1968. During the period 1968 to the present, there has been i n -creased concern about the competence of RNs, introduction of new technology and a desire on the part of nurses to be recognized as professionals i n the i r own r i g h t . These external and inter n a l influences have affected the educational program of the RNABC. The Association has shifted i t s focus to provision of educational opportunities that support the professional practice of i t s members, such as workshops on legal rights and r e s p o n s i b i l i t i e s , professionalism, evaluation of nursing practice and assistance in resolving problems that i n t e r f e r e with safe nursing p r a c t i c e . In summary, the Association has been able to change the nature of i t s educational a c t i v i t i t y i n response to member d i r e c t i o n , changes within nursing, and external events that a f f e c t the practice of nursing. The nature of the change i n Association focus has been either to add new a c t i v i t i e s , or s h i f t the focus, or both. Proactive or Reactive? The RNABC has been both proactive and reactive in response to trends and events a f f e c t i n g i t s educational program. During the early years, from 1912 to 1940, the Association was reactive to members' needs, for example, providing funds to a s s i s t members to attend u n i v e r s i t y , making provision for a nursing l i b r a r y to 86 support Association a c t i v i t y , and requesting that UBC provide courses for nurses, both c l i n i c a l and academic. The RNABC was proactive i n recognizing that the provision of educational programs was a good way to inform and increase the involvement of members. During the period 1941 to 1967, the Association was reactive to member requests for an expanded educational program and proactive i n developing the programs i n t e r n a l l y or requesting that others, such as government or UBC, provide funds for or provide the program for RNs. The Association was proactive i n r e a l i z i n g that other providers required support in development, so that the Association could withdraw from providing certain types of programs, especially c l i n i c a l l y oriented programs. The Association has continued to be both proactive and reactive i n the period 1968 to the present. The Association reacted to requests from the p r o v i n c i a l government for input in a review of continuing education in 1976. In developing i t s plans for nursing education i n 1971 and 1973, the Association was pro-active i n o u t l i n i n g i t s r e s p o n s i b i l i t i e s in r e l a t i o n to CNE. The RNABC was proactive i n developing a number of services and a c t i v i t i e s , wholly or i n part educational in nature, which assisted RNs to acquire the s k i l l s and knowledge necessary to practice competently. The Safety To Practice Conferences were developed to help nurses to understand their role as profes-sionals and to learn s k i l l s such as assertiveness, documentation of unsafe situations and self-evaluation. The Association has been both proactive and reactive to 87 government and educational i n s t i t u t i o n s . Both in response to government action and p r i o r to government decision making, the Association has provided input to government on a number of issues of importance to RNs, such as the need for c l i n i c a l s p e c i a l t y programs and the need for f i n a n c i a l assistance for RNs pursuing further education. In summary, the Association has been both proactive and reactive i n response to member needs, government action, and actions of educational i n s t i t u t i o n s which have affected i t s educational a c t i v i t i e s . Commitment to CNE RNABC has demonstrated a sustained commitment to continuing education. Continuing education i s an integral part of many Association a c t i v i t i e s . The Association has established educational a c t i v i t i e s i n three major areas: as a provider of continuing education opportunities for i t s members; as a monitoring agent i n r e l a t i o n to a c t i v i t i e s both within and outside of nursing that affect CNE; and, as a f a c i l i t a t i n g agent to a s s i s t members and others. In so doing, the Association has both served i t s own interests and, as well, promoted the general welfare of the public by contributing to the competence of the nursing profession of the province. 