Concept of Education and Training in Nursing Education

According to the Bureau of Labor

    Statistics (2006a), rising elderly
populations, in-home medical technologies, and patient preference for home
health care will increase the number of practical nurses needed in this area.
As a result, one can expect that practical nursing will continue to be an
integral part of the fabric of nursing education and nursing practice.

Nursing Education Diploma

    “Your own first steps toward a nurse’s skill and toward the coveted
nurse’s cap,” Miss Reamer said, “Will be classes. But not for long.” They [student
nurses] would learn the hospital routine gradually on the wards, then more and
more, until each student would be responsible for her own patients” (Wells,
1943, p. 29).

Training vs Educating In Nursing Education

    The quote above is from Cherry Ames, a
fictional series of books about nurses that enamored many, encouraged the
pursuit of nursing careers, and indeed reflected nursing diploma programs of
that time in nursing education’s history. Diploma nursing (originally known as “hospital nursing”) began during the latter part of the 19th century with a growth in hospitals.
Knowledge of a sepsis partially spurred hospitals’ growth and precipitated a
demand for more nurses. Training of hospital nurses at this time was based on
an apprenticeship model where nursing students provided service (direct patient
care) in exchange for a few educational lectures, room and board, and a monthly
allowance (King, 1987).

    The apprenticeship model flourished because
it offered women an opportunity for a vocation, it improved care of the sick,
and decreased the cost of nursing service in hospitals while student nurses
provided patient care services for a minimal allowance (Bullough &
Bullough, 1978). Despite the benefits of the apprenticeship model, it underwent
criticism from nursing education leaders. Goldmark (1923) in particular
emphasized that the training needs of students and the service needs of
hospitals were incongruent. She wrote that when “the needs of the sick must
predominate; the needs of education must yield” (Goldmark, p. 195). 

    In other
words, Goldmark argued that the hospital training of nurses was unbalanced. Training
in the care of children, for example, was relinquished if students were needed
to care for patients on the surgical ward. Similarly, May Ayres Burgess
published a report in 1928 titled Nurses, Patients, and Pocketbooks (later
known as the Burgess Report) that argued that within the apprenticeship model,
students’ patient assignments were based on the hospital’s needs rather than on
the educational needs of the students.

    To balance the academic needs of nursing
students with their need for clinical experiences, Dr. Richard Olding Beard
advocated for university education for nursing students. He contended that
university education would eliminate the inconsistency between the hospital’s
service needs and the educational needs of students. In 1909 Beard began a
nursing program at the University of Minnesota. 

    This program is often heralded
as the first baccalaureate nursing program. However, it closely resembled
diploma education because, even though nursing students met university
standards for admission and coursework, they were required to work 56 hours a
week on the hospital ward (Bullough & Bullough, 1984).

Shifting to a New Era in Diploma Nursing
Education

    Following Dr. Beard’s efforts, the National
League for Nursing Education (NLNE) made numerous attempts to redesign diploma
nursing education programs. In 1917, 1919, 1927, and 1937 the NLNE published
Standard Curriculum for dents’ time working on the ward and to increase their
education by offering 3 years of course work in the sciences and clinical
experiences caring for diverse populations (eg, medical surgical, pediatric,
and obstetric patients). 

    The work of Beard, the NLNE, and other reports on the
state of nursing education did contribute to restructuring diploma nursing
education. Stewart (1943), in fact, related that these efforts better informed
the public about the state of nursing education, promoted experiments with new
models of nursing education, and encouraged reform in schools of nursing (pp.
182–183).

    During the middle of the 20th century,
diploma nursing programs continued to thrive, and other reports such as Nursing
Schools at the Mid-Century, compiled by West and Hawkins and published in 1950,
promoted high standards in diploma nursing programs. Nonetheless, changes in
health care such as rapid advances in medical technology and the expansion of
knowledge in treatments for diseases required nurses to have sound theoretical
preparation (Melosh, 1982). These changes meant a decline in hospital-based
diploma programs and the beginning of a new era in nursing education where
education would occur predominantly in colleges and universities.

Understanding Diploma Nursing Education
Today

    As of 2006 there were only about 60 diploma
programs in the United States, with most of them located in the northeast
(National League for Nursing [NLN], 2006). Hospitals that continue to support
diploma programs maintain this educational option because these programs supply
the nurses needed in their hospitals, they provide a geographically accessible
program for some students, they offer a nursing degree in a short length of
time, and they often offer tuition remission .

    To meet the educational needs of diploma
students, many of these programs collaborate with colleges and universities to
offer students options to obtain associate and baccalaureate degrees.
Additionally, it is important to note that despite the reasons for the decline
of diploma programs mentioned earlier, some studies suggest that diploma nurses
are as competent in research, leadership, and critical thinking as graduates
from other undergraduate nursing programs (Clinton, Murrells, & Robinson,
2005). Thus, for now it seems that diploma programs, though having experienced
a turbulent history, are persisting and will continue to be a valuable asset to
the nursing profession.

Associate Degree Nursing Education

    “Every story in the mosaic of history has a beginning, a cast of
characters, a set of social circumstances, and its own momentum. The
development of a new, two year program for educating professional nurses during
the years just after World War II is no exception” (Haase, 1990, p. 1).