Pros and Cons of Mandatory Continuing Nursing Education: Competency, Certification, ANA Standards and Code of Ethics
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Discussion: Pros and cons of mandatory continuing nursing education
Discuss the pros and cons of continuing education in nursing in the following areas:
- Impact on competency.
- Impact on knowledge and attitudes.
- Relationship to professional certification.
- Relationship to ANA Scope and Standards of Practice.
- Relationship to ANA Code of Ethics.
Introduction
Nursing knowledge changes quickly. New drugs, technologies, guidelines and safety practices appear every year, and what a nurse learned in school can be outdated within a few years of graduation. To keep nurses current, many U.S. state boards of nursing require continuing nursing education (CNE) for license renewal. Typically, this means a set number of contact hours each renewal period, sometimes with required topics such as pain management, implicit bias, infection control or human trafficking. Requirements vary widely. A few states require no CE at all for RN renewal, while others combine CE with practice-hour or competency requirements.
Mandatory continuing education is widely supported, but it is also debated. Supporters see it as a safeguard for the public and a mark of professionalism. Critics argue that counting hours does not prove that a nurse is competent or that patient care has improved (Ross et al., 2013). The sections below weigh the pros and cons in the five areas the question asks about.
Skills stay current, but attendance does not prove performance
New evidence and openness, but possible “box-ticking”
Required for renewal, but costs time and money
Matches the Education standard, but mandates add little beyond it
Supports the duty to stay competent, but external rules can weaken self-direction
1. Impact on competency
Pros
- Keeps practice current. CE introduces new guidelines, medications, equipment and procedures, which helps nurses maintain safe practice throughout a long career (Ross et al., 2013).
- Reduces skill decay. Rarely used skills, such as resuscitation, neonatal care or managing a new infusion pump, fade without review. Required refreshers give nurses a structured way to rebuild them.
- There is evidence that education changes practice. A Cochrane review found that continuing education meetings and workshops probably lead health professionals to follow recommended practice more often and probably slightly improve patient outcomes (Forsetlund et al., 2021).
- Sets a minimum floor. A mandate ensures that every licensed nurse does at least some learning, including nurses who might otherwise do none.
Cons
- Hours are not competence. Mandates usually measure attendance and contact hours, not what the nurse can actually do. Attendance does not guarantee learning, and there is limited evidence that mandatory CPD itself improves patient outcomes (Ross et al., 2013).
- Effects are modest and vary. The Cochrane review found that the size of the effect varies a great deal and that it is unclear which types of educational meetings work best (Forsetlund et al., 2021).
- Content may not match the nurse’s practice. A nurse in the operating room may complete generic online modules that have little to do with daily work, just to meet a deadline.
- Uneven access. Rural nurses, night-shift nurses and nurses without employer funding face more barriers to quality education (Ross et al., 2013).
2. Impact on knowledge and attitudes
Pros
- Builds knowledge of current evidence. CE is one of the main ways evidence-based practice spreads from research to the bedside. It helps nurses appraise and apply new research (see our guide to nursing research and critical appraisal).
- Encourages a lifelong-learning attitude. Regular learning keeps nurses curious, confident and open to change. Nurses who learn continuously are often more willing to question routines and lead improvement projects.
- Can address attitudes as well as facts. Required topics such as implicit bias, cultural humility, ageism and ethics aim to change attitudes and behaviors, not only knowledge.
- Supports career growth and job satisfaction. Learning new skills can renew a nurse’s motivation and open doors to specialty roles, leadership and advanced practice.
Cons
- “Box-ticking” attitudes. When education is forced, some nurses focus on “getting their hours up” rather than learning (Ross et al., 2013). Cheap, fast online courses chosen only for convenience may add little knowledge.
- Resentment and fatigue. Nurses already facing heavy workloads, staffing shortages and burnout may resent unpaid study time, which can make them less receptive to learning.
- Short-lived knowledge gains. Without practice and reinforcement at work, new knowledge often fades.
- Cost and time burdens. Fees, travel, childcare and lost income are real barriers, especially when employers do not pay (Ross et al., 2013).