88 CHAPTER V SUMMARY, CONCLUSIONS AND IMPLICATIONS Continuing education i s an integral part of professional l i f e . The need for continuing education by professionals w i l l increase as consumers continue to demand increased e f f i c i e n c y and greater proficiency from professionals. The role of professional associations in continuing education w i l l likewise increase, based on i t s commitment to the continuing education of members, an expectation shared by the public and association members. The r o l e of the RNABC has evolved i n three d i s t i n c t stages, with changes in policy development and governance and a c t i v i t i e s and services, which have occurred i n response to changes within nursing and i n the world at large. It is the intention, in this Chapter, to summarize the major developments i n the Association's continuing education program since 1912, to show the changes in d i r e c t i o n and a c t i v i t y that have occurred, and to present con-clusions to the study in r e l a t i o n to the four study questions. Implications of this study for continuing education i n a professional nursing association w i l l be suggested. Summary During the formative years, from 1912 to 1940, the Association supported the development of a c t i v i t i e s and services to a s s i s t RNs to keep up to date. Financial assistance i n development of refresher programs and university degree programs 89 was provided, and, as well, members of the Association provided advice and assistance i n development of educational programs, p a r t i c u l a r l y at UBC. Educational events were part of each Annual Meeting, however, Association involvement as a continuing education provider began near the end of this period, with the i n i t i a t i o n of the t r a v e l l i n g i n s t i t u t e s . Continuing education a c t i v i t i e s were acknowledged as a viable role for the Association i n the late 1930's, with the a l l o c a t i o n of f i n a n c i a l and human resources to support a variety of a c t i v i t i e s . The period 1941 to 1967 was a time of expansion for RNABC a c t i v i t i e s i n continuing education. The Association became a major provider of education programs for RNs in B r i t i s h Columbia. The appointment of an Educational Consultant in 1959 s i g n i f i e d that continuing education was viewed as important i n terms of contributing to Association goals. With an increasing demand for continuing education i n the 1960's, and the develop-ment of continuing education within educational i n s t i t u t i o n s , the RNABC reviewed i t s r o l e as a provider of continuing education. As a consequence, the Association focused i t s ef f o r t s on providing assistance to educational i n s t i t u t i o n s to encourage the development of continuing education programs within these i n s t i t u t i o n s , p a r t i c u l a r l y at UBC. With the emergence of spec i a l t y units in hospitals, such as coronary and intensive care u n i t s , the Association recognized a need for post-basic c l i n i c a l programs to a s s i s t RNs to function competently in these new ro l e s . The l a t t e r 1960's saw the beginning of post-basic c l i n i c a l specialty programs, and the start of an ongoing 90 involvement of the Association i n advocating and supporting the development of these programs. Recognizing that a s i g n i f i c a n t portion of Association resources were committed to educational a c t i v i t i e s , the RNABC began a review of i t s role in this area in the l a t t e r 1960's. The review of continuing education was completed i n 1973, and the di r e c t i o n for Association a c t i v i t y in continuing education was established i n several areas. The RNABC would provide assistance i n the development and evaluation of continuing education a c t i v i t i e s , provide educational counselling, support the development of the UBC Division of Continuing Nursing Education, and engage i n a c t i v i t i e s which supported the professional practice of RNs. This plan also outlined the Association's view of the role of educational i n s t i t u t i o n s , health care agencies and the r e s p o n s i b i l i t y of