Trends in Nursing Education

Trends in Nursing Education

Tricia Lynn B. Cuaton, RN

US SITUATION

Growing shortfall of nurses since 2004 caused by a convergence of many pressures (financial constraints, a dissipating workforce, and an increasingly complicated and stressful work environment)

Aging RN factor—retirement of the “baby boomers” (those born between 1946 and 1964)

The average age of RN population is 45.2 years (in 1983 it was 37.7)

Only 9% of RNs are under the age of 30 Only 18.3% of RNs are under the age of 35 Only 37.7% of RNs are under the age of 40

…US SITUATION

The US will be needing a million new and replacement nurses by 2010

It is estimated that the US will lack 29% or more than 434,000 nurses by 2020

Fewer college students are choosing Nursing as a profession. There has been a decline of 26% from 1995 to 2000

There are not enough nurses in the educational pipeline to replace the ones leaving the workforce

PHILIPPINE SCENARIO

Nursing Practice in the Philippines is governed by RA 9173

The Nursing Law of 2002 envisioned to provide for a relevant nursing education, humane working conditions, better career prospects, and a dignified existence for nurses

Geographical data shows that most nurses are relocated in the urban areas. NCR has the highest number of nurses comprising about 33.4% from 2001 to 2003

Urban areas have a good number of tertiary hospitals which are used as springboards for future migration to other countries

PHILIPPINE SCENARIO

Favorite countries of destinations of Filipino nurses are Saudi Arabia, United Kingdom, United Arab Emirates, Singapore, Kuwait, the United States, Ireland, Libya, and Qatar.

Filipino nurse migrants are perceived to be predominantly female

Filipino nurses’ reason for leaving:› Economic› Job-related› Socio-political and economic environment

Reasons for returning:› Personal› Professional› Social

WHAT CAN BE DONE?(Nursing Side)

Dr. Marilyn Lorenzo suggested the following policy option:

1. Decrease supply of nurses Strict implementation of opening and closing of

nursing schools Increase public awareness of nursing oversupply

problems Create/identify a body that will undertake health

human resource planning and development for nurses

Develop nurses’ awareness of their rights for better compensation and working conditions

Establish a nursing information system that determines current supply

.. WHAT CAN BE DONE?(Nursing Side)

2. Increase demand for nurses Identify and fulfill local demand first Encourage and facilitate independent nursing

practice Establish a nursing information system Improve salary and working conditions of

nurses in private institution Strengthen networking with government

agencies and NGOs in generating employment Develop required nursing pools Strengthen nursing curriculum to encourage

role expansions and entrepreneurship

.. WHAT CAN BE DONE?(Nursing Side)

3. Improve existing policies Clarifying and delineating functions of

regulating bodies such as CHED and BON

Reviewing and implementing existing policies

Decentralizing CHED’s functions Coordinating with other agencies to

promote international employment Reviewing the Labor Code on hiring of

nurses Reviewing powers of BON vis-à-vis PRC

EFFECTS ON NURSING EDUCATION

Nurses in the 21st century will need to be knowledgeable in the uses of computer technology. Nursing education may involve more distance learning, and make it easier for nurses to continue their professional education. Computer technology will allow nursing students to simulate clinical conditions electronically to help them learn.

Because of globalization, nursing education will have to address the issue of the spread of disease across national boundaries, and deal with emerging disease threats around the world.

Nursing education will have to address the changing economic situation in health care. Nurses will need to have an understanding of how to care for patients in ways that improve quality, deal with the complexity of care, and do so in a cost effective way

…EFFECTS ON NURSING EDUCATION

There is also a trend in nursing education to incorporate more nursing science and research, which are playing much greater roles in nursing practice. Nursing research is providing a scientific model for health care. This research deals with how patient behavior affects health, how to manage symptoms of illness, helping patients and their families cope with the illness and its treatment

Another trend affecting nursing education is the increasing complexity of patient care. Patients in hospitals are more acutely ill—there are almost as many beds in critical care and other specialty areas now as there are in general use beds. Because life expectancy is now longer, there is an increase in the number, severity, and length of chronic conditions, which ads to the complexity of care needed.

…PROGRAMS IN NURSING EDUCATION

RN LPN CAREGIVER

INSTITUTIONAL HEALTH

CARE WORKER

Length of Training 4 yrs 2 yrs 786 hours 960 hours

Entry Requirements High School Graduate

The college or university may stipulate admission tests

High School diploma

Other requirements set forth by the school

can communicate both in oral and written form;

physically and mentally fit;

with good moral character; and

can perform basic mathematical computation.

