Discussion: Professional Identity & Socialization Questions

Chapter 4 Nursing Education in an Evolving Health Care Environment Copyright © 2017 by Elsevier Inc. All rights reserved. Future of Nursing: Leading Change and Advancing Health      2009: Patricia Benner – Educating Nurses: A Call for Radical Transformation 2011: Institute of Medicine – The Future of Nursing: Leading Change. Advancing Health. 4 Key Messages. 2009: Aiken and call for increased federal support 2010: Tri-Council for Nursing and Policy Statement ANA urged Congress to increase funding for Title VIII Nursing Workforce Development Programs (as contained in Public Health Service Act). Copyright © 2017 by Elsevier Inc. All rights reserved. 2 2011: IOM: The Future of Nursing: Leading Change. Advancing Health. 4 Key Messages. 1. Nurses must practice to the fullest extent of their education and training. 2. Nurses should attain higher education levels through a system of improved education with seamless progression across degrees. 3. As health care in the United States is being transformed, nurses should be full partners with other health care professionals in this effort. 4. Improved data collection and information infrastructure can result in more effective workforce planning and policy development. Copyright © 2017 by Elsevier Inc. All rights reserved. 3 Development of Nursing Education in the United States  Florence Nightingale and formal nursing preparation ➢ 1860: St. Thomas Hospital in London ➢ Belief: Nursing schools should be financially and administratively separate from hospitals.  1873: Establishment of first US training schools ➢  1900: 432 hospital-owned and hospital-operated nursing programs Diploma programs – hospital based nursing education. ➢ Nursing students staffed the hospital. ➢ High-quality nursing education was not the priority. Copyright © 2017 by Elsevier Inc. All rights reserved. 4 Early Studies of the Quality of Nursing Education  Oct 1899: American Society of Superintendents of Training Schools – Isabel Hampton Robb ➢ ➢  Investigate ways to prepare nurses for leadership Teachers College 1907: Mary Adelaide Nutting, first nursing professor in History School at Teachers College – Mother House of collegiate education ➢ Discussion: Professional Identity & Socialization Questions

“The Educational Status of Nursing” focused on students’ living conditions, nursing education curricula, and teaching methods. ➢ Copyright © 2017 by Elsevier Inc. All rights reserved. 5 Early Studies of the Quality of Nursing Education  1923: The Study of Nursing and Nursing Education in the United States (Goldmark Report) focused on: ➢ Clinical learning experiences of students, ➢ Hospital control of the schools, ➢ Desirability of establishing university schools of nursing, ➢ Lack of funds specifically for nursing education ➢ Lack of prepared teachers (Kalisch and Kalisch, 1995) Copyright © 2017 by Elsevier Inc. All rights reserved. 6 Early Studies of the Quality of Nursing Education    1924: Yale University opened the school of nursing*. 1934 – Nursing Schools Today and Tomorrow – reported the number of existing schools (NLNE, 1934) 1937 – A Curriculum Guide for Schools of Nursing – outlined 3-year curriculum (NLNE, 1937) Copyright © 2017 by Elsevier Inc. All rights reserved. 7 Recommendations of Early Studies of Nursing Education 1. Nursing education programs should be established within the system of higher education. 2. Nurses should be highly educated. 3. Students should not be used to staff hospitals. 4. Standards should be established for nursing practice. 5. All students should meet certain minimum qualifications on graduation. Copyright © 2017 by Elsevier Inc. All rights reserved. 8 Educational Paths to Become a Registered Nurse    Diploma Programs Baccalaureate Programs Associate Degree Programs Copyright © 2017 by Elsevier Inc. All rights reserved. 9 Diploma Nursing Programs Peak: 1920–1930 – ~200 programs in almost any state Mid 1960s – dramatic decline caused by: ➢ ➢ ➢ ➢ Growth of ADN and BSN programs, a move to the mainstream of higher education Inability of hospitals to continue to finance nursing education Accreditation standards have made it difficult for diploma programs to attract qualified faculty Increasing complexity of health care has required nurses to have greater academic preparation. Copyright © 2017 by Elsevier Inc. All rights reserved. 10 Diploma Nursing Programs  1800-early 1900s – Diploma programs provided formal education and jobs to women. ➢ Modified apprenticeship model ➢ Demanding schedule ➢ Duration: 3 years (current programs: 24 months)  Most colleges and universities did not recognize diploma programs. ➢ Current practice: Diploma programs establish agreements with colleges and universities. Copyright © 2017 by Elsevier Inc. All rights reserved. 