the individual nurse v i s - a - v i s continuing education. During the early 1970's, there was an increasing demand for professional accountability, partly as a result of recognition that technological change was such that preparatory programs for entry into the profession were no longer s u f f i c i e n t to assure continuing competence. In addition, consumers began to demand assurance that professionals demonstrate competence. The RNABC responded to these increased demands by embarking on a com-prehensive program to provide assistance to members, by informing them of t h e i r rights and r e s p o n s i b i l i t i e s as professionals, and by developing programs and services which supported members' professional practice. During the current period of development, the decentralization of r e p o n s i b i l i t y for continuing education 91 has continued, with educational i n s t i t u t i o n s becoming a major provider of continuing education for RNs, while the Association has focused i t s a c t i v i t y on the s p e c i f i c area of r e s p o n s i b i l i t y , a c t i v i t i e s and services which support the professional practice of RNs. The Association continues to provide consultation services for members, es p e c i a l l y related to the delineation of the scope of nursing practice, including legal and e t h i c a l issues i n nursing. The Association has developed a comprehensive set of standards for nursing practice, and continues to offer access to an extensive nursing l i b r a r y . The RNABC News offers information on nursing issues, c l i n i c a l topics and continuing education opportunities. The RNABC provides assistance in development of continuing education a c t i v i t i e s for members to educational i n s t i t u t i o n s , health care agencies, member groups, and other health related groups. The association has also become increasingly active as an advocate for continuing nursing education, for example, in promoting the necessity for continuing education among i t s members and speaking out on issues and concerns of i t s members in this area. Recently, the Association reviewed i t s continuing education a c t i v i t i e s , and reaffirmed i t s intention to pursue three roles in continuing education, as a provider, as a f a c i l i t a t o r , and as a monitor. S p e c i f i c a c t i v i t i e s which relate to each role w i l l be i d e n t i f i e d on an annual basis. In summary, there has been a s h i f t i n role by the Association, from a time when the Association was the single provider of continuing education for RNs, to an emphasis on 92 encouraging the development of opportunities by others, to the current s i t u a t i o n , with the Association assuming r e s p o n s i b i l i t y for supporting the professional development of i t s members. This l a t t e r r o l e i s si m i l a r to the second stage of development of CPE, as described in Chapter I I . Conclusions In r e l a t i o n to the four study questions, i t can be concluded that: 1. the nature of RNABC involvement i n continuing nursing education has changed in r e l a t i o n to the three time periods i d e n t i f i e d ; 2. the change of Association a c t i v i t y has occurred i n response to member d i r e c t i o n , changes within nursing, and external events that affect the practice of nursing; the nature of the change i n focus has been to add new a c t i v i t i e s , or to s h i f t the focus, or both; 3. the RNABC has been both proactive and reactive i n response to member needs, government action, and actions of educational i n s t i t u t i o n s which have affected i t s educational a c t i v i t i e s ; and 4. the RNABC has demonstrated a sustained commit-ment to continuing education, which has served i t s own interests and promoted the public welfare by insuring that i t s members provide competent nursing care to the public. 