nine-things-nurses-need-to-know-about-ces

9 Things You Need to Know About Continuing Education for Nurses

Beth Hawkes MSN, RN-BC - 10/17/17

Sarah was coming up on her second nursing license renewal . Two weeks before the expiration date, she added up her accrued contact hours. One of the certificates from a conference she attended did not have a provider number...would it be accepted? Did her prior nursing school classes count? Sarah soon realized she was 15 contact hours short of the 30 contact hour requirements. Panicked, Sarah began searching online for courses.

For many nurses, obtaining continuing education (CE) is a requirement that’s put off until the last minute. In addition to being a chore, the requirements and even terminology can be unclear.

 What is the difference between continuing education units (CEUs) and contact hours?  The term “contact hour” is defined as 50 or 60 minutes of instruction in a board-approved nursing continuing education class or activity. One CEU equals ten contact hours.

 In reality, the term “CEU” is often used interchangeably with “contact hour” as in “I earned 4 CEUs (or CEs)”, when the correct language is “I earned 4 contact hours.”

1. Licensing Renewal

CE requirements must be completed during the renewal period immediately preceding the license expiration date.

For example, if a nurse in a state with biennial licensure renewal is required to renew by December 31 2017, then CE requirements must be completed between January 1, 2015 and December 31, 2017.

Additional hours may not be “saved” and applied to future renewal periods. Likewise, contact hours earned prior to the issuance of a permanent license cannot be counted towards renewal requirements. 

In many states, newly licensed nurses are exempt from CE requirements for the first renewal period.  Following initial license renewal, the nurse must meet CE requirements according to state requirements.

2. Nursing CEU Requirements by State

CEU requirements vary by state. 

The number of contact hours required ranges from none in many states to 45 in the state of Washington. Licensure renewal periods range from annual to triennial. 

Margaret moved to California from Colorado to accept a job as Chief Nursing Officer. Colorado has no CE requirements. California requires 30 contact hours every two years. Three weeks before her license was due to expire, Margaret realized she needed 30 contact hours.

Some states accept alternative activities in lieu of contact hours. Options may include publication in a peer-reviewed journal, national certification in a nursing specialty, or completion of a nursing refresher course.

You can find your requirements by navigating to your state’s page on NursingCE.com. 

States with No CE requirements

In some states, CE is not required for nursing licensure.

Currently thirteen states have no CE requirements: Arizona, Colorado, Connecticut, Indiana, Maine, Maryland, Mississippi, Missouri, Oregon, South Dakota, Tennessee, Vermont, and Wisconsin. 

State Specific Content Requirements

Some states mandate specific  content as either a one-time requirement or as ongoing requirements. Here are some examples:

  • Bioterrorism (Nevada)
  • Domestic Violence (Florida, Kentucky)
  • HIV/AIDS (Washington, DC, Kentucky)
  • Infection Prevention (New York)
  • Shaken Baby Syndrome (Kentucky)
  • Child Abuse, Mandatory Abuse Reporting  (New York, Iowa)
  • Drug Diversion, Impairment in the Workplace (West Virginia, Florida)
  • Forensic Evidence Collection (Texas for ED nurses)
  • Tick-borne Diseases (Texas)
  • Geriatrics (Texas)
  • Human Trafficking (Michigan)
  • Prevention of medical errors (Florida)
  • Mental health conditions common to veterans (West Virginia)
  • Pain and symptom management (Michigan, Oregon)
  • Organ and Tissue Donation (New Jersey)
  • Substance abuse (Rhode Island)
  • Nurse practice code and rules (Alabama, Ohio)

3. CEs and Compact Licensure

The list of states belonging to the Nurse Licensure Compact (NLC) is located on the web page for the National Council of State Boards of Nursing.   

The NLC grants multi-state privileges and authorizes a nurse licensed and residing in a compact state (home state) to practice in other compact (remote) states.  The nurse maintains active licensure only in their primary state of residence.  

Jessica’s primary state of residence is Colorado, a compact state, where CE is not required. Jessica accepts a traveling position in South Dakota, also a compact state, where CE is required. Because Jessica’s home state is Colorado, she is not required to take CE but may practice in South Dakota.  Jessica can practice across state lines in all states participating in the Compact.

Primary State of Residence

Nurses with a compact license must reside in a compact state as their primary residence.

A primary state of residence, also called a “home state” is defined by the Compact as "the person’s fixed, permanent and principal home for legal purposes" and is generally evidenced by where a nurse holds a driver’s license, pays taxes, and/or votes.  

Nurses must meet all home state requirements for licensure renewal, including CE requirements.

Therefore, if a nurse’s home state is Iowa, the nurse must meet Iowa’s CE requirements (36 contact hours) even if the nurse only practices in South Dakota (no CE requirements).

4. Acceptable Content

CE must be relevant to nursing practice. Practice is defined as any activity, assignment, or task performed by the nurse that utilizes nursing knowledge, judgment, or skills. CE should augment basic nursing knowledge.