11 Baccalaureate Programs     Nurses need a bachelor’s degree to qualify nursing as a recognized profession and to provide leadership in administration, teaching, and public health. 1909: First BSN program in University of Minnesota 1919: Seven BSN programs. Most BSN programs were 5 years in duration. Growth of BSN was slow because of: ➢The reluctance of universities to accept nursing as an academic discipline ➢The power of the hospital-based diploma programs Copyright © 2017 by Elsevier Inc. All rights reserved. 12 Baccalaureate Programs  The theoretical, scientific orientation of the BSN program was in sharp contrast to the “hands-on” skill and service orientation that was the hallmark of hospital-based diploma education. Copyright © 2017 by Elsevier Inc. All rights reserved. 13 Influences on the Growth of Baccalaureate Education  1948: Lucille Brown. Nursing for the Future. (The Brown Report). Sponsor: Carnegie Foundation. ➢  Recommendation: Basic schools of nursing must be placed in universities and colleges with an effort to recruit men and minorities. 1965: ANA Position Paper. Educational preparation for Nurse Practitioners and Assistants to Nurses. It did not refer to Medicare and Medicaid. ➢ It concluded that baccalaureate education should become the foundation for professional practice. Copyright © 2017 by Elsevier Inc. All rights reserved. 14 Influences on the Growth of Baccalaureate Education  1970: National Commission for the Study of Nursing and Nursing Education published An Abstract for Action (Lysaught Report) ➢ ➢ Discussion: Professional Identity & Socialization Questions

It made recommendations concerning supply and demand for nurses, nursing roles and functions, and nursing education. Priorities identified by the study: • The need for increased research into both practice and education of nurses • Enhanced educational systems and curricula Copyright © 2017 by Elsevier Inc. All rights reserved. 15 Influences on the Growth of Baccalaureate Education  1980: National Commission on Nursing ➢ The major block to the advancement of nursing was the ongoing conflict about educational preparation for nurses. ➢ Recommendation: • Establish a clear system of nursing education including pathways for educational mobility and development of additional graduate education programs (DeBlack, 1991) Copyright © 2017 by Elsevier Inc. All rights reserved. 16 Influences on the Growth of Baccalaureate Education   1982 National League for Nursing Position Statement on Nursing Roles: Scope and Preparation – affirmed BSN as minimum educational level for professional nursing practice and ADN or diploma as the preparation for technical nursing practice. 1996: AACN Position Statement. The baccalaureate Degree in Nursing as the Minimal Preparation for Professional Practice. ➢ It supports articulated programs which enable ADN nurse to attain BSN. Copyright © 2017 by Elsevier Inc. All rights reserved. 17 Characteristics of Pre-licensure Baccalaureate Programs      4-year program. General education + nursing courses. Faculty qualifications – minimum of master’s degree BSN graduates are eligible to take licensure exams, prepared to move into graduate programs and advanced practice certification programs. 2008 AACN. The Essentials of Baccalaureate Education for Professional Nursing Practice. Rhode island Nurses institute Middle College Charter High School in Providence Copyright © 2017 by Elsevier Inc. All rights reserved. 18 Associate Degree Programs   Begun 1952. It is based on a model developed by Mildred Montag. Popularity of ADN is due to ➢ Accessibility of community ➢ Low tuition costs colleges ➢ Discussion: Professional Identity & Socialization Questions

Part-time and evening study opportunities ➢ Shorter duration of programs ➢ Graduates’ eligibility to take the RN licensure Copyright © 2017 by Elsevier Inc. All rights reserved. exam 19 Associate Degree Programs  Mildred Montag’s ADN program ➢ Short duration to prepare nurse technicians ➢ Nurse technicians function under supervision of professional nurses ➢ Routine care in acute and long-term settings ➢ Intended for end-point degree and not an incremental step to BSN  Current trends in ADN programs Copyright © 2017 by Elsevier Inc. All rights reserved. 20 External Degree Programs   Students attend no classes. Excelsior College (formerly: NY Regents External Degree Nursing Program) ➢  It does not offer clinical experiences to those seeking a basic nursing education and as such they are encouraged to seek basic education that includes clinical instruction. 1981: California State University Consortium offered a statewide external BSN program. Copyright © 2017 by Elsevier Inc. All rights reserved. 