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CONTEMPORARY NURSING Issues, Trends, & Management Barbara Cherry • Susan R. Jacob th 7 EDITION OY RESOURCES FREE WITH TEXTBOOK PURCHASE EVOLVE ELSEVIER.COM UNIT 1 The Development of Nursing 58 now use the Internet to access courses, electronic databases and other e-learning resources and integrate evidence based practice and critical thinking. As students integrate current trends and attempt to resolve issues , they create the trends for the next generation, and are SUMMARY Chapter 3 presented 10 major trends and related issues in nursing education programs and an overview of multiple types of nursing programs. They have a significant influ- ence on the content, learning process, and evaluation meth- ods used in all types of programs and have influenced the development of new degrees and majors. Additionally, they have had a remarkable effect on the persistence of various types of programs for entry into practice and on the in- creasing acceptance of diverse mobility and distance-learning programs. Regardless of the type of program, most students participating in nursing history in the making. The most profound trend in nursing education is learning to learn, to reason, and access relevant resources to solve problems. As Carl Rogers said "The only person who is educated is the one who had learned how to learn and change.' REFERENCES Academic Center for Evidence Based Practice (website). http:// www.acestar.uthscsa.edu/ June 7, 2015. Adelman DS, Legg TJ: Disaster nursing: a handbook for practice, Sudbury, MA, 2009, Jones and Bartlett. Agency for Health Care Research and Quality: Evidenced based practice (website). http://www.ahrq.gov/clinic/epcix. htm. Accessed April 23, 2015. American Association of Colleges of Nursing: Position statement: baccalaureate degree in nursing as minimal preparation for professional practice (website). http:// www.aacn.nche.edu June 7, 2015. American Association of Colleges of Nursing: Position state- ment on the practice doctorate in nursing (website). http:// www.aacn.nche.edu/DNP/DNPPosition Statement.htm. Accessed April 23, 2015. American Association of Colleges of Nursing: The clinical nurse leader: developing a new nurse, 2009a (website). http://www.aacn.nche.edu/cnl/index.htm. Accessed April 23, 2015. American Association of Colleges of Nursing: Clinical nurse leader certification (website). http://www.aacn.nche.edu/ cnl/cnl-certification/pdf/ExamHndbk.pdf. Accessed April 23, 2015. American Association of Colleges of Nursing: Degree comple- tion programs for registered nurses: RN to master's degree and RN to baccalaureate programs, 2009b (website). http:// www.aacn.nche.edu/Media/FactSheets/DegreeComple- tion Prog.htm. Accessed April 23, 2015. American Association of Colleges of Nursing: End of life care, 2009c (website). http://www.aacn.nche.edu/elnec. Accessed April 23, 2015. American Association of Colleges of Nursing: Government affairs, nursing policy beat: healthcare reform, 2009d (website with multiple links to shortage and strategies for change). http://www.aacn.nche.edu/Government/index. htm. Accessed April 23, 2015. American Association of Colleges of Nursing: Nursing faculty American Association of Colleges of Nursing: Issues bulletin: accelerated baccalaureate and master's degrees in nursing (website). http://www.aacn.nche.edu/media-relations/ AccelProgsGlance.pdf. Accessed April 23, 2015. American Association of Colleges of Nursing: The essentials of baccalaureate education for professional nursing practice, 2008a (website). http://www.aacn.nche.edu/education- resources/BaccEssentials08.pdf. Accessed April 23, 2015. American Association of Colleges of Nursing: Cultural com- petency in baccalaureate education (website). http://www. aacn.nche.edu/education-resources/cultural-competency. Accessed April 23, 2015. American Association of Colleges of Nursing: Nursing edi programs, 2008b (website) htto Educatio FactSheets/FacultyShortage.htm. Accessed April 23, 2015. shortage, 2009e (website). http://www.aacn.nche.edu/Media/ American Association of Colleges of Nursing: Core Compe- (website). http://www.aacn.nche.edu/education-resources tencies for Interprofessional Collaborative Practice, 2011 ipecreport.pdf. Accessed April 23, 2015 America 57 Contemporary Trends in Nursing Education CHAPTER 3 options and types of programs. Some target potentially underrepresented groups, such as men, minority groups, and those with existing academic degrees. The most rapidly growing are the accelerated, fast-track, or sec- ond-degree programs, designed for non-nurses with other degrees. In 2011, the AACN reported 235 acceler- ated BSN programs and 63 accelerated master's pro- grams available at nursing schools nationwide. In addi- tion, 33 new accelerated baccalaureate programs were in the planning stages, and 10 new accelerated master's programs were also taking shape. For a list of acceler- ated nursing programs, visit http://www.aacn.nche.edu/ Education-Resources/APLIST.pdf. Trends and issues that influence nursing education make it even more important to comply with quality standards that emphasize competency outcomes. Changes in number, diversity, and qualifications of students and shortage of faculty and finances make it necessary to develop more efficient and effective learn- ing strategies for on-campus and distant students. Al- though mobility and electronic options are more conve- nient, they present issues. In addition to learning to access multiple digital resources, students also need dis- cipline and determination to pursue courses and clinical learning when a teacher is not physically present or ac- cessible. Regardless of methods, they must achieve re- quired competencies in spite of other responsibilities and learn to integrate critical thinking, reflective judg- ment, and evidence-based practices in patient care. In contrast to previous decades, organizations and schools now require more creative, responsive programs and expect more documented competence from students and faculty (Box 3-1). Although these trends pose chal- lenges for nursing students, faculties, and employers, they move nursing toward more competent professional practice and improved patient safety (Boyer, 2008). BOX 3-1 Selected Organizations Relevant to Nursing Education: General Description and Purpose American Academy of Nursing (AAN) —The organization of activities on a national level; creates and administers leaders in all facets of nursing practice, education, admin- licensure examinations (NCLEX); develops computerized istration, research, organizations, and government; the licensure examinations; and works with other organiza- think tank of the profession; promotes advancement of all tions to promote nursing standards and regulations and aspects of nursing; and publishes position papers, confer- establish interstate licensure protocols. ence proceedings, and documents to advance nursing. National League for Nursing (NLN—The national organi- American Association of Colleges of Nursing (AACN zation of nurse educators with long-standing commitment The organization of deans and directors of baccalaureate to four types of basic programs (LPN, diploma, ADN, and and higher degree nursing programs: establishes stan- BSN): includes lay citizens concerned with nursing and dards for programs concerned with legislative issues that health care on its board; has councils for nursing informat- pertain to professional nursing education and publishes ics, research in nursing education, wellness centers, and the Journal of Professional Nursing, The Essentials of Bac- multiple types of print publications; initiated a certification calaureate Education (2008), and other related documents program and examination to certify excellence of nursing pertaining to the BSN and higher-degree education. educators; and established the Centers for Excellence for American Nurses Association (ANA)-The major na- nursing programs that meet designated standards. tional nursing organization concerned with a broad scope NLN Accreditation Commission (NLNAC Formed in of practice issues: standard of practice, scope of practice, 1997 as a subsidiary of the NLN with responsibility for ethics, legal, and employment issues; a federation of establishing and implementing standards and criteria and state nurses associations, and publications relate to an for accrediting all types of schools of nursing. array of practice issues and standards. National Organization of Nurse Practitioner Faculties Commission on Collegiate Nursing Education (CCNE) (NONPF-An organization of nurse practitioners in mul- A subsidiary of the AACN with responsibility for establish- tiple specialties: sets national standards and criteria for ing and implementing standards and criteria and for ac- programs and certification. creditation of baccalaureate and graduate degree National Student Nurses Association (NSNALA national organization of statewide student nurse associations: con- National Council of State Boards of Nursing (NCSBN cerned with education and career issues and provides The organization of all state boards: coordinates licensure student perspectives to other national nursing organizations programs in nursing. UNIT 1 The Development of Nursing technology with assessment methods makes nursing degrees accessible to an increasing number of nurses District of Columbia, with 59 programs in the planning stage, which is up from 217 DNP programs in 2012 (AACN, 2014). seeking additional preparation. Career ladder programs designed as "I plus ! 