Nursing education Achieving Excellence In Nursing Education and The National Perspective Perspective for Nursing describe the current affairs and innovations in health care settings.
Achieving Excellence In Nursing Education: The National League Perspectives for Nursing
Throughout its more than 100-year history, the National League for Nursing (NLN) has worked to advance excellence in nursing education. For many years, the NLN was the only nursing organization that attended to education-related issues, and its initiatives have improved the quality of education designed to prepare tomorrow’s nursing workforce and the future leaders of the nursing profession. This work continues into the 21st century, as the National League for Nursing strengthens its position as a leader in nursing education.
The Current State of Affairs in Nursing Education
For the past few decades, the broad higher education community has placed great emphasis on research productivity and on securing grants to fund such endeavors. In nursing, our desire to document the uniqueness of nursing and the outcomes of nursing interventions have led to an increased emphasis on developing the science of nursing practice and carving out roles for nurse practitioners, nurse midwives, and nurse anesthetists.
As a result of these converging circumstances, concerns about the preparation and ongoing development of faculty have been minimized, reward systems typically have not valued expertise in teaching, and the academy has failed to replace the many faculty members who are retiring. In addition to these broad issues, faculty members in nursing typically do not encourage undergraduate students to become nursing educators, nor do they help students consider a career path in education.
As a result, the profession now faces a significant faculty shortage, one that most recently led to approximately 125,000 qualified applications unable to be accepted for admission to various types of RN programs (NLN, 2004). Furthermore, fewer and fewer individuals now fulfilling faculty roles and teaching in nursing programs actually have been prepared for the teaching role.
These individuals typically have not studied the research on how students learn. For the most part, they have not been educated regarding curriculum design, curriculum integrity, or program evaluation. And far too many have a limited repertoire regarding innovative teaching/learning strategies and evaluation methods. Without enough adequately prepared faculty members, the potential for decline in the quality of educational programs is real.
And this is happening precisely at a time when the changing student population, the increased use of educational technology, and dramatic changes in the practice of nursing demand new approaches to and the transformation of nursing education. One of the reasons why today’s faculty members need to be prepared for their role relates to the fact that today’s students are more diverse and experience very different life circumstances than those we have known in the past.
Many students are working while they attend school; many do not have the educational foundations needed to succeed in college; and many have overwhelming family responsibilities that compete with study time. In addition, an increasing number of students are from countries outside of the United States and present faculty with values and cultural practices that are quite different from their own.
Faculty, therefore, needs to know how to meet individual learning needs, be more skilled in the ability to advise and counsel students, and design curricula that are more flexible and accommodating. In addition to the increased diversity in the student population with which faculty interact, today’s students have grown up with technology as a natural part of their lives, and technology is becoming an increasingly integral aspect of the educational enterprise—from asynchronous approaches to teaching and learning to collaborative learning strategies; from high-tech simulators to PDAs. All expectations are that technology will become increasingly integral to the learning process, and nursing education must change to accommodate and, indeed, benefit from this.
The health-care arenas in which graduates of today’s nursing programs will practice also are very different from those of the past, and the role of the nurse continues to evolve. Practice environments are characterized by uncertainty, ambiguity, chaos, conflicting information, constant change, and challenging ethical dilemmas. Health-care professionals collaborate through interdisciplinary teams to plan and implement care for patients, families, and communities. And increasingly sophisticated technology abounds.
Graduates of nursing programs, therefore, need to be prepared to think critically, manage uncertainty and ambiguity, be technologically proficient, work effectively on multidisciplinary teams, be comfortable with complexity and conflict, and be leaders who advocate for change that will benefit the recipients of care. This amounts to a tall task for those educating them to fulfill this demand. Finally, students, legislators, parents, and communities are demanding greater accountability on the part of institutions of higher education.
There is an expectation that outcomes of the educational enterprise will be documented and that schools will be able to demonstrate that the experience has made a difference in how students think, their openness to new perspectives, their abilities to communicate effectively, their self-understanding, their ability to synthesize enormous amounts of potentially conflicting information, and their ability to provide true leadership that leads to change.
All of these differences require that current faculty members unlearn how they were taught so they can re-learn strategies and approaches that are more relevant for today’s learners and today’s issues. It means that our old ways of educating nurses are no longer appropriate, and we must give up many of the “sacred cows” that have become entrenched in nursing education. We must become more innovative, rather than continue the way we have always done it.