21 Articulated Programs     Definition: Mobility between programs Purpose: Facilitate opportunities to move up the educational ladder. Multiple-entry and multiple exit programs Articulation agreements facilitate student movement between programs and accept transfer credit between institutions. These result in acceleration or advanced placement. Copyright © 2017 by Elsevier Inc. All rights reserved. 22 Alternate Paths in Nursing Education: Baccalaureate Programs for Registered Nurses RN-to-BSN Education  Diploma and ADN nurses are given credits to meet certain BSN requirements.  Transfer of general education courses  Options for advanced placement Programs for Second-degree Students  Accelerated or fast-track sequence to award a second bachelor’s degree or in some cases MSN Copyright © 2017 by Elsevier Inc. All rights reserved. 23 Alternate Paths in Nursing Education: Baccalaureate Programs for Registered Nurses Online and Distance Learning Programs  Intended to improve access for nurses from rural areas  Online education provides flexibility.  Distance Learning and issues of adequate and properly supervised clinical experiences  Fraudulent programs  Before committing to an online program… Copyright © 2017 by Elsevier Inc. All rights reserved. 24 Accreditation: Ensuring Quality Education     Accreditation – voluntary review process of educational programs by a professional organization The accrediting agency compares the educational quality of the program with established standards and criteria. It derives authority from the US Department of Education. Two agencies: ➢ Accreditation Commission for Education in Nursing (ACEN) ➢ Commission on Collegiate Nursing Education (CCNE) Copyright © 2017 by Elsevier Inc. All rights reserved. 25 Accreditation of Nursing Schools   An accredited program voluntarily adheres to standards that protect the quality of education, safety, and the profession itself. Accrediting agencies establish standards by which program effectiveness is measured. ➢ ➢ ➢  Self-study and site visits Continued accreditation Deficiencies Implications on prospective students and graduates Copyright © 2017 by Elsevier Inc. All rights reserved. 26 Accrediting Agencies   Commission on Collegiate Nursing Education (CCNE) – national agency for accreditation of bachelor’s and graduate nursing education programs. Accreditation Commission for Education in Nursing (ACEN) – accredits LPN/LVN, diploma, and ADN programs. ➢ It has a close relationship with National League for Nursing. Copyright © 2017 by Elsevier Inc. All rights reserved. 27 Advanced Degrees in Nursing: Master’s Education     What is the purpose of master’s education? 1899: Teachers College and graduate education 1950–1960s: Master’s degree as a terminal degree. 1970s: Development of doctoral degrees ➢ ➢ Master’s degree were shortened and emphasized on clinical specialization. Master’s programs sought voluntary accreditation from either ANEC or CCNE. Copyright © 2017 by Elsevier Inc. All rights reserved. 28 Advanced Degrees in Nursing: Master’s Education     Entrance requirements Duration of the program Curriculum Major areas of role preparation ➢ Discussion: Professional Identity & Socialization Questions

 Administration, case management, informatics, health policy/health care systems, teacher education, clinical nurse specialist, NP, nurse-midwifery, nurse anesthesia, and other clinical and nonclinical areas of study Common graduate degrees Copyright © 2017 by Elsevier Inc. All rights reserved. 29 Advanced Degrees: Doctoral Education  Doctoral programs prepare nurses to become faculty members in universities, administrators in schools of nursing or large medical centers, researchers, theorists, and advanced practitioners. ➢Research-focused degree—doctor of philosophy (PhD) ➢Practice-focused degree—doctor of nursing practice (DNP) Copyright © 2017 by Elsevier Inc. All rights reserved. 30 Advanced Degrees: History of Doctoral Education       1910: Columbia University’s Teachers College – creation of the Department of Nursing and Health 1934: New York University initiated the first PhD program for nurses. 1934–1953: No new nursing doctoral programs were opened. 1954: University of Pittsburgh opened the first PhD program in clinical nursing and clinical research. 1962: The federal government initiated nurse scientist programs. 1975: Nurse scientist programs were discontinued. Copyright © 2017 by Elsevier Inc. All rights reserved. 31 Current Status of Doctoral Education in Nursing   PhD – research-focused doctorate and DNS or DNSc – doctor of nursing science Oct 2004: AACN called a new doctorate, DNP ➢ Proponents ➢ Detractors  DNP and the shortage of primary care physicians Copyright © 2017 by Elsevier Inc. All rights reserved. 