Nursing and healthcare are currently riding a steeply cresting wave of change and innovation. So much has happened in just the last few years that it is difficult to point to any one event as the impetus to change. The book Nine Shift (2007)’s premise is that between 2000 and 2020, 75 % of how we live our daily lives (work, life and education) in the 21st century will change. Since we spend about 12 hours every day doing essential tasks such as eating and sleeping, for the rest of the 12 hours in a day, 75% or 9 hours will be spent doing things totally differently than we did just a few years ago. The last major shift was in 1900 to 1920 from an agrarian to industrialized and now from industrialized to a knowledge society. These predictions are already beginning to see fruition in many aspects of our lives including healthcare and education.
Several recent historic events have catalyzed the nursing profession. In 2010 the passage of the Affordable Care Act represented the most extensive health care reform in the last 45 years since Medicare and Medicaid. All parties including legislative bodies, insurance agencies, healthcare agencies and providers, professional organizations, and potential patients are immersed in transforming the healthcare system. Our 3 million nurses in the U.S. are in a position to help the nation achieve the objectives cited in this landmark legislation.
Since 2008, The Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) have assessed the nursing profession and produced an action-oriented blue-print for the future of nursing. Their publication, The Future of Nursing: Leading Change, Advancing Health (October, 5, 2010) had 4 key messages which are cited below:
1. Nurses should practice to the full extent of their education and training.
2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
3. Nurses should be full partners, with physicians and other healthcare professionals, in redesigning healthcare in the U.S.
4. Effective workforce planning and policymaking require better data collection and in improved information infrastructure.
The IOM also had 8 recommendations that potentially effect educational institutions and practices/activities. They are to: 1) remove scope of practice barriers, 2) expand opportunities for nurses to lead and diffuse collaborative improvement efforts, 3) implement nurse residency programs, 4) Increase the proportion of nurses with a baccalaureate degree to 80% by 2020, 5) Double the number of nurses with a doctorate by 2020, 6) Ensure that nurses engage in lifelong learning, 7) Prepare and enable nurses to lead change to advance health, 8) Build an infrastructure for the collection and analysis of interprofessional health care workforce data.
Nursing education has embraced these recommendations, challenges, and opportunities. According to the most recent data published by the American Association of Colleges of Nursing (AACN), enrollment in all levels of nursing programs, baccalaureate, graduate and doctoral programs is at an all time high. Nursing faculty are challenged to implement many curricular initiatives. The AACN ‘s Baccalaureate Essentials in Nursing (2008) promote enhancement of genetics, genomics, cultural acceptance, gerontology, information technology, team building, and communication content in the curricula. Quality and Safety Education in Nursing (QSEN) is a national initiative funded by the RWJF to provide full-time faculty with the skills, knowledge and resources to educate nursing students to deliver high-quality and safe nursing care. The Agency for Healthcare Research and Quality (AHRQ), with additional funding from the RWJF, has prepared a comprehensive, 1,400-page, handbook for nurses on patient safety and quality - Patient Safety and Quality: An Evidence-Based Handbook for Nurses (AHRQ Publication No. 08-0043).
Many nursing educators are utilizing ideas from the book, Educating nurses: A call for radical transformation (Benner, Sutphen, Leonard, & Day, 2010) to re-assess their curricula and incorporate more simulation and creative teaching techniques to improve clinical reasoning skills. Some schools simulate various hospital departments so nursing students interact with other healthcare professional students to coordinate patient care. It is predicted that as much as 25% of all clinical experiences will be by simulation to provide a safe practice environment for students and as an antidote to a lack of clinical sites to accommodate increasing enrollments in nursing across the nation. Simulated electronic health records (EHR) bring real-world documentation into the student’s world - classroom, simulation lab and clinical - and ensures that the students will be competent in electronic documentation on day one of their nursing careers. Most simulated EHRs have preset flow charts and standardized charting protocols for charting admission histories, physical assessments, vital signs, treatments, nursing care and patient teaching. Some systems such as NurseSquared by Elsevier include nursing education software (diagnosis, medications, nursing care plans and diagnostic tests) as well.
The AACN’s newest Master’s Essentials in Nursing basic core curriculum (2011) includes more emphasis on organizational and systems leadership, quality improvement and safety, translating and integrating scholarship into practice, informatics and healthcare technology, health policy and advocacy, interprofessional collaboration for improving patients and population health outcomes, clinical prevention and population health. Every masters prepared nurse except those in administration will need to study the 3 Ps (advanced pathophysiology, advanced pharmacology and advanced health (physical) assessment). Nursing curricula, particularly at the master’s and doctoral levels, will continue to promote political advocacy for the advanced practice nurse (APN) role. Removing barriers such as requiring a collaborative agreement with physicians will enable APNs (Nurse Practitioners, Clinical Nurse Specialists, Certified Nurse Midwives, Nurse Anesthetists) to more effectively meet the needs of their patients, practice to the full extent of their education, and ensure that the health care system provides accessible, affordable, quality care that leads to improved health outcomes.
Studies have long shown that morbidity and mortality statistics for hospital patients decrease as the educational level of the nurse increases. Some nursing employers are citing this data in their decisions to hire only BSN and higher prepared nurses. We can expect the proliferation of innovative programs, such as the RN to MSN, RN to DNP, and RN BS to BSN/MSN accelerated nursing programs to enable seamless progression to the Advanced Practice Nurse (APN) role. Online nursing programs with innovative teaching strategies to meet the needs of students residing across the county will be needed. The second of two historic Nursing Summits regarding the advancement of nursing education in Illinois was held on April 1, 2011. The educators from primarily Associate Degree Nursing (ADN) and Baccalaureate Degree Nursing (BSN) programs discussed IOM’s recommendation that 80% of nurses attain a BSN by 2020 and validated the need to develop strong ties and feeders from ADN to BSN programs (and beyond) to obtain this objective and increase the diversity of students prepared to meet diverse populations across the life span.
Transition-to-practice nurse residency programs are being recognized as essential in preparing both prelicensure and advanced practice degree nurses, and several innovative programs already exist in Illinois. The Illinois State Regional Action Coalition (RAC) was convened to advance The Future of Nursing: Campaign for Action, a collaboration created by the Robert Wood Johnson Foundation and the AARP Foundation. Illinois (along with Ohio and North Carolina) was selected as a RAC test site to determine best practices and research needs and identify replicable, sustainable models. The goal is to create high quality, patient-centered care in a health care system where nurses contribute as essential partners in achieving success.
Lifelong learning to prepare to take care of diverse populations across the life span can only be accomplished if we increase numbers of nursing faculty. Salaries and benefits of nursing faculty need to increase to reflect public sector gains so colleges and universities can effectively compete for nursing talent. Advocacy is needed to increase partnerships and grant funded initiatives in nursing education and to increase federal funding of scholarships, loan repayment programs, and faculty development. These are just a few of the most significant drivers of nursing education today. We are truly in the midst of a “nine shift” with more to follow.