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Major Changes Proposed in Nursing Education

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Aiken’s Suggestions for Changing Nursing Education

Nursing expert Linda Aiken, Ph.D., FAAN, FRCN, RN, calls for changing the way that public funding is used to support nursing education, including:

• Boosting the Title 8 funding from the U.S. Department of Health and Human Services that are designated to support baccalaureate education.

• Following up on the Nurse Training Act of 1964 with a similar but updated type of initiative that would support the new educational needs of the future nursing workforce.

• Using the $160 million in Medicare funds for nursing education to support the clinical training of graduate-level advanced practice RNs instead of diploma nursing programs.

• Using the $8 billion in Perkins funds from the U.S. Department of Education to help with developing and implementing a comprehensive strategy to insure that it’s possible for all future nurses to graduate with a bachelor’s degree.

Source: Aiken, Linda. (December 15, 2010). “Nurses for the Future,” New England Journal of Medicine.


By Jennifer Larson, contributor

January 7, 2011 - Linda Aiken, Ph.D., FAAN, FRCN, RN, thinks that it’s time to change the way we think about nursing education for the future.

Specifically, more public money needs to be channeled into nursing education in a way that would allow more nurses to begin their nursing careers with a baccalaureate degree. That would give more nurses a head start on pursuing a graduate degree. And many more nurses with graduate degrees—advanced practice nurses and nursing faculty—will be needed very soon.

In the December 15, 2010 issue of the New England Journal of Medicine, Aiken, a nationally recognized expert on the nursing workforce, wrote a column that explored this idea in more detail.  And she spoke with NurseZone recently to talk more about the need for change.

Aiken, who is a professor of nursing and the director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania, noted that the health care system is on the verge of a serious crisis. Within the next decade, half of the nation’s nursing school faculty will retire, leaving major gaps in the nursing education system, which will be sorely needed to educate more nurses to replace the estimated 500,000 nurses who will also be retiring.

Additionally, the advent of the landmark health care reform law passed in 2010 means that millions of additional people will be seeking care, as they will be added to the insurance rolls. Many more advanced practice nurses will be needed to provide that care.

Although more nurses with a higher level of education will be needed to serve the growing population, according to Aiken, the system is not currently set up to adequately address the problem.

Linda Aiken, Ph.D., FAAN, FRCN, RN
Industry expert, Linda Aiken, Ph.D., FAAN, FRCN, RN, proposes significant changes in nursing education

“People are thinking about this in outdated ways,” she said.

Part of the problem is that not enough nurses are pursuing graduate-level education to prepare them to become nurse faculty or advanced practice nurses. And a major reason they’re not pursuing graduate-level education is because many nurses would have to return to school two or three times to get enough education. That’s very unreasonable, Aiken said.

“Nurses have to go back to school too many times to get to the level of at least a master’s degree,” she said. “And this is why we don’t have enough faculty and we have a looming faculty shortage.”

She pointed out that only about 20 percent of nurses ever return to school for even one degree. Many others might like to return to school, but there are barriers that tend to prevent them from doing so: families, jobs, economic circumstances and other situations.

“People can’t just keep going back to school,” Aiken said.

Joanne Disch, Ph.D., RN, president-elect of the American Academy of Nursing (AAN), agreed that it’s not feasible to expect large numbers of nurses with associate degrees to have to return to school several times, interrupting their lives.

“They shouldn’t have to do that,” she said. “It’s really inefficient for them, and it really delays the public from benefitting.”

All over the country, community colleges have waiting lists. Many nursing students are finding that it is taking them three years (or longer) to get enough classes to receive an associate’s degree in the first place—about the same length of time as a baccalaureate program.  Why not find ways to help those schools offer a baccalaureate degree instead, Aiken said.

“So many nurses are being disadvantaged because of their choice of school,” she explained. “They really qualify for a baccalaureate (program) but they’re not getting it.”

Essentially, Aiken’s proposal calls for changing the pattern of initial education. She wants more people to begin their nursing careers with bachelor’s degrees already in hand. In effect, it would do away with the conventional model of articulation which still requires people to go on to pursue additional degrees.

Current articulation agreements between educational institutions typically help a student transition from an associate’s degree to a bachelor’s degree; there is also an articulation model that facilitates a transition from an associate’s degree to a master’s degree.

Aiken’s proposal dovetails with a recommendation recently issued by the Institute of Medicine (IOM) in a major report on nursing released in October 2010. The IOM called for increasing the amount of nurses who hold bachelor’s degrees from 50 percent to 80 percent by 2020.

Currently, only 36 percent of new nurses graduate from bachelor’s degree programs.

But for those nurses who already have an associate’s degree, some recommend offering more bridge programs that allow those nurses to jump directly from an associate’s degree to a master’s degree.

The National League for Nursing, for example, is a big proponent of academic progression, noted league president Beverly Malone, Ph.D., RN, who said that there should be more than one way for nurses to further their education and get a graduate degree.

If most people only return to school once, “Let’s make the most of it,” she said, citing RN-to-MSN bridge programs and online programs as being good options for many nurses who may feel that a traditional program will be too disruptive to their already busy lives.

Aiken supports bridge programs, too, adding that she just hopes the educational system can get to a point in the future where they will no longer be necessary.

Disch noted that a major challenge ahead is getting policymakers to grasp the importance of educating more nurses to a higher level. The AAN will be working to educate lawmakers and the public about the benefits of having more advanced practice nurses—and the need for more creative ways to help nurses reach those ranks.

“It does not help us nor the public if we prepare people who have to go back to school before they can move into those roles,” she said.

Aiken hopes policymakers will grasp the significance, too.  It will take collaboration among many stakeholders, including physicians and lawmakers and nurses, to achieve the change that is necessary, she said.

“I would really like to mobilize a different look at educational policy for the future, really trying to introduce a new idea that might challenge the debate about nursing education,” she said.

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