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

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

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

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 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 Nightingale revolutionized and professionalized nursing Opened 1 st nursing school in 1860 in London Opened 1 st nursing school in 1860 in London Principles: Principles: Nurses trained in educational institution Nurses trained in educational institution Independent of but affiliated with teaching hospital Independent of but affiliated with teaching hospital Curriculum of both theory & practice Curriculum of both theory & practice Nurses administer, instruct, & paid Nurses administer, instruct, & paid Students selected should live in “nurses’ houses” Students selected should live in “nurses’ houses” Students required to attend lecture, take quizzes, write papers, keep diaries Students required to attend lecture, take quizzes, write papers, keep diaries

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

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

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

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

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

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

ANA Again 1979 – ANA further strengthened its resolve by proposing 1979 – ANA further strengthened its resolve by proposing By 1985 the minimum prep for entry into professional nursing practice should be the baccalaureate 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 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 There should be increased accessibility to high-quality career mobility programs that use flexible approaches for individuals seeking academic degrees in nursing

Other Influences on Baccalaureate Education 1970: Lysaught Report recommendations 1970: Lysaught Report recommendations Need for increased research into both the practice and education of nurses Need for increased research into both the practice and education of nurses Enhanced educational systems and curricula 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 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

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

What skills do you have? 2008 AACN Publication The Essentials of Baccalaureate Education for Professional Nursing Practice 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: 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 Provider of care; designer/manager/coordinator of care and member of a profession 2000 NLN Educational Competencies for Graduates of Associate Degree Nursing Programs 2000 NLN Educational Competencies for Graduates of Associate Degree Nursing Programs 8 Core competencies 8 Core competencies Professional behaviors Professional behaviors Communication Communication Assessment Assessment Clinical decision making Clinical decision making Caring interventions Caring interventions Teaching and learning Teaching and learning Collaboration Collaboration Managing care Managing care

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

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

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

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

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

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