A Historical View of New Model of Education In Nursing
New Models of Nursing Education,The History of Associates Degree Nursing Education Emerging Controversies in Associate Degree Nursing Education,Understanding Associate Degree Nursing Education Today,Bachelor of Nursing Education,Advocating for University Education,The History of Baccalaureate.
New Models of Nursing Education
The History of Associates Degree Nursing Education
As noted previously, in 1943 Isabel Stewart
remarked that efforts to redesign diploma nursing education included
experimenting with new nursing education models. One model was associate degree
nursing education. It began in response to the post World War II nursing
shortage and it gained momentum following the Ginzberg Report (1949), which
suggested that in comparison to a 4-year nursing program it would be more
efficient and economical for colleges to offer a 2- year course of study in
nursing.
Ginzberg believed that not all nurses needed baccalaureate education
to provide patient care. Nurses could be prepared to provide safe and competent
patient care in less time than baccalaureate education, which would provide a
feasible solution to the nursing shortage.It was at this time that Mildred Montag
(1951) described how 2-year associate degree nursing programs, housed in
community colleges, could prepare registered nurses (RNs) as semiprofessionals.
This group of RNs would meet the demand for nurses by acquiring enough nursing
skill and judgment to provide nursing care, but not the expert skill and
judgment of baccalaureate prepared nurses. Further study by Montag (1959)
suggested that nurses prepared with an associate degree were performing
similarly to staff nurses prepared with baccalaureate degrees. Moreover, those
within the nursing profession believed that, with the exception of preparation
in leadership and public health, nurses with an associate degree provided
outstanding bedside nursing care (Smith, 1960).
Others contended the associate
degree program’s focus on learning rather than on service to hospitals provided
educationally sound preparation for nursing practice (Lewis, 1964). Still
others believed that its accessibility and affordability through community
colleges made this degree inclusive. For the first time in the history of
nursing education, the associate degree in nursing offered those with little
access to baccalaureate nursing programs the opportunity to become registered
nurses (Hassenplug, 1965).
Emerging Controversies in Associate Degree
Nursing Education
Indeed there were many advantages to
associate degree nursing education, and these advantages remain present in
today’s associate degree nursing programs. Nevertheless, at the height of this
program’s success, in 1965, the American Nurses Association (ANA) published a
position paper stating that those licensed to practice nursing should be
prepared in institutions of higher education (universities). It also stated
that the minimum preparation for the professional nurse should be a
baccalaureate degree.
In other words, the position paper equated professional
nursing with baccalaureate education. This potentially meant that associate
degree-prepared nurses could not practice as registered nurses unless they had
license requirements that were different from baccalaureate-prepared nurses.
Despite these challenging circumstances,
studies conducted since the ANA’s position paper through the 1990s showed that,
especially in hospital settings, there were unclear differentiations between
nurses prepared in associate degree nursing programs and those prepared in
baccalaureate degree programs (Bullough, Bullough, & Soukup, 1983; Bullough
& Sparks, 1975; Haase, 1990). In fact, many studies showed registered
nurses performed essentially the same in practice regardless of academic
preparation.
Studies occurring in the 2000s, however, are beginning to present
a different picture. Current research suggests that baccalaureate prepared
nurses are associated with improved patient outcomes, that hospitals prefer to
hire baccalaureate-prepared nurses, and that “magnet” hospitals have a higher
percentage of baccalaureate-prepared nurses (Graf, 2006).
This is not to say that associate degree
nursing programs (like many diploma programs) will disappear. However, these
studies do indicate mobility programs through which associate degree prepared nurses obtain baccalaureate and higher
degrees in nursing, will take on even greater significance than they have in
the past.
Understanding Associate Degree Nursing
Education Today
According to the US Department of Health
and Human Services Health Resources and Services Administration, National
Center for Health Workforce Analysis (2006), 52.8 percent of those wishing to
become nurses enter associate degree nursing (ADN) or associate degree in
science (ASN) programs .
As a result, these programs remain one of the most
feasible options of becoming an RN, and they address the nursing shortage by preparing
nurses who are safe practitioners.Moreover, faculty members of ADN/ASN
programs take responsibility for ensuring graduates are prepared for registered
nurse roles in advocacy, leadership, professional involvement, lifelong
learning, and evidence-based practice (National Organization for Associate
Degree Nursing [N-OADN] , 2006).
Clearly, the nursing profession must
support such nurses in practice and the educational programs that prepare them.
However, it is important to note that only 20.7 percent of associate degree
nurses return to school for baccalaureate and higher degrees (US Department of
Health and Human Services, 2006).
Because the associate degree in nursing is
considered an initial entry degree into practice as a registered nurse, it is
important to investigate why so few associate degrees prepared nurses return to
school. Advocates of nursing education need to provide opportunities and
incentives for associate degree prepared nurses to pursue further education.
Bachelor of Nursing Education
“Very many private schools [hospital schools] of nursing still
exist, but like the private schools of medicine that remain, there is hand writing
upon the walls of their future. It says that their days are numbered,
that “the old order changeth, giving place to the new, and”that the
day of the university education of the nurse has come” (Beard, 1920, p.
955).
Advocating for University Education
The
History of Baccalaureate
Nursing Education Dr. Richard Olding Beard
(quoted above), a great supporter of baccalaureate nursing education, followed
the thinking of Florence Nightingale and the Nightingale Schools. Nightingale
believed that nursing education should occur outside of hospitals and the
medical model (Stewart, 1943). This model of nursing education would avoid
apprenticeships where nursing students received less education in the
principles of nursing care because they were providing long hours of service to
hospitals.
Nightingale advocated for nursing students
to learn sound theory in anatomy and physiology, surgery, chemistry, nutrition,
sanitation, and professionalism; to train under the guidance of ward sisters
who were nurses with experience and dedication to the profession; and to be
part of a system that was financially independent from hospitals (Stewart).
The Nightingale philosophy initially
succeeded in the United States when Bellevue School of Nursing in New York
adopted it in 1873. However, opposition to it, which included arguments that
nurses do not need to be overeducated, that hospitals needed nurses for
service, and that independent Funding for nursing schools was unrealistic,
maintained diploma nursing education.
Despite the overwhelming support for
diploma schools, several nursing education leaders during the early 1900s continued
to believe in university education for nurses and subsequently persisted in
advocating for baccalaureate nursing education.
For example, in 1901, Ethel Gordon Bedford
Fenwick, founder of the International Council of Nurses, asserted it was time
for nurses to be educated in universities where they could become skilled
practitioners able to address local, national, and international health issues
(Fenwick, 1901). Additionally, Dr. Beard supported leaders in nursing education
who wanted higher educational standards for nurses.
He convinced the University
of Minnesota to begin moving nursing education into higher education. In 1909
this university began its first nursing program. Though, as referred to
previously, it resembled diploma programs, it did represent the beginning of a
slow movement in nursing education toward baccalaureate education for nurses.