A number of factors are preventing nursing education from reaching its full potential. Nursing education has not changed significantly in the last half century. There appears to be a lack of clinical training availability and faculty. Other issues include: RNs have little financial incentive to leave clinical nursing to become instructors, upwards of half of all present faculty will retire within this decade, that faculty are not being replaced at the same rate and yet there will be a need for even more instructors soon.
It has been suggested that the many ways to enter nursing does not encourage enough graduates to continue on past the ADN or BSN therefore missing the opportunity to become instructors. Without faculty, potential applicants will not become nurses. Unfortunately, many thousands of applicants are turned away yearly. How can the system be changed to correct this situation?
In Educating Nurses A Call for Radical Transformation, Patricia Benner set out to investigate present nursing education with this question: Are nurses graduates adequately prepared to practice to their maximum potential? The answer she found was no.
There were strong points in present nursing education but areas where changes could be made. This is not entirely because of any shortfall of nursing education. There are pressures, challenges, and issues that place unprecedented demand on the nursing profession. Many of them originate outside of the nursing profession.
The first challenge is the state of professions in general. The Benner mentions that one hallmark that distinguishes professions from other career paths is it’s sense of social responsibility. Professions must advance society’s good. Yet in recent decades society and therefore the professions have placed more of an emphasis on technical knowledge and adherence to the business model. Health care professions and nursing have not been immune to this philosophical shift in the professions. Nurses must often feel caught between their core values and fulfilling the bottom line, especially given that much of health care in the nation is private and for profit.
The turmoil in the health care system does not create the ideal environment for nurses to be adequately prepared on graduation. Turmoil and change can often result in philosophies that deal with crises in a short term way, often sacrificing long term vision as a result. For example the enormous need for more nurses puts pressure on educational institutions to lower admission requirements and to fast track students to achieve the numbers over quality. That urgency will only increase this decade, so nursing education needs to transform as Benner stated.
What does this transformation look like? She emphasizes the importance of integration of the 3 foundations of nursing education.
All three foundations must be integrated and not taught in isolation. The first foundation is nursing knowledge and science. Yet the acquisition of knowledge is not the end goal. Learning must be experiential, situated coaching in a community of practice. She stresses clinical reasoning and teaching for a sense of salience which she describes as gauging what is important to know and do for a patient and his/ her particular situation. It is knowing how to use the knowledge the student has acquired. Health care is unpredictable and open ended so the student must be able to evaluate what is the best course of action. She cites 2 examples of this from her interviews with instructors:
The student didn’t realize that 7 days was too long for a patient with an appendectomy to be in hospital. So they examined the patient and took a better history. Although they looked at the report it wasn’t as thorough as it could be; it did not provide any clues. Through investigation they discovered gangrene in his colon; that was why he was there so long.
Part two of this article next week.
Sources:
Educating Nurses: A Call For Radical Transformation. P Benner et al. The Carnegie Foundation for the Advancement of Teaching 2010 Jossey Bass
http://www.ocne.org
http://www.rwjf.org/grants/grant.jsp?id=67700
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