The concept of life-long learning is not new, but it is only in the last years that the nursing profession has taken a strategic approach to the provision and support nurses undertaking Continuing Professional Education. Continuing nursing education, also referred to as "continuing professional development", "continuing professional education", "continuing competence", and "lifelong learning", involves improving the knowledge, abilities, and mindset of nurses.1

According to American Nurses Credentialing Center’s Commission on Accreditation,2 Continuing Nursing Education (CNE) includes learning activities aimed exclusively at nursing professionals and intended to improve the educational and experiential bases of the nursing profession. The importance of CNE is emphasized internationally due to the widespread changes in different domains. Globalization, social and political changes, technological advances, consumerism, the industrialization of health, the spread of technology, new scientific knowledge, and climate changes have challenged the healthcare environment and they are specific reasons explaining CNE is paramount.3 Additionally, in the last years due to the global pandemic of Coronavirus disease 2019 (COVID-19), the face of healthcare has changed dramatically and nursing education must be able to keep up with these changes.4

The motivation of nurses for self-learning and participation in continuing nursing courses is affected by external factors, intrinsic motivation, personal experiences, and free will. Motivational orientations can be grouped into 5 categories: (a) Professional improvement and development, (b) professional service, (c) learning and interaction with colleagues, (d) personal benefits and job security, and (e) professional commitment.5

As nursing profession plays an important role in healthcare due to the influence on patients’ and community health status, it is crucial to know which are the motivational factors regarding the participation in CE programs.6 Generally, nurses have a positive attitude about the current CNE programs. However, many studies revealed several barriers and difficulties concerning CNE.7

A descriptive, correlational design was adopted for this study and determined to be appropriate to answer the research question, “What are the motivational factors influencing nurses’ participation in Continuing Education?” A quantitative approach, through questionnaires was used, because this kind of research can be easily applied and reach a large sample of participants.8

A self-completed questionnaire was used for the data collection, which consists of demographic questions, a Participation Reasons Scale (PRS), the Deterrents Participation Scale (DPS), and other questions asking participants about their opinion and experiences regarding the barriers to CNE.

The demographic questions requested information about participants' gender, age, marital status, the number of children, the educational level, specialty, level of English, and computer knowledge, and if they have a master or a PhD degree. These questions also request participants to ask about the duration of working professionally in health sector in general and the duration of work and experience in the current position.

The PRS, which was created by Grotelueschen et al,9 is a valid and reliable assessment tool for measuring the reasons of doctors and nurses for participating in CPE.9 Extensive evidence supports that the exploration of such factors facilitates the designing and executing well-suited educational programs that benefit all the stakeholders, including the health professionals, the patients, the managers, the policy makers, and society as a whole. The scale was consisted of 5 factors (dimensions) covered by 30 questions: (a) Professional improvement and development, (b) professional service, (c) collegial learning and interaction, (d) personal benefits and job security, and (e) professional commitment.

PRS was used again in a sample of Greek nurses including a 5-point Likert scale (1 = not important, 2 = less important, 3 = important, 4 = quite important, 5 = extremely important). Analysis of the questionnaire’s reliability showed a statistically significant level of agreement for each item (P < .001). Factor analysis of the 30 possible reasons for participating in CPE revealed 4 main motivational factors: “Improvement of professional competence and patient service”, “professional commitment”, “collegial learning and interaction”, and “personal benefits and job security”.10

Our sample consists of 15% men and 85% women with mean age 36 years (19–56 years) and with 1 child per family. 30.5% completed 2- or 3-years nursing school, 38.3% completed University school, and 31.2% completed postgraduate studies. 53% were married, 37% single, 8.4% divorced, and 1.3% widower. 64.5% of participants work in the public sector and 35.7% in the private sector. 40.3% of participants work fixed hours and 59.7% rolling hours. 35.7% of participants work 20–39 h weekly and the remaining 64.3% 40–60 h. 30% of participants work in the clinic unit, 25.3% in geriatric unit, 29.2% in school, and 15.6% in another unit. The median of participants working experience was 10 years (1–35 years) (Table 1).

The findings from this study are consistent with other studies regarding this topic. Specifically, the sample consists mainly of women. This is in accordance with the worldwide opinion that nursing continues to be a female-dominated profession.11

This study includes Greek clinic nurses, school nurses and geriatric nurses (n = 154) working on private and public sector and examines their motives for engaging in continuous nursing education.

The results of this study have shown that all factors explored within the 4 dimensions by PRS, have generated a positive response. Specifically, the results have shown that the highest ranked motive was improving professional skills and patient service. This suggests that nurses place a high value on improving their knowledge and skills to provide the best possible care to their patients.

