In addition to a looming shortage of nurses and a current shortage of nurse faculty, the nursing profession faces another hurdle as it moves into the 21st century: Nurse training programs are using out-of-date curricula.
That’s the conclusion of a new book that calls for sweeping reforms to nursing education programs around the country. The nation’s nurses are not getting the kind of education they need to provide the highest quality of care to their patients, argue the authors of Educating Nurses: A Call for Radical Transformation.
“A significant gap exists between today’s nursing practice and the education for that practice, despite some considerable strengths in nursing education,” the authors write. “Simply requiring more education will not be sufficient; the quality of nursing education must be uniformly higher.”
The book, which was released in December, summarizes the findings of a three-year study of nursing education under the auspices of the Carnegie Foundation for the Advancement of Teaching. The project is the first national study of nursing programs in the United States in four decades and was funded by the Atlantic Philanthropies.
“We’ve had a kind of silence on teaching and learning in nursing for last 30 years,” explains Patricia Benner, R.N., Ph.D., F.A.A.N., lead author of the book and professor emerita and former chair of the Department of Social and Behavioral Sciences at the University of California in San Francisco. The reason for the lag is that research dollars have gone toward clinical and scientific research in recent years rather than to research on education practices, she says.
As a result, nursing school curricula have not kept pace with changes in the science and technology of nursing, and nurses—and the patients they care for—are paying the price, Benner says. This problem comes at a time when the profession is also facing a shortage of nurse faculty and a growing shortage of nurses, which also threaten to undermine the quality of patient care.
Authors Make Dozens of Recommendations for Change
Benner and her three co-authors—Molly Sutphen, M.S., Ph.D., a historian at the University of California in San Francisco; Victoria Leonard, R.N., Ph.D., a family nurse practitioner and child care health consultant in San Francisco; and Lisa Day, B.S.N., M.S., Ph.D., a clinical nurse specialist at the University of California in San Francisco—say dozens of changes are needed to bring nursing education up to speed.
Recommendations include requiring nurses to earn four-year baccalaureate degrees before they practice, and master’s degrees in nursing within 10 years of earning their baccalaureate degrees.
They also want community colleges to redesign their programs so associates degree nursing students can make a smoother transition to baccalaureate programs and to ensure that all nursing students complete their studies in a reasonable period of time.
The authors want nursing school educators to make a greater effort to emphasize integration of clinical practice in student coursework. And they urge nursing schools to do a better job of preparing nurses to work not just in hospitals but in a variety of settings.
Benner says the book has been well received by nurse educators, and she is hopeful that it will serve as a catalyst for change at schools around the country. A good first sign of that came last fall when nurse educators at the University of Pennsylvania invited Benner to help them change their nursing school curricula to reflect lessons learned from the study.
“This new study from the Carnegie Foundation for the Advancement of Teaching is important, and its recommendations are bold,” said Susan Hassmiller, Ph.D., R.N., F.A.A.N., the Robert Wood Johnson Foundation (RWJF) senior adviser for nursing. “I commend the authors for their work and all the thought they put into this. Nurses and how they are educated is such an important issue that the Foundation is also working on a series of recommendations through its Initiative on the Future of Nursing, at the IOM, which will have recommendations of its own this fall. Together, these two reports can help reshape the future of nursing and nursing education in this country.”
Still, the Carnegie Foundation study’s authors have encountered some resistance to their recommendations—especially to their proposals for heightened education requirements and changes to community college nursing programs. But Benner counters that increased education requirements have been shown to improve patient outcomes. “It’s really important given the need for more advanced practice nurses,” she says. “We find it ridiculous that a teacher needs a four-year degree but a nurse can enter the field with only two years of education.”