In a perfect world, how would YOU like to see nursing education improved?

[WestCoastSunRN]

If you spend any time on AN, you'll see a common theme of dismay regarding nursing education -- especially, but not limited to, graduate nursing programs. Let's pool our ideas here about how to improve the whole system -- as if someone tasked you to come up with improvements that would actually be employed within nursing academia. We can list improvements for all levels of education. I'm sure we won't all agree on the ideas, but it might be interesting to see the variety. I'll go first.

UNDERGRADUATE:

- all ADN programs should be linked to a BSN bridge program

- chemistry and biochem should be added to prereqs (some schools do require), as well as a full year of statistics (as opposed to one semester)

- Nursing Theory should be covered (and sprinkled lightly) within the context of other classes in order to show application, as opposed to a separate course.

- Written work should be heavily focused on case studies and literature review pertaining to expected or actual clinical experiences.

- Clinical hours should provide plenty of hands-on experience for students to do bedside procedures and manage patient load.

- Clinical hours should be closely supervised, and taught, by clinical instructors (not a drop off the baby nurse and run scenario and hope you got a good nurse to teach 'em)

GRADUATE

- Tightened accreditation standards for ALL schools offering MSN or DNP programs -- regardless of APRN or not, resulting in reduced admissions and closed schools.

- Incentives for schools offering Education tracks and for students pursuing this to help meet the shortage of nursing faculty.

- Direct Entry APRN programs requiring 2,000 hours of nursing practice prior to a minimum of 1,000 hours of APRN practicum in specialty.

- ALL APRN programs requiring 1,000 hours minimum of practicum in specialty.

- DNP programs either research or clinically focused -- adding 500 clinical hours and result in adding a specialty or narrowing focus on one (cardiac, critical care, heme onc, etc).

- ALL APRN programs have a business course included.

- Paid preceptors -- preceptors are considered faculty and contracted

- Hybrid learning (online and in class) with state schools incentivized to offer programs.

Here's a few. What do others think?

[Wuzzie]

8 minutes ago, LibraSunCNM said:

We need nurses to have a stronger educational foundation than just mastery of hands-on tasks.

I am certainly not anti-intellectual but currently it seems that schools are pumping out students with minimal ability to do those hands-on tasks even at the most basic level. We have swung too far in the other direction and it shows.

[LibraSunCNM, BSN, MSN, CNM]

4 minutes ago, Wuzzie said:

I am certainly not anti-intellectual but currently it seems that schools are pumping out students with minimal ability to do those hands-on tasks even at the most basic level. We have swung too far in the other direction and it shows.

That is for sure a problem. I completely agree that more clinical time is vital to improving nursing education. But rotations in community health, being able to read and critically appraise research, strong writing skills, knowledge about our current healthcare system and insurance coverage, etc., are also really important. I just have to roll my eyes when people claim the answer to all the problems is to "bring back diploma nurses."

[Wuzzie]

Just now, LibraSunCNM said:

I just have to roll my eyes when people claim the answer to all the problems is to "bring back diploma nurses."

Careful there. I am a diploma grad and I had all of the things you think are important. I think diploma education was much more involved than most people want to believe.

[Jedrnurse, BSN, RN]

20 minutes ago, LibraSunCNM said:

Thank you. I hate when these nursing education debates become so stringently anti-ANYTHING remotely intellectual. Nursing is more than just a series of tasks that need to be mastered! Yes, the pendulum can swing too far and there are issues with some nursing theory and research, no doubt. But keeping your head in the sand and pretending like nursing is going to stay the way it always was is ridiculous. Healthcare has completely changed within the last few generations when diploma nurses were the norm. We need nurses to have a stronger educational foundation than just mastery of hands-on tasks.

I'm not anti-intellectual, but I'm anti pseudo-intellectual. Many of the models/nursing theories put forth in school have a somewhat..tenuous relationship to reality.

[LibraSunCNM, BSN, MSN, CNM]

11 minutes ago, Jedrnurse said:

I'm not anti-intellectual, but I'm anti pseudo-intellectual. Many of the models/nursing theories put forth in school have a somewhat..tenuous relationship to reality.

As I said---there are certainly problems with it. But I also bristle when people refer to educational pre-requisites in any type of liberal arts as "fluff."

[WestCoastSunRN, MSN, CNS]

11 minutes ago, Wuzzie said:

Careful there. I am a diploma grad and I had all of the things you think are important. I think diploma education was much more involved than most people want to believe.

Diploma nurses rock! But I agree with Libra -- we are in a different time and every industry is requiring more academics and/or credentials.

