The Future of Nursing Leading Change, Advancing Health (2011) / Chapter Skim
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4 Transforming Education
4 Transforming Education
Pages 163-220
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From page 163... ...
To respond to the underrepresentation of racial and ethnic minority groups and men in the nursing workforce, the nursing student body must become more diverse. Finally, nurses should be educated with physicians and other health professionals as students and throughout their careers.
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From page 164... ...
And advanced practice registered nurses (APRNs) need graduate programs that can prepare them to assume their roles in primary care, acute care, long-term care, and other settings, as well as specialty practices.
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From page 165... ...
. For the past four decades, nursing students have been able to pursue three different educational pathways to become registered nurses (RNs)
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From page 166... ...
During the 20th century, as nursing gained a stronger theoretical foundation and other types of nursing programs increased in number, the number of diploma programs declined remarkably except in a few states, such as New Jersey, Ohio, 2 While titles for LPNs and LVNs vary from state to state, their responsibilities and education are relatively consistent. LPNs/LVNs are required to pass the National Council Licensure Examination for Practical Nurses (NCLEX-PN)
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From page 167... ...
Entry into Practice: The Licensing Exam3 Regardless of which educational pathway nursing students pursue, those working toward an RN must ultimately pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN) , which is administered by the National Council of State Boards of Nursing (NCSBN)
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From page 168... ...
Greater emphasis must be placed on competencies related to community health, public health, primary care, geriatrics, disease prevention, health promotion, and other topics beyond the provision of nursing care in acute care settings to ensure that nurses are ready to practice in an evolving health care system. Costs of Nursing Education Although a limited number of educational grants and scholarships are available, most of individuals seeking nursing education must finance their own education at any level of preparation.
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From page 169... ...
Why More BSN-Prepared Nurses Are Needed The qualifications and level of education required for entry into the nursing profession have been widely debated by nurses, nursing organizations, academics, and a host of other stakeholders for more than 40 years (NLN, 2007)
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From page 170... ...
A more educated nursing workforce would be better equipped to meet these demands. An all-BSN workforce would also be poised to achieve higher levels of education at the master's and doctoral levels, required for nurses to serve as primary care providers, nurse researchers, and nurse faculty -- positions currently in great demand as discussed later in this chapter.
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From page 171... ...
. Absent a nursing shortage, then, nurses holding a baccalaureate degree are usually the preferred new-graduate hires in acute care settings (Cronenwett, 2010)
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From page 172... ...
The formal education associated with obtaining the BSN is desirable for a variety of reasons, including ensuring that the next generation of nurses will master more than basic knowledge of patient care, providing a stronger foundation for the expansion of nursing science, and imparting the tools nurses need to be effective change agents and to adapt to evolving models of care. As discussed later in this chapter, the committee's recommendation for a more highly educated nursing workforce must be paired with overall improvements to the education system and must include competencies in such areas as leadership, basic health policy, evidence-based care, quality improvement, and systems thinking.
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From page 173... ...
Online education programs make courses available to all students regardless of where they live. For prospective nursing students, there are traditional 4-year BSN programs at a university, but there are also community colleges now offering 4-year baccalaureate degrees in some states (see the next section)
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From page 174... ...
. Community college between the five geographically dis- nursing students can obtain their persed campuses of Oregon Health & associate's degree in 3 years and Science University (OHSU)
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From page 175... ...
advanced practice registered nurses, Dr. Tanner is working on edu or clinicians prepared for a future continued The ADN-to-MSN program, in particular, is establishing a significant pathway to advanced practice and faculty positions, especially at the community college level.
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From page 176... ...
Additionally, there are federal resources currently being used to support diploma schools that could better be used to expand baccalaureate and higher education programs. The committee anticipates that it will take a few years to build the educational capacity needed to achieve the goal of 80 percent of the nursing workforce being BSN-prepared by 2020, but also emphasizes that existing BSN completion programs have capacity that is far from exhausted.
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From page 177... ...