16 years old and above

Must pass the trainability / aptitude test

Can communicate effectively both orally and in written form

Physically, emotionally and mentally fit

Can perform basic mathematical computation

…PROGRAMS IN NURSING EDUCATION

RN LPN CAREGIVER INSTITUTIONAL HEALTH

CARE WORKER

Licensing Exam Needed

NLE Competency assessment by accredited Competency Assessors

Competency assessment by accredited Competency Assessors

Competency assessment by accredited Competency Assessors

Typical Skill Level Direct patient care Passing

medications Completing

treatments More advanced

skills such as IV skills, IV medications

Direct patient care Passing oral

medications Completing

treatments

Provide care and support to children

Foster physical, social, intellectual, creative and emotional development of children

Clean living room, dining room, bedrooms, toilet and bathroom

Wash and iron clothes, linen and fabric

Prepare hot and cold meals

Prepare and maintain beds

Collect and maintain linen stocks at end-user location

Assist with patient mobility

Assist in transporting patient

Assist with bio-psychosocial care of patient

Handle waste in a health care environment

…PROGRAMS IN NURSING EDUCATION

RN LPN CAREGIVER INSTITUTIONAL HEALTH

CARE WORKER

Typical Places of Employment

Hospitals Home Health Care Nursing Homes Clinics Insurance

Companies

Nursing Homes Doctor’s Offices Clinics

Hospitals Nursing Homes Home Health Care

Hospitals Nursing Homes Home Health Care

Potential for Advancement

May work in many settings… a charge nurse in a nursing home or hospital; the Director of a nursing home; a nurse manager. May need further education such as a bachelor’s degree for higher level nursing careers.

Will probably work in a nursing home with elderly clients. May be a charge nurse in a long term care environment.

Will probably work in a nursing home or home health care with elderly clients.

Will probably work in a nursing home with elderly clients.

MASTERS DEGREE PROGRAMS IN NURSING

Prepares nurses for specialty roles in nursing practice Prepares nurses with a functional focus of educator,

manager/administrator, clinical specialist, or nurse practitioner

Educational Setting: Masters degree programs are offered in colleges and universities with graduate programs. The Masters Program is usually located in schools with baccalaureate nursing programs

Entry Requirements: Requirements for most Masters degree program include graduation from a BSN Program. Other admission criteria may include experience related to the field of nursing and RN licensure and evidence of scholastic ability as measured in qualifying exams.

…MASTERS DEGREE PROGRAMS IN NURSING

The graduate from a Master’s degree program is prepared to perform the following:

› Incorporate theories and advanced knowledge into nursing practice

› Demonstrate competence in selected roles› Identify researchable nursing problems and participate

in research studies in advanced nursing practice› Use leadership, management, and teaching knowledge

and competencies to influence nursing practice› Assume responsibility for contributing to improvement in

the delivery of health care and influencing health policy› Assume responsibility for contributing to the

advancement of the nursing profession

DOCTORAL DEGREE PROGRAMS IN NURSING

Doctoral programs prepare nurses for roles as administrators, academicians, advanced clinical scientists, researchers, consultants, and independent practitioners.

Educational Setting: Doctoral programs in nursing are offered in colleges and universities with graduate programs in nursing. The school of nursing may be aligned with the university and follow an academic model for doctoral education, or be located in a health sciences setting with a professional model focus.

Entry Requirements: Admission requirements to doctoral programs are set by the nursing program and the college or university. They may include completion of a Master’s program, evidence of scholastic achievement, and admission examinations

Curriculum: There are 4 types of nursing doctoral programs, the Doctor of Nursing Science (DNSc, DSN); the Doctor of Philosophy (PhD) which is the most common; the Doctor of Education (EdD); and the Nursing Doctorate (ND)

EDUCATIONAL MOBILITY IN NURSING

Movement from one degree in nursing into another degree

It facilitates multiple points of entering the profession of nursing as well as career advancement through additional education without a loss of credits from previous education.

One major advantage of educational mobility is that there are a number of options for nursing education. The options fit student educational interests and abilities, career plans, and financial and work commitments.

Another advantage of a mobile nursing education system is that students can graduate with another degree and be employed while earning another degree.

ALTERNATIVE CURRICULUM PLANS IN NURSING

A. CURRICULUM DESIGN1. External Degree Programs

An external degree is a degree awarded for study that does not take place within the typical structure of the classroom, but rather takes place outside the classroom and is self-paced.

The outcome of learning is assessed through standardized criteria and referenced performance examinations, which may be cognitive, affective, and/or psychomotor components

Proponents of external degree programs cite emphasis of professional practice, self-direction, use of adult education principles, accessibility, and match with learning style as advantages of this curriculum

Often criticized for the decreased contact with faculty and student peers, lack of academic rigor, and supervised clinical practice

…ALTERNATIVE CURRICULUM PLANS IN NURSING2. Competency based Curricula

Involves the definition of specific knowledge, skills and attitudes (competencies) to be demonstrated.

Instructional strategies are selected to facilitate learner attainment of competencies.

Evaluation strategies are developed to indicate the criteria for successful performance, and are used to measure outcomes in multiple modes and contexts

3. Accelerated Programs Offer the nursing the nursing major in a compacted time frame. These programs are developed to facilitate educational mobility

and to expedite entry into the workforce Courses are offered in a sequence that is convenient for the

learner and can completed with delay of disrupted course sequence

Course work that might that might typically be completed in 2-4 years can be completed in 12-18 months.