1" Or u and those rapidly s ond deg other de "2 plus 2" options have been offered for many years by some schools and through several statewide programs, Multiple mobility programs are available for LPNs to obtain an ADN degree, such as one offered by the New York Coalition for Education Mobility (2004). RN to FLEXIBLE EDUCATION, MOBILITY, AND DISTANCE-LEARNING PROGRAMS schools as of 2011 (AACN, 2012). In addition, some 165 ated BS grams a tion, 33 the pla prograr ated no Educat Trer make standa Chang studer Various and nontraditional mobility programs now are commonplace. The AACN and NLN websites attest BSN programs are available in approximately 600 to the growing number of programs that offer some form of flexible, alternative program, in addition to position statements on technology in nursing educa- programs admit ADN graduates into MSN programs tion, distance-learning, and online programs. This (AACN, 2012). With the shortage of nurses and nurse well-developed trend is based on the success of these educators, some schools are finding ways to streamline programs, the documented needs of students, the RN to BSN programs. nursing shortage, and the expansion and acceptance of Changes in social, political, financial, and philosophic electronic learning technology (Shovein et al, 2005). trends; the extensive use of communication and learning Distance or mobility programs include those for LPN technology; verified success from past experiences; and or LVN to ADN and BSN; diploma and ADN gradu- the continuing shortage of nurses have combined to ates to BSN and MSN; and BSN to MSN and doctoral make education mobility and distance-learning opportu- programs. Almost all use some form of Internet-based nities a necessity and a reality nationally and internation- courses, and some are entirely online. Some require ally. Whereas the NLN continues to support all levels of periods of intensive on-campus classes or assigned education programs, the AACN and other organizations clinical experiences with preceptors. vigorously support the BSN for "entry into practice" and The most controversial but pace-setting distance- the professionalization of nursing (IOM, 2010). In 2003, learning program in nursing was developed under the the New York State Board of Nursing approved a pro- New York Board of Regents as "the external degree pro- posal that would require future graduates of diploma and gram.” Initially named the NY Regents External Degree Program (NYREDP), it later was renamed Excelsior ADN programs to earn a BSN degree within 10 years to College. Its ADN program, initiated in 1972, and the be eligible for renewal of licensure; as of this writing, it BSN, in 1976, were fully accredited by the NLN shortly has not been passed. The New York Organization of thereafter, albeit with considerable difficulty. This in- Nurse Executives supports this effort and describes the rationale for it on its website (NYONE, 2006). many disciplines for adult learners underserved by tra- In October 2010, the IOM released The Future of Nursing: Leading Change, Advancing Health, which pro- BO and Ame lead istra thin asp end А The ang da: ре the novative college provides quality degree programs in ca ре tid e ditional programs by using assessment methods to document prior learning and theory and performance examinations to validate current knowledge and com- petence. The nursing programs enroll thousands of students and are accessible regardless of geographic lo- cation; the students primarily are LPNs or RNs, some of whom also have other degrees or health-related certifi- cates. Early studies documented their competence in the workplace (Lenburg, 1990). It initiated a master's degree program in 2000 with two specialty options. Over the Years, many nursing programs have accepted and modi- vides a blueprint for transforming the nursing profes- sion. A key message of this IOM report was that nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. A variety of innovative strategies that include online education and simulation as well as consortium programs will need to be increased to create a seamless pathway from ADN to BSN, ADN to MSN and BSN-DNP and PhD. This will affect the needed transformation of nursing education S a A (IOM, 2011). fied the distance-learning and assessment approach originally developed by the NYREDP and continued as Excelsior College. The integration of electronic learning The escalating nursing shortage and the aging of the current nursing workforce and nurse educators have prompted more schools to offer flexible mobility CHAPTER 3 Contemporary Trends in Nursing Education 55 nurse specialist, and nurse practitioner followed by six population foci. This document provides data to guide nursing licensure, accreditation of programs, certification, and educational programs (https://www. ncsbn.org/7_23_08 Consensue_APRN Final.pdf). Currently there are 504 master's in nursing programs in the United States (NLN, 2013). Clinical Nurse Leader In 2000, the national movement to enhance quality and safety in health care led to discussions between the AACN, nurse executives, and other health care leaders that led to the development of a new nursing role-the clinical nurse leader (CNL). In July 2002, the AACN board created the TFER 2 (Task Force on Education and Regulation). Its focus was the nurse competencies needed in current and future health care systems to