I am a proponent of BSN as entry level for RN licensure. However, before I get tomatoes thrown at me -- let me qualify that by saying I also think the quality of said BSN should be superior to what we see today. I think a necessary aspect of increased quality is churning out new grads with a basic level of clinical proficiency -- and I think we should most certainly look to diploma program models for how to do this.

Makes me wonder about making DNP entry level requirement for APRN -- but not the current DNP -- a DNP that is clinically based -- as lack of clinical preparedness is a huge complaint of APRN grads.

[LibraSunCNM, BSN, MSN, CNM]

19 minutes ago, Wuzzie said:

Careful there. I am a diploma grad and I had all of the things you think are important. I think diploma education was much more involved than most people want to believe.

That's awesome. My aunt is a graduate of St. Vincent's in NYC, one of the most well-known diploma programs of the past (not least because of their unique, ultra-Flying-Nun-eque caps!) and had an excellent education and is an excellent nurse. But like it or not, most of those programs have gone the way of the dodo. All I'm saying is it's time for nursing to move on and adapt because healthcare has. It's incredibly complex and we need nurses who are smart and able to navigate the challenges of the system, and in my opinion that requires a certain amount of pre-reqs that don't involve traditional, hands-on nursing tasks.

[Wuzzie]

8 minutes ago, LibraSunCNM said:

It's incredibly complex and we need nurses who are smart and able to navigate the challenges of the system, and in my opinion that requires a certain amount of pre-reqs that don't involve traditional, hands-on nursing tasks.

I don't disagree but we seem to have thrown the baby out with the bathwater in our efforts to expand nursing education at the basic level. I don't think anyone is advocating a curriculum that is technically based however we clearly need to revamp the clinical aspect of nursing school. The diploma model of clinical/didactic education with an additional year of related academic prerequisites/adjuncts would seem to fit the bill.

[KCMnurse, BSN, MSN, RN]

53 minutes ago, Wuzzie said:

Careful there. I am a diploma grad and I had all of the things you think are important. I think diploma education was much more involved than most people want to believe. 

@Wuzzie I totally agree. I am a diploma grad too. The perception is that we were taught to be the Physician's handmaid and that is so far from the truth. Certainly increased clinical exposure is an important component of nursing education that is sorely missing now for a number of reasons.

[JKL33]

15 minutes ago, Jedrnurse said:

I'm not anti-intellectual, but I'm anti pseudo-intellectual.

There you have it.

@LibraSunCNM this portion of the discussion would have a different tone if the assignments related to these other important topics were different. As it is, they are presented in a "fluff" manner or engaged only at their most basic levels, and the result is BSN programs where engaging research ideas means very little more than a requirement to have a "nursing research article published in a peer-reviewed journal within the last 5 years" if you so much as want to write that the sky seems to be blue. And, in order to make sure things aren't too rigorous, people are allowed and encouraged to mostly "research" hot topics; god help you if what clinical thing you are interested in isn't a current/recent "hot topic."

That's the problem. It isn't that Community Health or (the concept of) practicing in an evidence-based manner, or learning about how nursing theories have affected patient care aren't important.

Side note/example: We had a post here months ago from someone looking for current research articles about x, y, z clinical question. They (appeared to) have no idea how to approach it given that they hadn't been able to find the answer in via sufficiently recent research articles. There didn't seem to be any thought about researching the supporting concepts involved or any of that, just "I need an article that answers this or I can't present my assertion/perspective." Well now that's not intellectual.

*****

Also (moving on...), there is a problem with what seems to be an idea that being able to expertly perform a skill is something different than (or even worse: beneath) being appropriately intellectual or being a professional. Why do nursing skills (that matter to patients) have to be assigned to non-nurse personnel in order for nurses to be considered proper professionals?

And since that ^ has already happened - can we say that our professional status has been improved?? Hardly. Now we have a bunch of people running around who can find a nursing research article about "incivility" published in the last 5 years while not necessarily understanding what is happening with the patients they are responsible for and not being the experts on technical stuff that matters to patients, like maintaining sterile procedure during a difficult urinary catheterization or even obtaining a proper blood pressure for that matter. Let's not forget that if you can't do some of these things you aren't fit to properly monitor the delegation of them, either - and your NPA most likely does indeed say that you are responsible for all of this. Meanwhile your NPA does not care if you can write a PICOT question about whether your facility can get by with one person watching 20 patients on a grainy camera instead of attending them properly - and then receive accolades for proving that you can reduce costs in this way (to say nothing of patient safety).

