Rethink Nursing Education
Nurses who develop their role as teachers will help the profession thrive

By Barbara Brown, Ed.D., RN, FAAN, Editor, Mountain West Edition
August 6, 2001

'Baccalaureate entry into nursing practice!" We have beaten this drum since the Flexner Report; Esther Lucille Brown's "Nursing for the Future," circa 1948; the Lysaught Report, "An Abstract for Action," circa 1970; and the '70s, when more than 35 states were actively involved in promoting baccalaureate education as the entry into "professional" nursing practice.

I even got on the bandwagon in the '80s in Washington, where I spoke at several statewide forums for the entry-into-practice discussions. Now, where has this gotten us?

The traditional hospital school of nursing view of the head nurse as teacher has been abandoned, and nursing service has been separated from nursing education, except for a few joint practice settings such as Rush University in Chicago.

Do we need to renew teaching nursing where the patients are? If professionally oriented nursing practice settings do not control the environment for teaching future nurses, nurse educators cannot teach the professional practice of nursing.

Many health care systems have found that new graduates from associate degree, baccalaureate and diploma (although far and few remain) programs need longer orientation programs in order to develop realistic integration into nursing staff positions. Education programs have not adequately prepared most new graduates to function in a 24-hour-a-day, seven-day-a-week health care delivery system, although not all nursing positions require this. Even if primary care is the focus, all nurses, as students, need exposure to the acute care setting in a realistic way.

New graduates and even some faculty do not understand what 24-hour accountability and responsibility for clinical decision-making mean for individual nurses. Most graduates are ill-prepared to assume this accountability and have untested clinical competence to enable them to make decisions regarding patient care, whether in an acute care or ambulatory care setting. While internships for new graduates may bridge this gap in some practice settings, we still are faced with the discrimination of what kind of education the nurse has-professional or technical?

So, what determines who is what?

Whether an RN is an AD, diploma or BSN graduate, the professionalism comes from continuing to grow and learn how to give the best possible care to patients, and I have seen them all do that.

So, give credit where credit is due in this era of nursing shortages and move forward with the workforce that we have, honoring and respecting each nurse. Many nurses come to nursing through associate degree programs later in their life, rather than right out of high school. They have raised families, cared for aging parents and are at-home nurses long before entering the profession. They are dedicated patient care professional nurses. Others simply cannot afford a university education and their community colleges offer access and opportunity.

Sure, you can't use knowledge that you don't have, but that's where continuing education comes in. Tomorrow's illiterates will be those who have not learned how to learn. Has the nursing profession developed only through imitation and memorization? Or have higher forms of learning been developed in which nurses may learn to advance the profession of nursing to the highest level possible?

Will nursing become a "planning profession" in which all nurses participate in the planning? Or will nursing become a "planned profession" in which the planning experts, the elite few-especially in government-set the goals and make the plans for us?

More than 100 million pages of new information are published in hard copy or electronic form each year on science and technology. The half-life of a nurse's education is about three years. So every nurse is a teacher and has the responsibility to continue to learn and share their knowledge with other nurses.

Every nurse I know cares about the profession and the meaning of nursing as a caring profession. Unless we all continue to learn and have a willingness to advance this profession, we will deserve whatever edicts others would place upon us. Excellence in nursing practice requires excellence in nursing education. It is our responsibility to work together for our future.

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