Should Nursing School Curriculum Be Standardized?

From The Floor

Should Nursing School Curriculum Be Standardized?

The Benefits of a Flexner Study to Nursing

By Genevieve M. Clavreul, RN, PhD
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In my opinion, the nursing profession is at a very critical juncture that mirrors challenges faced by doctors at the turn of the 20th century. Over the past several years, various schools of thought have struggled to define the profession of nursing. The time may be ripe for an in-depth, objective research project such as the Flexner Study, which gave rise to our modern day, standardized curriculum for medical schools and licensure for physicians. The commissioning of such a study could be used to weave all the disparate ideas regarding the nursing profession into one approach used at all nursing schools nationwide. If all nursing students were exposed to the same curriculum, it would lend a great deal of uniformity and cohesion to the profession as a whole.
First, a little background on the original Flexner Study. Prior to 1910, anyone who wanted to be a doctor could accomplish their goal by applying to an obliging medical school and, in some cases, literally purchasing a diploma. In the early 1900s, high school principal Abraham Flexner wrote a report on the status of higher education in the United States and was later chosen by the Carnegie Foundation to do a study on the status of medical schools. His report is credited, for good and bad, with the state of modern-day physician education in this country.

The Flexner report developed a comprehensive roadmap for curriculum, state licensure, public health, scientific research and public hospitals. Though controversial in some corners, his work allows medical schools to produce a continuous stream of generally well-qualified physicians—a system that is often the envy of the world.

What good might come of such a study in the field of nursing? Three things come to mind: 1) a first of its kind, top-to-bottom evaluation of nursing education;  2) a plan to standardize nursing curriculum in all 50 states;  3) the development of a nursing career path to allow nurses to easily and efficiently "move up the ladder" by gaining further education.

There are those who would see both of these suggestions as a bit heretical since many feel that nursing education needs to be somehow tailored to fit each community or state’s specific core values. However, medical schools throughout our nation use a standardized curriculum that has not prohibited them from educating their students in the concept of community standards of care.

Therefore, my proposition is rather simple, and if allowed to be fully explored—and, yes, fully funded—nursing could realize its true potential for the next century. My objectives for this plan would be the following:


•  Commission a small team of experts, comprised of at least one of each of the following RN disciplines (diploma, Associate and Bachelor-prepared), at least one person from nursing education and another from management, and at least one sociologist. This team would work with a facilitator who not only has staff nurse experience, but as a nursing educator and manager, will be savvy enough to navigate the political arena.

The team would compile data on all the approved nursing schools, assess nursing statistics and data, interview various key stakeholders and so forth, to develop a comprehensive picture of the status of nursing programs today and where they need to be in the future to meet our nation’s needs. At present, many states have invested hundreds of thousands of dollars to develop local “state of nursing” roundtables, groups, institutes, etc., but there seems to be little, if any, focus on a national approach, which I believe is critical if we wish to claim success in the long run over our staffing pipeline.

•    Designate appropriate funding for the commission. We must pay the commissioners for their work; this should not be a volunteer or loaned position. My rationale for this is simple: if the commission was comprised solely of volunteers they would have to either self-fund all their work expenses or find someone to support them financially, such as their employer or organization. The first optiion would limit participation to a small handful of experts who are independently wealthy. The latter would ultimately, no matter how well intentioned, give implied power to the participant’s employer or organization, allowing for the question as to what influence this may play in decision making.

•    Set a “sunshine date” for the commission and stick to it. All too often commissions are formed with a “sunshine date” of one, two or three years; however, when that sunshine date approaches, no one seems willing to end the work, instead finding myriad excuses to perpetuate it. For the Flexner-like study to have any effect at all, there needs to be a termination point for the study so work towards implementation can begin.

•    A comprehensive report must be given and a commitment to action must be taken to implement the recommendations of the commission—no planning the plan.


A nationwide, standardized nursing curriculum at both the associate and bachelor levels would allow nursing students to move effortlessly between schools, and in turn, allow nursing schools to fill vacant seats where appropriate. Far too often, a student drops out and that seat remains vacant for the remainder of the semester or year. A standardized educational curriculum also provides for an easier transfer of faculty from campus to campus, university to university.

It is my hope that the commission would be charged with helping to develop a flexible nursing career ladder, and to designate which nursing degree preparation is appropriate for entry-level, intensive care, and advanced practice. By developing a sound career ladder, I believe more nurses would pursue additional nursing educational degrees, thus expanding their knowledge and skills, which in turn would benefits patients. Consider the military, where, as a rule, everyone starts at more or less the same rank. There is a well-defined understanding that everyone will move up the career ladder. When was the last time you met an enlisted person who was a private for his or her entire military career? The same principle could be applied to nursing, where there is a well-defined career path.

I believe it is time that we take a lesson from the medical school playbook and set in motion a Flexner-like study to make the modernization of nursing education a reality.  

Geneviève M. Clavreul RN, PhD, is a healthcare management consultant who has experience as a director of nursing and as a teacher of nursing management.

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