Nursing Education: Are You Ready for the 21st Century?


Nursing Education: Are You Ready for the 21st Century?

Bold and exciting changes are coming

By Daria Waszak, RN, MSN, CEN, COHN-S
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The high-fidelity manikin looks and presents much like a real patient: an adult male groaning with simulated chest pain as perspiration beads on “his” lifelike skin. The nursing student listens to the “patient’s” lung sounds, finds his speedy pulse, starts an IV and administers emergency medication as the simulator shows the patient’s response on a computer monitor. Afterwards, the student can review the exercise on video while being debriefed by nursing faculty.

Some manikins can talk, cough, vomit, bleed, cry, convulse, wheeze, go into cardiac arrest or even give simulated birth. Such advanced technology is improving the quality and safety of patient care by allowing nurses to practice their skills and use critical thinking in a realistic but calm, non-intimidating environment before facing real-life experiences as a professional nurse.  

The Skills to Lead

“When we went to school, we practiced injections on oranges,” says Beverly Malone, RN, Ph.D., FAAN, the CEO of the National League of Nursing. “We’ve always used simulation, but now we are using it at a higher technical level. There is now virtual simulation, which is how pilots are trained. Nurses can push the injection into the manikin and get the same feeling as if they hit a nerve.”
Advanced simulation technology is just one example of the plethora of changes that has transformed nursing education over the last decade. Patients today are sicker, older and have more chronic conditions than in the past. The old healthcare model, designed around acute care, is just not as applicable anymore.

Jan Jones-Scheck“Patient care is experiencing widespread change that will affect everyone,” says Jan Jones-Schenk, RN, DHS, MNA, NE-BC, CNO and national director of the College of Professions at Western Governors University (WGU). “Are competences aligned with what’s happening in the real world, which is in flux?”

Many of the changes that are needed in nursing education were outlined in the October 2010 Future of Nursing report from the Institute of Medicine (IOM). The IOM recommended greater focus on leadership, health policy, system improvement, research, evidence-based practice, decision-making, teamwork and care coordination.

America’s new healthcare model, as outlined in the 2010 Affordable Care Act, is intended to be patient-centered, which requires greater collaboration across the spectrum of healthcare professionals. Technical and leadership skills have become paramount to nurses of any specialty.

“There is a focus on collaboration and teamwork and much more nursing leadership happening,” Malone says. “It reflects well on teams. When it’s appropriate, nurses step up to lead the team.”

1.2 Million New Nurses

David NealNursing, already the largest healthcare profession in the U.S. with 2.6 million nurses in 2012, is expected to grow by an additional 1.2 million over the next decade. The Bureau of Labor Statistics projects that by 2020, nursing will have the fastest job growth of any profession. That growth means lots of new grads. The IOM report recommends development of more nurse residency programs to help transition nurses into the workforce or new clinical areas.

Methodist Hospital of Southern California has already established a residency program for new graduates. “New hires go through our new hire orientation and then work with the preceptor on the assigned unit,” explains David Neal, RNC, BSN, Methodist Hospital’s vice president of nursing and CNO. “Oversight is provided by the educator and the manager assigned to the unit.”

Kaiser Permanente now has a 10-week regional program using simulation training. “The new grads’ understanding and clinical judgment skills are assessed through the use of simulation scenarios, self-reflective practice and clinical performance,” says Julia A. Chapman, RN, PHN, department administrator of staff education and development at Kaiser Permanente Orange County Medical Center.

High-Fidelity Training

Technology, one of the most significant areas of change in nursing education, has certainly made its mark, from teaching and learning methodologies to electronic health records. “Technology in nursing education and delivery is a way to promote the exchange of health information, protecting patients’ privacy, and improving safety, efficacy and quality of care,” says Angie Strawn, RN, MSN, associate dean of the College of Health Sciences and Nursing and chief nurse administrator of the Division of Nursing at University of Phoenix.

Dee HartTechnologies to assist with teaching, such as Microsoft PowerPoint, are also being used to better equip students for fully engaged, active learning. “Students will come prepared with previous study, so class is ready for application and utilization,” says Dynnette Elaine Hart, RN, DPH, CPNP, associate dean of the undergraduate program at Loma Linda University School of Nursing. “Students love to be fed with their mouths open, but they don’t learn best that way.”

Hart explains that Loma Linda now requires all nursing students to complete a new course in nursing informatics. “Nursing informatics helps nurses keep abreast of, access and utilize evidence-based practice,” she explains. “We must use it for electronic records, research and writing.”

Most nursing schools now have some type of simulation technology, ranging from the very basic (“low fidelity”) to very advanced (“high-fidelity”), high-tech systems. At Loma Linda University School of Nursing, for example, simulation is used for teaching both nursing and interpersonal skills. The school has a high-tech lab that allows nursing students to work together with students from other disciplines, such as medicine, to create dynamic teamwork challenges.

Diane VinesMount St. Mary’s College is integrating simulation into all levels of theory and clinical courses. “We use simulation technologies with high-fidelity manikins to teach medical surgical nursing, pediatric and obstetrical nursing,” says Diane Vines, RN, Ph.D., director of the BSN program at Mount St. Mary’s. “We are developing four community health simulations to provide realistic clinical experiences in settings where students may not otherwise get the experience.”