32 Becoming Certified: Validating Knowledge & Proficiency   Licensure Certification ➢ Benefits of being a certified nurse ➢ ANCC and standardized certification ➢ Requirements Copyright © 2017 by Elsevier Inc. All rights reserved. 33 Continuing Education: Maintaining Expertise and Staying Current      Lifelong learning Versus: Staff development Role of ANCC Contact hours Mandatory continuing education Copyright © 2017 by Elsevier Inc. All rights reserved. 34 Challenges  Faculty and other resources shortages ➢ ➢ ➢   Average age of professors: 59 years Average age of associate professors: 52 years Trends Quality and safety education for nurses (QSEN) IOM (2003) identified five problems in professional health education. Copyright © 2017 by Elsevier Inc. All rights reserved. 35 Continuing the Evolution of Nursing Education   2005: NLN Position Statement: Transforming Nursing Education – emphasis on evidencebased education 2008: NLN Position Statement: Preparing the Next Generation of Nurses to Practice in a Technology-rich Environment: An Informatics Agenda – call on nursing programs to prepare graduates to use of electronic health records Copyright © 2017 by Elsevier Inc. All rights reserved. 36 What is an accurate statement regarding nurse certification? 1. Certification is required at the entry point to practice. 2. Certification is the government’s way of ensuring currency in practice. 3. Certification refers to agency efforts to maintain competence. 4. Certification validates knowledge, skills, and abilities. Copyright © 2017 by Elsevier Inc. All rights reserved. 37 Chapter 5 Becoming a Professional Nurse: Defining Nursing and Socialization into Practice Copyright © 2017 by Elsevier Inc. All rights reserved. Discussion: Professional Identity & Socialization Questions

Why Define nursing?    A definition establishes the parameters (or boundaries) of the profession and clarifies the purposes and functions of the work of nursing. A definition guides the educational preparation of aspiring practitioners and guides nursing research and theory development. A clear definition makes the work of nursing visible and valuable to the public and to policy makers who determine when, where, and how nurses can practice. Copyright © 2017 by Elsevier Inc. All rights reserved. 2 Defining Nursing  “If we cannot name it, we cannot control it, finance it, research it, teach it, or put it into public policy.” (Styles, 1991). Copyright © 2017 by Elsevier Inc. All rights reserved. 3 Evolution of Definitions of Nursing  Florence Nightingale – Notes on Nursing: What It Is and What It Is Not (originally published 1859) I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet—all at the least expense of vital power to the patient (Nightingale, 1946, p. 6). Copyright © 2017 by Elsevier Inc. All rights reserved. 4 Early 20th Century Definitions  Shaw’s Textbook of Nursing (1907) “It properly includes, as well as the execution of specific orders, the administration of food and medicine, the personal care of the patient” Copyright © 2017 by Elsevier Inc. All rights reserved. 5 Early 20th Century Definitions  Harmer’s Textbook of the Principles and Practice of Nursing (1922) “The object of nursing is not only to cure the sick… but to bring health and ease, rest and comfort to mind and body. Its object is to prevent disease and to preserve health”  Harmer and Henderson (1939) “Nursing may be defined as that service to an individual that helps him to attain or maintain a healthy state of mind or body” Copyright © 2017 by Elsevier Inc. All rights reserved. 6 Post-World War II Definitions       World War II helped advance available technologies. 1950–1960: Master’s graduates and nursing theories 1952: Hildegard Peplau – “Nursing is a significant, therapeutic, interpersonal process.” 1959: Dorothea Orem 1960: Virginia Henderson 1961: Martha Rogers and inclusion of nursing process Copyright © 2017 by Elsevier Inc. All rights reserved. 7 Professional Associations Define Nursing  American Nurses Association (ANA) ➢ ➢ ➢ Nursing’s Social Policy Statement: The Essence of the Profession Six essential features of contemporary nursing practice Preface to the Code of Ethics for Nurses (ANA, 2015a): “Nursing encompasses the prevention of illness, the alleviation of suffering, and the protection, promotion, and restoration of health in the care of individuals, families, groups, and communities” (p. 10). Copyright © 2017 by Elsevier Inc. All rights reserved. 8 Professional Associations Define Nursing  Royal College of Nursing ➢ ➢ 2014: RCN’s Nursing Policy and Practice Committee clarified the role of nursing Nursing is the use of clinical judgment in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever t …