3. Relationship to professional certification
Specialty certification is voluntary, but keeping it requires ongoing professional development. For example, ANCC certification is valid for 5 years. Renewal requires 75 contact hours of continuing education, and at least 60 of them must be formally approved. Nurse practitioners and clinical nurse specialists must include 25 hours of pharmacology. Certificants must also complete at least one additional professional development category, such as academic credits, presentations, an evidence-based practice or quality improvement project, a publication, precepting, professional service or retaking the exam (American Nurses Credentialing Center [ANCC], n.d.).
Pros
- Proves specialty knowledge over time. Ongoing CE helps show employers, patients and Magnet-designated organizations that a certified nurse’s expertise is current, not just valid on the day of the exam.
- Double benefit. The same CE hours often count toward both license renewal and certification renewal.
- Rewards activities beyond courses. Certification renewal recognizes precepting, research, presenting and quality improvement, which encourages richer professional development than seat time alone.
Cons
- Extra cost and paperwork. Certification fees, renewal fees and specialty-specific CE add expense and administrative work on top of licensure requirements.
- Strict deadlines. ANCC has no grace period, so a nurse who misses the renewal date loses the credential (ANCC, n.d.).
- Still focuses on inputs. Like licensure, renewal mostly verifies activities completed rather than directly testing current clinical performance, unless the nurse chooses to retake the exam.
4. Relationship to the ANA Scope and Standards of Practice
Nursing: Scope and Standards of Practice describes what every registered nurse is expected to do. It includes a Standard of Professional Performance on Education, which expects the registered nurse to seek knowledge and competence that reflect current nursing practice (American Nurses Association [ANA], 2021). Related standards on evidence-based practice and research, quality of practice and professional practice evaluation also depend on continuing learning.
Pros
- Mandatory CE puts the Education standard into practice. It turns a professional expectation into a measurable requirement that boards can enforce.
- Supports other standards. Learning about new evidence supports the standards for evidence-based practice, quality improvement and leadership.
- Protects the public. The standards exist to promote safe, quality care, and CE requirements give the public some assurance that nurses keep learning.
Cons
- The standards ask for more than hours. The Education standard describes self-directed learning, reflection and applying knowledge in practice. A mandate that only counts hours may meet the letter of the standard while missing its intent.
- Professional responsibility versus regulation. Some argue that a profession that sets its own standards should not need state mandates to follow them. Mandates can shift the motivation from professional responsibility to compliance.
- Self-assessment is not built into most mandates. The standards expect nurses to evaluate their own practice and learning needs, yet most CE rules do not require a learning plan or self-assessment (see our professional development plan template for one way to do this).
5. Relationship to the ANA Code of Ethics
The Code of Ethics for Nurses was revised in 2025 and now has 10 provisions, including a new provision on global health. The revision also stresses that self-care and patient care are inseparable (ANA, 2025). Provision 5 describes the nurse’s duties to self, which include maintaining competence and continuing personal and professional growth. Provision 4 holds nurses accountable for their practice, and the provisions on advancing the profession call for nurses to contribute to its knowledge and standards.
Pros
- Puts an ethical duty into action. Ongoing education is how nurses meet their ethical obligation to maintain competence and grow professionally.
- Protects patients. Competent, current practice supports beneficence and nonmaleficence: doing good and avoiding harm.
- Builds public trust. Nursing is consistently one of the most trusted professions. Visible commitment to learning helps maintain that trust.
- Supports ethics education. Some states require ethics or jurisprudence CE, which helps nurses handle moral dilemmas, advocacy and new issues such as artificial intelligence.
Cons
- Compliance is not the same as ethical motivation. The Code presents learning as a personal and professional duty. Compulsion can make learning feel like an external rule rather than a moral commitment.
- Tension with duties to self. The Code emphasizes self-care and well-being. Heavy CE demands on top of long shifts and family responsibilities can add stress and burnout if workplaces do not support protected learning time.
- Justice concerns. When nurses pay for CE themselves, the burden falls hardest on lower-paid nurses and those in under-resourced areas.
