Education and Training in Nursing Education Introduction
The evolution of nursing education is a reflection of broader societal changes and the ongoing quest for improving healthcare delivery. From its roots in early apprenticeship models to contemporary academic and clinical education, nursing education has undergone significant transformation. This article explores the concept of education and training in nursing, focusing on diploma nursing education, the shift from apprenticeship to formal education, and the rise of associate degree programs. Understanding these historical developments provides insight into the current state of nursing education and its future directions.
According to the Bureau of Labor
The Bureau of Labor Statistics (2006a) highlighted several factors influencing the demand for practical nurses, including the aging population, advances in home medical technology, and patients’ preferences for home-based care. These trends are expected to increase the need for practical nurses, underscoring the integral role of practical nursing within the broader nursing education and practice landscape. Practical nursing, with its foundational role in patient care, continues to be a critical component of the nursing workforce.
Nursing Education Diploma
Historical Context
The origins of diploma nursing education trace back to the late 19th century, a period marked by the expansion of hospitals and the increasing need for trained nurses. During this time, diploma nursing education, also known as “hospital nursing,” emerged as a prominent model for training nurses. The apprenticeship model was prevalent, where nursing students provided direct patient care in exchange for minimal educational lectures, room and board, and a small allowance (King, 1987). This model not only provided women with a vocation but also contributed to improved patient care and reduced hospital costs.
However, the apprenticeship model faced criticism from nursing education leaders. In 1923, Josephine Goldmark published a report that underscored the imbalance between the educational and service needs of nursing students. Goldmark argued that the focus on hospital service often overshadowed the educational needs of students, leading to a misalignment between their training and practical experiences (Goldmark, 1923).
May Ayres Burgess, in her 1928 report, echoed similar concerns, emphasizing that students’ assignments were often dictated by hospital needs rather than their educational requirements. These critiques highlighted the need for a more balanced approach to nursing education, where academic and clinical experiences were integrated to benefit both students and patients.
Advocacy for University Education
In response to the limitations of the apprenticeship model, Dr. Richard Olding Beard advocated for a university-based nursing education program. Starting in 1909, Beard established a nursing program at the University of Minnesota, which is often regarded as one of the first baccalaureate nursing programs. Although this program adhered to university admission standards and coursework, it still required students to work extensive hours on hospital wards (Bullough & Bullough, 1984). Beard’s efforts were instrumental in paving the way for a more structured and academically rigorous approach to nursing education.
Shifting to a New Era
The early 20th century saw several attempts by the National League for Nursing Education (NLNE) to reform diploma nursing programs. Publications in 1917, 1919, 1927, and 1937 aimed to standardize curricula and enhance educational quality by incorporating more extensive coursework and clinical experiences. These efforts sought to address the criticisms of the apprenticeship model by emphasizing the need for a comprehensive education that balanced academic learning with practical training.
Despite these reforms, the mid-20th century brought rapid advancements in medical technology and a growing body of knowledge in healthcare. These changes necessitated a more robust theoretical foundation for nursing practice, leading to a decline in hospital-based diploma programs. The shift towards higher education institutions, such as colleges and universities, marked the beginning of a new era in nursing education.
Understanding Diploma Nursing Education Today
By 2006, only about 60 diploma programs remained in the United States, primarily concentrated in the northeastern region (National League for Nursing [NLN], 2006). Hospitals that continue to support diploma programs do so for several reasons, including the need for a steady supply of nurses, the accessibility of educational options for local students, and the provision of tuition remission. Despite the decline in diploma programs, they remain a valuable asset to the nursing profession.
Many diploma programs have adapted by collaborating with colleges and universities to offer pathways for students to obtain associate and baccalaureate degrees. Research suggests that diploma nurses are as competent in areas such as research, leadership, and critical thinking as their counterparts from other undergraduate programs (Clinton, Murrells, & Robinson, 2005). This persistence of diploma programs highlights their continued relevance and contribution to the nursing field.
