Nurse Education in Practice 50 (2021) 102963

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Nurse Education in Practice

journal homepage: www.elsevier.com/locate/issn/14715953

Review

Nurses’ continuing professional development: A systematic

literature review
Mónica Vázquez-Calatayud a, b, Begoña Errasti-Ibarrondo b, c, *, Ana Choperena b, c
a
Clínica Universidad de Navarra, Avenida Pío XII, 31008, Pamplona, Navarra, Spain
b
IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
c
University of Navarra, Faculty of Nursing, Calle Irunlarrea 1, 31008, Pamplona, Navarra, Spain

A R T I C L E I N F O A B S T R A C T

Keywords: Nurses’ continuing professional development (CPD) improves the quality of nursing care, patients’ safety, nurses’
Continuing professional development satisfaction and healthcare costs. However, evidence has shown that nurses do not always participate in their
Interpretive synthesis CPD and that CPD does not always address nurses’ real needs. To examine this issue, a systematic review of the
Literature review
literature on nurses’ experiences regarding their CPD in the clinical context was carried out. The studies selected
Nurse/nursing
for this review (n = 9) were analyzed thematically, through which three themes were identified: The relevance of
Organizational support
CPD to nurses; the intrinsic and extrinsic motivations of nurses to participate in CPD; and the specific needs of
nurses to participate in CPD. The findings of this review highlight that nurses’ experiences regarding their CPD is
a key issue that has not been deeply studied. For nurses, their CPD continues throughout their professional
career, and keeping their knowledge and skills up to date is important. The goals, motivations and needs that
nurses may have to lead and participate in their CPD may vary according to their age and position. Organizations
should consider nurses’ specific professional situation as well as their actual needs to boost their CPD through
different approaches and enhance nurses’ retention at hospitals.

1. Introduction
In an environment of continuous change characterized by scientific
and technological progress and increased demands and needs, both so­
cial and of the health system itself, arises the continuing professional
development (CPD) of nurses as a right and a professional “obligation”
(Koff, 2016; Law 44/2003 of the Regulation of Health Professions,
2003). Nurses have the professional responsibility to participate in CPD,
which is key to maintaining their skills and motivation to work as well as
providing safe care to patients (Joint Commission International, 2008;
Steven et al., 2018).
Promoting the CPD of nurses in the clinical context is fundamental,
given its positive impact on patients, professionals and organizations
(Aiken et al., 2003; Carlisle et al., 2011; Hariyatia and Safril, 2018;
Levett-Jones, 2005; Gibbs, 2011). Specifically, CPD contributes to
improving the quality of care and health outcomes, such as reducing the
likelihood of patients dying or the odds of failure to rescue them (Aiken
et al., 2003; Levett-Jones, 2005). CPD also promotes motivation,
commitment and satisfaction among professionals (Hariyatia and Safril,
2018) and, as a consequence, their retention and performance (Carlisle
et al., 2011). All of these elements affect not only nurses themselves but
also organizations, as patient safety is increased and healthcare costs are
reduced (Gibbs, 2011).
1.1. Background
Despite the relevance of CPD, there is little consensus on its defini­
tion, as the term is used indistinctly from other terms such as continuing
professional education, lifelong learning and professional development;
sometimes, the term has even been used with different meanings (Gal­
lagher, 2007; Hegney et al., 2010; Lawton and Wimpenny, 2003; Manley
et al., 2018). Thus, for example, in some countries such as Spain, the
meaning attributed to professional development is “public, expressed
and individualized recognition of the development achieved by a health
professional” (Law 44/2003 on the Regulation of Health Professions,
2003, p. 13). In this definition, however, the “continuing” nature of CPD
is not considered, having been implied as an outcome rather than as a
process. Given that CPD should be a continuum through practice (Ryan,
2003), for this review, the definition proposed by the American Nurses
Association (ANA), which conceives of CPD as “a lifelong process of

* Corresponding author. University of Navarra, Faculty of Nursing, Calle Irunlarrea 1, 31008, Pamplona, Navarra, Spain.
E-mail addresses: mvazca@unav.es (M. Vázquez-Calatayud), meibarrondo@unav.es (B. Errasti-Ibarrondo), achoperena@unav.es (A. Choperena).