. Community colleges must foster a culture that promotes and values academic progression and should encourage their students to continue their education through strategies that include making them aware of the full range of educational pathways and opportunities available to them (e.g., ADN-to-MSN and online RN-to-BSN programs)
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From page 178... ...
Diploma Associate's Baccalaureate FIGURE 4-3 Distance between nursing education program and workplace for early Fig 4-3.eps career nurses (graduated 2007−2008)
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From page 179... ...
Aging and Shortage of Nursing Faculty There are not enough nursing faculty to teach the current number of nursing students, let alone the number of qualified applicants who wish to pursue nursing. The same forces that are leading to deficits in the numbers and competencies of bedside nurses affect the capacity of nursing faculty as well (Allan and Aldebron, 2008)
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From page 180... ...
Petersburg Junior in nursing students can take classes College changed its name to St. on campus or online.
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From page 181... ...
affordability of the BSN programs available at community colleges. Jean Wortock, PhD, MSN, ARNP, dean and professor of nursing at Saint Peters burg College, said her school's BSN program is opening up an important channel for Florida nurses to advance their education in a state where 46 percent of qualified applicants to BSN programs were turned away in 2009 because of faculty shortages and other factors (Florida Center for Nurs ing, 2010)
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From page 182... ...
. 2 Number of qualified applicants not accepted in baccalaureate generic RN and RN to-BSN programs, based on National League for Nursing data in Nursing Data Review (2004-05, Tables 3 & ; 2005-0, Tables 2 & 5; 2007-08; Tables 2 & 5)
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From page 183... ...
, a potential opportunity to relieve faculty shortages could involve the creation of programs that would allow MSN, DNP, and PhD students to teach as nursing faculty interns, with mentoring by full-time faculty. Box 4-4 presents a nurse profile of one assistant professor and her experience moving into an academic career.
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From page 184... ...
Wenzel has explored, among other topics, rural African Americans with cancer and self-care in patients with diabetes. She has also studied "professional bereave ment" and resilience in oncology nurses -- how nurses cope with the recurring loss of patients -- with lead researcher Sharon Krumm, PhD, RN.
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From page 185... ...
listen. The national program aids junior She earned an associate's degree nursing faculty in becoming aca after two years and went on to demic leaders, skilled teachers, and complete the bachelor's in two more productive scholars.
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From page 186... ...
to enable nursing schools to expand enrollment is a mathematical improbability" (Aiken et al., 2009)
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From page 187... ...
offers an incentive designed to offset lower faculty salaries by providing up to $35,000 in loan repayments and scholarships for eligible nurses who complete an advanced nursing degree and serve "as a full-time member of the faculty of an accredited school of nursing, for a total period, in the aggregate, of at least 4 years."7 However, the ACA does not provide incentives for nurses to develop the specific educational and clinical competencies required to teach. Projections of future faculty demand To establish a better understanding of future needs, the committee asked the RWJF Nursing Research Network to proj 7 Patient Protection and Affordable Care Act, HR 3590 § 5311, 111th Congress.
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From page 188... ...
This projection is based on historical nurse faculty retirement rates and on graduation trends in research-focused nursing PhD programs. Although a doctoral degree is often required or preferred for all current faculty vacancies, some of these positions can be filled with faculty holding DNP or master's degrees.
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From page 189... ...
. While efforts are being made to expand placements in the community and more care is being delivered in community settings, the bulk of clinical education for students still occurs in acute care settings.
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. The majority of nursing schools still educate students primarily for acute care rather than community settings, including public health and long-term care.
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From page 191... ...
Nursing students may gain exposure to leading health care disciplines and know something about basic health policy and available health and social service programs, such as Medicaid. However, their education often does not promote the skills needed to negotiate with the health care team, navigate the regulatory and access stipulations that determine patients' eligibility for enrollment in health and social service programs, or understand how these programs and health policies impact health outcomes.
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From page 192... ...
Each instructor from the nursing school. Her instruc teaches no more than two students tion is overseen by both a university at a time, but the DEU can be used faculty member and the unit's nurse around the clock.
