Chapter 03

Chapter 3
The Influence of Contemporary
Trends and Issues on Nursing
Education
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

 Knowledge expansion, use of technology, the Internet
 Unlimited information is available
• Use of digital technology to guide patient care
 Requires more time and skill to navigate the Web, even though
most students have less time for study
• Peer to peer learning
 Faculty revising curriculum and courses
 More courses and degree programs delivered online
• Simulation to evaluate competency
 Increase in social media
• Code of ethics being developed by employers and professional
nursing organizations
 Informatics competencies developed
• QSEN
• NONPF
Trends and Issues in
Contemporary Nursing Education
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 2

 Practice-based competency outcomes
 Business world uses competency outcomes to set
directions and goals
 Students (nurses) must achieve the competency
outcomes that develop the skills actually needed in
practice
 Competence in realistic, practice-based outcomes is
the target
Trends and Issues in Contemporary
Nursing Education (cont'd)

 Outcomes approach is very different for students
and teachers
 Students must change from memorizing class notes
and readings to learning to integrate knowledge,
make decisions, and be competent and confident in
the abilities contained in course outcomes

 Performance-based learning, assessment methods
 Related issues
• Changes in roles of teachers and learners
• Refocusing responsibility and accountability
• Shifting the perception of students from passive receivers of
information to active learners
 Skills required of nurses
• Problem solving
• Communication
• Teaching
• Caring
• Management

 These skills are most effectively learned through
activities such as:
• Problem-based learning
• Case studies
• Diverse projects in many community agencies
 Evaluation is based on documenting competence
• Performance-based examinations
• Developing a structured portfolio
 Faculty issues
• Creating interactive learning strategies
• Creating performance examinations
Trends and Issues in
Contemporary Nursing Education
(cont'd)

 Sociodemographics, cultural diversity, economic and
political changes
 Aging population—people living longer
 Diverse population
• Use of traditional practitioners and treatments other than traditional
Western medicine
 Increasing number of people living in poverty, homeless, and/or
uninsured
 Disrespect for others
 Domestic abuse of women and children
 Various forms of violence in homes, schools, and public places
 Obesity epidemic
 Nontraditional families

 Community-focused, interdisciplinary
approaches
 Interprofessional emphasis
 Influenced by efforts to reduce health care costs
 Shift from “illness care” to “health promotion”
 Challenge for faculty to prepare students to care for
critically ill patients in acute care, as well as culturally
diverse clients in community settings
 Global health

 Consumer-oriented care: engagement, safety, and
privacy
 Shift from “giving care” to “working with” the patient as a
member of the health care team
 Increased number of medical errors leading to lawsuits have
supported the need to insist on competency-based
performance examinations in schools of nursing and as part of
employer evaluations and accreditation
 Ethics and bioethical concerns
 Different ways of responding to illness, care providers, and
therapies raise ethical issues of who is right and who has the
right to prevail

 Diversity in backgrounds conveys diversity in interpretation of
behaviors, events, and language
 Faculty must teach ethical concepts, use case studies, guide
learning experiences, and focus discussions to explore ways of
interacting with patients who present behaviors that are very
different from the norm
 Shortage of nurses and faculty
 Trend over past decades
 Consequence is medical errors
 Current workforce is older, with fewer nurses available
 Fewer qualified preceptors for students
10Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

 Disasters, violence, and terrorism
 Domestic violence has increased
 Violence in the workplace and schools
 More mass disasters such as hurricanes, floods, and
earthquakes
 Nurses need to be prepared to function effectively
with other first responders

 Explosion of new information and technology
 Interactive out of class learning
 New health information technology
 Multiple care settings
 Increasing responsibilities for aging parents and children
 Professional requirements to stay current and pursue
professional development
 Higher stress related to personal and professional
demands
 Importance of self-care and “caring communities”
Increasing Professional and
Personal Responsibilities

1. A nurse is preparing to talk at a community meeting about
current trends that affect nursing and nursing education. Which
of the following should be included in this discussion?
A. Citizens are living longer, resulting in a shift in nursing practice
from community-based care to the acute care setting.
B. As our population is becoming more diverse in ethnicity, sexual
preference, and how family is defined, ethical decisions are less
clear because the values and preferences of the individual who
is seeking care must be taken into consideration.
C. Fewer individuals are choosing and entering nursing, which is
causing a near-crisis situation in terms of the nursing shortage.
D. The focus of caring for individuals suffering from domestic
violence continues to decrease, with an increase in the need to
be competent in biochemical containments in the event of
terrorist acts.