https://doi.org/10.1016/j.nepr.2020.102963
Received 30 July 2020; Received in revised form 17 December 2020; Accepted 22 December 2020
Available online 29 December 2020
1471-5953/© 2020 Elsevier Ltd. All rights reserved.
M. Vázquez-Calatayud et al.
active participation by nurses in learning activities that assist in devel­
oping and maintaining their continuing competence, enhancing pro­
fessional practice and supporting achievement of their career goals,”
was taken as a reference (American Nurses Association and National
Nursing Staff Development Organization, 2010, p. 1).
There are different initiatives to promote the CPD of nurses. At the
international level, one standout is a report published by the Institute of
Medicine on the future of nursing that emphasizes the need for (1)
highly trained nurses to respond to the changing needs of patients; (2) an
educational system that allows the development of advanced skills; (3)
lifelong learning opportunities; and (4) enough nurses with the neces­
sary skills to contribute to quality of care (Institute of Medicine (US)
Committee on the Robert Wood Johnson Foundation Initiative on the
Future of Nursing, at the Institute of Medicine, 2011). Along these lines,
countries such as the United States and the United Kingdom have
regulated the participation of nurses in lifelong learning activities,
which is a mandatory requirement for working (Cutcliffe and Foster,
2010). However, some countries in Europe, like the Netherlands, Spain
and Greece, lack a systematic approach to the CPD of nurses, and their
participation is voluntary. In this regard, it is notable that in countries
that lack national professional development requirements, the engage­
ment rates of nurses in CPD are lower than in countries where partici­
pation is mandatory (Heat, 2018).
A recent literature review has identified that self-motivation, rele­
vance to practice, preference for workplace learning, strong enabling
leadership and a positive workplace culture are key factors to enable or
optimize the impact of nursing CPD (King et al., 2020). Likewise, in the
current rapidly changing healthcare context, in which professional
development is not always recognized (Hoeve et al., 2014), the litera­
ture shows that nurses participate in CPD when they have reasons to do
so (Billett, 2006, 2010; Govranos and Newton, 2014). It is key, there­
fore, that strategies aimed at promoting the participation of nurses in
CPD address their real needs (Griscti and Jacono, 2006; Nolan et al.,
2000). However, as pointed out by Gould et al. (2007) and Jho and Kang
(2016), the strategies designed to promote nurses’ CPD do not always
consider these needs. Given the above information, approaching nurses’
experiences regarding their CPD in the clinical context may provide
insight into the complexity of nurses’ involvement (or lack thereof) in
CPD as well as help identify their needs to consider when designing
effective and motivating strategies that realistically support nursing
CPD.
2. Methods
2.1. Aims
To critically review the published evidence of nurses’ experiences
regarding their CPD in the clinical context to improve the understanding
of the role it plays in their clinical practice and assist in identifying their
needs.
2.2. Design
A systematic literature review and a critical interpretive synthesis of
the data from the studies were carried out (Miles and Huberman, 1994;
Patton, 2015; Whittemore, 2005).
2.3. Search methods
The literature search was carried out in the CINAHL, PubMed, Web
of Science and PsycINFO databases from their inception up to June 2020
by M.V.C. and reviewed by A.C. Each search was constructed differently
to use the relevant search terms or MESH/Thesaurus/Keyword headings
for each database. All searches essentially combined all terms found
(and their truncated forms): (“Continuing professional development”
OR “CPD” OR “Continuing education” OR “CE”) AND (“Nurs*“) AND
2
Nurse Education in Practice 50 (2021) 102963
(“Experience*” OR “Perception*” OR “Perspective*” OR “Feeling*” OR
“Attitude*“). The search was only limited by language (articles pub­
lished in English and Spanish).
In the search strategy, the term “clinic context” was omitted because
it did not yield results and did not redefine the search towards the
specific area of study.
In addition, the reference lists of the selected studies were reviewed
through the “snowballing” technique, and a manual review of the five
most recent years in relevant journals for the study of the phenomenon
of interest was conducted: Journal of Advanced Nursing, Journal of Clin­
ical Nursing, International Journal of Nursing Studies and Nurse Education
Today.
The inclusion criteria were (1) research studies exploring clinical
nurses’ experiences regarding CPD (qualitative, quantitative or mixed
methods); (2) studies with an adequate quality level in accordance with
Hawker et al. (2002); (3) studies conducted at hospitals; and (4) liter­
ature reviews in which primary studies were not included in the review.
Gray literature, editorials, comments and essays were excluded.
The search and selection processes were manually recorded and
handled. All the studies were independently screened by two reviewers
(M.V.C. and A.C.). When reviewers disagreed on study inclusion, they
discussed the study’s suitability for the review. Disagreements between
the raters were resolved through discussion and adjudication by a third
reviewer (B.E.).
2.4. Search outcomes
An initial total of 1604 references was retrieved. After search limits
were applied and titles were read, 247 articles were retained. After the
abstracts of these articles were read, 63 were selected, of which 15 were
eliminated because they were duplicates. Finally, the authors reviewed
the full text of 48 studies; after a thorough reading and application of the
inclusion criteria established for this review, these were reduced to six.
In a third step, three new articles were obtained through the manual
search of the journals and application of the “snowballing” technique.
Fig. 1 shows the study selection process.
2.5. Quality appraisal
The selected studies were evaluated by two authors (M.V.C. and A.
C.) according to the methodological quality criteria described by
Hawker et al. (2002). This method examines nine study domains: ab­
stract and title, introduction and aims, method and data, sampling, data
analysis, ethics and bias, results, transferability or generalizability and
implications and usefulness. Each domain can be scored from 1 (very
poor) to 4 (good), so each study can attain a score between 9 and 36
points. The studies selected for this review had to obtain a score greater
than 20 points to be considered as having an adequate quality level, as
recommended by previous studies (Walshe et al., 2009; Cohen et al.,
2011). No studies were excluded due to low quality.
2.6. Data analysis
A critical interpretive synthesis that involved a thematic analysis of
the data was carried out (Miles and Huberman, 1994; Patton, 2015;
Whittemore, 2005) by M.V.C. and A.C. and critically reviewed by B.E.
Table 1 reflects in detail the steps and strategies followed in the data
abstraction and analysis of the selected studies.
Findings.
2.7. Characteristics of the selected studies
Of the nine articles included, five were quantitative studies, three
were qualitative, and one used combined quantitative and qualitative
methodology. With regard to the context of the research, five studies
were conducted in countries where CPD is regulated and is mandatory:
M. Vázquez-Calatayud et al.
Fig. 1. Flowchart of the study selection.
the United Kingdom (n = 4) and Australia (n = 1). The remaining four
studies were carried out in countries where CPD is voluntary: the
Netherlands (n = 2), Greece (n = 1) and Jordan (n = 1). Table 2 shows
the main characteristics of the nine studies included in the review as well
as their main results, limitations and quality appraisal score. The
methodological quality of the studies was adequate, since all the studies
but one scored between 28 and 35 points overall and between 3 and 4
points on each of the nine domains. The study by Wood (2006) scored 25
points because it provided neither sufficient detail to replicate the
research nor enough evidence to support the findings.
2.8. Nurses’ experiences in relation to CPD
Based on the analysis of the articles reviewed, three main themes
that explain the experiences of nurses regarding their CPD in the clinical
context were identified: (1) relevance of CPD to nurses, (2) motivations
of nurses to participate in CPD and (3) needs of nurses to facilitate their
participation in CPD.
2.8.1. Relevance of CPD to nurses
The relevance of CPD to nurses is a recurring theme in the nine
studies identified (Gould et al., 2007; Hughes, 2005; Jaradeh and
Hamdeh, 2010; Katsikitis et al., 2013; Pool et al., 2013; Pool et al., 2016;
Ryan, 2003; Wood, 2006; Yfantis et al., 2010). In these studies, nurses,
regardless of their greater or lesser degree of experience, agree that CPD
is key to developing and maintaining their knowledge and professional
skills (Gould et al., 2007; Hughes, 2005; Jaradeh and Hamdeh, 2010;
3
Nurse Education in Practice 50 (2021) 102963
Katsikitis et al., 2013; Pool et al., 2013; Pool et al., 2016; Ryan, 2003;
Wood, 2006; Yfantis, Tiniakou I & Yfanti, 2010).
These nurses report that CPD makes it possible for them to be more
competent, improve the care provided and ensure the safety of patients
(Gould et al., 2007; Hughes, 2005; Jaradeh and Hamdeh, 2010).
Regarding these issues, one surveyed nurse indicates that CPD allows
nurses “… to be more competent and deliver good and quality nursing
care to our patients” and that CPD “… promotes patients’ safety and
minimizes harm” (Jaradeh and Hamdeh, 2010, p. 317).
In the study by Gould et al. (2007), another respondent notes that
“CPD helps us stay up-to-date and avoid mistakes that put patients at
risk” (p. 605).
CPD also plays a key role in the personal and professional develop­
ment of nurses (Gould D, Drey N, Berridge, 2007; Hughes, 2005; Jaradeh
and Hamdeh, 2010; Katsikitis et al., 2013; Pool et al., 2013). This role is
reflected by more than half of the nurses who participated in a survey
about their perception of CPD that was conducted in two hospitals in the
United Kingdom (Hughes, 2005). Nurses perceive CPD as motivation to
maintain their professional interests, avoid stagnation and increase their
opportunities for promotion (Hughes, 2005). In addition, they perceive
that their professional development not only benefits their practice but
also that of those around them by transferring the training they receive
(Hughes, 2005).
Nurses also believe that CPD helps them meet the demands of their
role. It gives them confidence and relationship skills to work within a
multidisciplinary team. By gaining competence and trust, CPD helps
nurses cope with the stress they experience related to their practice
M. Vázquez-Calatayud et al. Nurse Education in Practice 50 (2021) 102963