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From page 193... ...
It might appear that the university The partnership has led to changes profits far more than the hospital -- in teaching and in clinical care. After a especially since nearly 40,000 quali student made an error by injecting a fied applicants were turned away medication into the wrong tube, the from baccalaureate nursing programs hospital changed its policy on syringe in 2009 because of shortages of placement, and the school added a faculty and clinical teaching sites "tubes lab" to its courses.
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From page 194... ...
The core curriculum for DNPs is 12 Nursing-relateddoctoral degrees are defined by the National Sample Survey of Registered Nurses as non-nursing degrees that are directly related to a nurse's career in the nursing profession. "Nursing-related degrees include public health, health administration, social work, education, and other fields" (HRSA, 2010b)
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From page 195... ...
78.6 73.1 77.2 Doctoral 17,256 26,100 28,369 Doctorate in nursing 8,435 11,548 13,140 Nursing-related doctoral degree 8,821 14,552 15,229 Percent of doctorates that are nursing 48.9 44.2 46.3 SOURCE: HRSA, 2010b. guided by the AACN's Essentials of Doctoral Education for Advanced Nursing Practice.13 Schools of nursing have been developing DNP programs since 2002, but only in the last 5 years have the numbers of graduates approached a substantial level (Raines, 2010)
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From page 196... ...
Preparation of Advanced Practice Registered Nurses Nurses prepared at the graduate level to provide advanced practice services include those with master's and doctoral degrees. APRNs serve as NPs, certified nurse midwives (CNMs)
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From page 197... ...
Research Roles Graduate-level education produces nurses who can assume roles in advanced practice, leadership, teaching, and research. For the latter role, a doctoral degree is required, yet as noted above, fewer than 1 percent of nurses have achieved 14 Personalcommunication, Jean Johnson, Dean, School of Nursing, George Washington University, September 3, 2010.
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From page 198... ...
Research on Nursing Education At no time in recent history has there been a greater need for research on nursing education. As health care reform progresses, basic and advanced nursing practices are being defined by the new competencies alluded to above and discussed in the next section, yet virtually no evidence exists to support the teaching approaches used in nursing education.15 Additionally, little research has focused on clinical education models or clinical experiences that can help students achieve these competencies, even though clinical education constitutes the largest portion of nurses' educational costs.
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From page 199... ...
The result has been a serious mismatch between the urgent need for knowledge and innovation to improve care and the nursing profession's ability to respond to that need, as well as a limitation on what nursing schools can include in their curricula and what is disseminated in the clinical settings where nurses engage. A chapter of the National Research Council's 2005 report, Advancing the Nation's Health Needs: NIH's Research Training Program, focuses on nursing research; it identified factors that would likely influence its future, for example: an aging cadre of nursing science researchers, longer times required to complete doctoral degrees, increasing demands on nursing faculty to also meet workforce demands, and the emergence of clinical doctoral programs (NRC, 2005)
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From page 200... ...
It has proven difficult to establish a single set of competencies that cover all clinical situations, across all settings, for all levels of students. However, there is significant overlap among the core competencies that exist because many of them are derived from such landmark reports as Recreating Health Professional Practice for a New Century (O'Neil and Pew Health Professions Commission, 1998)
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From page 201... ...
Assessing Competencies Changes in the way competencies are assessed are also needed. In 2003, the IOM's Health Professions Education: A Bridge to Quality called for systemwide changes in the education of health professionals, including a move on the part of accrediting and certifying organizations for all health professionals toward mandating a competency-based approach to education (IOM, 2003a)
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From page 202... ...
From Continuing Education to Continuing Competence Nurses, physicians, and other health professionals have long depended on continuing education programs to maintain and develop new competencies over the course of their careers. Yet the 2009 IOM study Redesigning Continuing Education in the Health Professions cites "major flaws in the way [continuing education]
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From page 203... ...
