Chapter 7: Educational Patterns in Nursing

1. Chapter 7: Educational Patterns in Nursing Bonnie M. Wivell, MS, RN, CNS

2. Diversity • The one major characteristic of nursing education today • Influenced by • Societal changes • Periodic shortages • Historical factors • Public expectation • Professional standards • Legislation • National studies • Constant changes in the health care system

3. Introduction Nursing Programs in 2006 There were 1, 547 state approved RN programs in the U.S. ADN 58.8% BSN 37.2 % Diploma 4% Advanced Practice in 2008 Masters programs: 458 Doctoral programs: 166 Other: LPN/LVN, Cont Ed, Advanced Practice Certification Programs

4. Early Nursing Education Before Nightingale nursing care was delivered by relatives, religious or military individuals, or self-trained persons who were held in low regard Nightingale revolutionized and professionalized nursing Opened 1st nursing school in 1860 in London Principles: Nurses trained in educational institution Independent of but affiliated with teaching hospital Curriculum of both theory & practice Nurses administer, instruct, & paid Students selected should live in “nurses’ houses” Students required to attend lecture, take quizzes, write papers, keep diaries

5. First Nursing Education in USA 1872 First US Training Programs for Nurses Bellevue Hospital, New York New England Hospital of Women & Children, New Haven, Connecticut Massachusetts General Hospital, Boston 1 year in length Linda Richards first “trained nurse” 1873 By 1900 432 hospital-based diploma programs

6. Early Studies of Quality • 1899 – Isabel Hampton Robb chaired a committed to investigate a means to prepare nurses better for leadership • Mary Adeline Nutting 1st Nursing Professor • 1912 – The Educational Status of Nursing • 1923 – The Study of Nursing and Nursing Education in the U.S called the Goldmark Report • 1924 – Yale School of Nursing own University Dept • $1 million endowment by Rockefeller Foundation • 1934 – Nursing Schools Today and Tomorrow • 1937 A Curriculum Guide for Schools of Nrsg (National League of Nursing Education)

7. 5 Recommendations • Nursing education programs should be established within systems of higher education • Nurses should be highly educated • Students should not be used as hospital staff • Establish standards of nursing practice • All students should meet certain minimum qualifications upon graduation

8. Ed Paths to Become Nurse Diploma Program Hospital based 1920-30s: 2000 programs, 3 years to complete Today: 62 programs, 24 months to complete Most colleges refused to give credit for courses taken in diploma program Baccalaureate Program 1st 1909 University of Minnesota 1948 Brown Report University based Recruit men/minorities

9. Ed Paths to Become Nurse Cont’d. • Associate Degree Program • Began in 1952 as result of post WWII shortage • Model developed by Mildred Montag • Most common type of basic nursing education program in US • Shorter program • External Degree Program: Learning Independently and is assessed through highly standardized and validated competency-based outcomes assessments; “virtual university” • Articulated Programs: Ed ladder LPN-ADN-BSN+

10. ANA Position Paper • 1965: Educational Preparation for Nurse Practitioners and Assistants to Nurses • Created conflict and division within nursing, but had significant impact on growth of baccalaureate education • 4 recommendations • Education should take place in institutions of higher learning • Minimum prep for professional nurse should be baccalaureate • Minimum prep for technical nurse should be associate • Education for assistants should consist of short, intensive vocational education, not OJT

11. ANA Again • 1979 – ANA further strengthened its resolve by proposing • By 1985 the minimum prep for entry into professional nursing practice should be the baccalaureate • Two levels of nursing practice should be identified (professional and technical) and a mechanism to devise competencies for the two established by 1980 • There should be increased accessibility to high-quality career mobility programs that use flexible approaches for individuals seeking academic degrees in nursing

12. Other Influences on Baccalaureate Education • 1970: Lysaught Report recommendations • Need for increased research into both the practice and education of nurses • Enhanced educational systems and curricula • Early 1980s – National Commission on Nursing published two reports suggesting that the major block to the advancement of nursing was the ongoing conflict within the profession about educational prep

13. Other Influences on Baccalaureate Education Cont’d. • 1982: NLN approved the Position Statement on Nursing Roles: Scope and Preparation • Affirming baccalaureate as minimal education level for professional nurse • Associate or diploma as prep for technical nurse • 1996: American Assoc. of Colleges of Nursing approved position stated baccalaureate as minimal prep for professional practice • Updated in 2000 • Supports articulated programs which enable associate degree nurses to attain the baccalaureate

14. What skills do you have? • 2008 AACN Publication The Essentials of Baccalaureate Education for Professional Nursing Practice • BSNs are prepared to practice within complex healthcare systems and assume the following roles: • Provider of care; designer/manager/coordinator of care and member of a profession • 2000 NLN Educational Competencies for Graduates of Associate Degree Nursing Programs • 8 Core competencies • Professional behaviors • Communication • Assessment • Clinical decision making • Caring interventions • Teaching and learning • Collaboration • Managing care

15. Alternatives Baccalaureate Programs for RNs 1960-70s; RN to BSN Programs for second-degree students Online and distance learning programs

16. LPN First program in 1942 during WW II to meet demand State Approval vs National Difference from RN Education program lasts 12 months Settings vary Licensing: NCLEX-PN Scope of practice meet basic needs of patient in hospitals, long term care, and homes Practice under supervision of MD or RN Not a substitute for RNs

17. Accreditation Voluntary review process of ed program by a professional organization 1952 National League for Nursing Accreditation Commission 1996 Commission on Collegiate Nursing Education organized by American Association of Colleges of Nursing

18. Graduate Education in Nursing Master’s Entrance requirements: BS in nursing, RN licensure, GRE, GPA of 3.0 18-24 months Admin, Case Management, Informatics, Health policy, Teaching, CNS, NP, CNMW, CRNA, other RN/MSN, MSN/MBA, MSN/JD (juris doctor) Doctoral: ND, DNSc, DNP ND transitioning to DNP Certification Programs: Licensure, Certified Continuing Education: maintain expertise ANCC responsible for oversight of certification and CE

19. Challenges in Nursing Education Faculty Shortages severe 2010 Resources Shortages—clinical sites Complex Health Care Needs

20. Transform Nursing Education Diverse students Critical thinking skills Communicate, form interpersonal relationships, make decisions collaboratively/interdisciplinary Increase APN & health promotion-maintenance Community based care, increased accountability, state of the art clinical skills & info management skills Cost effective Articulation and career mobility Faculty development to support practice, teaching, research