Table 1 master’s degree – provide them with less added value than those of
Steps and strategies followed in the analysis of the studies. Based on Patton informal learning, such as daily experience (Gould et al., 2007). This
(2015), Whittemore (2005) and Miles and Huberman (1994). difference is illustrated by one of the nurses in the study by Pool et al.
Steps Strategies (2013):
1. Reduction of data: determination of - Design of a standard format to I do not think that development means you have to do one course
a global classification system for data summarize the descriptive and
after the other. Naturally, at a certain moment, you have reached a
management from various methodological data as well as the
methodologies. findings and limitations of the selected ceiling and it is not necessary any more. But I think you are devel­
studies (see Table 2). oping every day. Day-by-day you hear new things or you check
2. Visualization of the data: - Design of a single table that shows at a things with your colleagues. (p. 39).
conversion of the data extracted from glance the selected studies and their
individual sources into a presentation main results (see Table 2). This experiential learning is also highlighted by the nurses who
that gathers the data from multiple participated in a study by Wood (2006). In this case, they add that
primary sources around particular
variables or subgroups.
reflection in action (that is, when faced with a new situation and
3. Comparison of data: iterative - Identification of the main themes of problem, they think and learn while they act) is an essential component
process of examining data from the results of the studies (see Tables 2 of experiential learning and of the CPD of nurses (Wood, 2006).
primary studies to identify patterns, and 3). Regarding extrinsic motivations, several studies show that nurses are
themes or relationships. - Distinction of common and unusual
not moved primarily by external pressure to participate in CPD (Gould
patterns.
Establishment of relationships between et al., 2007; Hughes, 2005; Jaradeh and Hamdeh, 2010; Katsikitis et al.,
the themes and patterns identified in the 2013; Ryan, 2003). This finding contrasts with that obtained in a study
different studies. by Pool et al. (2016), in which the majority of nurses consider fulfilling
In this phase, the summary of data from requirements as one of the main reasons for participating in CPD.
the tables and the results of each primary
source has been reviewed and compared
However, this reason is not the only one because they also perceive the
in an iterative manner. need to participate in learning activities to expand their skills and stay
4. Conclusion: the final phase of the - Synthesis of the data examined based current (Pool et al., 2016).
analysis that moves from the on the interpretation of the patterns, Although nurses, in general, are not motivated by external pressures,
descriptive interpretation of patterns themes and relationships identified.
those over 35 years of age recognize that they feel social pressure to
and relationships to more abstract - Integration of the most important
levels, considering the particularities elements of each identified subgroup continuously develop (Pool et al., 2013). They also perceive that some
within the general concepts. in order to establish generalities about CPD activities and purposes are more recognized than others. Specif­
the phenomenon. ically, they state that social standards favor formal learning activities,
such as master’s studies, as opposed to informal activities, continuing
education and experiential learning. In addition, they note that devel­
(Wood, 2006). Likewise, through CPD opportunities, they feel “valued”
opment “far” from patients’ bedside often involves a higher salary than
and “motivated”, which favors their retention, especially in the case of
developing skills for direct patient care. This fact, although it does not
experienced nurses (Gould et al., 2007, p. 605).
influence them to participate in CPD, can negatively affect nurses who
have been working at the bedside for longer. This is reflected by several
2.8.2. Motivations of nurses to participate in CPD
nurses older than 50 years:
The motivations experienced by nurses to participate in CPD were
categorized into two dimensions: (1) intrinsic (the internal forces that When I tell them that I have worked in nursing for 25 years, they say:
come from an individual) and (2) extrinsic (external forces, such as “what, are you still there?” People from outside think that you
money or policies that encourage someone to achieve personal, orga­ stagnate, while I think, “I do not stand still.” So I never take courses,
nizational and professional goals) (Table 3). Among the intrinsic moti­ at least not those which result in a diploma. This always feels a bit
vations, nurses emphasize the following: increase in professional like “failing”, as if I do not develop. (Pool et al., 2013, p. 40).
knowledge, improvement in quality of care and practical skills and
advancement in their professional career (Gould et al., 2007; Hughes, In light of the above, it should be noted that all these motivations can
2005; Jaradeh and Hamdeh, 2010; Katsikitis et al., 2013; Ryan, 2003). be affected by the concrete and determinant conditions that affect the
In contrast, extrinsic motivations are reduced to how to respond to CPD of nurses. Therefore, it is of crucial interest to address the specific
pressure exerted by the administration to participate in CPD (Jaradeh circumstances or needs expressed by nurses to participate in CPD.
and Hamdeh, 2010; Ryan, 2003). In light of the experiences of nurses, it
should be noted that extrinsic motivations are significantly less relevant 2.8.3. Needs of nurses in order to participate in CPD
than intrinsic motivations. Five of the studies reviewed reveal that three essential aspects
Based on a study by Pool et al. (2013), intrinsic motivations to determine whether nurses will participate in CPD activities: (1) support
participate in CPD may have different connotations according to the age for access to CPD, (2) CPD opportunities and (3) balance between family
of the nurses. For nurses between 20 and 49 years of age, participating in life and professional life (Gould et al., 2007; Hughes, 2005; Jaradeh and
CPD to advance their professional career may involve moving away from Hamdeh, 2010; Katsikitis et al., 2013; Yfantis, Tiniakou I & Yfanti,
direct patient care and assuming other roles in nursing, such as that of a 2010).
teacher or team leader. In contrast, for nurses older than 50 years, their One of the needs that nurses have in order to participate in CPD is the
professional development is centered on the patient. In both cases, support they receive to access development activities (Gould et al., 2007;
nurses seek to become better professionals. However, there is a di­ Hughes, 2005; Jaradeh and Hamdeh, 2010; Katsikitis et al., 2013;
chotomy between them in terms of their purposes for future develop­ Yfantis, Tiniakou I & Yfanti, 2010). Many of the nurses report not being
ment, which in the first case is described as “away from the patient” and able to access CPD learning activities due to lack of staff to cover their
the second as “around the patient” (Pool et al., 2013, p. 38). absence while attending training, the cancellation of some courses due
In this same vein, young nurses focus their development more to not reaching quota or lack of spots in high-demand courses, especially
broadly and are open to participating in development opportunities that those with the potential to help advance one’s professional career
are offered to them, while older nurses tend to reach a “ceiling” (Gould (Gould et al., 2007; Jaradeh and Hamdeh, 2010). In this regard, Yfantis
et al., 2007). They perceive that they have reached a high level of et al. (2010), in a survey of experienced nurses, found that unforeseen
expertise and that formal learning activities – through courses or a workloads make it difficult to organize learning and free-up personnel to

