Carnegie Foundation Calls for 'Radical Transformation' of Nursing Education

January 06, 2010

Nursing-education programs need to undergo sweeping change to remedy a severe shortage of nurses and stop producing undergraduates who are poorly prepared to deal with profound changes in science, technology, and the nature of their work, according to the results of a national study released Wednesday by the Carnegie Foundation for the Advancement of Teaching.

A new book on the study, Educating Nurses: A Call for Radical Transformation (Jossey-Bass), argues that the current climate for nursing education "rewards short-term focus and cost savings over the quality of nursing education and patient care." It says changes in nursing and the health-care industry "call for equally profound changes in the education of nurses and the preparation of nurse educators," and describes the redesign of nursing education as "an urgent societal agenda."

The study, part of a multiyear effort by the Carnegie Foundation to examine professional education in the United States, was based on visits to a variety of different kinds of nursing programs and on surveys of nursing faculty members and students administered with the help of the American Association of Colleges of Nursing, the National Student Nurses' Association, and the National League for Nursing.

Based on its examination of the current landscape, the book says nursing-education programs need to increase their capacity by about 90 percent to meet current and projected nurse shortages. But—due partly to a severe shortage of nursing faculty members and a dearth of nurses with baccalaureate degrees who are ready to enter graduate programs—the number of applicants being rejected by nursing schools actually has increased sixfold since 2002.

Part of the problem, the book says, is that nursing schools have a hard time retaining novice faculty members who can earn higher salaries in practice. In addition, most people who earn master's or doctoral degrees in nursing do so without receiving much training on how to teach.

Reconsidering the Associate Degree

The book's diagnosis of the education now being received by nursing students also is bleak. Although, it says, most nursing programs are doing a good job of providing students with clinical training, they are not effective when it comes to teaching nursing science, or the natural and social sciences, or technology, or the humanities. Courses in such areas tend to teach the subject matter through standardized lectures, and not to require rigorous scholarship.

The book's long list of recommendations includes a call for a re-evaluation of the associate-of-nursing degree offered by community colleges in light of the lengthy amount of time it takes many student nurses to complete such programs. The book also argues that nurses should be required to obtain at least a baccalaureate degree in their field to be allowed to practice, and that steps should be taken to ensure that all nurses who receive a baccalaureate go on to complete a master's degree in their field within the next 10 years.

Beverly L. Malone, chief executive of the National League for Nursing, on Wednesday questioned the wisdom of the book's recommendation of a baccalaureate-degree requirement, saying her field has debated the minimum education levels needed by nurses for decades without making much progress in moving more of them through the educational pipeline. Noting that more than half of nurses have only associate degrees, she argued that it would be better to focus on how to get those nurses to continue their education because "we have too many nurses out there who are not going back to school to earn those degrees."

For the most part, however, Ms. Malone praised the book as likely to spur necessary improvements.

Fay Raines, president of the American Association of Colleges of Nursing, similarly called the book "a wonderful asset" and predicted that a transformation of nursing education to increase the supply of nurses with advanced degrees would lead to significant improvements in health care and the well-being of patients.

"I think that the recommendations are appropriate and realistic," Ms. Raines said, although, she added, "that does not mean that all of them can be implemented overnight."

Among its other recommendations, the book says:

  • The capacity of nursing programs needs to be expanded so that more students can get through them in a reasonable amount of time.
  • Nursing schools need to alter their course work to better integrate classroom teaching with clinical practice.
  • Nursing students should be introduced to the profession early on, by being required to take prerequisites for clinical courses in their first two years of college.
  • The salaries of nursing faculty members should be increased to be brought in line with clinical salaries and the salaries paid faculty members in other disciplines.
  • Considering that more than half of nurses work outside of hospitals, nurses must be prepared for a variety of different clinical settings, and their clinical time should not be focused just on acute care.
  • A national advisory group should be established to determine what prerequisites in the humanities, natural sciences, and social sciences are actually relevant to clinical practice.
  • All master's- and doctoral-level programs in nursing should include teacher-education programs, to better prepare future members of the faculties of nursing schools.

The book was written by Patricia Benner, a senior scholar with the Carnegie Foundation and professor emerita at the University of California at San Francisco School of Nursing; Molly Sutphen, a research scholar at Carnegie and a historian at the San Francisco campus; Victoria Leonard, a family nurse-practitioner at the California Childcare Health Program at the San Francisco campus; and Lisa Day, a clinical nurse specialist for neuroscience and critical care at that campus.