NURSING TRENDS: EVOLUTION OF NURSE EDUCATION

Due to the new healthcare reform the demands for health professionals will continue to increase. The role of the healthcare professional has also taken on more responsibilities. With these responsibilities comes a greater need for nurses with high levels of education. Already nurses with only a licensed practitioner or licensed vocational degree (LPN/LVN) are being limited in their roles and reduced in the field. Hospitals and clinics no longer entrust them with patient care despite there being a large number of them and normally with a vast amount of experience. The mark of a smart nursing student is to go ahead and receive a bachelors degree in nursing (BSN). Not only does it increase your potential to be hired but sets you on the correct path to advance your education should you choose to excel up the ladder of your nursing career. There are also several programs to help current nurses with only an associates degree in nursing (ADN) to bridge into a BSN and many nurses are taking advantage of it. These increases in education requirements have placed great demands on colleges with nursing programs to increase their student body and to hire more nursing professors. It has made colleges re-evaluate the courses they require students to learn such as evidence-based skills, leadership roles, and emphasis on autonomy. Undergraduate level education is not the only area to be tweaked as graduate nurses are being pushed to exceed from a masters to a doctorate. As the healthcare system evolves to service more patients due to new health insurance requirements and an aging baby boomer generation, the need for advanced nurse practitioners is increasing. Nurse practitioners are nurses who can practice in a number of specialties: neonatal, acute care, pediatrics, geriatrics, family medicine, midwives, and nurse anesthetists. They are allowed to diagnose and treat patients with or

NURSING TRENDS: EVOLUTION OF NURSE EDUCATION

without a doctor supervising (depending on the state). They can also prescribe medication to patients (some states dont allow them to prescribe narcotics though). The responsibilities of a nurse practitioner are ever-growing as the need for healthcare increases among the population. The current education requirement for a nurse practitioner is normally a bachelors degree in registered nursing, clinical experience, and then a masters degree in nursing (MSN). The MSN program generally takes two years to complete and most of it is online. However, new guidelines have been set forth that will require all advanced nurse practitioners to obtain a doctoral degree in nursing (DNP). This new requirement will affect nursing programs, future nurses and current nurse practitioners. The expense of getting a doctoral degree is difficult for many people including registered nurses who already face tough economic times. Current NPs may have to stop their practice in order to go back for further education causing undue burden on not only themselves but their patients. The new education requirement will give more authority to the NP role, make nurses more knowledgeable in their field, and create more leaders in the health profession. The history of nursing education extends back to ancient times when it was more of an art form than a profession. During this time anyone could simply call himself or herself a nurse; the idea of nursing meant one who simply nurtures the ill. A wide variety of members of society would take on the responsibilities of the nurse from Priestesses and the elite of society to slaves and servants. It was during the 1800s when nursing was mainly looked down upon because of the prostitutes and criminals who would fill the role, often as a punishment or inability to pay for their own medical care.

NURSING TRENDS: EVOLUTION OF NURSE EDUCATION

It was not until 1836 that the Kaiserwerth Institute of Deaconesses was established in Germany that nursing began to make a turn. Pastor Theodore Fliedner created the nursing program as a way for Deaconesses (female servants of the Church) to provide service for the community. Kaiserwerth is the same school that Florence Nightingale received her nursing training at during a three-year program. Nightingale revolutionized nursing as we know it today. She is the first person who applied a standard to nursing by stating, a unique body of knowledge is required to practice professional nursing. In 1860 she founded a training school for nurses at Saint Thomas Hospital London. The program was one year long and graduating nurses were recorded on the Register for Certified Nurses. This style of nursing education (hospital diplomas) would continue well into the 20th century; however, it was not until after the Civil War that hospital schools would be established in the United States. The first hospital school in the United States was the Bellevue Hospital in New York City, New York in 1873. Training involved basic cleanliness, neatness, and patient comfort and by the late 1870s doctors began to lecture on Anatomy and Physiology as well as hygiene. Despite the development of nurse training programs, hospitals were still churning out nurse graduates who were woefully unprepared to care for patients. Due to concerns of the care of ill patients and the incompetence of nurses to fulfill these duties the Nurses Associated Alumnae of the United States and Canada was formed (now known as the American Nurses Association). This also led to the American Society of Superintendents of Training Schools for Nurses (now known as the National League for Nursing

