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Nursing Education
We will continue to openly discuss these issues, listening to all opinions, at ICNR meetings. We have also established a Policy Forum on this site, open to ICNR members, to give you a chance to voice your opinion. If you are interested in reacting to any of these issues, either for or against, or have thoughts about evidence to be gathered, or other perspectives to be considered, we invite you to click on Policy Forum and follow the instructions at that tab for voicing your opinion. Baccalaureate Degrees at Community Colleges Baccalaureate Degrees at Community Colleges The emergence of baccalaureate nursing programs at community colleges as recently publicized reflects some significant issues and concerns governing both programs. By way of introduction, the Community college system was designed to serve the community residents within its respective district. Monies were allocated by the state governments to supply resources for community residents to be better prepared to function within the economy by providing programs which offered technical and skill based preparation. The mission was directed towards providing associate degrees in the field of the resident’s own choosing. The program of nursing was no exception. The Associate Degree in Nursing (ADN) program was designed to provide a two year program whereby students could rapidly complete their prerequisites and nursing courses, complete a pre-licensure examination and pending passage, function as registered nurses in hospitals and long term care settings as staff nurses at the bedside. Historically, the ADN programs were initiated in NY in 1952 as pilot programs among the seven satellite institutions of NY University to provide a technical program designed to alleviate the nursing shortage. The designer’s (Dr. Mildred Montag-Columbia University) intent was directed toward a technically based program. However, with the onset of severe nursing shortages, available monies at the local level and the creations of more community colleges to support its residents, the technical program evolved into a professional initiative. In fact, by 1960 there were 57 programs, however, by 1980, 750 programs had developed within the community colleges. The current nursing programs in community colleges by foundational design, exclude Leadership, Community Health nursing, Research and Physical Assessment courses, since the mission and intent is to serve as staff and is limited to hospital and long term care settings. Community college leaders report that their initiatives are directed towards meeting the needs of community residents, reducing the current nursing shortages that are so prevalent, and providing the resources that are available to current students. (Note: Currently no community colleges in Illinois offer a Bachelors of Science in Nursing although 47 of the 48 Illinois Community colleges do offer Associate Degree nursing programs and the 48th McHenry County College is currently developing its nursing curriculum.) CLINICAL NURSE LEADER ROLE As advances in biomedical sciences and in the complexity of health care have been revealed, they have also created situations in which sicker and older patients require more sophisticated and complex nursing care. This coupled with a worsening nursing shortage and numerous reports of unsafe and inadequate patient care have prompted concerns about both nursing education and nursing practice. In 2000, the American Association of Colleges of Nursing (AACN) conducted a thorough study of nursing education, regulation and practice issues. They sought consultation from numerous professional sources, regulators and other professionals. Results of the study proposed several new educational models for preparing well-qualified nurse generalists, including models at the master’s and professional doctorate levels. The study also revealed the need for a new nursing professional, the clinical nurse leader (CNL), in order to foster clinical excellence in nursing. In 2004, the AACN embarked on a nationally oriented process to develop guidelines that will prepare students in addressing clinical competence, professional values and leadership. The CNL is designed to create provision of exemplary leadership in preparing and supporting nurses in delivering excellent-quality and evidence- based care to individuals and groups of patients, as well as to their families and their communities. It is designed to incorporate expectations that results in improved patient outcomes. The CNL project is a risk taking, pilot project which is built on a careful analysis of what patients need from professional nurses today and in the future (Long, 3-4/2004, JPN, AACN). It is designed to prepare to meet the need in practice settings for professionals who can effectively coordinate, manage and evaluate care for groups of patients in complex health systems. It is designed to envision a significantly different future where patients receive better care and nurses prepared at all levels are valued and employed appropriately. As a pilot project, many colleges/schools of nursing will not likely endorse and/or pilot the clinical nurse leader role. And, not all practice settings will opt to change care delivery to accommodate the CNL’s. However, as Long (2004) urges, throughout this process of experimentation and possible transition, the focus must remain on patients’ needs (Note: See the list of Illinois nursing programs currently offering the Clinical Nurse Leader/ Master of Science in Nursing degree under the Nursing Education Issues and Initiatives tab on this website.) INCORPORATION OF AGING INTO BACCALAUREATE AND GRADUATE