Nursing education--is it time to go back to the future?

This article attempts to project the future of nursing education by learning the lessons of the past. Since 1989, a constant discourse has evolved: pre-registration nurses are emerging from nursing education programmes without essential clinical skills. It is argued that, if the profession is to heed the lessons from the past, a focus on this constant discourse is inevitable. This is because, in the UK, nursing practice-based learning has long been valued and considered to be of equal importance to institution-based learning. The article thus draws on lessons that can be learnt from the evolution of models of nursing education over the past two decades. Having identified and outlined three models of nursing education, the article predicts the demise of pre-registration nursing and the development of practice-based assistant practitioner programmes and practice-based postgraduate nursing programmes owned and managed by primary care trusts and NHS foundation trusts.

A return to diploma-prepared registered nurses.

A quarter of a century ago, the nursing profession in Canada took a bold step: to establish baccalaureate preparation in nursing as the standard for practice as a registered nurse in Canada. Towards that end, hospital schools of nursing gave way to collaborative programs designed to help hospital and college diploma nursing students make the transition into baccalaureate nursing programs. It is thus paradoxical that, today, the nursing profession in Canada should do anything to jeopardize its goal to have RNs prepared at the baccalaureate level. The purpose of this paper is to focus Canadian nurse leaders' attention on that very possibility, given that some professional nursing organizations in Canada have conceptualized a future RN practice that could result in the emergence of a new kind of healthcare professional and a return to diploma preparation of RNs.

Trends in registered nurse education programs 1998-2008.

In 1999, the Connecticut Colleagues in Caring team conducted a pilot study to identify trends in RN education programs. The present study replicates the pilot study for a national sample. In 2003, a 15-page questionnaire, divided into six distinct areas of importance to nursing education, was mailed to the directors of 1,459 nursing programs; the response rate was 46.8 percent. Respondents were asked to comment on the extent to which they currently emphasized topics covered by 187 distinct items as compared to that item's emphasis in 1998 and its forecasted emphasis in 2008. Items were reported as significant when more than 50 percent of respondents agreed that the item was receiving more emphasis now than in the past and would continue to receive more emphasis in the future. The findings validate many of the trends found in the pilot work. Consistent across five of the six categories is the important role of technology in nursing education's future. Faculty will need ongoing development to meet the demands this trend will require. Further, faculty in the future will be required to employ more active learning strategies to effectively meet the changing expectations in the teaching/learning environment.

Action research in nursing.

The present work is of theoretical character and its basic aim is to demonstrate the essence of the action research, analysed from the point of view of the theoretical and practical nursing. Indirectly, the assumption is to show the possibilities of influencing the quality of nursing care through the purposeful and systematic reference to this strategy. Available nursing publications in English stress that the action research (as applied research) is a strategy adopted by both theoreticians and practitioners. It is a way to seek solutions to actual problems that appeared while the professional tasks were carried out. The problem is solved immediately where it originated, mainly by the practitioners who can access the knowledge and experience of the theoreticians (researchers). The practitioners approach the theoreticians to take up a specific research procedure in order to determine the essence of the difficulty they have come across in their work with the subject of care, its causes and the chances of its elimination or possible reduction by using the capacities the theoreticians (researchers) have at their disposal. This requires implementation of certain methods, used to gather information about the problem as well as to process it.

Nursing education in Sweden: development from vocational training to higher level education.

Recent decades have seen several changes within Swedish nursing education. The length of Swedish nursing education was previously 2 years; today, however, it has been adapted to the rules laid down by the European Union, which means that it covers 3 years. Swedish nursing education was raised to university college level as early as 1977; however, it is only in recent years that the education can be said to meet the requirements placed on it. The requirement that the education should be scientifically based entails that the teaching staff should include teachers not only with nursing experience but also with a doctor's degree in nursing. The county councils are the authorities responsible for nursing education with the exception of three university colleges of nursing education which are independent. During the past year, however, seven nursing programmes have gone over to State control, and several more are discussing co-operation. A central evaluation made of Swedish university colleges of nursing education shows that 10 colleges provided education which could not be considered to correspond to the required level of higher education. No university college of nursing education has yet been accorded the right to provide education for the bachelor's degree. The future of the Swedish nurse is uncertain due to a large extent to the reorganization that has taken place within the health services.

Medicare funding of nurse education. The case for policy change.

OBJECTIVES: To determine the magnitude and distribution of US Medicare funding for nursing education and to assess the extent to which Medicare funding contributes to meeting national health care workforce priorities. DATA SOURCES: Medicare Hospital Cost Report Information System, American Hospital Association Annual Survey of Hospitals, and National League for Nursing national surveys of schools of nursing. DATA ANALYSIS: Using hospital identifiers, data from three data sets were merged and analyzed to estimate percentage distributions of Medicare funding according to types of educational programs, hospital characteristics, and student enrollment. RESULTS: Fifteen percent of direct Medicare graduate medical education funding goes to hospitals for the training of nurses and paramedical personnel. Totaling approximately $174 million in 1991, 71% of these funds went to hospitals for nursing education costs. Most of the nation's teaching hospitals (289 of 381 Council of Teaching Hospitals member hospitals) and nurse education programs (1112 of 1484) do not qualify under existing policies for Medicare nursing education reimbursement. Sixty-six percent of Medicare nurse training funds, totaling $114 million in 1991, went to 145 hospitals operating diploma nursing programs; these programs produce less than 10% of nurse graduates. Three states (Pennsylvania, New Jersey, and Ohio) received nearly one half (48%) of the $114 million for diploma nursing education. CONCLUSIONS: Medicare is the largest single source of federal support for nursing education. Yet, the majority of Medicare nursing education funding goes to hospitals affiliated with an increasingly smaller, idiosyncratic subset of nurse training programs. Unlike graduate medical education, Medicare supports primarily preprofessional education in nursing. Graduate education, including the preparation of nurse practitioners, does not generally qualify for reimbursement. Medicare reimbursement for nursing education must be retargeted.

Changes in the recruitment pool: the Australian experience.

This paper examines the changes in the recruitment pool from which we draw nursing students. In New South Wales, the change in venue from hospital to college institutions has significantly accelerated a change which began more than 20 years ago. College programmes attract more males directly from school and less mature age males than hospital programmes. There is a difference in the socioeconomic level of the household from which nursing draws its recruits in hospital and college programmes. College programmes attract more recruits from lower socioeconomic level households than hospital programmes. In New South Wales, this was found to be particularly so for the female group but not for the male group. From the national perspective, where students had the choice to enter either a hospital or higher education programme to attain a nursing qualification, it was found that there was no difference in the socioeconomic level of the household of origin between students who choose to enter a hospital programme which paid a wage while training and students who choose to enter a higher education programme which offered no such financial reward. This finding remained consistent when the study sample was cross-tabulated by state, gender and age group (young vs mature).