Transforming Nursing Education to Meet Emerging Health Care Needs
The Robert Wood Johnson Foundation Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? Today’s post is by Judith Halstead, PhD, RN, FAAN, ANEF, president of the National League for Nursing and executive associate dean for Academic Affairs at the Indiana University School of Nursing.
The changes proposed by health care reform have the potential to significantly alter the environment in which nurses and other health care professionals will practice. The emerging emphasis on primary care, transition care, and accountable care organizations underscores a fundamental shift in how the US health care delivery system is envisioned to function in the future. This future health care environment is very different from the one that many of us in academia currently prepare our students to practice in, i.e., an environment that has been predominately focused on preparing students for practice in the acute care setting. The IOM’s Future of Nursing: Leading Change, Advancing Health (2011) clearly identifies changes that need to occur in nursing education if we hope to prepare nurses with the competencies and skills required to practice in a redesigned health care system.
What is the role of nursing education in realizing a transformed health care system? The role can be a significant one, but only if we are willing to re-examine our current nursing education models. To produce nurses prepared to practice in reformed health care environments, we can no longer educate our nursing students using the traditional educational practices that we have long embraced. There exists no substantive evidence to suggest that our traditional means of clinical education in nursing and other health professions are particularly effective in developing clinical reasoning, so it is an opportune time to closely examine our educational practices and create new learning paradigms that are grounded in evidence. I believe we need to focus on four priority areas in order to achieve meaningful transformation in our nursing education models: 1) building faculty capacity; 2) designing new models of clinical education; 3) developing innovative models of academic/practice collaboration; and 4) advancing the science of nursing education through research.
Building faculty capacity in our nursing education programs is a key factor in transforming nursing education. The existence and causes of our nurse faculty shortage are well documented. An aging faculty workforce, compensation that is not competitive with practice settings, and an insufficient pipeline of nurses qualified to teach in our academic programs are some of the most commonly cited reasons for the shortage. But it is short-sighted to believe that building our faculty capacity can be addressed solely by recruiting additional nurses into academia. It is also be important for us to emphasize academic preparation in nursing education and faculty development programs to help novice educators develop their teaching skills in interactive learning environments. It is equally important to re-tool current faculty who are being challenged to teach in a changing and increasingly complex health care environment in which they do not have extensive practice experience.
We also need to focus on the redesign of our clinical education models. New models are needed that will provide our students with learning experiences in patient-centered environments spanning the care continuum. We will need to design evidence-based learning experiences that prepare nurses to work in interprofessional health care teams and manage care transitions among settings. Where and how we teach our students also needs to be reconsidered. Our traditional, fragmented approach to clinical education is failing to adequately prepare graduates for transition into practice. The practice of moving students through multiple clinical agencies requiring frequent re-orientation to new facilities results in the loss of valuable learning time. One innovative clinical education model that would diminish fragmentation and prepare students for delivering transitional care, would be the creation of sustained “learning communities.” These groups would consist of student cohorts and faculty in partnership with selected clinical agencies and community entities throughout the course of the students’ clinical education. The unique education/practice/community partnership established within learning communities would facilitate student movement across care settings, with the students remaining associated with specific institutions and communities throughout their program. The time spent on learning how to deliver patient-centered care would be maximized for learners in such a clinical model.
I believe that we have learned the value of academic/practice models of collaboration in health professions education, where education and practice partner to ensure that graduates are prepared with the competencies necessary to practice in our current and proposed health care environments. The academic and practice silos of the past are much less in evidence today. However, we still have much to learn about how to most effectively use partnerships to evaluate the impact of education on improved patient care outcomes. Such partnerships will become increasingly important to leverage the expertise and resources of both academic and practice settings which are needed to address the complexity of patient care needs that we face in our country.
And finally, to advance the science of nursing education and evaluate the learning outcomes associated with innovative new education models and teaching strategies, it is essential that we base our practice as educators on evidence. The National League for Nursing has identified national research priorities for nursing education (2012) that are designed to lead the reform in nursing education needed to prepare nurses to meet emerging health care needs. Federal funding initiatives dedicated to supporting educational research in nursing and other health professions are needed to help build a well-qualified health care workforce. Large-scale funding can help us demonstrate the linkages between education and quality patient care outcomes, and be a contributing catalyst to the continued transformation of our health care system.