93 In addition, i t can be concluded that RNABC a c t i v i t y in CNE can be described i n three d i f f e r e n t areas: major developments, p o l i c y development and governance, and educational services and a c t i v i t i e s . These three broad areas may be useful in providing d i r e c t i o n and decision-making related to future a c t i v i t i e s of the Association i n the area of continuing nursing education. Implications of the Study There are several implications of this study for continuing education i n a professional nursing association. It i s clear that the professional association has a r e s p o n s i b i l i t y to be concerned about the continuing education of i t s members i n order to insure that i t s obligation to the public is met, and to provide a service valued by i t s members. The Association has a r e s p o n s i b i l i t y to insure that members keep up to date with changes i n practice so that the public can fe e l confident that nurses are competent. Members look to the Association to provide continuing education opportunities, especially i n the area of professionalism. It also seems clear that no single i n s t i t u t i o n can meet the diverse continuing education needs of RNs, therefore, there i s a need for cooperation among providers, and a clear delineation of r o l e s . The professional association has an obligation to insure that educational opportunities are available, either through other groups or as part of i t s educational program. The Association should develop clear statements about role require-ments for RNs working in dif f e r e n t c l i n i c a l and functional areas, 94 so that educational programs based on these statements can be developed. The Association also has a r e s p o n s i b i l i t y to use pr i n c i p l e s of adult education in i t s own educational a c t i v i t i e s , to demonstrate a continuing commitment to continuing nursing education, to speak out on CNE issues, and to help i t s members develop as s e l f - d i r e c t e d learners. Lastly, the Association has a r e s p o n s i b i l i t y to c l e a r l y define i t s role in continuing nursing education, p a r t i c u l a r l y i n r e l a t i o n to future issues and di r e c t i o n s . One way to as s i s t the Association to define i t s role i n through nursing research. Several questions have been i d e n t i f i e d for future study. These are: 1. What ro l e does the Association have i n insuring the competence of i t s members? 2. What i s the Association's role i n coordinating CNE a c t i v i t i e s ? 3. What i s the nature and extent of the Association's role as a provider of CNE a c t i v i t i e s ? as a f a c i l i t a t o r ? as a monitor? 4. What is the Association's role in providing leader-ship i n CNE? 5. What role should the Association take in ide n t i f y i n g and addressing future issues i n continuing nursing and continuing professional education? 6. What i s the relationship between Association continuing education a c t i v i t i e s and i t s position supporting entry l e v e l into the nursing profession at the baccalaureate level? 95 Investigation of these study questions w i l l help the Association to set short term and long term goals i n r e l a t i o n to i t s role in continuing nursing education. As a major participant i n past and present CNE a c t i v i t i e s , the Association has an obligat i o n to continue i t s involvement into the future, however, i t i s important that the scope of i t s a c t i v i t i e s be c l e a r l y defined. The Association should continue to provide leadership to i t s members and provide assurance to the public that RNs are and w i l l remain competent to practice. The nature of CNE a c t i v i t i e s should continue to change, i n response to needs of members and the public, however, i t is clear that i t is in the best interests of RNs and the general public for RNABC to continue to play an active role in continuing nursing education. 96 REFERENCES Apps, J.W. Problems i n Continuing Education. New York: McGraw-H i l l Book Company, 1979. Apps, J.W. Improving P r a c t i c e i n Continuing E d u c a t i o n . San F r a n c i s c o : Jossey-Bass P u b l i s h e r s , 1985. A r g y r i s , C. and Schon, D.A. Theory i n P r a c t i c e : I n c r e a s i n g P r o f e s s i o n a l E f f e c t i v e n e s s . San F r a n c i s c o : Jossey-Bass P u b l i s h e r s , 1974. B r i t i s h Columbia C o u n c i l on P o s t - B a s i c C l i n i c a l S p e c i a l t y Courses Minutes. December 13, 1972 and March 28, 1973. Canadian Nurses Foundation. Terms of Reference. Ottawa: Author. 