We must strive to achieve excellence, rather than settle for mediocrity. We must help faculty prepare for and stay current in their role as educators. We must begin to expect that the practice of teaching will be evidence-based. While this presents an enormous challenge to the nursing education community, it is not an insurmountable one. And there are many initiatives currently underway to facilitate this transformation, to encourage more nurses to go into nursing education, and to help faculty develop in this role.
Transforming Nursing Education
There are a number of initiatives at work to transform nursing education. Underlying all of these initiatives are the themes of promoting excellence and innovation, as well as integrating evidence-based nursing education. Using technology to its best advantage is another necessity in transforming nursing education.
Promoting Excellence
The literature suggests that “excellence means striving to be the very best we can be in everything we do—not because some…’authority’ figure pushes us to do that, but because we cannot imagine functioning in any other way” (Valiga, 2003, p. 275). It means setting high standards and holding ourselves to those standards despite challenges encountered when striving to reach that level of performance or pressures placed upon us to accept less than the very best.
Those who strive for excellence are unwilling to accept the status quo; they ask why things are done the way they are; they examine the assumptions that underlie existing practices; and they are willing to invest enormous amounts of time and energy to design, implement, and evaluate the effectiveness of new approaches.
The National League for Nursing has developed an Excellence in Nursing Education Model©(NLN, 2005b) that depicts the many elements that must be in place if we are to achieve excellence. As noted, excellence in nursing education will be achieved if we have clear program standards and hallmarks that raise expectations, well-qualified faculty, and administrators who create healthful work environments for faculty, interactive learning, and innovative curricula, among other things.
For example, if the standards that guide program development are static and seek only acceptable levels of achievement, it is unlikely that we will achieve excellence. If faculty complements do not include expert teachers and educational “architects” as well as researchers and physicians, academic programs may become irrelevant and fail to prepare graduates for the health-care arena in which they will practice.
In addition to developing a visual model that depicts the elements needed to achieve excellence in nursing education, the National League for Nursing has formulated Hallmarks of Excellence in Nursing Education (NLN, 2005c) that describe targets toward which faculty should strive in order to achieve excellence in their programs . For example, excellence is characterized by students who are excited about learning, exhibit a spirit of inquiry and a sense of wonderment, and commit to lifelong learning. It also is reflected in:
- Curricula that are flexible and dynamic, rather than static and rigid.
- Curricula that emphasize students’ values development, as well as gains in their cognitive learning and ability to perform psychomotor skills.
- Environments that empower students and faculty and promote collegial dialogue, innovation, and creativity.
Nurse educators who strive for excellence are passionate and “inflamed” by their work (Diers & Evans, 1980). They are guided by the Excellence in Nursing Education Model and the Hallmarks of Excellence in Nursing Education as they design curricula, design appropriate teaching/learning strategies and evaluation methods, engage in evidence-based teaching practices, and implement the full scope of the faculty role. In addition, they are open to new ideas and are innovative.
Innovation
“Innovation [in nursing education] must call into question the nature of schooling, learning, and teaching and how curricular designs promote or inhibit learning, as well as excitement about the profession of nursing, and the spirit of inquiry necessary for the advancement of the discipline” (Diekelmann, 2001). “New pedagogies are required that are research-based, responsive to the rapidly-changing health care system, and reflective of new partnerships between and among students, teachers and doctors. Our students and recipients of nursing care deserve no less” (NLN, 2003a, p. 1).
If nurse educators are to meet this challenge, they must be creative in their approaches to teaching/learning, evaluation of learning, and program design. This is no small challenge for many of today’s faculty members, however. Most of today’s faculty members have experienced curricula that are content-loaded and highly structured. Their orientation has been on what to teach, rather than on how to teach, and they focus on covering content more than on the process of learning.
Such a model is no longer appropriate to prepare graduates for the chaotic, ambiguous, uncertain world that characterizes 21st century nursing practice, nor is it adequate to prepare graduates who can serve as leaders in helping the profession create its preferred future. Instead, what is needed are new interactive, student-centered pedagogies, such as narrative pedagogy and collaborative learning, that call upon nursing educators, students, consumers, and nursing service representatives to “form partnerships that will dramatically reform [nursing education] and the relationships between and among students, teachers, researchers and doctors” (NLN, 2003a).
Conversations about innovation must not focus on the content or subject matter to be covered in, added to, or updated in nursing curricula. Rather, nurse educators must conceptualize our overall approach to and design of nursing education to ensure that it focuses on learning, is student-centered, allows for multiple ways to achieve intended outcomes, and acknowledges the importance of unintended outcomes.
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