Choosing Sides

The debate about the most appropriate preparation for nursing practice has raged for the past 40 years. With the publication last week of "Educating Nurses: A Call for Radical Transformation," the Carnegie Foundation for the Advancement of Teaching has made an invaluable contribution to this discussion. In most ways, we at the National League for Nursing believe the foundation has done a great service, with its call to raise the standards of nursing education in America, thus elevating the issue in the public eye and pointing a promising way forward.

But in one significant way -- by recommending a requirement that nurses have a bachelor’s degree for entry into practice -- Carnegie missed the mark.

We must bear in mind that more than half of all registered nurses are ADN-credentialed only. And that despite the nursing profession’s decades-long debate over the minimum levels of education nurses need to practice, we have not made much progress in moving more of them through the educational pipeline. The NLN remains convinced that the more reasoned and effective strategy is to focus attention on how best to propel those with associate degrees, and also those with baccalaureate degrees, to continue their education.

In fact, our Reflection and Dialogue, “Academic/Professional Progression in Nursing” (NLN, 2007), was developed in response to proposed legislation in New York, New Jersey, and elsewhere that would require nurses prepared in diploma or associate degree programs to obtain a baccalaureate degree in nursing within 10 years of initial licensure. The NLN framed the conversation away from entry into practice to a focus on how to approach academic and professional progression for all nurses. We felt it essential to sidestep the argument of required baccalaureate entry to instead support the following principles:

• Options (such as RN to BSN or RN to MSN) that are not based on entry but are rather viewed as opportunities for lifelong learning and progression for those who enter the nursing profession through diploma and associate degree programs will help the nursing profession to practice effectively in a health care environment that includes shorter hospital stays, higher patient acuity, increasing numbers of older adults with multiple chronic conditions, rapid technological advances, and proliferation of drug therapies. It is essential that the nursing profession take fullest advantage of the diversity offered by multiple points of entry and encourage all nurses (regardless of initial preparation) to continue their education.

• The ability of nursing practice settings to provide appropriate clinical learning experiences must be addressed. And ways must be found, for example through online/distance learning programs, to expand the capacity of baccalaureate and master’s programs to accommodate all RNs who would be required by legislative fiat or other institutional standards to earn an advanced academic degree.

• As many Americans are finding higher education less accessible financially, the cost of financing additional education must be addressed. The nursing profession must work proactively through government channels – national, state-wide, and regional/local – to harness the political power of 2.9 million nurses to lobby for more funding for nursing workforce development and direct scholarship relief.

The National League for Nursing has long championed the nursing profession’s multiple entry points. With the NLN’s proud tradition as the voice for nursing education, for faculty who teach in programs across the spectrum of higher education, the League has considered in depth the approach to lifelong learning for all nurses, regardless of their initial level of preparation. Our mission, goals, and history have positioned us to be a catalyst for the exchange of ideas about this important issue which will have profound effects on nursing education, the ethnic/racial diversity of our nursing workforce, access to safe, quality health care, the cost of health care, and public policy.

Despite our fundamental disagreement with authors Benner et. al regarding their recommended requirement of BSN for entry into practice, we do believe that "Educating Nurses" will undoubtedly spur necessary improvements in nursing education and in the safety and quality of health care. There is much to praise within its pages. Indeed many of the findings reflect or complement NLN goals and core values. We, too, encourage more faculty and student diversity, new means of student assessment and evaluation, the inclusion of teacher education courses in master’s and doctoral programs, the development of new pedagogical practices, and more healthful work environments.

Other points of agreement between the authors and the NLN include advocacy for better compensation for nurse faculty; for increasing public awareness of the nurse faculty shortage, one source of which is the dearth of nurses who choose to pursue master’s level preparation required for teaching; for mentoring and professional development of faculty; and for improving clinical education. For example, the NLN offers new programs that incorporate innovative approaches and content, such as our Simulation Innovation Resource Center, which assists faculty in learning how to develop and integrate the latest advancements in simulation into nursing curricula. The recent NLN Survey on Clinical Education highlighted barriers to effective clinical education in pre-licensure nursing programs, revealing the need for continued research in this area so that students will be better prepared for the rapidly evolving health care environment they will encounter when they graduate into practice.

My hat is off to authors Patricia Benner, Molly Sutphen, Victoria Leonard, and Lisa Day, who, addressing their “nursing organization collaborators and partners… in the tradition of the Carnegie Foundation for the Advancement of Teaching, now give the study to your stewardship…to make the findings accessible and useful within the profession.”

The NLN is proud to be among these contributors and in calling for an ongoing dialogue, asks:

• How will we inspire graduates of associate degree, diploma, and bachelor’s degree programs to continue their formal nursing education, to expand leadership and communication skills in an increasingly complex health care system?
• What incentives will encourage nurses to attain additional formal credentials, as well as value lifelong learning and continued professional practice?
• How can we think creatively about articulation and build seamless transition models that incorporate flexible scheduling and convenient meeting places, that provide opportunities for diverse nursing graduates to pursue individual interests, and that do not repeat nurses’ previous education and experiences?

In answering these questions nurse educators, public policy and workforce experts, health care organizations, and all other interested parties will transform the dialogue from entry into practice into academic progression within the profession.