1962. Caplan, R.M. Continuing Education and P r o f e s s i o n a l A c c o u n t a b i l i t y . In C.H. McGuire, R.P. F o l e y , A. Gorr, R. W. R i c h a r d s and A s s o c i a t e s . Handbook o f Health P r o f e s s i o n s E d u c a t i o n . Washington: Jossey-Bass P u b l i s h e r s , 1983. C l a r k , C.C. The Nurse As C o n t i n u i n g Educator. New York: S p r i n g e r P u b l i s h i n g Company, 1979. C o n t i n u i n g Education As The P u b l i c R e l a t i o n s Arm. The J o u r n a l o f  C o n t i n u i n g Education i n Nursing, 1982, 13:6, 20-21. Cooper, S.S. The P r a c t i c e of Continuing Education i n Nursing. Maryland: Aspen Systems C o r p o r a t i o n , 1983. Cooper, S.S. and Hornback, M.S. Continuing Nursing E d u c a t i o n . New York: McGraw-Hill Book Company, 1973. DuGas, B.M. C o n t i n u i n g Education Programs Sponsored By The R e g i s t e r e d Nurses A s s o c i a t i o n o f B r i t i s h Columbia 1940 to 1967: A H i s t o r i c a l Review. Vancouver: Author. 1968. Grabowski, S.M. P r e p a r i n g Educators of A d u l t s . Washington: Jossey-Bass P u b l i s h e r s , 1981. Graduate Nurses A s s o c i a t i o n o f B r i t i s h Columbia. Annual Meeting and C o u n c i l Minutes. 1913-1935. Green, M.M. Through the Years With P u b l i c H e a l t h Nursing. Ottawa: The Canadian P u b l i c H e a l t h A s s o c i a t i o n , 1984. Gross, S.J. The P r o f e s s i o n a l As Regulator and S e l f - R e g u l a t o r . In M.R. S t e r n , (Ed.) Power and C o n f l i c t i n C ontinuing P r o f e s s i o n a l Education. Belmont, C a l i f o r n i a : Wadsworth P u b l i s h i n g Company, 1983. 97 Hohmann, L. The Professional Associations. In H.J. Alford, (Ed.) Power and C o n f l i c t i n Continuing Education: Survival and Prosperity for A l l ? Belmont, C a l i f o r n i a : Wadsworth Publishing Company, 1980. Houle, CO. The Role of Continuing Education i n Current Professional Development. American Library Association B u l l e t i n , 1967, 61:3, 259-267. Houle, CO. The Design of Education. Washington: Jossey-Bass Publishers, 1976. Houle, CO. Continuing Learning in the Professions. Washington: Jossey-Bass Publishers, 1980. Houle, CO. Possible Futures. In M.R. Stern, (Ed.) Power and C o n f l i c t in Continuing Professional Education. Belmont, C a l i f o r n i a : Wadsworth Publishing Company, 1983. Kennedy, F.A. Symposium on Resources for Education. Author. Undated. Kermacks, C. Post-Basic C l i n i c a l Nursing S k i l l s and Their Relationship Based on Rated Importance i n the Jobs of B r i t i s h Columbia Registered Nurses. Vancouver: Registered Nurses Association of B r i t i s h Columbia, 1981. Knowles, M.S. The F i e l d of Operations in Adult Education. In G. Jensen, A.A. L i v e r i g h t , and W. Hallenbeck, (Eds.) Adult Education: Outlines of an Emerging F i e l d . Washington: Adult Education Association, 1964. Knowles, M.S. The Professional Society As A Learning Community. Training and Development Journal, 1979, 33:5, 36-40. Licensed P r a c t i c a l Nurses' Association of B r i t i s h Columbia, Registered Nurses' Association of B r i t i s h Columbia, and Registered Psychiatric Nurses Association of B r i t i s h Columbia. Joint Statement. Guide to the D e f i n i t i o n of The Roles and Functions of the Licensed P r a c t i c a l Nurse, the Registered Nurse, and the Registered Psychiatric Nurse. Author. 1981. Long, H.B. Adult and Continuing Education: Responding To Change. New York: Teachers College Press, 1983. Loring, R. New Trends i n Professional Continuing Education. In R.W. Axford, (Ed.) Professional Continuing Education Comes of Age. Proceedings of a Conference on Professional Continuing Education. Tempe, Arizona: 1980. Mauksch, I.G. An Analysis of Some C r i t i c a l Issues in Nursing. The Journal of Continuing Education i n Nursing, 1983, 14:1, 4-8. 98 Manning, P.R. Continuing Educat ion in the Health Sciences: Can we change the Paradigm? Mobius, 1982, 2:2, 5-7. Merton, R.K. The Functions of the Professional Association. The American Journal of Nursing, 1958, 58:1, 50-54. Ministry of Education, Science and Technology. Nursing Education Study Report. Province of B r i t i s h Columbia, 1979. M i l l e r , G.E. Continuing Education for What? Journal of  Medical Education, 1967, 42:4, 320-326. Mussallem, H.K. A Path to Quality. Ottawa: Canadian Nurses Association. 