…ALTERNATIVE CURRICULUM PLANS IN NURSING4. Expanded Programs In this type of program, the learner can enroll in part-

time studies over a longer period of time. The curriculum is developed to encourage options for

students who are unable to enroll5. Instructional Delivery Systems

a. videoteleconference Uses television to broadcast courses to students at

distant sites. The course is broadcast from a studio classroom and

received at one or more reception sites The same class that is offered on campus is thus

available to students at reception sites city, state, or worldwide

…ALTERNATIVE CURRICULUM PLANS IN NURSINGb. Correspondence

The courses are preproduced prepackaged courses in which there is an active participation of the student through lessons, assignments, and examinations

The courses are the same as those offered on campus, but permit the student flexibility of time to complete the lessons and can be used when the student is at a distance from the school offering the course.

c. Computer conferencing The computer can be used to provide an electronic telecommunications

network to provide interactive instruction in the same way as correspondence instruction.

The technology can also be coupled with audio and graphics, and used to provide instantaneous access to print material at remote sites.

d. Off-campus programs Brings the program to a geographically convenient site, often referred to as

outreach site This may involve developing nursing programs in an existing system

campus, developing a local school site, or having faculty commute to the site.

The curriculum offered on the parent campus is thereby offered at a time and place convenient to students who might otherwise be unable to attend the program

…ALTERNATIVE CURRICULUM PLANS IN NURSING6. Self-directed Learning

Students and faculty advisers design a personal learning plan. The plan includes the content, how the content will be learned, the time period, and the criteria for evaluating outcomes. The content is comparable to courses in the curriculum and carries equivalent course credit.

Encourages flexibility and independence in meeting course objective and fosters responsibility for self-learning

…ALTERNATIVE CURRICULUM PLANS IN NURSING

B. COOPERATIVE PROGRAMS1. Internships

Involves an educational experience that provides a transition from student to practitioner.

Provides classroom experience, often in the are of assignment, as well as clinical practice

May be used as a recruitment tool for health care agencies and have benefits of a well-oriented and prepared staff nurse who is likely to remain at the agency for an extended period of time.

2. Preceptorships Are specially designed relationships matching a

novice with an expert to facilitate acquisition of skills, knowledge, and values, and orientation to the work environment.

…ALTERNATIVE CURRICULUM PLANS IN NURSING

c. Work-study Combine employment and education The study and work may be alternated, that is

students engage in a period of study, followed by a period of employment

The classroom experience provide the theory base, and the employment period provides time for application and testing of the theory.

Work-study arrangements may also be designed so that employment and study take place concurrently

The advantages of work-study accrue to the employer and the student, and include self-paced education, recruitment, and retention opportunities, and financial benefits for both parties.

THE FUTURE OF NURSING EDUCATION: 10 TRENDS TO

WATCH(Oros & Crowley)

1. Changing demographics and increasing diversity

2. The technological explosion

3. Globalization of the world’s economy and society

4. The era of the educated consumer, alternative therapies and genomics, palliative care

5. Shift to population-based care and the increasing complexity of patient care

THE FUTURE OF NURSING EDUCATION: 10 TRENDS TO

WATCH(Oros & Crowley)

6. The cost of health care and the challenge of managed care

7. Impact of health policy and regulation

8. Growing need for interdisciplinary education and collaborative practice

9. The current nursing shortage/opportunities for lifelong learning and w Significant advances in nursing science and research workforce development

10. Significant advances in nursing science and research

EXPORTATION OF EDUCATION There is a worldwide demand for higher education due to the

increasing labor market needs for highly skilled workers such as nurses.

The most rapidly growing areas for transnational education are information technology, management and business administration, engineering, international law, medicine, and the nursing specialties.

Exported educational services are delivered in various ways: (a) as students travel abroad to receive their education; (b) as education is given to them through distance learning; and (c) as educational institutions from one country provide onsite classes in another country, often through establishing branch campuses and/or franchises.

In the 1950s, the Philippines began to prepare nurses for export, mainly to the US (Brush & Solchalski, 2007). Educated in English with American-based curricula, Filipino nurses have migrated to the Middle East and throughout the developed world.

…EXPORTATION OF EDUCATION The Philippine Overseas Employment Administration (POEA) has reported

that nearly 88,000 nurses left the Philippines between 1992 and 2003

The number of Nursing schools in the Philippines has increased from 170 in 1999 to 470 by 2005 (Alvez Tan, 2006)

A critical issue in transnational nursing education is the absence of a body that has international authority to monitor educational standards worldwide, even though some attempts have been made to establish international standards that reconcile standards with cultural diversity.

There is also a lack of internationally sanctioned mechanisms for making comparisons among programs of different countries.

One project which focuses on the quality of nursing education is the recently formed Joint Task Force on Creating a Global Nursing Education Community. This initiative is designed to share information and promote quality standards. The goal is to initiate the development of global standards for basic nursing and midwifery education and to address patient safety and quality care issues that result from the large-scale migration of health care providers. Major themes include the development of global standards for program admission criteria, program development requirements, program content components, faculty qualifications, and program graduate characteristics