Evaluation of Alabama'sMWandatory Continuiing EducationProgram for Reasonableness,Access, and ValueJean B. Lazarus, EdD, RN, Anne Permaloff, PhD,and Charlie J. Dickson, EdD, RN, FAANABSTRACTBackground: As a measure of quality control,the Alabama Board of Nursing subjected the regu-lations for mandatory continuing education(MCE) for licensure to an evaluation of theirimpact and effectiveness. This study focused onlicensees' perceptions of the regulations regardingreasonableness, access, and value.Metihod: Evaluation research methods wereused to answer research questions related to therules governing continuing education (CE)requirements for nursing licensure. Data wereobtained from a survey of a random sample (N =406) of RNs and licensed practical nurses. Bothqualitative and quantitative methods wereapplied to data analysis.States are authorized to take whatever actions nec-essary to protect the public from incompetent prac-titioners. One means of invoking this authority isthrough the provision of regulatory agencies empow-ered to admit qualified individuals to licensure. InDr. Lazarus is Research Consultanit, Alabama Board of Nursing,Montgomery, Alabama. Dr. Permialoff is Consumer Memlber, AlabamaBoard of Nursing, and Professor, Departmenit of Political Scicnice an1dPublic Administration, Auburna University at Montgomery, Montgomery,Alabama. Dr. Dicksont is Chairperson, Continui ig Competence andContinuting Education Committee, Alabama Board of Nursing, andProfessor, Tuskegee University, College of Veterinary Medicine, AlliedHealth and Nursing, Tuskegee, Alabama.The authors acknowledge the other members of the Conitinuinig Comi-petence and Continuing Education Committee, Alabama Board of Nursing:Yvonne Albert, LPN; Joyce Chappelear, MSN, RN; Gregory Howard, LPN;Marjesta Jones, LPN, aind N. Genell Lee, MSN, RN, JD, Executive Officer.Address correspondence to Jean B. Lazarus, EdD, RN, ResearchConsultant, Alabama Board of Nursing, 770 WVashington Avellue, Suite250, Monttgomery, Alabama 36130-3900.Findings: Requirements for CE were perceivedas reasonable; however, concerns were identifiedrelated to cost, access, and quality of presenta-tions. Licensees perceived CE to be of value, andapplied CE to decision-making and action in nurs-ing practice. Chi-square analysis was significantto license type related to selected variables (e.g.,rights and responsibilities). Qualitative analysisprovided insight regarding licensees' concernsand recommendations for change.Conclusion: Mandatory continuing education(MCE) plays a significant role in promoting com-petence in nursing practice and is a mechanism forenhancing public protection. A high noncompli-ance rate on the MCE audit has ramifications forenforcement regulations.Alabama, continuing education (CE) has been man-dated by the legislature as a measure of assuringhealth professionals are competent to practice.Mandatory conitinuing education (MCE) for RNs andlicensed practical nurses (LPNs) in Alabama was ini-tiated in 1991 in accordance with Article 2 of The NursePractice Act (1989). Chapter 610-X-10 of the AlabamnnAdministrative Code (1991) delineates required contacthours, acceptable content and activities, and the offi-cial period in which the CE contact hours must beearned for licensure. The regulations also provide foran audit to determine compliance and establish crite-ria for entities to become providers of CE for nurses.The rules have been amended three times to accom-modate implementation of the law.Currently, licensees from numerous professionsand organizations with political, economic, and socialinterests in the delivery of health care contest theVolume 33, Number 3, May/June 2002._ IIIIII-._,-- ..... .... ...- .....-...... ... ...102LAZARUS, PERMALOFF, & DICKSONvalue of MCE. Every state in the union and numerousother countries impose CE requirements for licenserenewal on various professions. More than 50% of thestates have mandatory CE requirements for nursing.Additionally, more than 50% of member boards ofnursing specify requirements for CE for reinstatementor reentry into practice (National Council of StateBoards of Nursing, Inc., 1999).Annual audits conducted by the Alabama Board ofNursing have shown a noncompliance rate rangingfrom 9% to 37% (Alabama Board of Nursing, 1993,1998). Most noncompliance rests in failure of thelicensee to meet the 30-day requirement of response tothe notice of audit and in failure to earn the contacthours within the official earning period. The rise innoncompliance, sporadic complaints from licenseesabout acceptable activities, and a continuing dialog onthe value of CE as a contributor to continuing nursingcompetence resulted in a the Alabama Board ofNursing's decision to authorize a study of licensees'perceptions of the program through research.PURPOSEThe purpose of the study was to evaluate the MCEprogram for nurses with Alabama licenses in relation toreasonableness, access, and value. Intended aims wereto use the findings to facilitate program improvement,enhance decision-making in relation to potentialamendments to the rules, and to promote licensee com-pliance with the legislature's mandate for CE. An over-all goal was, and continues to be, the enhancement ofnursing practice for the public's safety and welfare.LITERATURE REVIEWThe merits of MCE have been debated formally andinformally for more than 100 years. Individuals of var-ious occupations have contested the mandating ofongoing education. However, as early as 1889, theUnited States Supreme Court recognized the power ofthe states to impose conditions on the practice of cer-tain professions for the protection of society.Specifically, the Court placed no limits on the state'spower to regulate, observing thatthe power of the state to provide for the general wel-fare of its people authorizes it to prescribe all such reg-ulations as in its judgment will secure or tend to securethem from the consequences of ignorance and incapac-ity, as well as of deception and fraud (Dent v. WestVirginia, [1889]).Two later cases, Gamble v. Board of OsteopathicExaminers (1942), and State ex rel. Week v. WisconsinState Board of Examiners in Chiropractic (1947), support-ed the concept of ongoing professional learning by cit-ing the states' authority to act on behalf of the gener-al welfare of the public.Courts at all levels have supported the rights of statesto require CE for license renewal, and to prescribe CE asa condition for the