Panagiotopoulou,12 in her research, examined the participation and motivational orientations of Greek healthcare professionals. The findings showed that the most important reason for nurses to participate in CNE was the need to improve professional competence and patient service received.12 Other studies have found an important reason for nurses to pursue CNE is to ensure that they retain professional certification, advance in their careers, and improve their knowledge.13

According to Brekelmans et al.,14 nurses believe that the main benefit of continuing nursing education is the improvement of their skills and knowledge. Similarly, according to Tachtsoglou et al.,15 the main concern of nurses is their updating on developments in healthcare and acquisition of new professional knowledge. In another study (taken place in 2 hospitals in south-east Morocco) by Ali et al.,16 the results have shown that participants’ motivation for continuing education was mainly intrinsic factors, specifically related to professional competence and knowledge seeking.

Personal benefits and job security have been recognized as a motive for continuous nursing education, which highlights the importance of continuous education in terms of career advancement and job security in the nursing profession. Personal benefits and job security refer to the advantages individuals gain, such as higher wages and improved chances for personal advancement within their careers. According to a study conducted in the United Kingdom involving 620 nurses, it was found that 8 years after completing their nursing education, participants identified that increased job opportunities, intellectual growth, and improvement in clinical judgment were the primary motivations for pursuing postgraduate education.17

Professional commitment was also identified as an important motivator. This refers to the responsibility of a professional to contribute and guide the overall development and advancement of their field by actively serving and engaging with the professional community. Kamarianaki et al.,18 surveyed Greek nurses and found that professional improvement and development, professional service, collegial learning and interaction, personal benefits, job security, and professional commitment are the main motivational factors for nurses to participate in CE. Specifically, the higher scores were recorded for “professional commitment” and “personal benefits and job security”, indicating that nurses may participate in CNE to provide motivation or drive for the nursing profession and for personal profits. Moreover, related to this professional commitment and professional performance proving, have been identified as motivators in similar studies.19

Nurses placed a high value on collegial learning and interaction as well, indicating that nurses see continuing education as an opportunity to learn from, collaborate with their peers and maintain contact with other professionals as a means of challenging their intellectual abilities.20

Collegial learning refers to the professional's inclination or aspiration to stay connected with other professionals in the same field. This connection serves to stimulate and challenge their intellectual capabilities. Peer relationships in nursing play a vital role due to various reasons. These relationships are crucial for coordinating patient care across different shifts or locations, ensuring high-quality and safe care, and establishing and upholding professional standards. Collegial learning and interaction seemed to be an important factor in Kamarianaki et al. research.18

Regarding the demographic characteristics, results show that demographic variables are associated with higher levels of motivation for both improving professional skills and patient services, as well as personal benefits and job security among nurses. Nurses with higher levels of education demonstrated higher values for both motives compared to those who completed only 2–3 years of nursing school. Educational level affects participation in CNE.18,21

In addition to education, English language proficiency was also found to be associated with higher levels of motivation for both improving professional skills and patient services (P < .0005), and personal benefits and job security (P < .0005). In the literature, it is mentioned that learning engagement might be affected by individuals’ English fluency, which might impact his/her academic performance.22

As far as personal characteristics concerned, fixed work hours were also associated (P < .0005) with higher levels of motivation for both improving professional skills and patient services, as well as personal benefits and job security compared to nurses with rolling work hours. Additionally, the study also found that nurses working in clinics or schools showed higher values for both improving professional skills and professional commitment, compared to geriatric nurses. Similar studies have found that certain personal characteristics such as age, income level, academic rank, and the nature of working hours have a significant impact on an individual's participation in Continuing Education (CE) programs.23

In DeSilets study,24 results have shown that factors such as their initial nursing training, area of work, age, and years of experience influence their involvement in educational programs. Moreover, nurses who work in larger hospitals and those who work in specialized units or have supervisory roles are also more likely to participate in continuing education.25

Finally, the study found a negative correlation between the number of children and the motive of improving professional skills and patient services (r = −0.172, P = .033). This suggests that nurses with more children may have less time and resources to devote to continuous education and professional development. Similar with other studies nurses who are more likely to participate in continuing educational programs are those who do not have any children and those who have children older than 5 years old.26

It is crucial to investigate the incentives that motivate nurses for continuing professional education and recognize their actual training needs. When individuals' continuing education and training needs are acknowledged, it will become possible to develop training plans, promotion, and strategies that are aligned with their specific needs and objectives.27

By prioritizing the professional development for nurses, we can ensure that they have the necessary skills and knowledge to provide excellent care to patients, especially in the face of difficult circumstances.28

Moreover, it is recommended that they have to collaborate with other training and educational institutions such as universities to create and implement continuing educational programs. This partnership will aid in the advancement and implementation of contemporary training methods and enhance the quality of education offered. Furthermore, it will increase the number of educational materials produced.29

It is important for organizations to provide sufficient funding and easy access to ongoing professional development opportunities. This will enable nurses to consistently improve their skills and knowledge, which is essential for maintaining high standards of nursing care through competent practice. On the other hand, nurses should take an active role in pursuing these opportunities to ensure they are providing the best possible care to their patients.30