Nursing education must transform itself to keep pace with a rapidly changing health care system and an aging population, experts said at a forum organized by the Initiative on the Future of Nursing in late February in Houston. The Initiative is a two-year, joint effort of the Robert Wood Johnson Foundation and the Institute of Medicine to examine issues facing the nursing profession and develop recommendations to ensure that the nursing workforce can meet the demands of reformed health care and public health systems.
The forum was the last of three hosted by the Initiative before the panel makes its recommendations. It was arranged in a series of “armchair discussions,” with a moderator directing questions to diverse experts.
What Should Be Taught
The populations that nurses serve in the future will be older and more complex, with many more people managing multiple conditions or medications. The United States will add another 10 million people over the age of 80 in the next few years, and “we are moving from urgent to crisis,” Terry Fulmer, Ph.D., R.N., F.A.A.N., dean of the College of Nursing at New York University, told the audience. In addition to scientific and evidence-based knowledge, the panelists recommended that nursing education include a focus on the needs of older patients.
Speakers also advocated cross-team and interdisciplinary collaboration, not only in education, but also in practice. “Right now we teach… patient-nurse interactions, rather than thinking more broadly in a systems approach,” said National League of Nursing chief program officer M. Elaine Tagliareni, Ed.D., R.N., C.N.E. With an increasing patient population and a shift to treatment outside of acute care settings, nurses cannot do it alone, panelists said.
There was no clear consensus among the panelists about how to drive more nurses to advanced and higher education. Linda Cronenwett, Ph.D., R.N., F.A.A.N., professor and dean emeritus of the School of Nursing, University of North Carolina, Chapel Hill, said the number of graduate-level nurses will not increase unless the number of people exposed to nursing for the first time increases. She recommended increasing funding and scholarships for entry-level nursing students. Fulmer also recommended decreasing the time it takes to complete the higher degree process.
“I think we need to make a distinction between what someone needs to learn when they’re preparing to practice, and what information and knowledge they need to continue their practice across the lifespan,” said Marla Salmon, Sc.D., R.N., F.A.A.N., dean of nursing and a professor at the University of Washington School of Nursing. She added that we need more nurse researchers and scientists to generate the knowledge to increase quality of care.
How It Should Be Taught
As methods and models of health care delivery change, nursing education has begun making strides to keep up. A variety of successful initiatives have been implemented across the country to engage nursing students more fully in their education and service delivery. Several experts said this approach should be implemented more broadly.
The use of simulations, for example, “allow nurses to problem solve in a safe environment,” Pamela Jeffries, D.N.S., R.N., F.A.A.N., A.N.E.F., associate dean of academic affairs at Johns Hopkins University, School of Nursing said. Simulations are especially effective when they focus on a specific competency, but there should be a set of national standards for them, she added.
Residency programs also allow for additional practice, said Cathleen Krsek, R.N., NEA-BC, F.A.C.H.E.. They ease the transition from school to practice, reducing turnover and increasing staff satisfaction. Nurses in the University Health Systems Consortium’s UHC/AACN Nurse Residency Program, which Krsek manages, also continue their education with an evidence-based research project during the one-year program.
Robert Mendenhall, Ph.D., told the panel that e-learning and online education are both cost-effective ways to expand the capacity of nursing education. Western Governors University, where Mendenhall serves as president, operates an entirely online program with no credit hours or grades. Completion is based on mastering and passing specific competencies. Because the program is self-paced, faculty become mentors instead of content deliverers, and students report more interaction with faculty than in a classroom, he said. The online program serves more students, with fewer educators, than a traditional setting and is self-sustaining through the cost of tuition.
Florida International University (FIU) also offers a non-traditional program setting. Its inter-professional program pairs nursing students with students in other health care disciplines in a community-based curriculum. Groups of students are assigned to households in underserved, ethnically diverse neighborhoods, where they work together to assess health care and social service needs, provide health education, identify unmet health care needs, and make recommendations to the appropriate community agencies. Not only does the program produce “culturally competent students [who] understand diversity” and collaboration, said John Rock, M.D., senior vice president for medical affairs and founding dean of the Herbert Wertheim College of Medicine at FIU, it engages the entire community to improve quality of life.
Where It Should Be Taught
The third panel continued making a case for classrooms and curricula fit for nursing schools of the future, in order to ensure that existing resources will reach more students. The state of Florida, for instance, has created nine nursing programs at community colleges that offer bachelors degrees instead of the traditional associate degree. Oregon’s 18 nursing schools have joined together to create a statewide core curriculum based on competencies instead of course hours. Additionally, some students who are admitted to the state’s community colleges are simultaneously admitted to universities, to remove barriers to getting a degree.
Catherine Rick, R.N., NEA-BC, F.A.C.H.E., chief officer of the Veterans Administration (VA), Office of Nursing Services, discussed the VA Nursing Academy—a partnership with nursing schools to increase student enrollment while also increasing recruitment and retention of VA nurses.
The Area Health Education Center (AHEC) of Southern Nevada provides another model, using existing community resources to develop interdisciplinary sites where students in various health fields learn and practice. The groups rotate team leadership, and do not always follow a traditional medical model. “They link community, academia and practice by developing clinical rotation experiences for students,” Executive Director Rose Yuhos, R.N., said.
See a webcast of the Forum here.
The Initiative on the Future of Nursing will present its recommendations late this year.