NURSING TRENDS: EVOLUTION OF NURSE EDUCATION Education) whos purpose was to create standards for nurse education. Later, states would begin to pass nurse licensure laws (Smith, T). World War II, the Social Security Act (provided financial assistance for nurses who studied Public Health), and the Hill-Burton Act (called for a greater amount of

hospitals in the U.S.) would advance nursing as these events created a shortage of nurses. In 1964 the Comprehensive Nurse Training Act was established. This measure brought together all the different avenues of nurse education and provided financial support for nursing students. It was this act that would also compel the American Nurses Association (ANA) to write its first position paper on Education (Smith, T.) During this time that ANA wrote their first position paper on nursing education, the nursing field had a variety of ways to become a nurse: Licensed Practical Nurse, Registered Nurse (RN) Diploma Program, RN Associate Degree Nurse (ADN), and RN Baccalaureate Degree Program (BSN). It is also important to note this was the same time period that Medicare and Medicaid health reforms were passed. This reform led to a greater patient demand thus a greater nursing demand and in different roles. Another significant factor is nurses were still being treated as assistants to physicians. Nursing was predominantly hospital based and even if nurses sought education outside the hospital setting, once in practice they were under the hospitals decision as to where and how they would practice their profession. As the healthcare system evolved to the point that hospitals only provided acute care and outside medical services provided preventative and primary care, so did the need of educated nurses. Only BSN nurses are prepared to practice in critical care, outpatient care, public health, and mental health.

NURSING TRENDS: EVOLUTION OF NURSE EDUCATION

Another consideration is that a liberal education prepares a nurse to deal with different cultural and societal perspectives of patients. ANAs position paper sought to upgrade the education level of the nurse, to cement its role as a profession and not an occupation, and to elevate the role of the nurse as an autonomous professional (not a assistant of the doctor). In order to do this they set the following goals: technical nurses that would seek two year education programs in junior colleges (ADN) and professional nurses that would obtain a four year education at a college or university (BSN). The RN BSN would be the minimum preparation for a professional nurse. In addition, there would be assistants in healthcare settings who would seek shorter education in technical schools (LPN). Altogether, diploma RNs would no longer be necessary and hospitals would be a place to help colleges train their students but do no educational training themselves. It also defined roles for each level of education. The effects of this position paper have primarily limited the diploma RN workforce but the evolution of nursing education is still occuring. As of 2000 Spratley, Johnson, Sochalski, Fritz & Spencer found that since 1995 55.4 % of RNs have associate degrees, 38% have a bachelors degree, and 6% come from diploma schools. This is not to say that changes are not still taking effect; it is just that the changes did not take effect as soon as ANA would have envisioned. Most associations such as the National Advisory Council on Nurse Education and Practice, the American Acute Critical Care Nurses, and Pew Health Professions commission are calling for at least two-thirds of the nursing workforce to be trained in BSN. The nations military and Public Health Service only accept RN BSN. Even Veteran Affairs offers a program to train nurses to become BSN

NURSING TRENDS: EVOLUTION OF NURSE EDUCATION nurses. Some states have also instituted the BSN-in-10 program requires all nurses to obtain a bachelors degree within ten years of graduation in a diploma or ADN program. The history of the evolution of nursing education as of yet is interesting and

important to note because now the AACN has put out a new position paper stating that all nurse practitioners should obtain a doctorate in nurse practitioner instead of a masters degree (which was formerly the accepted standard). The need for reformation of the nurse practitioner education came stemmed from data that showed a large rate of medication errors in the United States. From there commissions deduced that a more thorough level of education for nurse practitioners was needed. Other noted needs for change listed in the position paper included one name for a nurse practitioner. As of this date there are several different names which leads to public confusion (Im still confused). There are ND (doctorate in nursing), DrNP (doctor of nurse practitioner), DNP (doctorate in nurse practitioner), and DSN (doctorate in science of nursing) titles to identify a nurse practitioner with a doctoral degree. There also needed to be a curriculum with practice-based emphasis instead of research-based emphasis. The program needed to stress leadership roles as NP would be required to be the executive in many scenarios, and solve clinical problems within the healthcare setting. The authors also noted that the level of hours currently required for a masters in advanced nurse practition were well above the number for any other masters degree program. Implications for this new program are a lot. First, there arent that many doctorate programs offered by universities. There is also a financial burden on nurses who will have to go back and complete the program. There is no standard curriculum even though the AACN wants all nurse practitioners to fall under the same title. Now it

NURSING TRENDS: EVOLUTION OF NURSE EDUCATION

has also been brought to have some sort of certification examination. While the association for nurse anesthetists have been on board with this level of education for their speciality other associations have not been so enthusiastic. Nurse practitioners with a general care practice do not feel the need to advance their education any further. They believe that the masters degree is the foundation and terminal degree for their profession. Another problem is the lack of nurse educators to education a student to the doctoral degree. And this is where Im going to stop because my brain is fried!