It’s in Our DNA

Today’s nursing curriculum includes competencies that are complex rather than just task-based, reflecting the latest legislation and trends in healthcare. Since the focus of the healthcare system has shifted from acute care to primary care, public health and long-term care, nursing education has done the same.

“We have a new curriculum for the BSN program at Mount St Mary’s College that includes integrative health, palliative care and an increased emphasis on quality, safety and evidence-based care,” says Vines. “We incorporate evidence-based practices in all our nursing courses, but focus intensively on these practices in our new evidence-based practice course.”

WGU uses subject matter experts from industry as advisors on the latest developments in nursing practice and science. One example is one of the most noteworthy developments in nursing education: the addition of genetics and genomic content to nursing curricula. “We are living in the age of personalized medicine,” says Jones-Schenk. “Instead of looking always at patients as big, homogenous groups, now, with mapping of the genome, we know some people don’t respond to pain medication at all.”

BSN = 80 percent by 2020

The Future of Nursing recommends that more nurses earn their baccalaureate and doctoral degrees. That is not a new idea; a 2009 publication entitled Educating Nurses: A Call for Radical Transformation, based on the Carnegie National Nursing Education Study, recommended that all entry-level RNs have at least a bachelor’s degree and obtain a graduate degree within 10 years.

The number of nurses with bachelor’s degrees is expected to hit 80 percent by 2020!

One of the most popular graduate degrees is the doctor of nursing practice (DNP). The DNP is a practice-based degree, not research-based like a Ph.D. or DNS; a DNP is analogous to an M.D., doctor of pharmacy or doctor of social work degree. The American Association of Colleges of Nursing’s 2004 position statement recommended the DNP degree for all advanced practice nurses, including nurse practitioners, nurse midwives, clinical nurse specialists and nurse anesthetists. This trend has prompted many schools to extend their graduate programs to the doctoral level.

Do You Know What You Do Not Know?

Last but not least, the IOM Future of Nursing report recommends that all nurses continue to learn. In some cases, nurses may even have someone to nudge them when they need to change their nursing practice, especially in larger institutions that maintain formal nursing educator positions.

“The role of nurse educators at Kaiser Permanente has expanded beyond conducting classes,” says Chapman. Educators train staff using a wide variety of methods, from in-services to formal classes, and often use online and simulation technology.
Kaiser Permanente’s nurse educators also take pains to stay up to date on nursing practice. “Internally, we use sources such as quality improvement data, clinical practice guidelines and our regional nursing research team,” says Chapman.  “Externally, we rely on the expertise of entities such as the Joint Commission and the Institute for Healthcare Improvement  and information from national professional nursing associations, practice resource network standards, practice alerts and our community partners.”

Methodist Hospital of Southern California partners with academia and is moving toward centralizing the hospital’s education department. “We are working closely with Azusa Pacific’s School of Nursing to transform the nursing educator role, utilizing the academic approach along with the hospital-based clinical approach,” says Neal. “Moving away from the traditional approach to skills days, where staff are checked off on a specific skill, to a format utilizing simulation training at all levels of the organization.”

It’s also important for all nurses to maintain a level of humility and strive to keep themselves up to date through continuing education and pursuit of specialty certifications. “The biggest challenge is the evidence-based emphasis in nursing,” says Malone. “There is so much new knowledge; there is no way to know everything, and that is okay. But you have to know how to get it.”
Being able to tap into nursing resources electronically through handheld applications and smartphones can help. “When I went to school, you had to put it all in your head,” Malone says. “Now it’s more about, ‘Do you know what you don’t know?’”

Wanted: Faculty!

Despite the projections for career growth in the nursing profession, there is still a nursing faculty shortage. “At Loma Linda University School of Nursing, about 30 to 40 percent of faculty will be retired soon because there was a gap,” says Hart. “At one point about 10 to 20 years ago, there was not a strong application pool. That is why we are seeing this shortage in faculty.”

The required graduate degree doesn’t help, nor do lower salaries.  “You can go across the street to the tertiary care medical center and make twice the salary,” Hart explains, noting that nurses “must be dedicated” to choose to become educators.
To help address the nursing faculty shortage, WGU launched a nursing education program option. “A lot of it has to do with the credentials required to be a faculty,” Jones-Schenk says. “With online programs like WGU’s, faculty can work asynchronously, enabling those who are qualified to teach but who do not live near a university to become faculty.”

Boldly Facing the Future

Over the last decade, nursing education — both in academic and professional settings — has undergone an immense transformation. There have been spectacular advances in technology and research, huge changes to the healthcare system and a major shift in patient demographics. Fortunately, nursing students are better prepared than ever before. Today’s student nurses benefit from more technology and evidence-based practice, higher-level competencies and an ever-changing curriculum.

“The nursing role has been upgraded, revised and strengthened,” says Malone. “Nurses should practice to the full extent of what they are prepared to do.”  

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