improve patient care and what the "new nurse" role might look like. This work resulted in the publication of the White Paper on the Role of the Clinical Nurse Leader (CNL) in 2007 (AACN, 2009a). The CNL is a master's prepared generalist clinician, not an advanced practice nurse, who oversees the care coordination of a distinct group of patients, evaluates patient outcomes, and has the decision-making authority to change care plans when necessary. The CNL actively provides direct patient care in complex situations, serves as a lateral integrator who provides centralized care coor- dination for a distinct group of patients, and puts evidence-based care into practice to ensure that pa- tients benefit from the latest innovations. A CNL is a leader in the health care delivery system with expertise in quality improvement and cost-effective resource utilization (Rosseter, 2009). The CNL is not an ad- vanced practice nurse, nor is the CNL prepared in an area of clinical specialty; however, the CNL can consult with a Clinical Nurse Specialist as needed and, further, the CNL can provide evidence-based care to complex patients (Harris et al, 2011). The Commission on Nurse Certification, an autonomous arm of the AACN, began certifying CNLs in 2007. By August 2014, more than 3,000 individuals earned CLN certification, up from more than 1850 individuals in 2012. As of 2014, 94 colleges and universities were offering CNL pro- grams that prepare graduates to sit for the CNL awarded at the CNL Summit in 2015 (http://www.aacn. nche.edu/leading initiatives/cnl/cnl-certification/pdf/ DirectoryState2010.pdf). Doctoral Programs Changes in society and health care and the trend of need- ing well-educated nurse leaders and researchers to initiate and lead nursing doctoral programs. The first doctoral program for nurses was developed at Teachers College, Columbia University, and the first nurse graduated in 1932 with a doctor of education degree (EdD). In 1934, New York University offered a PhD program for nurses, . More than 30 years elapsed before doctoral programs in nursing (instead of for nurses) were offered (e.g., the doc- tor of nursing science degree (DNS or DNSc]). For the past few decades, three types of doctoral degrees in nursing were available: (1) the doctor of philosophy (PhD) for those interested in research; (2) the DNS or DNSc for those interested in advanced clinical nursing practice; and (3) the doctor of nursing (ND) for those with BS or higher degrees in non- nursing fields who want to pursue a career in nursing leadership. The ND degree, which prepared nurses for basic licensure (NCLEX-RN®), was first offered at Case Western Reserve University in 1979. Shortly after, Rush University, the University of Colorado Health Sciences Center, and others offered this degree. Nursing schools have transitioned and no longer offer the ND. Beginning in 2000, AACN leaders developed and implemented a new clinical-focused doctoral degree: the doctor of nursing practice (DNP) (AACN, 2014a; see AACN webpage for updated information and statis- tics). The DNP is conceived as preparation for contem- porary advanced nurse practitioners; it is viewed as the clinical equivalent to the research-oriented PhD nursing degree. The AACN has recommended that all advanced practice education programs move from the master's to the doctoral level by 2015. Although the DNP prepares clinicians, and does not formally prepare nurse educa- tors, many individuals who complete a DNP degree frequently shift from practice to a dual role and serve in faculty roles, in addition to clinical roles. In 2014, the AACN reported that from 2012 to 2013 the number of students enrolled in DNP programs increased from 11,575 to 14,688; during the same period, the number of DNP graduates increased from 1,858 to 2,443. Additionally, as of August 2014, 243 DNP pro grams are enrolling students within 48 states plus th certification examination. The AACN and CNC are recognizing CNL faculty leaders first ever CNL Educator Vanguard Award, to be
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Summary: Chapter 13
The healthcare system and demands are rapidly changing. In turn, new courses,
programs, experiences, and requirements have emerged in nursing to widen opportunities for
new as continuing nursing practice and both postgraduate and undergraduate levels train and
effectively perform in this evolving nursing environ. Changes to basic nursing education
programs, emergent of new innovative degree courses, masters, and Ph.D. as well as mobility
and distance learning are some of the contemporary trends within nursing. Those students who
gain an insight of these trends not only cope with the swiftly changing nursing education pattern
but also with the speedy changing delivery systems in the healthcare.
To begin with, there has been a general knowledge expansion and intensive technology
use in nursing. Owing to ever-growing technology...


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