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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