While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
A lot, according to Mary Ellen Smith Glasgow, PhD, RN, ACNS-BC, a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow (2009-2012) and the new dean of the school of nursing at Duquesne University.
Last year, while serving as associate dean for nursing, undergraduate health professions and continuing education at Drexel University, she incorporated the tenets of the Japanese car manufacturing system—which emphasizes concepts such as quality and safety and waste reduction—into Drexel University’s nursing school curriculum. She was the first nursing school faculty member in the country to do so, and she plans to integrate the system into the nursing school curricula at Duquesne, too.
Glasgow is one of countless nurse educators and administrators across the country who are rethinking teaching methods to better prepare students to ensure that all Americans have access to high-quality care in a reformed health care system.
It is, in fact, a new dawn in the way nurses are educated in both academic and clinical settings, according to nurse education experts.
“I see more excitement and innovation across nursing education now than I’ve ever seen before in my career,” said Gwen Sherwood, PhD, RN, FAAN. She is associate dean for academic affairs and professor at the school of nursing at the University of North Carolina at Chapel Hill and co-investigator of Quality and Safety Education for Nurses (QSEN), an RWJF-supported initiative. “It’s a very exciting time.”
Innovation in nurse education, of course, is nothing new. But the pace of change has accelerated in the last few years thanks to a number of recent events, experts say.
In January 2010, the Carnegie Foundation for the Advancement of Teaching released a report calling for a “radical transformation” in nurse education. In March of that year, President Obama signed into law unprecedented reforms to the U.S. health care system. In October of 2010, the Institute of Medicine (IOM) released a groundbreaking report about the future of nursing that discusses innovation in nurse education. And that November, the Foundation launched The Future of Nursing: Campaign for Action, an initiative to advance comprehensive change in the nation’s health care system that is grounded in the IOM report; it is also helping to spur changes in nurse education.
These events build on other philanthropic programs that are prompting nurse researchers, educators and administrators to review and evaluate curricula and innovations. RWJF-funded or initiated programs include QSEN, which aims to help nurse educators discover effective ways to promote student learning to prepare future nurses to become full partners in the work of improving patient safety and health care systems; Evaluating Innovations in Nursing Education, which funds evaluations of nurse education innovations targeting faculty work-life and productivity; and Academic Progression in Nursing, which aims to advance state and regional strategies to create a more highly educated nursing workforce.
“Changes such as health care reform, the aging nurse faculty workforce, and the increasing complexity of health care demand that we do something different,” said Judith Halstead, PhD, RN, FAAN, president of the National League for Nursing. “It’s almost a perfect storm that requires us to really examine what we’re doing in the classroom.”
Patricia Benner, PhD, RN, FAAN, an expert on nurse education and professor emerita and former chair of the Department of Social and Behavioral Sciences at the University of California in San Francisco, agrees. “The discussion about nurse education had become dormant. I’m really encouraged by the response that the schools are making.”
Barriers to change remain in place, not least of which is the pressure to meet education and regulatory requirements set by academic institutions and professional organizations. But nurse educators and administrators must overcome those barriers, Benner and others say.
Much of the current nurse education system is based on the “Tylerian model,” which was formulated more than 50 years ago and emphasizes content, structure and measurable, behavioral outcomes, according to the National League for Nursing.
Now, Benner and other nurse researchers are calling for curricular changes that emphasize how, along with what, students learn. Educators are bringing classroom and clinical teaching together by integrating knowledge acquisition and situated knowledge use in the classroom and clinical practice. The health care system and the patient population have undergone dramatic changes in the last half-century, but many nurse educators teach their students in the same way that they were taught decades ago.
“A significant gap exists between today’s nursing practice and the education for that practice, despite some considerable strengths in nursing education,” Benner and her co-authors wrote in the Carnegie report, Educating Nurses: A Call for Radical Transformation. “Simply requiring more education will not be sufficient; the quality of nursing education must be uniformly higher.”
Nursing school educators and administrators are responding to that call with innovations that will help nurses provide a higher quality of care in a range of settings. Many innovations fall into one of several broad categories: simulation technology and narrative pedagogy; new and stronger partnerships between academia and practice; new education systems that help students earn their degrees and advance their education; and the increasing use of new technology in the classroom. Others, like Glasgow’s integration of the Toyota model into nursing curricula, don’t fit into one of these categories but bring their own brand of creativity and responsiveness to the demands of educating nurses in the 21st century.
The use of dynamically sophisticated simulation technology and narrative pedagogy is one of the hottest trends in nursing education. In these situations, nurse educators create a narrative, or a story, about a fictional patient in need of medical attention. Students respond and provide treatment to the fictional patient on a high-fidelity mannequin that responds as if it were an actual person.
Many nursing schools also are forging stronger partnerships with hospitals and other health care institutions. The results include postgraduate nurse residency programs at health care organizations and dedicated education units at hospitals or other health care facilities that provide clinical education to nursing students and patient care at the same time.
Nurse administrators are also experimenting with new education systems that make it easier for students to earn nursing degrees and to advance their education. These include partnerships that ease the transition between associates-degree and baccalaureate nursing programs. Eight community colleges and one university in Oregon, for example, have created a shared curriculum in nursing, which enables nurses with associate degrees to move more easily into baccalaureate programs. Learn more about the Oregon Consortium for Nursing Education here.
Other innovative systems enable nursing students to earn baccalaureate and master’s nursing degrees at an accelerated pace or to complete some coursework online.
Proponents of these types of new educational systems say they will help more nurses advance their education, a goal supported by the Institute of Medicine in its groundbreaking report The Future of Nursing: Leading Change, Advancing Health. It recommends that 80 percent of the nursing workforce be prepared at the baccalaureate level by the year 2020 to ensure that all Americans have access to high-quality, patient-centered care in a reformed health care system.
Proponents of innovation also cite benefits such as enhanced faculty productivity and school capacity, which could alleviate a shortage of nurse faculty and a looming shortage of nurses; opportunities for interdisciplinary education; and higher rates of patient satisfaction. Researchers are currently evaluating whether, and to what extent, these hypotheses are true.
Technological innovations are also changing the way today’s nursing students learn. Electronic readers are replacing textbooks, faculty are showing YouTube videos during class and creating virtual “Second Life” teaching scenarios, and students are connecting with each other via social media outlets like Facebook and Twitter. But experts caution that while the tools themselves may be new, they do not necessarily represent innovation in nurse education. That, they say, only comes by using the new tools to teach in creative and innovative ways.
However technology is used in the classroom, change is a given, Halstead says. “The classroom of the future will be very interactive and technologically well-equipped. Students won’t come into the classroom and line up in chairs and have content delivered to them. Rather, students will be very much engaged in interactive learning.”
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