Chapter 7: Educational
Patterns in Nursing
Bonnie M. Wivell, MS, RN, CNS
Diversity
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The one major characteristic of nursing
education today
Influenced by
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Societal changes
Periodic shortages
Historical factors
Public expectation
Professional standards
Legislation
National studies
Constant changes in the health care system
Introduction
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Nursing Programs in 2006
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There were 1, 547 state approved RN programs in the
U.S.
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Advanced Practice in 2008
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ADN 58.8%
BSN 37.2 %
Diploma 4%
Masters programs: 458
Doctoral programs: 166
Other: LPN/LVN, Cont Ed, Advanced Practice
Certification Programs
Early Nursing Education
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Before Nightingale nursing care was delivered by
relatives, religious or military individuals, or selftrained persons who were held in low regard
Nightingale revolutionized and professionalized
nursing
Opened 1st nursing school in 1860 in London
Principles:
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Nurses trained in educational institution
Independent of but affiliated with teaching hospital
Curriculum of both theory & practice
Nurses administer, instruct, & paid
Students selected should live in “nurses’ houses”
Students required to attend lecture, take quizzes,
write papers, keep diaries
First Nursing Education in USA
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1872 First US Training Programs for Nurses
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Bellevue Hospital, New York
New England Hospital of Women & Children, New
Haven, Connecticut
Massachusetts General Hospital, Boston
1 year in length
Linda Richards first “trained nurse” 1873
By 1900 432 hospital-based diploma programs
Early Studies of Quality
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1899 – Isabel Hampton Robb chaired a committed to
investigate a means to prepare nurses better for
leadership
Mary Adeline Nutting 1st Nursing Professor
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1923 – The Study of Nursing and Nursing Education in
the U.S called the Goldmark Report
1924 – Yale School of Nursing own University Dept
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1912 – The Educational Status of Nursing
$1 million endowment by Rockefeller Foundation
1934 – Nursing Schools Today and Tomorrow
1937 A Curriculum Guide for Schools of Nrsg (National
League of Nursing Education)
5 Recommendations
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Nursing education programs should be
established within systems of higher
education
Nurses should be highly educated
Students should not be used as hospital staff
Establish standards of nursing practice
All students should meet certain minimum
qualifications upon graduation
Ed Paths to Become Nurse
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Diploma Program
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Hospital based
1920-30s: 2000 programs, 3 years to complete
Today: 62 programs, 24 months to complete
Most colleges refused to give credit for courses taken
in diploma program
Baccalaureate Program
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1st 1909 University of Minnesota
1948 Brown Report
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University based
Recruit men/minorities
Ed Paths to Become Nurse Cont’d.
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Associate Degree Program
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Began in 1952 as result of post WWII shortage
Model developed by Mildred Montag
Most common type of basic nursing education
program in US
Shorter program
External Degree Program: Learning
Independently and is assessed through highly
standardized and validated competency-based
outcomes assessments; “virtual university”
Articulated Programs: Ed ladder LPN-ADN-BSN+
ANA Position Paper
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1965: Educational Preparation for Nurse
Practitioners and Assistants to Nurses
Created conflict and division within nursing, but
had significant impact on growth of
baccalaureate education
4 recommendations
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Education should take place in institutions of higher
learning
Minimum prep for professional nurse should be
baccalaureate
Minimum prep for technical nurse should be associate
Education for assistants should consist of short, intensive
vocational education, not OJT
ANA Again
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1979 – ANA further strengthened its resolve by
proposing
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By 1985 the minimum prep for entry into professional
nursing practice should be the baccalaureate
Two levels of nursing practice should be identified
(professional and technical) and a mechanism to
devise competencies for the two established by 1980
There should be increased accessibility to high-quality
career mobility programs that use flexible approaches
for individuals seeking academic degrees in nursing
Other Influences on Baccalaureate
Education
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1970: Lysaught Report recommendations
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Need for increased research into both the
practice and education of nurses
Enhanced educational systems and curricula
Early 1980s – National Commission on
Nursing published two reports suggesting
that the major block to the advancement
of nursing was the ongoing conflict within
the profession about educational prep
Other Influences on Baccalaureate
Education Cont’d.
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1982: NLN approved the Position Statement on
Nursing Roles: Scope and Preparation
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Affirming baccalaureate as minimal education level for
professional nurse
Associate or diploma as prep for technical nurse
1996: American Assoc. of Colleges of Nursing
approved position stated baccalaureate as
minimal prep for professional practice
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Updated in 2000
Supports articulated programs which enable associate
degree nurses to attain the baccalaureate
What skills do you have?
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2008 AACN Publication The Essentials of Baccalaureate
Education for Professional Nursing Practice
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BSNs are prepared to practice within complex healthcare
systems and assume the following roles:
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Provider of care; designer/manager/coordinator of care and
member of a profession
2000 NLN Educational Competencies for Graduates of
Associate Degree Nursing Programs
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8 Core competencies
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Professional behaviors
Communication
Assessment
Clinical decision making
Caring interventions
Teaching and learning
Collaboration
Managing care
Alternatives
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Baccalaureate Programs for RNs 1960-70s;
RN to BSN
Programs for second-degree students
Online and distance learning programs
LPN
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First program in 1942 during WW II to meet
demand
State Approval vs National
Difference from RN
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Education program lasts 12 months
Settings vary
Licensing: NCLEX-PN
Scope of practice meet basic needs of patient in
hospitals, long term care, and homes
Practice under supervision of MD or RN
Not a substitute for RNs
Accreditation
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Voluntary review process of ed program
by a professional organization
1952 National League for Nursing
Accreditation Commission
1996 Commission on Collegiate Nursing
Education organized by American
Association of Colleges of Nursing
Graduate Education in Nursing
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Master’s
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Doctoral: ND, DNSc, DNP
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Entrance requirements: BS in nursing, RN licensure, GRE, GPA of
3.0
18-24 months
Admin, Case Management, Informatics, Health policy, Teaching,
CNS, NP, CNMW, CRNA, other
RN/MSN, MSN/MBA, MSN/JD (juris doctor)
ND transitioning to DNP
Certification Programs: Licensure, Certified
Continuing Education: maintain expertise
ANCC responsible for oversight of certification and CE
Challenges in Nursing Education
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Faculty Shortages severe 2010
Resources Shortages—clinical sites
Complex Health Care Needs
Transform Nursing Education
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Diverse students
Critical thinking skills
Communicate, form interpersonal relationships,
make decisions collaboratively/interdisciplinary
Increase APN & health promotion-maintenance
Community based care, increased accountability,
state of the art clinical skills & info management
skills
Cost effective
Articulation and career mobility
Faculty development to support practice, teaching,
research