Training vs Educating in Nursing Education
The Dichotomy of Training and Education
The distinction between training and education in nursing has been a subject of debate throughout the history of nursing education. Training often refers to practical, hands-on experience focused on specific skills and tasks, while education encompasses a broader, theoretical foundation that prepares individuals for a wide range of professional responsibilities.
Historically, the apprenticeship model of diploma nursing education leaned heavily towards training, with students providing patient care under the supervision of experienced nurses. This model emphasized hands-on experience but often at the expense of a comprehensive theoretical education. The shift towards a more formal educational approach aimed to address this imbalance by integrating academic coursework with clinical practice.
The Role of Curriculum in Modern Nursing Education
Modern nursing education strives to balance the practical and theoretical aspects of training. Curriculum development in nursing programs reflects this balance by incorporating both clinical experiences and academic instruction. Students are exposed to a wide range of topics, including nursing theory, research methods, ethics, and advanced clinical skills. This comprehensive approach ensures that graduates are well-prepared for the diverse challenges they will encounter in their professional practice.
Student-Centered Learning
The concept of student-centered learning has gained prominence in nursing education, emphasizing the active involvement of students in their own learning process. This approach encourages students to take responsibility for their education, engage in critical thinking, and apply their knowledge to real-world scenarios. Faculty members act as facilitators, guiding students through their learning journey and providing support as needed.
Student-centered learning aligns with the evolving needs of the healthcare system and the nursing profession. By focusing on the development of critical thinking and problem-solving skills, this approach helps prepare students for the complexities of contemporary nursing practice.
Associate Degree Nursing Education
Historical Development
The development of associate degree nursing programs represents a significant milestone in the evolution of nursing education. The introduction of these programs in the years following World War II addressed the need for a more accessible and efficient pathway to nursing practice. As Haase (1990) noted, the establishment of two-year programs for professional nurses was driven by a combination of historical, social, and educational factors.
Associate degree programs were designed to provide a more streamlined and cost-effective route to nursing education compared to traditional diploma programs. These programs typically involve two years of coursework and clinical training, culminating in the awarding of an Associate Degree in Nursing (ADN). The ADN program has become a popular option for individuals seeking to enter the nursing profession quickly while receiving a solid foundation in both theory and practice.
The Role of ADN Programs in Nursing Education
Associate degree nursing programs have played a crucial role in addressing workforce shortages and expanding access to nursing education. By offering a shorter and more affordable educational path, ADN programs have enabled a broader range of individuals to pursue careers in nursing. These programs also provide a strong foundation for further education, with many ADN graduates choosing to pursue bachelor’s or advanced degrees in nursing.
Current Trends and Challenges
Despite their success, associate degree nursing programs face several challenges. The rapid pace of advancements in healthcare and the increasing complexity of patient care require ongoing curriculum updates to ensure that graduates are prepared for contemporary practice. Additionally, ADN programs must address issues related to faculty shortages, clinical placement opportunities, and program accreditation.
In response to these challenges, many ADN programs are collaborating with universities and healthcare organizations to enhance their curricula and expand opportunities for students. These collaborations aim to provide students with a more comprehensive education and improve their readiness for the evolving demands of the nursing profession.
Conclusion
The concept of education and training in nursing has undergone significant evolution from the early apprenticeship models to contemporary academic and clinical programs. The transition from diploma nursing education to associate degree programs reflects broader changes in healthcare and education, highlighting the need for a balanced approach that integrates practical skills with theoretical knowledge.
Diploma nursing programs, despite their decline, continue to contribute to the nursing profession by providing valuable training and educational opportunities. Associate degree programs have emerged as a viable and effective pathway for individuals seeking to enter the nursing field quickly while receiving a solid foundation in nursing practice.
As nursing education continues to evolve, ongoing efforts to enhance curricula, address challenges, and support students will be essential in preparing future generations of nurses. By understanding the historical context and current trends in nursing education, we can better appreciate the diverse pathways available for individuals pursuing careers in nursing and the ongoing efforts to improve healthcare delivery.