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M. Vázquez-Calatayud et al. Nurse Education in Practice 50 (2021) 102963

Table 2
Characteristics of the selected studies in this review.
Study Aim Sample Main results Limitations QA
Country Design Data collection methods score

Gould et al. Exploring the experiences of CPD 384 nurses Five themes emerged from the data: - Does not include the questionnaire. 29
(2007) nurses - Questionnaire - For what and who is the CPD? The psychometric properties of the
United - Access to CPD. patient are unknown.
Kingdom Inquiry - One size does not fit all. - It only shows the qualitative analysis
- Reconciling work, life and CPD. of the open-ended question of the
- Making the best of CPD. questionnaire.
Hughes (2005) Investigate the perceptions of - Questionnaire: 42% of - Reasons for CPD: improve care and - Response rate <50%. 28
United nurses about the value of CPD and 200 nurses in the public practical skills. - The sample size of the interviews is
Kingdom analyze the factors that influence sector and 13 in the - Benefits in CPD practice: education, determined at the convenience of the
those perceptions and the private sector staying up-to-date, learning from researcher, not by the theoretical
potential barriers to its success. - Interviews: 8 others, responsibility, challenge, saturation of the data (15% of the
Sequential triangulation - Questionnaire research, reflection and motivation. sample that participated in the
- Semistructured interviews - Barriers to CPD: they highlight the questionnaires).
leadership style of the managers and - It does not include the questionnaire
the difficulty in reflecting on their designed by the authors; it has been
practice. piloted, but the psychometric
properties of it are unknown.
Jaradeh and To explore the experiences of 80 nurses - The main motivator for participation: - Generalization of the results that 28
Hamdeh nurses regarding their CPD and Self-administered improving the quality of nursing care. come from two private hospitals.
(2010) the factors that influence their questionnaire with open- The four main motivators were - The questionnaire as a method of
Jordan participation. ended questions about improving performance, increasing data collection. A qualitative
Cross-sectional descriptive study barriers. professional knowledge, increasing approach could have revealed needs
self-esteem and improving the status and barriers in greater depth.
of the profession.
- The barriers expressed to capture CPD
indicated four issues: difficult access
to CPD; relevance of CPD; work-life
balance, and maximizing CPD
outcomes.
- No significant differences were found
in terms of age.

Katsikitis et al. Investigate perceived barriers or 289 nurses - Attitudes: 92% importance of CPD for - A single context. 35
(2013) incentives in CPD - Questionnaire nursing practice; 85.4% helps - There is no difference between the
Australia Inquiry maintain interest 84.4% important CPD alternatives provided.
part of reflection; 80.3% important
part of career advancement.
- Barriers to involvement in CPD: low
staff and interferes with time outside
of work.
Pool et al. Explore the relationship between 21 nurses - Reasons: increase competence (all - Overlap between the reasons and 36
(2016) the reasons and activities of - Semistructured interviews formal and informal activities); activities that are difficult to avoid.
The nurses for CPD. comply with the (formal) - A single context.
Netherlands Qualitative requirements; deepen knowledge (all, - Retrospective narratives.
plus postgraduate); improve
professional career (postgraduate);
improve health care (conferences and
informal). [Few nurses: increase self-
esteem, compensate for gaps in prior
training, build a professional
alliance].
- Informal learning activities:
experience, social interaction, media
consulting; formal activities:
conferences, courses and postgraduate
studies.
Pool et al. Explore the perceptions of nurses 22 nurses Two categories were obtained: - Use of focus groups with nurses of 35
(2013) about CPD in older and younger 3 Focus groups - CPD perceptions associated with three similar age, which could increase the
The people. o I. 20–34 years dimensions: 1. purpose, 2. level of risk of attributing stereotypes;
Netherlands Qualitative exploratory o II. 35–49 years formality of CPD activities, and 3. CPD therefore, the results should be
o III. 50–65 years vision. interpreted with caution.
- Differences in CPD between young
and senior nurses: 1. level of focus, 2.
creating possibilities to stop direct
practice with the patient, 3. ambition
of young nurses, 4. same resources,
different requirements and 5. a
“ceiling” in courses for older nurses.

Ryan (2003) Understand the influencing 150 nurses - Intrinsic factors: increase professional - The representativity of the sample, 31
United factors for nurses to be motivated - Questionnaire knowledge, stay up to date, show limited to the subjects of a single
Kingdom to participate in CPD professional competence. hospital.
Inquiry - Extrinsic: increases professional
status.
(continued on next page)

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Table 2 (continued )
Study Aim Sample Main results Limitations QA
Country Design Data collection methods score

Wood (2006) Explore the experiences of 5 “senior” nurses after 2 Four themes were identified: - It does not provide much detail about 24
United “senior” nurses in CPD. years of being registered. - Be an opportunist. how they have developed the study in
Kingdom Hermeneutic phenomenology - Semistructured - Keep up to date. order to replicate it (sample access,
interviews - Experiential learning data analysis.).
- Satisfy the demands of the role. - Does not include textual citations to
support the findings.
Yfantis et al. Analyze opportunities to 56 nurses - Barriers to CPD: busy, lack of time and - Low response rate: 23/56 (41%) 29
(2010) participate in CPD. - Questionnaire lack of support in applying knowledge - Do not specify if the sample size was
Greece Inquiry in practice. sufficient.
- Questionnaire designed by the
authors; it is unknown if it was
validated.

