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Wednesday, October 6, 1965

While the University of Kansas had been training nurses since 1906, it had not instituted any systematic continuing nursing education program until enabled to so by the 1965 Regional Medical Program Act. This federal government initiative developed under the auspices of President Lyndon Johnson’s “Great Society” program was signed into law on October 6, 1965. It made federal funding available for continuing education and provided the KU Department of Nursing, working with the Kansas State Nursing Association, the opportunity to enter this vital undertaking in a major way.



The intent of the national legislation for Regional Medical Programs was “to improve health care by providing another resource for continued learning [by nurses in the field] and, hopefully, decrease the disparity between what is known and what is practiced,” as KU Nursing Department chair Hester Thurston described it in a 1982 paper presented in Wichita. She further observed that “the half life of a nurse’s education is approximately five years” because of ongoing advances in technology and scientific knowledge. This made the institution of continuing education for nurses imperative.



A case could be made that it was also long overdue, because the KU School of Medicine had been offering some sort of continuing education for physicians in Kansas since 1911. However, when it came to nurses, lack of state funding and personnel had prevented development of similar programs. All this began to change when the 1965 Regional Medical Program Act set the stage for the inauguration of the Kansas Regional Medical Program in 1967.



The impetus for the new law came, in part, from the goals of Lyndon Johnson’s War on Poverty and Great Society programs. Nursing leaders from throughout Kansas, including especially those at the University of Kansas Department of Nursing, had long hoped for opportunities to institute continuing nursing education. Evidence indicates they were particularly keen on adapting the traveling circuit plan approach that the School of Medicine had pioneered in 1927 to provide physicians around the state with updated knowledge of medical procedures.



With the passage of the federal legislation, these hopes now entered the realm of the possible. In May 1966, Kansas became one of the first five states to receive a Regional Medical Program grant from the federal government. This funding enabled planning for the 1967 launch of what became the first serious University of Kansas Nursing Continuing Education program. Hester Thurston led the planning and implementation effort. From the beginning, it was envisioned as both an in-house and distance-learning approach.



In October 1967 a cooperative six-week clinical nursing review program began at Central Kansas Health Center in Great Bend. This program built on earlier efforts at the Kansas City campus to provide out-of-practice nurses with the tools necessary to gain re-licensure at outlying locations.



In December 1967 the first Kansas Regional Medical Program Circuit Course for nurses was inaugurated at six locations across Kansas – Parsons, Emporia, and Sabetha in eastern Kansas, and Colby, Garden City, and Great Bend in the western part of the state. The selection of these sites evolved through the planning of the University of Kansas nursing education faculty, the Kansas State Nurses’ Association, Kansas League for Nursing and the Kansas Regional Medical Plan Coordinator for Nursing.



Educational content in these circuit courses concentrated on upgrading the skills of nurses working with patients suffering from cancer, heart disease, stroke or related diseases. Emphasis came in training already employed nurses in the new techniques and technology then under development to ease pain and effect partial or total cures in these disease fields.



Initial enrollment during 1967-68 totaled 1,264, a number that increased to 1,443 in 1968-69. By 1970 more than 1,800 nurses participated in continuing education at one of the sites including at the Medical Center in Kansas City. “This enrollment,” noted Hester Thurston, “suggests that in a time when there was no impetus for mandatory [Continuing Education], nurses were eager to continue their learning.”



Led by KU Department of Nursing faculty, the Kansas State Nursing Association adopted a position in 1970 that put it squarely behind these continuing education efforts. At the group’s convention that year, the membership approved a motion “That the KSNA Board of Directors develop and implement a system for assigning point credit for designated educational and/or professional activities of KSNA members and that such a system provide a plan for verification and recognition of continuing education of KSNA members.”



No institution in the state was better prepared to help the Association implement their goals than the KU Department of Nursing, but first it seemed necessary to get one more player into the mix – the State of Kansas itself. While it appeared that the voluntary response of Kansas nurses should have been testament enough, the reality was something different. A bit of state coercion would be required before some of the nurses most needing to update their knowledge and skills in the profession could be persuaded to do so.