1964. Puetz, B.E. The Role of the Professional Association i n Continuing Education in Nursing. The Journal of Continuing  Education i n Nursing, 1985, 16:3, 89-93. Puetz, B.E. and Peters, F.L. Continuing Education For Nurses. Maryland: Aspen Systems Corporation, 1981. Registered Nurses Association of B r i t i s h Columbia. Annual Meeting. 1937-1970. . Annual Report. 1944-1947. . A Proposed Plan for the Orderly Development of Nursing Education in B r i t i s h Columbia. Part II: Post-Basic Nursing Education. January, 1971. . A Proposed Plan for the Orderly Development of Nursing Education in B r i t i s h Columbia. Part I I I : Continuing Nursing Education. January, 1973. . Board of Directors Minutes. 1971-1985. . Brief to Faris Commission. Continuing Education For Registered Nurses i n B r i t i s h Columbia. Author. 1976. . B r i e f to Winegard Commission. The Development of Academic and Professional Programs Outside of the Vancouver and V i c t o r i a Metropolitan Areas, and Academic Transfer Programs and Their A r t i c u l a t i o n . Author. 1976. . Committee on Assessment of Safety to Practice: Report to the Board of Directors. November, 1976. . Committee on Educational Loans Minutes. February 15, 1968. . Committee on Educational Needs of Registered Nurses Minutes. November 4, 1961. 1950. T935T 1955. 1969. 1969. 99 Committee on E d u c a t i o n a l P o l i c y M i n u t e s . June 19, Committee on E d u c a t i o n a l P o l i c y M i n u t e s . J a n u a r y 13, Committee on L i b r a r y . M a r c h 19, 1969. Committee on N u r s i n g E d u c a t i o n M i n u t e s . December 19, Committee on N u r s i n g E d u c a t i o n M i n u t e s . May 7, 1965. Committee on N u r s i n g E d u c a t i o n M i n u t e s . J a n u a r y 28, Committee on N u r s i n g E d u c a t i o n M i n u t e s . December 10, . C o m p e t e n c i e s and S k i l l s R e q u i r e d F o r N u r s e R e g i s t r a t i o n F o r A G r a d u a t e o f A B a s i c Program. A u t h o r . 1978. . C o u n c i l M i n u t e s . 1928-1968. E s s e n t i a l M anual S k i l l s F o r A New G r a d u a t e . A u t h o r . T97B: E x e c u t i v e Committee M i n u t e s . 1946-1974. . J o i n t M e e t i n g o f t h e Committees on N u r s i n g E d u c a t i o n and N u r s i n g P r a c t i c e M i n u t e s . A p r i l 14, 1977. . R e g i s t e r e d N u r s e s A c t . 1918. R e p o r t o f t h e E x e c u t i v e D i r e c t o r t o t h e B o a r d o f D i r e c t o r s . J a n u a r y , 1986. . Resume o f RNABC A c t i v i t i e s R e l a t e d t o C o n t i n u i n g and P o s t - B a s i c N u r s i n g E d u c a t i o n . A u t h o r . O c t o b e r , 1967. Ruhe, C.H.W. What i s t h e S t a t u s o f C o n t i n u i n g E d u c a t i o n F o r H e a l t h P r o f e s s i o n a l s ? M o b i u s , 1982, 2_2, 8-14. S c h r o e d e r , W.L. A d u l t E d u c a t i o n D e f i n e d and D e s c r i b e d . I n R.M. S m i t h , G.F. A k e r , and J.R. K i d d , ( E d s . ) Handbook o f A d u l t E d u c a t i o n . New Y o r k : M a c M i l l a n . 1970. The Scope o f C o n t i n u i n g N u r s i n g E d u c a t i o n As A F i e l d Of P r a c t i c e . The J o u r n a l o f C o n t i n u i n g E d u c a t i o n i n N u r s i n g , 1982, 13:6, 13-19. 100 Selden, W.K. Professional Standards, Competency, and Continuing Education: Roles and Re s p o n s i b i l i t i e s of Professional Associations. In D.E. Moore, (Ed.) Mandatory Continuing Education: Prospects and Dilemmas for Professionals. I l l i n o i s : University of I l l i n o i s . 1976. Stein, J. (Ed.) Dictionary of the English Language. New York: Random House, 1979. Stern, M.R. (Ed.) Power and C o n f l i c t i n Continuing Professional Education. Belmont, C a l i f o r n i a : Wadsworth Publishing Company, 1983. Weldy, A.A. Structuring For Continuing Education Within The Professional Association. The Journal of Continuing Education i n  Nursing, 1970, 1__2, 36-40. Williams, B.V. and Huntley, J.A. The Role of the Professional Association in Continuing Education. In P.P. LeBreton. The Evaluation of Continuing Education for Professionals: A Systems View. Seattle: Division of Academic and Professional Programs, Continuing Education, University of Washington. 1979. 

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