CPD: Continuing professional development.

QA: Quality assessment (Hawker et al., 2002).

Table 3
Motivations of nurses to participate in CPD.
Categories Motivations and description Studies

Pool et al. Ryan Gould Hughes Wood Jaradeh and Katsikitis

(2016) (2003) et al. (2005) (2006) Hamdeh et al. (2013)
(2007) (2010)

Intrinsic Increase my professional knowledge: Stay updated and deepen my ■ ■ ■ ■ ■ ■ ■

knowledge
Improve quality of care: Allows improving care and maintaining ■ ■ ■ ■ ■ ■
patient safety
Increase practical skills: Keeping up to date and improving ■ ■ ■ ■ ■ ■
practical skills
Career advancement: Increase the possibilities of moving into a ■ ■ ■ ■ ■ ■
new area of work, through role expansion in nursing or another
specialty of nursing, or other work within or outside of nursing
Improve self-esteem: Increase self-esteem and self-confidence ■ ■
during practice.
Extrinsic Pressure exerted by the administration to participate in CPD ■ ■ ■

attend programs. A smaller group of nurses also reflected having expe­
rienced difficulties in accessing CPD due to having a shorter workday,
working exclusively on nights and weekends and being close to retire­
ment (Gould et al., 2007; Jaradeh and Hamdeh, 2010; Katsikitis et al.,
2013; Yfantis, Tiniakou I & Yfanti, 2010). This lack of support from
managers also extends to the implementation of new ideas derived from
the participation of nurses in some learning activities (Hughes, 2005).
This fact affects their attitude towards CPD, with feelings of frustration,
apathy and disappointment, making it difficult to retain these in­
dividuals (Hughes, 2005).
Another identified need is CPD opportunities, which have been asso­
ciated with financial support and the learning activities offered (Gould
et al., 2007; Hughes, 2005; Katsikitis et al., 2013; Pool et al., 2013; Pool
et al., 2016). Hospital financial resources are decreasing and, as a result,
so are opportunities to invest in development activities. In countries
such as the United Kingdom and Australia, where CPD is regulated and
mandatory, nurses value the benefits of continuous learning and take
advantage of CPD opportunities, meeting the requirements and
assuming that CPD should be shared (Hughes, 2005; Katsikitis et al.,
2013). In this sense, Katsikitis et al. (2013) identified that there are
sectoral differences because more than half of the nurses in the public
sector considered that CPD should be fully financed, while those in the
private sector felt that costs should be shared. In contrast, in a study
conducted in Jordan, where CPD is voluntary, only 60% of nurses
participated in CPD activities, noting that the main barrier is financial
constraints, where the cost of courses is high and the salaries to pay for
them is insufficient (Jaradeh and Hamdeh, 2010).
Regarding CPD activities, two types are distinguished according to
the level of formality: (1) informal, acquired through experience, social
interaction and consultation; and (2) formal, which include lectures,
courses and postgraduate education (Gould et al., 2007; Pool et al.,
2016). Formal activities can satisfy the specific individual needs of one
type of learning, such as deepening knowledge of a specific area or
advancing in a professional career (Gould et al., 2007; Pool et al., 2013;
Pool et al. al., 2016). However, most nurses perceive that informal
learning activities, which take place in the field of practice, are the most
effective or preferred approach for CPD (Gould et al., 2007; Pool et al.,
2013; Pool et al., 2016). This training is essential for keeping nurses
up-to-date and maintaining their skills (Pool et al., 2016). Some nurses
with more experience even complain about the lack of formal activities
that meet their needs (Gould et al., 2007).
The third aspect that nurses indicate is necessary to participate in
CPD activities is the balance between family and professional life (Gould
et al., 2007; Hughes, 2005; Jaradeh and Hamdeh, 2010; Katsikitis et al.,
2013). When the demand for patient care is greater, the organization can
pressure staff to attend CPD activities in their personal time to meet the
requirements of the service (Gould et al., 2007). In a study by Katsikitis
et al. (2013), 50% (n = 144) of the nurses surveyed indicated that they
felt they had to invest a substantial amount of their personal time to
improve their quality of care and that their personal time was important.
In the study by Gould et al. (2007), the nurses interviewed reported that
when they use their personal time to participate in CPD activities, doing
so directly conflicts with their family life, their free time and vacations.
This was reported by several nurses in the interviews:
You get home, you are very tired. I have a girl and I would like to
spend time with her. The last thing I want to do is read nursing
journals when I get home.” “When I have done the work of a full
week, I want to feel that my days off are for me. I can, if not, feel that
my work is annulling my personal life and it is good to have free time
and just enjoy being at home, being with the family … finding