The road to state requirements for nursing continuing education had begun in California in 1971 when the first state law in the US was passed mandating that nurses participate in a specified number of continuing education hours in order to gain re-licensure. The necessity for such requirements was demonstrated in part by registered nurses who held “…that a nurse’s basic professional education ensures lifetime competency and some brag they haven’t ‘cracked’ a book since obtaining their license.”



One commentator observed with regard to those resistant to participating in continuing education as individuals whose “…ideas have hardened before their arteries.” While this attitude did not prevail in Kansas as witnessed by the early strong participation in the first voluntary continuing education programs, it did apply sufficiently for the Kansas legislature to pass a mandatory continuing education requirement for nurses in 1976.



This law began to be phased in during 1978. Initially, nurses had to demonstrate participation in at least five contact hours of continuing education to qualify for re-licensure. In 1980, the requirement increased to 15 contact hours. It then doubled to a full 30 contact hours of instruction in 1982 when the law took full effect.



By 1982, the number of sites in Kansas offering continuing education through the School of Nursing had increased to nine including Wichita, Hays and Pittsburg. This expansion took place in spite of the fact that federal funding had lapsed and Kansas Regional Medical Program no longer existed. In 1980-81, the number of individuals participating in the KU School of Nursing continuing education programs came to 1,587 even though by that time many other providers of continuing nursing education had set up shop in Kansas. Altogether, some 4,800 nurses attended some kind of continuing education program during that year. The fact that almost exactly one-third of these participated in KU-sponsored nursing continuing education opportunities spoke quite highly of the respect held for the institution.



When Dean Hester Thurston gave up her chief administrative duties in 1975 with the hiring of Dr. Doris Geitgy as dean of the Nursing School, Thurston retooled her expertise in continuing education and took on the responsibility of further enhancing that function.



She refined the circuit course for nurses to retain certification, adjusted the class locations to fit the demands of nurses seeking re-licensure, and brought together nursing school faculty, outstanding Kansas nursing practice advocates, and the best in nursing educators from across the nation to provide Kansas nurses with the sort of specific continuing education experiences they so desperately wanted and needed.



By the time Thurston retired in 1987, the foundation of the current extensive program was fully laid. What she had once called “the furor over continuing education” – when some practicing nurses thought the new requirements were an unfair confiscation of their time and an unnecessary retraining in the same old techniques – was no longer an issue.



Indeed, at the dawn of the 21st century, Kansas nurses can take either refresher courses or specialized advanced sections in the latest techniques and with state-of-the art equipment taught by the most skilled practitioners available.



Continuing education classes are offered in Kansas City, Hays, Wichita, and Pittsburg. Faculties usually include Nursing School representatives, Medical School physicians, area nursing specialists, and a sprinkling of nationally known nursing leaders brought in from other parts of the country.



Moreover, continuing education in nursing has moved into a central position among the responsibilities of the KU School of Nursing. It is a primary way that the School reaches out to Kansas as a whole and affects the lives of the state’s citizens through the increased skill levels and improved capabilities of Kansas nurses.



Due to this continuing commitment to continuing education, professional obsolescence for nurses – what Hester Thurston once defined as “the loss of acquired knowledge and the non-acquisition and/or non-utilization of new knowledge” – is not an option.



William S. Worley

Adjunct Professor of History

University of Missouri-Kansas City

 

[Source notes: The documents and materials consulted for this article can mostly be found in the University of Kansas Medical Center Archives. They include the following: Hester I. Thurston, “An Historical Perspective of Continuing Education in Kansas” with special reference to nursing continuing education; Cyril O. Houle, “To Learn the Future,” Medical Clinics of North America 54:5-18, 1970; and the web site of the University of Kansas School of Nursing and Continuing Education.]