New Study Proposes Sweeping Overhaul of Nursing Education

The Carnegie Foundation's ''Educating Nurses: A Call For Radical Transformation'' is the first comprehensive national study of nursing education in 30 years - and it found that the system is equally out of date. From a major overhaul of the curriculum to stricter licensing requirements, the report calls for sweeping changes to the way America educates its nurses.

Carnegie Foundation

Overcoming the Shortage

Educating Nurses is a multiyear study drawing from field research at a broad range of nursing schools, as well as a national survey of nursing students and teachers conducted with the National League for Nursing (NLN), the American Association of Colleges of Nursing (AACN) and the National Student Nurses' Association (NSNA). The study comes at a time when there's a great need for more and better educated nurses. The U.S. is facing a major shortfall - Educating Nurses suggests that nursing education programs need to increase their capacity by an astonishing 90% to meet current and projected nursing shortages.

In spite of this problem, the number of rejected nursing school applicants has increased sixfold since 2002. The report offers two possible causes for the decline in nursing school admissions. First, there is an equally severe shortage of nursing faculty. Very few bachelor- or master-level nursing programs actually train their students to teach, and many of the young nurses who do go into teaching end up switching to practice to earn higher salaries.

Second, there are relatively few nurses with bachelor's degrees who are ready to go into professional nursing school. This is symptomatic of one of the greater problems the report points to: many nurses are undereducated. While most nursing programs provide good clinical training, they're sorely lacking in academic areas such as nursing science, technology, the humanities and the natural and social sciences. Courses in these subjects are typically offered in a standardized format with low academic standards. Consequently, nurses are lacking important knowledge and skills required to understand and advance their practice.

Nursing Studies

Providing a More Rigorous Education

One of the more controversial solutions proposed by Educating Nurses is the elimination of the associate-level nursing degree. Patricia Benner, director of the study, notes that she's not against community college education. But she points out that associate-level nursing programs are typically unreliable and leave many graduates unprepared to go into advanced nursing. They don't even provide the quick access to practice that they claim. Benner points out that most two-year programs typically require at least three years to complete, and due to the long list of prerequisites and overfull courses, most students actually take four to five years. In the same amount of time students could earn a baccalaureate degree that would better prepare them for both graduate education and advanced practice.

The study argues that a bachelor's degree should be the minimum requirement for licensure. Furthermore, they feel that steps should be taken in the industry to require that nurses with a baccalaureate go on to complete a master's degree within the first ten years of their practice. The report contends that by improving nurses' overall level of education and integrating teacher training into all master- and doctoral-level nursing programs, the system could solve both its academic challenges and its struggle to provide enough faculty and graduates to keep up with the nursing shortage.

Of course, advocates for community college nursing programs object to the suggestion that a bachelor's degree should be required for entry into the field. They feel that the two-year degree makes nursing practice more accessible to people who are older, often have families and need a quick route to a career. A member of the National Association for Associate Degree Nursing (N-OADN) points out that those students who take more time are typically working other jobs while in school and need access to the flexible schedule and lighter course load offered by associate's programs. Furthermore, N-OADN contends that there is no evidence that there is a safety discrepancy between levels of education.

A Nursing Classroom

Other key suggestions the study makes for improving nursing education include:

Improve the integration of classroom learning into clinical practice.

Much of the nursing curriculum is presented as taxonomy or abstract theory. Nursing schools can improve students' understanding of important concepts by guiding them in the practical application of their learning. The study adds that this integration could also be improved by teaching certain concepts such as diagnostics in a real clinical setting.

Broaden students' modes of thinking.

Most programs place an emphasis on critical thinking to the exclusion of critical imagination and scientific, creative and critical reasoning. These modes of thought are crucial to teaching practitioners to 'think on their feet' when working with patients.

Nurse and Patient

There were also two important positive findings in the report. First, the study found that American nursing programs promote a strong sense of ethics and professional identity. Second, the study found that direct clinical experiences with patients is one of the greatest strengths of U.S. nursing education. Although schools typically fail to integrate clinical experiences with classroom experiences, nursing students are still getting invaluable opportunities through clinical responsibilities and assignments.

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