Summary table
| Area | Pros | Cons |
|---|---|---|
| Competency | Keeps skills current; reduces skill decay; education probably improves practice | Hours do not prove competence; effects modest; content may be irrelevant |
| Knowledge and attitudes | Spreads evidence; builds lifelong learning; can address bias and ethics | Box-ticking; resentment and fatigue; cost and time |
| Certification | Shows current specialty expertise; hours count twice; rewards precepting and research | Added fees and paperwork; strict deadlines; measures inputs |
| ANA Scope and Standards | Enforces the Education standard; supports EBP and quality | Hours miss the intent of self-directed learning; shifts motivation to compliance |
| ANA Code of Ethics | Fulfills duty to maintain competence; protects patients and public trust | External compulsion; conflicts with self-care; unequal burden |
Making mandatory CE more meaningful
Many of the drawbacks come from how CE is designed, not from learning itself. Organizations and regulators can improve mandatory CE by linking it to a personal learning plan based on self-assessment, choosing accredited and interactive education, matching content to the nurse’s specialty, paying for CE and protecting learning time, and evaluating whether learning changes practice (Ross et al., 2013).
Sample discussion post
Original example for study purposes. Use it as a model, not as your submission.
Mandatory continuing education has clear benefits and real limits. On competency, CE keeps nurses up to date with new guidelines and refreshes rarely used skills. A Cochrane review found that educational meetings probably improve adherence to recommended practice and slightly improve patient outcomes (Forsetlund et al., 2021). However, mandates measure hours, not performance, and attendance does not guarantee learning (Ross et al., 2013).
On knowledge and attitudes, CE spreads current evidence and can build a habit of lifelong learning, although forced education can lead to “box-ticking” and resentment when nurses must pay for it on their own time. For certification, CE is essential. ANCC renewal requires 75 contact hours over 5 years plus another professional development category (ANCC, n.d.), which shows that expertise remains current but adds cost.
CE directly supports the ANA Education standard, which expects nurses to seek knowledge that reflects current practice (ANA, 2021), and the Code of Ethics, which includes maintaining competence and professional growth among the nurse’s duties to self (ANA, 2025). The risk is that compulsion replaces the professional and ethical motivation the standards and the Code intend. In my view, mandatory CE is worthwhile as a minimum, but it works best when employers fund it and nurses choose learning based on their own practice gaps.
Frequently asked questions
Do all U.S. states require continuing education for nurses?
No. Most states require CE for RN license renewal, but the number of hours and required topics vary, and a few states have no CE requirement. Always check your state board of nursing.
Does continuing education improve patient outcomes?
Education meetings and workshops probably improve professional practice and slightly improve patient outcomes, but the effect varies (Forsetlund et al., 2021). There is less evidence that the mandate itself improves outcomes.
Which ANA standard covers continuing education?
The Standard of Professional Performance on Education in Nursing: Scope and Standards of Practice (ANA, 2021).
Which provision of the Code of Ethics covers competence?
Provision 5, which addresses the nurse’s duties to self, including maintaining competence and continuing personal and professional growth.
Related reading: Professional development plan and career legacy map, the nurse’s role as health educator, nursing research and evidence-based practice, nursing vs. medical practice problems, Florence Nightingale’s legacy, professional nursing values and philosophy of nursing practice.
Conclusion
Mandatory continuing nursing education supports competence, current knowledge, certification, the ANA Scope and Standards of Practice and the ethical duty to maintain competence. Its weaknesses are that it often measures hours rather than performance, can encourage box-ticking, and adds cost and stress for nurses who are already stretched. The strongest approach keeps a mandatory minimum while making education relevant, accessible, supported by employers and connected to each nurse’s own learning goals.
References
American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
American Nurses Association. (2025). Code of ethics for nurses. American Nurses Association. https://www.nursingworld.org/nurses-books/Code-of-ethics-2025/
American Nurses Credentialing Center. (n.d.). Certification renewal requirements. https://www.nursingworld.org/globalassets/certification/renewals/ancc-certrenewalrequirements.pdf
Forsetlund, L., O’Brien, M. A., Forsén, L., Mwai, L., Reinar, L. M., Okwen, M. P., Horsley, T., & Rose, C. J. (2021). Continuing education meetings and workshops: Effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, (9), CD003030. https://doi.org/10.1002/14651858.CD003030.pub3
Ross, K., Barr, J., & Stevens, J. (2013). Mandatory continuing professional development requirements: What does this mean for Australian nurses. BMC Nursing, 12, 9. https://doi.org/10.1186/1472-6955-12-9