CURRICULA Increasing the nation’s capacity to provide quality and affordable care for its rapidly growing older adult population has become increasingly challenging. Older adults require this care since their diseases and disabilities escalate, are often chronic and coexist with other diseases, which impact their interventions as much more complex and long term. And, as older adults increase their life span, and the older adult population rapidly grows with baby boomers totaling 79 million soon to be reaching age 65 and over, the aging population will reach major proportions by the year 2030. A dramatic increase in the demand for professionals to care for them will be required. Currently, more than one half of hospitalized clients represent adults over 65. However, to date, only nine percent of professional nurses have indicated an interest in caring for older adults. And the current shortage of registered nurses specializing in gerontological nursing is magnified and will become more critical as student preferences for other nursing specialties contribute to the current shortage, with only 1.9% of students identifying working with older adults as their career choice. In 2000, of the 590 baccalaureate educational programs surveyed, only 38 reported requiring a separate gerontological theory and clinical course at the undergraduate level (Labunski, 2000). Rationale for lack of inclusion was three-fold: it was primarily related to the fact that aging adults were merely adults and had the same problems, thus should not be separated. Also, students were exposed to older adults in clinical settings and long term settings early in their educational programs (which promoted even greater negative attitudes toward the aged). Third, student attitudes were affected by their faculty’s attitudes toward aging, hence, showed little interest in aging. In June 2001, AACN was awarded an extensive grant by the Hartford Foundation of New York to enhance curriculum development in 20 baccalaureate and 10- graduate schools of nursing. Over the four year grant program, they learned that the single most necessary precursor to the successful implementation and maintenance of geriatric curricula is faculty development – expanding their knowledge base and fostering positive attitudes toward aging. Further, students need a separate, solid grounding in the art and science of gerontological nursing theory and an opportunity to apply the theory and interact with older adults in diverse clinical sites. Also, traditional early clinical sites, as in nursing homes, although offer a slower paced environment, perpetuate the myth that the care of nursing home residents requires less expertise in nursing skills, assessment, critical thinking, and leadership as compared with the care of hospitalized patients. It ignores the complexity of nursing home residents who reflect multiple chronic conditions, complex medication regimens, end-of-life issues, decision-making and treatment issues and family relationship issues, as well as the range of skilled nursing and rehabilitative services post-hospitalization and specialized care for dementia. It further ignores population statistics which indicate that only 4.5%of older adults reside in nursing homes (Administration on Aging, 2004). In summary, laying the groundwork for older adults theory and clinical curricula in undergraduate programs by providing faculty education and development, then, instituting separate, required undergraduate courses in gerontological nursing as part of the nursing major and thereafter, offering graduate tracks in aging adults, suggests much hope and potential for dispelling myths regarding aging. Comments such as, “although I was hesitant about spending an entire semester on this course, I really enjoyed the content and consider it so important for this population which deserves our best”, and “the gerontological course needed to be added to the curriculum; there are a lot of myths…which were dispelled… and it has helped me with my nursing care considerably” (Aud et.al, 3-4/2006, JPN, AACN). DOCTORATE IN NURSING PRACTICE In October 2004, the American Association of Colleges of Nursing (AACN) proposed a Practice Doctorate in Nursing (DNP) in the form of a position paper. As preliminary to the work of the AACN, the Institute of Medicine (2001) issued a call for new directions in and emphasis on the education of health care professionals. It called for development of the practice doctorate as the appropriate credential and level of education for advanced practice. (Clinton and Sperhac, 2006) Nursing leaders proposed that the practice doctorate be accepted as the terminal practice degree for nurses who wish to have as their major focus, clinical practice, given the complexity of health care systems. Clinton and Sperhac (2006) report that the degree is in no way designed to exclude the current advanced practice roles of clinical specialists, nurse anesthetists, nurse midwives and nurse practitioners. The intent is that those with advanced practice would seek the practice doctorate. It will include information that provides students with the knowledge and skills to practice competently in the present and appreciate that practice will change based on evolving clinical evidence. The list of core essentials allows for diversity in programs to address the specific focus on need for knowledge and skills in specialty areas. The core competencies reflect a universal, but not prescriptive, foundation for the DNP. Essential areas include scientific underpinnings for practice, advanced nursing practice, organization and system leadership, quality improvement and system thinking, analytic methodologies related to