Interprofessional education is thought to foster collaboration in implementing policies and improving services, prepare students to solve problems that exceed the capacity of any one profession, improve future job satisfaction, create a more flexible workforce, modify negative attitudes and perceptions, and remedy failures of trust and communication (Barr, 2002) .19 19 This paragraph draws upon a paper commissioned by the committee on "The Future of Nursing Education," prepared by Virginia Tilden, University of Nebraska Medical Center College of Nursing (see Appendix I on CD-ROM)
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From page 204... ...
The program began in 2008 as munity in a suburb of Boston. She a pilot project to train licensed RNs made the move to long-term care to work in four community settings through the Nursing for Life: RN that may be less physically demand Career Transition program at Michi- ing than acute care -- home care, gan State University (MSU)
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From page 205... ...
Other she is now an instructor in nursing at states may provide similar assistance.) a Michigan community college.
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From page 206... ...
As a first step, the collaborative is developing a shared and mutually endorsed set of core competencies that will frame the education of the six represented health professions. 20 Efforts have been made to evaluate the effectiveness of interprofessional education in improving outcomes, including increased student satisfaction, modified negative stereotypes of other disciplines, increased collaborative behavior, and improved patient outcomes.
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From page 207... ...
The recommendations focused on expediting strategies to increase the number of minorities in health professions, improving the education pipeline for health professionals, financing education for minority students, and establishing leadership and accountability to realize the commission's vision of increasing the diversity of health professionals. The committee believes the implementation of these recommendations holds promise for ensuring a more diverse health care workforce in the future.
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From page 208... ...
In the nursing profession, creating bridge programs and educational path ways between undergraduate and graduate programs -- specifically programs such as LPN to BSN, ADN to BSN, and ADN to MSN -- appears to be one way of increasing the overall diversity of the student body and nurse faculty with respect to not only race/ethnicity, but also geography, background, and personal experience. Mentoring programs that support minority nursing students are another promising approach.
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From page 209... ...
One professional organization that works to encourage men to join the nursing profession and supports men who do so is the American Assembly for Men in Nursing (AAMN) .23 To increase opportunities for men interested in joining the profession, the AAMN Foundation, in partnership with Johnson & Johnson, has awarded more than $50,000 in scholarships to undergraduate and graduate male nursing students since 2004 (AAMN, 2010b)
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From page 210... ...
The committee found that each of these models provided important insight into creative approaches to maximizing faculty resources, encouraging the establishment and funding of new faculty positions, maximizing the effectiveness of clinical education, and redesigning nursing curricula. Veterans Affairs Nursing Academy In 2007, the VA launched the VANA -- a 5-year, $40 million pilot program -- with the primary goals of developing partnerships with academic nursing institutes; expanding the number of faculty for baccalaureate programs; establishing partnerships to enhance faculty development; and increasing baccalaureate enrollment to increase the supply of nurses, not solely for the VA, but for the country at large.
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From page 211... ...
Across the state, HEET-funded programs support industry-based reform of the education system and include preparation and completion of nursing career ladder programs. HEET seeks to develop educational opportunities that support
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From page 212... ...
Nurses and physicians -- not to mention pharmacists and social workers -- typically are not educated together and yet are increasingly required to cooperate and collaborate more closely in the delivery of care. To address these barriers, innovative new programs to attract nursing faculty and provide a wider range of clinical education placements must clear long-stand
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From page 213... ...
The nursing profession must adopt a framework of continuous lifelong learning that includes basic education, academic progression, and continuing competencies. More nurses must receive a solid education in how to manage complex conditions and coordinate care with multiple health professionals.
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2010b. Enhancing diversity in the nursing workforce: Fact sheet updated March 2010.
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2009. A new model for the clinical instruction of undergraduate nursing students.
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2009. Redesigning continuing education in the health professions.
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2009. Battle of degrees heats up: Universities, community colleges spar over four-year pro grams.
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From page 218... ...
1998. Recreating health professional prac tice for a new century: The fourth report of the Pew Health Professions Commission.
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2004. Missing persons: Minorities in the health professions: A report of the Sullivan Commission on Diversity in the Healthcare Workforce.
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