6
M. Vázquez-Calatayud et al. Nurse Education in Practice 50 (2021) 102963

quality time for me. I just want to be X when I go home. (Gould et al., through practice (Gould et al., 2007; Hughes, 2005; Jaradeh and
2007, p. 607). Hamdeh, 2010; Katsikitis et al., 2013; Pool et al., 2013; Pool et al., 2016;
Ryan, 2003; Wood, 2006; Yfantis et al., 2010). In two of these studies, it
CPD in their personal time can cause resentment, fatigue and
is also suggested that the motivations of nurses can vary across this
demotivation in nurses, especially when they are subjected to an
continuum (Gould et al., 2007; Pool et al., 2013). This finding is
elevated workload, a reduced workforce and many rapid changes (Gould
consistent with the theory by Patricia Benner (1982) on nursing exper­
et al., 2007; Hughes, 2005).
tise. At the beginning, nurses need opportunities to develop and refine
A summary of the main findings for the experiences of nurses
their skills. Once they have become competent, the time they remain in
regarding their CPD is provided in Fig. 2. Through this figure, CPD is
practice, close to the patient, is associated with the need they have to
shown as a continuum through practice, with three key issues identified
update their skills and stay abreast of new developments. The expansion
in this process: the relevance of CPD to nurses, the motivations they
of the role of nursing, away from the patient, is associated with the need
experience and their needs in order to participate in CPD.
to provide new opportunities to expand nurses’ skills and allow them to
diversify and develop personally and professionally. As retirement age
3. Discussion and recommendations
approaches, nurses report having reached a “ceiling” (Gould et al., 2007;
Pool et al., 2013). In this sense, it is important to design specific CPD
Through this review, the existing findings regarding the experiences
strategies for each phase of the learning process experienced by nurses.
of nursing professionals about their CPD in the clinical context have
It should be noted, however, that the findings of both studies should be
been made known. More specifically, this review has identified the
treated with caution given their methodological limitations. The first
relevance of CPD to nurses, the motivations experienced and their needs
study (Gould et al., 2007) was conducted from a quantitative approach
to facilitate their participation in CPD. However, in the case of such a
and may have lost relevant information about how nurses experience
key issue for the development of nursing professional practice, few
this process and what their needs are. The second study (Pool et al.,
studies address the experiences of nurses. Notably, of the nine studies
2013), although from a qualitative approach, used focus groups with
included in the review, five were quantitative, three were qualitative,
nurses of a similar age, which, as recognized by the authors of the study,
and one used a combined methodology. In this sense, there may be as­
could increase the risk of attributing stereotypes to nurses from the same
pects of nurses’ experiences that have been left unexplored in enough
age group, and the results were not conclusive.
detail. Therefore, it is of interest to conduct more studies, with quali­
Another noteworthy finding of this last study is the age-related dif­
tative designs or combined methodologies, that address the experiences
ferences found in nurses’ development goals, such goals being a variable
of nurses and that allow for addressing them in their complexity and in
aspect throughout their CPD (Pool et al., 2013). While younger nurses
depth.
aspire to assume other roles “away from the patient,” older nurses center
With respect to the relevance of CPD for nurses, one of the recurring
their professional development “around the patient” (Pool et al., 2013).
aspects has been their role in keeping up-to-date (Hughes, 2005; Jaradeh
These results are consistent with the theory of selection, optimization
and Hamdeh, 2010; Katsikitis et al., 2013; Pool et al., 2013; Pool et al.,
and compensation (Baltes et al., 1999), which emphasizes age-related
2016; Ryan, 2003; Wood, 2006; Yfantis et al., 2010). Through keeping
differences in goal orientation. Young people mainly seek “growth,”
their knowledge and skills updated, nurses improve the development
while older people focus more on “maintenance and prevention of los­
and maintenance of their competence and, consequently, the quality of
ses” (Ebner et al., 2006). Age-related changes for the purposes of CPD
care provided, the safety of patients and their professional and personal
can also be explained based on the theory of socioemotional selectivity
development. The findings obtained in the present review are therefore
(Carstensen et al., 1999), which postulates that the selection of objec­
consistent with the definition of CPD provided by the American Nurses
tives is influenced by a variable temporal perspective. People select
Association and the National Nursing Staff Development Organization
goals in line with their perceptions of the future. As they become older,
(2010, p. 1). Given that there is no consensus in the literature on the
people become more oriented towards the present and worry less about
definition of CPD and that this term continues to be used interchange­
the distant future (Carstensen et al., 1999). Notably, these results come
ably with others, causing confusion (Gallagher; 2007; Kemp and Baker,
from the only study that has explored the perception of CPD in young
2013; Lawton and Wimpenny, 2003), having a coherent definition of
and veteran nurses (Pool et al., 2013). Given this background and the
CPD from a nursing perspective could facilitate its understanding,
fact that currently, several generations of nurses–baby boomers, gen­
implementation and evaluation. Therefore, future research addressing
eration X, generation Y (millennials) and, the latest, generation Z
CPD can use the definition proposed by the ANA as a reference.
(centennials)–work together in practice, it would be interesting to
The results of this review also show that CPD should be a continuum

Fig. 2. Summary of the main findings of the review.