evaluation of practice, use of technology for improvement and transformation of health care, health policy development, etc., and interdisciplinary collaboration (Clinton & Sperhac, 1-2/ 2006, JPN, AACN). Outcome competencies and follow up accreditation will likely be developed following the implementation of curricula. An AACN appointed Task Force was charged with identifying essentials that would distinguish the DNP from the current MSN template, standards and competencies and criteria for accreditation. The AACN recommendations clearly differentiate between the DNP and the research-focused PhD, as well. To date, ten institutions nationwide offer the Doctor of Nursing Practice program. In Illinois, Rush University solely offers the DNP program. BACHELOR OF SCIENCE IN NURSING VERSUS MASTER OF SCIENCE IN NURSING CLINICAL TEACHING Documented shortages of health care workers in the St. Louis MO area coupled with insufficient capacity for quality applicants and limited, available clinical faculty prompted the creation of the Missouri Nurse Workforce Initiative; as a five year expansion project, it is designed to supplement Master of Science prepared nurses with Bachelor of Science in Nursing graduates to serve as clinical faculty. And, given its proximity to Illinois and the continuing collaboration among professionals within the two states, the Missouri initiative has sought to jointly participate with Illinois in this project. Pursuant to a similar advancing nursing shortage within Illinois, the Missouri initiative is specifically seeking project exemption from the Illinois’ State Board of Nursing and working with members within the Illinois Organization of Nurse Leaders (IONL) to shape the formal recommendations for the Missouri Nurse Workforce Initiative. Based upon the clear need for increasing supplies of nurses in Illinois’ workforce, the project is being presented to varied groups in the state of Illinois. It documents that baccalaureate prepared nurses are being groomed to serve as clinical practice supervisors of students; however, they are required to actively enrolled in master’s programs and enroll in a two day teaching seminar prior to clinical supervision. The project was designed to be initiated in fall 2005. In reviewing the initiative, potential opportunities for expansion appear promising. Challenges also abound regarding the initiative. First, the current Illinois Nursing Act specifies the requirement that all clinical faculty hold an earned Master of Science with a major in Nursing degree to be eligible for supervising students in the clinical practice area with minimal exceptions. Furthermore, specialized, professional accrediting bodies specify those same requirements for clinical supervision of nursing students. And, given the purposeful intent of the Missouri Workforce Initiative, Illinois is in a position that prohibits those modifications. It is unprepared to handle modifications in qualifications. Moreover, with the exception of requirements for entry into nursing practice, concomitant requirements of entry into practice of other health care professional disciplines have escalated, so that they soundly surpass nursing and require a minimum of a master’s degree as the entry level for their discipline. Examples include physical therapists and occupational therapists. Against a backdrop of accreditation and related disciplines’ requirements, the profession of nursing has continued to modify its requirements for entry to meet the challenges of nursing shortages throughout the years of its existence. For example, following World War I, a dramatic increase in numbers of hospitals and hospital based programs and practical nurse programs occurred. Subsequent to World War II, the creation of associate degree programs (60 by 1960) surged. And although they were initially designed as vocational/ technical vis-à-vis professional programs, extensive increasing community funding promulgated their proliferation so that by 1980 (after the Cold War), 753 programs nationwide were in progress. All were intended to relieve the shortfalls in the nursing workforce. Rationale for the current state’s rules of administration, accreditation requirements and schools of nursing requirements in Illinois are four fold: First, graduate schools require depth and breadth of knowledge to serve in a variety of responsibilities, settings and locations. Second, graduate education also requires roles of leadership, management and/or teaching skills. Third, graduate preparation provides a foundation of scientific inquiry which includes validation and incorporation of research findings into practice and evaluation of nursing theory appropriate for professional practice and supervision of students in practice. Finally, graduate preparation advances the credibility of the professional nurse to the public and other professional disciplines (e.g. physician, physical therapist, occupational therapist). Graduate degrees build upon the knowledge and skills of baccalaureate nursing preparation. Graduate preparation equips clinical faculty to provide leadership, advanced nursing roles and to participate in the formulation and refinement of nursing science in the care and supervision of patient care. Based upon the above explanation, the five year (5) implementation project is currently in its beginning stages of progress; evaluation of its expected outcomes will follow. Results should reflect data regarding its success and/or need for modifications. References: (Note: See a more detailed description of the Missouri Nurse Initiative in the Nursing Education Issues and Initiatives section of this website.) |
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