Acceptable content must be beyond the basic educational level for entry into practice. Acceptable content may include:

  • Clinical technology, procedures, and nursing implications
  • Specialty areas of nursing practice
  • Nursing practice related to care of the patient
  • Administration, management, and supervision in health care delivery
  • Social, legal, and ethical aspects of nursing
  • Nursing education
  • Nursing research, theory, and practice issues
  • Quality improvement and management, accrediting standards, and processes
  • Initial ACLS, PALS, NRP
  • Professional conduct

Nurses advancing their education through BSN or graduate degree programs may be awarded contact hours for completion of college credit courses at an accredited institution of higher learning.

Academic courses must be within the framework of a curriculum that leads to an academic degree in nursing or is relevant to nursing practice.

Typically, one academic semester unit is equal to 15 contact hours; one academic quarter unit is equal to 10 contact hours.  

  • 10 contact hours = One academic quarter hour
  • 15 contact hours = One academic semester hour

5. Courses Not Accepted

Many state BON/BRNs define content that is not acceptable for CE credit.

Prerequisite courses and general ed, such as mathematics, government, anatomy, physiology, etc., cannot typically be counted towards CE requirements.

Some states do not recognize Basic life Support (BLS) as an augment to a nurse’s basic knowledge. Therefore it doesn’t meet the definition of continuing nursing education.

Likewise, in some states, Advanced Cardiac Life Support (ACLS) may be used for CEs when initially obtained, but ACLS for re-certification may not be used. The same rationale applies for Pediatric Life Support (PALS) and  Neonatal Resuscitation Program (NRP) re-certification courses. It’s important to check with your state BON/BRN before counting on these courses as contact hours.

Note: In Texas, both initial and renewal ACLS courses are eligible as CE for license renewal. By contrast, in California and Florida, renewal ACLS courses are not eligible as CE for license renewal.

In some states (California) nurses may use Category I continuing medical education (CMEs) such as those offered at vendor-sponsored educational activities for medical providers-but in others, states, only advanced practice registered nurses (APRNs) may use CMEs.

Chris is an experienced nurse changing jobs. His new employer requires one week of classroom orientation followed by working with a preceptor. Chris expects to be awarded 40 contact hours. 

Facility orientation does not count towards nursing CE. Likewise, in-service programs that provide specific information about the work setting’s philosophy, policies and procedures fall in the category of not acceptable.

The following activities are common examples of activities not acceptable for CE credit in most states:

  • Basic CPR
  • On-the-job training and equipment demonstration
  • Refresher courses designed to update knowledge
  • Orientation programs designed to introduce employees to a specific work setting
  • Courses focusing on self-improvement, changes in attitude, self-therapy, self-awareness, weight loss, or yoga
  • Economic courses for financial gain, e.g., investments, retirement, preparing resumes and techniques for job interviews
  • Liberal Art courses in music, art, philosophy, etc., when unrelated to patient/client care
  • Courses for lay people
  • Advanced Skills Renewal Courses (ACLS, PALS, NALS, etc.)
  • Repetition of any educational activity with identical content and objectives within a single reporting period
  • Agency specific orientation or in-service programs
  • Self-directed independent study activities that have not been approved for CE
  • Community service or volunteer practice
  • Professional meetings or conventions except for those portions approved for CE. 

6. Approved Providers

Contact hours must be obtained from an approved provider. What does approved provider mean? 

CE providers must be approved by state BON/BRNs or by the American Nurses Credentialing Center (ANCC). All BON/BRNs recognize ANCC approved CE.  For example, national nursing organizations that provide CE at annual conventions are approved by the ANCC. ANCC approval is considered the gold standard.

Approved providers are issued provider numbers that must be printed on the learner’s certificate.

7. When You Hold a Certification

Specialty certifications issued through the ANCC require ANCC approved contact hours for renewal. Contact hours used for certification renewal can also be used for licensure renewal.

8. Record Keeping

Keep CE records as if you’ll be audited. You’ll need title of the course taken, number of contact hours awarded, date offered, and provider number.

Scan copies of your certificates to your computer to keep an electronic file. Make sure the certificate has the provider number on it. Check with your state BON/BRN for how long to keep records.

In Texas, for example, nurses must keep records for three licensure renewal cycles.

9. Meaningful Education

Many nurses wait until the last minute to earn CEs and then choose topics based on how quickly they can be completed. To keep pace with the rapidly changing healthcare environment, the BON/BRN expects nurses to maintain and improve competencies in current knowledge, skills, and abilities relevant to area of practice.   

The best nurses are curious and life-long learners. Increase your skills by picking a topic that intrigues you, such as interpreting ABGs, or 12 lead EKGs. Commit to seeking evidence-based guidelines in your specialty.

Enjoy building your expertise and being the best nurse you can be. Start earning CEs now so you’ll be prepared in time!