7
M. Vázquez-Calatayud et al.
continue exploring what the CPD process is like across the continuum and
the possible differences with respect to values, motivations, etc., that
can exist among different generations (Stevanin et al., 2018) and career
stages (Price and Reichert, 2017), as well as how all these aspects can
influence CPD. With such knowledge, more effective interventions could
be designed to promote the participation of nurses who are attending to
their different career stages and/or are at different ages.
In addition to the above, the literature reviewed has identified three
needs that nurses consider a priority for participating in CPD: (1) sup­
port for access to CPD, (2) CPD opportunities and (3) balance between
their professional and personal lives (Gould et al., 2007; Hughes, 2005;
Jaradeh and Hamdeh, 2010; Katsikitis et al., 2013; Yfantis et al., 2010).
These needs are extrinsic and can be modified so that organizations
could work to meet them, for example, through proper management of
human resources, providing financial support and facilitating atten­
dance at learning activities within the workday or, failing those,
compensating nurses for the personal time dedicated to such activities.
However, it is important to consider that these findings respond to a
scarce investigation of the needs in order to participate in CPD and that
all studies have examined these needs through surveys. This fact raises
the possibility that the needs experienced by nurses have not been
identified with sufficient depth and breadth. As ongoing professional
development is an expressed expectation and need among nurses at
various career stages (Price and Reichert, 2017; Scammell, 2018), con­
ducting research studies using qualitative or combined methodologies
could help researchers gain a more complete view of the needs that
nurses may have regarding their participation in CPD.
The findings of this review suggest that age is a key factor in the
needs of nurses regarding their CPD. As noted by Pool et al. (2013), age
can affect nurses’ motivations to participate in CPD and the needs they
may perceive. Therefore, it would be advisable to (1) conduct studies
examining the needs of nurses in their CPD with respect to age and (2)
design strategies to improve the participation of nurses in CPD activities,
acknowledging their needs at different stages of their professional
career.
Finally, given that healthy work environments are perceived by
nurses as those that invest in CPD to ensure their continuous growth
(Price and Reichert, 2017) and that the CPD not only influences the way
in which nurses feel valued but is also a key factor in their retention,
nurses’ access to CPD should be preserved and fostered (House of
Commons Health Committee, 2018). Such access is especially important
to consider in the current context, in which there is a shortage in the
nurse workforce (Royal College of Nursing, 2018; World Health Orga­
nization, 2020), and the budget for nurses’ CPD has been cut (House of
Commons Health Committee, 2018). As such, we should rethink the
following paradox: CPD is an important issue for the quality of nursing
care, patients’ health outcomes, nurses’ satisfaction and retention, but
budget cuts exert a negative effect on nurses’ CPD.
Among the limitations of this review, it is necessary to point out that
the search was limited to language, so studies written in languages other
than English and Spanish were excluded. This approach might have
removed articles that could have added value to the review. However, a
rigorous search strategy and article selection process, as well as a
comprehensive analysis of the selected articles, led to broadly based
results and important findings with implications for nursing practice,
research and education.
Future research, with qualitative designs or combined methodolo­
gies, could add depth to the topic and reinforce the results of this study.
Nevertheless, nurse managers and lecturers could use the findings of the
present review to design tentative educational and managerial strategies
or programs directed at boosting nurses’ CPD and enhancing their
retention at hospitals. Thus, improving of CPD would enhance the
quality of care, health outcomes, patients’ safety and nurses’ satisfaction
and would decrease healthcare costs.
8
Nurse Education in Practice 50 (2021) 102963
4. Conclusions
Nurses’ experiences regarding their CPD is a key issue that has not
been deeply studied. The analysis of the selected studies shows that for
nurses, their CPD is a continuum throughout their professional career,
and keeping their knowledge and skills up to date is important. The
goals, motivations and needs that nurses may have to lead and partici­
pate in their CPD may vary according to their age and position. Orga­
nizations should consider nurses’ particular professional situations as
well as their real needs–support for access to CPD, CPD opportunities
and balance between their professional and personal lives–to boost their
participation in CPD.
Funding source
This work was supported by the Faculty of Nursing of the University
of Navarra.
Ethical approval
Not applicable.
Declaration of competing interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
Acknowledgments
Our deep gratitude for the research group “Innovation for a Person
Centered Care” (Faculty of Nursing, University of Navarra) for their
contribution in the discussion meetings.
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://doi.
org/10.1016/j.nepr.2020.102963.
References
Aiken, L.H., Clarke, S.P., Cheung, R.B., Sloane, D.M., Silber, J.H., 2003. Educational
levels of hospital nurses and surgical patient mortality. J. Am. Med. Assoc. 290 (12),
1617–1623. https://doi.org/10.1001/jama.290.12.1617.
American Nurses Association and National Nursing Staff Development Organization,
2010. Nursing Professional Development: Scope and Standards of Practice. Silver
Spring, MD. Nursesbooks.org.
Baltes, P.B., Staudinger, U.M., Lindenberger, U., 1999. Lifespan psychology: theory and
application to intellectual functioning. Annu. Rev. Psychol. 50 (1), 471–507.
Benner, P., 1982. From novice to expert. Am. J. Nurs. 82 (3), 402–407.
Billett, S., 2006. Constituting the workplace curriculum. Journal Curriculum Standard 38
(1), 31–48. https://doi.org/10.1080/00220270500153781.
Billett, S., 2010. The perils of confusing lifelong learning with lifelong education. Int. J.
Lifelong Educ. 29 (4), 401–403. https://doi.org/10.1080/02601370.2010.488803.
Carlisle, J., Bhanugopan, R., Fish, A., 2011. Training needs of nurses in public hospitals
in Australia: review of current practices and future research agenda. J. Eur. Ind.
Train. 35 (7), 687–701. https://doi.org/10.1016/j.nepr.2016.11.004.
Carstensen, L.L., Isaacowitz, D.M., Charles, S.T., 1999. Taking time seriously: a theory of
socioemotional selectivity. Am. Psychol. 54 (3), 165–181. https://doi.org/10.1037/
0003-066X.54.3.165.
Cohen, E., Jovcevska, V., Kuo, D.Z., Mahant, S., 2011. Hospital-based comprehensive
care programs for children with special health care needs: a systematic review. Arch.
Pediatr. Adolesc. Med. 165 (6), 554–561. https://doi.org/10.1001/
archpediatrics.2011.74.
Cutcliffe, J., Foster, S., 2010. Professional regulatory nursing bodies: international
variation in the protection of the public. Int. J. Nurs. 47 (11), 1343–1345. https://
doi.org/10.1016/j.ijnurstu.2010.03.010.
Ebner, N.C., Freund, A.M., Baltes, P.B., 2006. Developmental changes in personal goal
orientation from young to late adulthood: from striving for gains to maintenance and
prevention of losses. Psychol. Aging 21 (4), 664–678. https://doi.org/10.1037/
0882-7974.21.4.664.
Gallagher, L., 2007. Continuing education in nursing: a concept analysis. Nurse Educ.
Today 27, 466–473. https://doi.org/10.1016/j.nedt.2006.08.007.
M. Vázquez-Calatayud et al.