The disconnect is because this whole "professionals at the bedside" thing has not panned out the way nurses who enjoy and are good at the totality of "patient care" could have imagined. Professional nurses caring for patients are not wanted at the bedside. Conveyor belt workers who have been taught to toe the line while being distracted from serious issues are wanted at the bedside. I think many nurses are very short-sighted with regard to the idea that professional bedside nurses shouldn't be focused on the whole package, including skills and direct cares. What does "nursing" look like in the near future when a professional nurse is not needed for anything that is considered a "task?" This all easily becomes a case of "careful what you wish for."

[TheMoonisMyLantern, ADN, LPN, RN]

I'm all for promoting intellectualism in nursing but I'm also for promoting clinical competence. Liberal arts education has been sewn into nursing education which is fine however now it takes 6 months to 1 year for a new grad nurse to become competent in their position assuming they last that long. That is the problem with the current model, you can hate on "task oriented nursing" as much as you want but the truth is that the current model does not promote clinical ability which is the core of what bedside nursing is all about.

What's more is that many new grads are coming to the work force with not only a lack of clinical ability but a lack of resilience needed to build clinical ability. Within a month their ready to abandon ship or go back to grad school to get the hell away from bedside nursing.

[LibraSunCNM, BSN, MSN, CNM]

2 hours ago, JKL33 said:

There you have it.

@LibraSunCNM this portion of the discussion would have a different tone if the assignments related to these other important topics were different. As it is, they are presented in a "fluff" manner or engaged only at their most basic levels, and the result is BSN programs where engaging research ideas means very little more than a requirement to have a "nursing research article published in a peer-reviewed journal within the last 5 years" if you so much as want to write that the sky seems to be blue. And, in order to make sure things aren't too rigorous, people are allowed and encouraged to mostly "research" hot topics; god help you if what clinical thing you are interested in isn't a current/recent "hot topic."

That's the problem. It isn't that Community Health or (the concept of) practicing in an evidence-based manner, or learning about how nursing theories have affected patient care aren't important.

Side note/example: We had a post here months ago from someone looking for current research articles about x, y, z clinical question. They (appeared to) have no idea how to approach it given that they hadn't been able to find the answer in via sufficiently recent research articles. There didn't seem to be any thought about researching the supporting concepts involved or any of that, just "I need an article that answers this or I can't present my assertion/perspective." Well now that's not intellectual.

*****

Also (moving on...), there is a problem with what seems to be an idea that being able to expertly perform a skill is something different than (or even worse: beneath) being appropriately intellectual or being a professional. Why do nursing skills (that matter to patients) have to be assigned to non-nurse personnel in order for nurses to be considered proper professionals?

And since that ^ has already happened - can we say that our professional status has been improved?? Hardly. Now we have a bunch of people running around who can find a nursing research article about "incivility" published in the last 5 years while not necessarily understanding what is happening with the patients they are responsible for and not being the experts on technical stuff that matters to patients, like maintaining sterile procedure during a difficult urinary catheterization or even obtaining a proper blood pressure for that matter. Let's not forget that if you can't do some of these things you aren't fit to properly monitor the delegation of them, either - and your NPA most likely does indeed say that you are responsible for all of this. Meanwhile your NPA does not care if you can write a PICOT question about whether your facility can get by with one person watching 20 patients on a grainy camera instead of attending them properly - and then receive accolades for proving that you can reduce costs in this way (to say nothing of patient safety).

The disconnect is because this whole "professionals at the bedside" thing has not panned out the way nurses who enjoy and are good at the totality of "patient care" could have imagined. Professional nurses caring for patients are not wanted at the bedside. Conveyor belt workers who have been taught to toe the line while being distracted from serious issues are wanted at the bedside. I think many nurses are very short-sighted with regard to the idea that professional bedside nurses shouldn't be focused on the whole package, including skills and direct cares. What does "nursing" look like in the near future when a professional nurse is not needed for anything that is considered a "task?" This all easily becomes a case of "careful what you wish for."

I agree with everything you're saying. I guess I just don't think that it has to be either/or---making nursing programs focus solely on clinical skills/tasks vs. completely disregarding them and filling up the programs with "fluff." I don't think that promoting a BSN as entry to practice, for example, means that nurses are inevitably going to lose their place at the bedside and their mastery of patient care skills, and I do think that many BSN programs have serious issues and need more clinical time for students.

I've also worked in large academic medical centers where I personally didn't get that vibe that "professional nurses caring for patients are not wanted at the bedside." I guess I've been lucky in that respect.