 Licensed practical nurse/licensed vocational
nurse (LPN/LVN) programs
 Shortest programs that prepare students for
licensure
 LPN/LVN programs are 9 to 12 months long and
focus on technical aspects of nursing care
 State boards of nursing set scope of practice in each
state
Major Types of Education
Programs

 Hospital diploma programs
 Linda Richards: the first nursing diploma graduate in
1873; began the movement of nurses teaching and
supervising nurses rather than those functions being
the exclusive domain of physicians
 Length of program was 1 to 2 years in the late 1800s
but subsequently changed to 3 calendar years of
practice and study
Programs (cont'd)

 All classes/experiences were under the authority of the
funding hospital
 Operated as apprenticeship programs to meet staffing
needs of the hospital until more recent times when
education took a more primary role
 Number has drastically declined because of changes in
the marketplace and a new concept of nursing education
 As programs are phasing out, some have partnered with
community colleges to provide an associate degree, and
some have become college programs
 In 2012, only 64 diploma programs remained in the U.S.
• Only 78% are accredited programs
Programs (cont'd)

 Associate degree programs
 Developed in the 1950s to shift nursing education
from the vocational and apprenticeship orientation of
LPN/LVN and hospital diploma schools to the college
environment
 Require 2 years of academic study with 2 semesters
of liberal arts and sciences
 Today largest percentage of nurses are ADN
graduates
Programs (cont'd)

 Baccalaureate degree programs
 First nursing program in a collegiate setting opened in 1909 at
University of Minnesota as a diploma school under the College
of Medicine; completion did not result in a college degree
 In 1924 Yale University had first separate department of nursing
and offered the first BSN degree
 BSN programs were developed on the premise that nurses could
provide more comprehensive and compassionate care if they
had a foundation in the arts and sciences
 BSNs require 2 years of arts and sciences and 2 years of
nursing courses and completion of 126 to 136 credits
 In 2008 about 610 generic, and 621 RN-BSN programs were
available
 In 2011 there were and 235 accelerated programs and 33 in
planning stage
Programs (cont'd)

 Master’s degree nursing programs
 Developed because of increasing complexity of health care and
need for nurse educators, administrators, expert clinicians
 National and federal recognition of the shortage of master’s- and
doctorate-prepared nurses led to increased funding for programs
and individual students
• Health Amendment Act of 1956 provided education funds for RNs to
prepare for positions in teaching, supervision, and administration
• Nurse Practice Act of 1964 provided construction costs for nursing
school buildings and funds for traineeships and fellowships for
nurses to obtain advanced degrees for positions in education,
administration, practice, and research
• Most MSN programs prepare advanced nurse practitioners and
clinical specialists
Programs (cont'd)

 LACE Report–Model of Regulation
 Licensure, accreditation of programs, certification and
education programs
 4 APRN Roles
• Nurse anesthetist
• Nurse midwife
• Clinical nurse specialist
• Nurse practitioner
Programs (cont'd)

 Clinical nurse leader program
 New role
 White paper on CNL 2007
 2007 AACN began certifying CNL’s
 Academic and practice partners are working together
to develop academic programs and to integrate CNLs
into health care systems
 Master’s prepared generalist clinician
• As of 2011 there were 99 programs across the county
• As of February 2012 there are 1926 certified CNL’s
Programs (cont'd)

 Types of MSN programs
 Most require BSN for admission
 2011–63 accelerated master’s programs and 10 in
planning stage
 RN to MSN
• Vanderbilt
• University of Maryland
 Bachelor’s degree in any field to MSN
• Yale University
• University of Tennessee
• University of Texas at Austin
Major Types of
Education Programs (cont'd)

 Doctoral degree programs
 Undergone major changes during the past 4 decades
 For many years the only program was offered by
Teachers College, Columbia University; the first nurse
graduated in 1932 with an EdD degree in nursing
education
 More than 30 years elapsed before doctoral programs
in the discipline of nursing were offered, resulting in
the doctor of nursing science degree (DNS, DNSc)
 By the 1990s the number of universities offering the
EdD degree declined and the number of nursing
doctoral degree programs increased to more than 50
Programs (cont'd)

 Two doctoral degree options
• Doctor of Philosophy (PhD)—for students interested in
research and generating new knowledge
• Doctor of Nursing Practice (DNP)—for students
interested in advanced clinical nursing practice and
clinical leadership
 As of 2012 there were 184 programs in 40 states
– 65 accredited programs and 110 programs pursuing
accreditation
 AACN position statement—by 2015 DNP should be the
entry into advanced practice nursing
Programs (cont'd)

 Distance mobility programs
 External degree model
 Makes it possible for experienced adult learners to
earn one of many degrees, including ADN and BSN,
by taking college level examinations or by combining
college coursework with specialized standardized and
performance examinations without attending class
 Known as “classroom without walls”
• Excelsior College: previously known as the New York
Regents College
• University of Phoenix Online
Flexible Education Mobility and
Distance Learning Programs

2. An RN received a diploma as entry into
professional nursing. The RN was able to
progress to an academic degree by completing
an RN-to-BSN program. This progression from
diploma preparation to an academic degree is
known as:
A. Performance-based assessment
B. Educational mobility
C. Practice-based competency
D. Continuing education

 Challenges for students
 Access to current technology and the time, money,
and ability to use it
 Students must have discipline and determination
 Career ladder programs
 Systems that offer a stepwise progression within a
single school
Flexible Education Mobility and
Distance Learning Programs
(cont'd)

Chapter 03

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Chapter 03

Editor's Notes