Gibbs, V., 2011. An investigation into the challenges facing the future provision of
continuing professional development for allied health professionals in a changing
healthcare environment. Radiography 17 (2), 152–157. https://doi.org/10.1016/j.
radi.2011.01.005.
Gould, D., Drey, N., Berridge, E.J., 2007. Nurses’ experiences of continuing professional
development. Nurse Educ. Today 27 (6), 602–609. https://doi.org/10.1016/j.
nedt.2006.08.021.
Govranos, M., Newton, J.M., 2014. Exploring ward nurses’ perceptions of continuing
education in clinical settings. Nurse Educ. Today 34 (4), 655–660. https://doi.org/
10.1016/j.nedt.2013.07.003.
Griscti, O., Jacono, J., 2006. Effectiveness of continuing education programmes in
nursing: literature review. J. Adv. Nurs. 55 (4), 449–456. https://doi.org/10.1111/
j.1365-2648.2006.03940.x.
Hariyatia, R.T.S., Safril, S., 2018. The relationship between nurses’ job satisfaction and
continuing professional development. Enfermería Clínica 28 (Suppl. 1 Part A),
144–148. https://doi.org/10.1016/S1130-8621.
Hawker, S., Payne, S., Kerr, C., Hardey, M., Powell, J., 2002. Appraising the evidence:
reviewing disparate data systematically. Qual. Health Res. 12 (9), 1284–1299.
https://doi.org/10.1177/1049732302238251.
Heat, S., 2018. Explaining Nurses’ Decisions to Participate in a Professional Development
and Recognition Programme: A Mixed Methods Study. Institute of Education. Massey
University. Doctoral Dissertation.
Hegney, D., Tuckett, A., Parker, D., Robert, E., 2010. Access to and support for
continuing professional education amongst Queensland nurses: 2004 and 2007.
Nurse Educ. Today 30 (2), 142–149. https://doi.org/10.1016/j.nedt.2009.06.015.
House of Commons Health Committee, 2018. The Nursing Workforce. Second Report of
Session 2017-2019. Retrieved from: https://tinyurl.com/y9db5t5f. (Accessed 17
June 2020).
Hoeve, Y., Jansen, G., Roodbol, P., 2014. The nursing profession: public image, self-
concept and professional identity. A discussion paper. J. Adv. Nurs. 2 (70), 295–309.
https://doi.org/10.1111/jan.12177.
Hughes, E., 2005. Nurses’ perceptions of continuing professional development. Nurs.
Stand. 19 (43), 41–49. https://doi.org/10.7748/ns2005.07.19.43.41.c3904.
Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative
on the Future of Nursing, at the Institute of Medicine, 2011. The Future of Nursing:
Leading Change, Advancing Health. National Academies Press (US).
Jaradeh, M., Hamdeh, H.A., 2010. Nurses’ experiences of continuous professional
development. Jordan Med. J. 44 (3), 313–322.
Jho, M.Y., Kang, Y., 2016. Perceptions of continuing nursing education in Korea. J. Cont.
Educ. Nurs. 47 (12), 566–572. https://doi.org/10.3928/00220124-20161115-10.
Joint Commission International (Ed.), 2008. Illinois: Joint Commission Resources.
Retrieved from. http://www.jointcommission.org/SentinelEvents/SentinelEvent
Alert/sea40.html. (Accessed 5 March 2018).
Katsikitis, M., McAllister, M., Sharman, R., Raith, L., Faithfull-Byrne, A., Priaulx, R.,
2013. Continuing professional development in nursing in Australia: current
awareness, practice and future directions. Contemp. Nurse 45 (1), 33–45. https://
doi.org/10.5172/conu.2013.45.1.33.
Kemp, S.J., Baker, M., 2013. Continuing Professional Development - reflections from
nursing and education. Nurse Educ. Pract. 13 (6), 541–545. https://doi.org/
10.1016/j.nepr.2013.04.009.
King, R., Taylor, B., Talpur, A., Jackson, C., Manley, K., Ashby, N., Tod, A., Ryan, T.,
Wood, E., Senek, M., Robertson, S., 2020. Factors that optimise the impact of
continuing professional development in nursing: a rapid evidence review. Nurse
Educ. Today. https://doi.org/10.1016/j.nedt.2020.104652 (in press).
Koff, S., 2016. Nursing in the European Union: Anatomy of a Profession, vol. 1.
Transaction Publishers, New Brunswick, NJ.
Lawton, S., Wimpenny, P., 2003. Continuing professional development: a review. Nurs.
Stand. 17 (24), 41–44. https://doi.org/10.7748/ns.17.24.41.s52.
Nurse Education in Practice 50 (2021) 102963
Levett-Jones, T.L., 2005. Self-directed learning: implications and limitations for
undergraduate nursing education. Nurse Educ. Today 25 (5), 363–368. https://doi.
org/10.1016/j.nedt.2005.03.003.
Ley 44/2003 de ordenación de las profesiones sanitarias, 2003. BOE núm. 280, de 22/
11/2003. Retrieved from: https://www.boe.es/eli/es/l/2003/11/21/44/con.
(Accessed 2 December 2018).
Manley, K., Martin, A., Jackson, C., Wright, T., 2018. A realist synthesis of effective
continuing professional development (CDP): a case study of healthcare practitioners’
CPD. Nurse Educ. Today 69, 134–141. https://doi.org/10.1016/j.nedt.2018.07.010.
Miles, M.B., Huberman, A.M., 1994. Qualitative Data Analysis. Sage Publications,
Thousands Oaks, CA.
Nolan, M., Owen, R., Curran, M., Venables, A., 2000. Reconceptualising the outcomes of
continuing professional development. Int. J. Nurs. Stud. 37 (5), 457–467. https://
doi.org/10.1016/S0020-7489(00)00025-0.
Patton, M.Q., 2015. Qualitative Research & Evaluation Methods, fourth ed. Sage
Publications, Thousands Oaks, CA.
Pool, I.A., Poell, R.F., Berings, M.G., Ten Cate, O., 2016. Motives and activities for
continuing professional development: an exploration of their relationships by
integrating literature and interview data. Nurse Educ. Today 38, 22–28. https://doi.
org/10.1016/j.nedt.2016.01.004.
Pool, I., Poell, R., Ten Cate, O., 2013. Nurses’ and managers’ perceptions of continuing
professional development for older and younger nurses: a focus group study. Int. J.
Nurs. Stud. 50 (1), 34–43. https://doi.org/10.1016/j.ijnurstu.2012.08.009.
Price, S., Reichert, C., 2017. The importance of continuing professional development to
career satisfaction and patient care: meeting the needs of novide to mid-to late-
career nurses throughout their career span. Adm. Sci. 7 (2), 17. https://doi.org/
10.3390/admsci7020017.
Royal College of Nursing, 2020. Left to Chance: the Health and Care Nursing Workforce
Supply in England. Policy Report. Royal College of Nursing, 20 Cavendish Square,
London, W1G 0RN. Retrieved from: https://www.rcn.org.uk/professional-develop
ment/publications/pdf-006682#copyrightTab. (Accessed 17 June 2020).
Ryan, J., 2003. Continuous professional development along the continuum of lifelong
learning. Nurse Educ. Today 23 (7), 498–508. https://doi.org/10.1016/S0260-6917
(03)00074-1.
Stevanin, S., Palese, A., Bressan, V., Vehviläinen-Julkunen, K., Kvist, T., 2018.
Workplace-related generational characteristics of nurses: a mixed-method systematic
review. J. Adv. Nurs. 74, 1245–1263. https://doi.org/10.1111/jan.13538.
Steven, A., Larkin, V., Stewart, J., Bateman, B., 2018. The value of continuing
professional development: a realistic evaluation of a multi-disciplinary workshop for
health visitors dealing with children with complex needs. Nurse Educ. Today 67,
56–63. https://doi.org/10.1016/j.nedt.2018.04.021.
Walshe, C., Todd, C., Caress, A., Chew-Graham, C., 2009. Patterns of access to
community palliative care services: a literature review. J. Pain Symptom Manag. 37
(5), 884–912. https://doi.org/10.1016/j.jpainsymman.2008.05.004.
Whittemore, R., 2005. Combining evidence in nursing research: methods and
implications. Nurs. Res. 54 (1), 56–62. https://doi.org/10.1097/00006199-
200501000-00008.
Wood, J., 2006. Exploring staff nurses’ views on professional development. Nurs. Times
102 (13), 36–38.
World Health Organization, 2020. State of the World’s Nursing 2020: Investing in
Education, Jobs and Leadership. World Health Organization, Geneva. Licence: CC
BY-NC-SA 3.0 IGO. Retrieved from: https://www.who.int/publications/i/item/
nursing-report-2020. (Accessed 17 June 2020).
Yfantis, A., Tiniakou, I., Yfanti, E., 2010. Nurses’ attitudes regarding Continuing
Professional Development in a district hospital of Greece. Health Sci. J. 4 (3),
193–200.