Evidence-Based Regulation and Research

AZBN Research Agenda

Arizona State Board of Nursing - Research Regulatory Agenda

Education Department - September 2017

Background information

Members of the Education Committee identified the need for a research agenda related to regulatory topics related to the education of nurses in Arizona. Our belief is that creating a research agenda for the Arizona Board of Nursing would identify current issues that require more evidence or new evidence to inform and improve regulatory decisions. The research agenda would identify priorities for nurse researchers and needs for student projects. Members of the community are encouraged to engage nursing students in researching these topics as Capstone or Dissertation projects. Additional recommendations for this work are always welcome. 


  1. Engage the public, researchers and students in the work of regulation
  2. Advance conceptualizations of nursing regulation; build theory; identify important regulatory issues
  3. Identify evidence/ research that would improve nursing regulation
  4. Publish findings in the Journal of Nursing Regulation
  5. Analyze available NCSBN, IOM, RWJ etc. data and link Arizona data
  6. Create new partnerships with local, state and national organizations
  7. Recommend regulatory changes based on evidence
  8. Manage risks to patient safety from and evidence-driven perspective

Potential areas of focus:

  1. Workforce supply
  2. Analyze impact of simulation/technology project (SCC, ASU, AZBN)
  3. Transition to practice
  4. Substance abuse/ opioid crisis
  5. Remediation impact of discipline, probation stipulations
  6. Continued competence
  7. Delegation
  8. Impact of legalized marijuana
  9. Cost analysis of regulations
  10. Advanced practice role impact
  11. Effective curriculum models
  12. Evaluation of ethics evaluations (pre-& post nursing behaviors)
  13. Do our outcomes make a difference?

Examples of questions:

  1. What is the evidence for assessing 100, 150, and > 150% completion rates for nursing programs?
  2. What is the evidence for 45% On Time Graduation rates as a measure?
Continuing Education

An Environment Scan of State-Regulated Mandatory Continuing Education’s (MCE) Relationship to Nurses’ Continuing Competence

Shannon Campbell MSN/M. Adm., RN, PCCN & David P Hrabe, PhD, RN, NC-BC

Arizona State University (Campbell, DNP Student), Arizona Board of Nursing (Hrabe, AZBN Staff)

In the ever evolving world of healthcare, education is imperative to keep nurses competent. Do state MCE statutes develop and maintain competence?

An Environment Scan of State-Regulated Mandatory Continuing Education’s (MCE) Relationship to Nurses’ Continuing Competence


Developing and maintaining professional competence among Registered Nurses/Licensed Practical Nurses is of utmost importance to public safety. While both education for entry into practice and work experience contribute to ongoing competence, debate continues about the impact of mandatory continuing education’s (MCE) relationship compared to voluntary continuing education (VCE) on nurses’ continuing competence. In a 2003 seminal study sponsored by The National Council of State Boards of Nursing (NCSBN), Smith concluded that while nurses will accumulate more CE hours if they are mandated to do so, they will also earn more CEs that are not related to their work or interests. Also, “nurses with and without CE mandates estimate the same levels of growth in 10 professional abilities” (Smith, p. 30).

Relevance to Nursing

While MCE is a common feature in many states’ nurse practice acts or state law, its efficacy in relation to continuing competence remains unclear.

“Nurses with a CE mandate attend more hours of CE unrelated to their work or interests” (Smith, 2003, p. 30)


The purpose of this environment scan was to explore contemporary evidence regarding the impact of mandatory continuing education upon nurses’ competence.

33 of the 50 states have MCE requirements (Nurse.com, n.d).*

*Maryland has no MCE, but an approved refresher course is needed

Environment Scan

A literature search was conducted (August, 2018) in CINAHL, Medline, Cochrane databases and the Internet for articles published from 2004 to present. Keywords used were: “nursing” ‘continuing education’, ‘continuing competencies’, ‘mandatory’. Next, “healthcare” was added to broaden the search to other health professions. To assure thoroughness, a healthcare librarian validated the search results. Finally, individual state board of nursing websites were evaluated for continuing education and related requirements.

Findings and Highlights

  • Since Smith’s 2003 article, no new studies have been conducted to establish a link between MCE and the development of professional competence in nursing.
  • Six states allow national certification by a national certifying body to qualify as their content requirement (Campbell, 2018).
  • While educational opportunities are associated with increased job satisfaction, many employed nurses struggle with access to continuing education (Whithead & Haun, 2008).
  • Nurses must be active partners in the process of advocating for effective organizational policies and ensuring quality CNE opportunities (Nalle, Wyatt, & Myers, 2010).
  • In a literature review of 300 articles across all healthcare disciplines, Tran et al. (2014) remarked that the published literature is not reflective of current continuing education practices.
  • Through CE, nurses are exposed to new information and useful tools from other disciplines and content experts. These new ideas can help to reframe thinking and behavior that can affect the culture of care (Tarnow, Gambino, & Ford, 2013). The link between MCE and continuing competence, however, remains elusive.


  • It is imperative that nurses maintain their clinical competence.
  • The public policy perspectives regarding nursing competency are multifaceted and challenging in addressing this critical issue (Jordan et al., 2008).
  • With three fifths of U.S. states having a statutory requirement of MCE, a re-examination of the role of MCE as it relates to continuing competence is important to determine the best regulatory approach.


Campbell, S. (2018). Continuing education scan of U.S. states, unpublished.

Jordan, C., Thomas, M., Evans, M., & Green, A. (2008). Public policy on competency: How will nursing address this complex issue? The Journal of Continuing Education in Nursing, 39(2), 86-91.

Nurse.com. (n.d.). Nursing CE requirement my state. Retrieved from https://www.nurse.com/state-nurse-ce-requirements

Ross, K., Barr, J., & Stevens, J. (2013). Mandatory continuing professional development requirements: What does this mean for Australian nurses. BMC Nursing, 12(1), 7 pages.

Smith, J. (2003). Exploring the value of continuing education mandates: NCSBN research brief. NCSBN. 1-30. Retrieved from https://www.ncsbn.org/public-files/CEStudy.pdf

Tarnow, K. Gambino, M. L., and Ford, D.J. (2013). Effect of continuing education: Do attendees implement the tools that are taught? Journal of Continuing Education in Nursing. 44(9), 391-396. DOI:10.3928/00220124-20130701-68

Tran, Deanna, Tofade, Toyin, Thakkar, Namrata, & Rouse, Michael. (2014). US and international health professions' requirements for continuing professional development. American Journal of Pharmaceutical Education,78(6), 129.

Nalle, M. A., Wyatt, & Myers,C. R. (2010). Continuing education needs of nurses in a voluntary continuing nursing education state. The Journal of Continuing Education in Nursing,41(3), 1