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Nursing Education: A History and Future of the Dynamic Professional Pathways to Excellence in Care
providing our patients of today with the best possible care while remaining steadfast in our goal to provide patients of tomorrow with better outcomes through collaborative research and innovation. As such, we agreed that we have a duty to understand the broad impact that racism has on various aspects of health and began an initiative to incorporate discussions on racism and justice into our Physician Scientist Forums. Over this past year, we held four 90-minute sessions on racism in medicine and focused each session on specific minority populations in the U.S. We discuss the diverse ways that racism and injustice exist within the health care field, how we can be better providers to patients from minority communities and what role research plays in either perpetuating or correcting health disparities. We believe that learning about how racism contributes to medical injustice, we can contribute to eradicating it through our collective careers by applying best practices at the bench and bedside.
As we look to the future, our goal remains to provide the next generation of physician scientists with the tools required to make a mark on healthcare discovery and innovation. We welcome any members of the Worcester medical community to contact us if interested in collaborating on local projects or participating in our Physician Scientist Forums. +
Silvia Corvera, MD, is professor of molecular medicine, endowed chair in diabetes research and director of the MD/PhD program at the University of Massachusetts Medical School. Email: silvia.corvera@umassmed.edu.
Philip A. Feinberg is a student in the MD/PhD program at the University of Massachusetts Medical School working on understanding and treating neuropsychiatric disorders. Email: Philip.feinberg@umassmed.edu.
references:
1. Medical Scientist Training Program. Accessed July 27, 2021. https://www.nigms.nih.gov/training/ instpredoc/pages/predocoverview-mstp.aspx
Elizabeth DelSignore MS, RN Michelle Page, DNP, RN
The need for formal nurse training arose when there was a need to care for wounded soldiers during the Civil War. The first school of nurse training in the United States opened at the New England Hospital for Women and Children in Boston in 1872. Student nurses completed apprenticeship-style training which included long hours on the hospital wards caring for patients followed by physician lectures in the evenings. Nursing education transitioned into the university setting in the early part of the 20th century and the National League for Nursing (NLN) developed one of the first sets of curriculum guidelines.
By the 1950s, the associate degree of nursing (ADN) at community colleges was piloted to provide “technical” practitioners during a nursing shortage (1). The advent of intensive care units in the 1960s required a broader range of skills, and the application of clinical reasoning became a vital part of the role. The NLN and the American Nurses Association (ANA) called for baccalaureate prepared Registered Nurses (RNs) in the mid-1960s, but the social climate at that time discouraged the advancement in the education of women and progress was hindered. Although there has been an increase in the percentage of baccalaureate prepared nurses for initial RN licensure since 2013, 37.7% of registered nurses in 2020 report the ADN as their highest degree at initial licensure (2).
academic pathways and the need for baccalaureate-prepared nurses
There are educational options a student may consider for initial licensure as a RN, including the diploma, the associate degree, and the baccalaureate degree (BSN) however, many stakeholders encourage the BSN as the minimum educational preparation for entry into professional nursing practice (3,4). Many schools have bridge programs for nurses with a licensed practical nursing (LPN) certificate, diploma,
or ADN to obtain a BSN or a master’s degree in nursing (MSN). There is solid research linking the educational level of a nurse with patient outcomes, including a decreased risk of patient mortality and adverse events when nurses are prepared with a BSN or higher (5,6).
Despite the IOM recommendation that 80% of the nursing workforce be BSN prepared by 2020 (4), as of 2018 only 57% of RNs were prepared with a BSN or higher (7) with projections that only 66% of nurses will have a BSN or higher by 2025 (8). In response to the IOM recommendation, the Robert Wood Johnson Foundation, the Tri-Council for Nursing, and the American Organization for Nurse Executives spearheaded the Academic Progression in Nursing (APIN) task force. The APIN program provided grant funding and resources to nine U.S. states, including Massachusetts, to help fulfill the goal of more BSN-prepared nurses at the bedside (3).
academic progression model best practices
Massachusetts developed a statewide curriculum model designed to facilitate ADN to BSN transition, the Massachusetts Nurse of the Future Core Competencies © (9). The most recent update of the competencies was influenced by feedback from local practice partners to address the needs of the organizations hiring newly licensed nurses (3). This curriculum model, when used in conjunction with articulation agreements between community colleges and universities, allows students to obtain their BSN within 15 months of completing an ADN (2).
Preliminary findings from the four-year APIN project revealed that curricular integration and overlapping curricula, overlapping admission or dual enrollment in community colleges and universities, and having excellent relationships with practice partners in the community were some of the keys to successful academic progression and increasing the number of BSN-prepared nurses (3). Every state involved in the APIN project successfully decreased the length of time for students to progress from the ADN to the BSN, with 80% of students who completed the ADN continuing their education in a BSN program (3). Findings from academic progression programs highlight similar themes in best practices including a curriculum design that eliminated redundancies, dual admission models that created seamless progression through simultaneous curriculums, and intentional advising practices which also eliminated and identified redundancies in program course work (10). One of the most integral policies developed as part of the Massachusetts APIN initiative was the Nurse Educator Transfer Compact (NETC). The compact directly addressed the seamless progression for Massachusetts ADN students allowing for participating nursing programs to accept and apply 72 transfer credits for a BSN degree completion. Massachusetts programs that have applied the NETC in Massachusetts can be found at: https://www.mass.gov/service-details/about-board-approved-prelicensure-nursing-programs.
future considerations for academic progression
With the need for a standardized curriculum across all levels of nursing practice and with a consistent eye on the dynamic changes in the healthcare environment, the American Association of Colleges of Nursing (AACN) recently updated their nursing curriculum guidelines (The Essentials of Professional Nursing Practice) which outline ten domains and associated competencies and concepts that “represent the essence of professional nursing practice” (11). The competencies are designed to be met throughout four spheres of care- disease prevention and health promotion; chronic disease care; restorative or regenerative care; and hospice, palliative, and supportive care; and integrated in each level of the nursing program of study (11). These components of practice are not new to nursing; however they are re-framed as integral competencies that thread throughout all care areas as key to the holistic support of patients. As nurse educators plan to meet the next set of evidence-based benchmarks to achieve the goal of the BSN for entry to practice for all registered nurses, competency-based educational models will be a key component in the future considerations of curricular design for academic progression pathways. As educators continue to provide seamless professional pathways for academic progression, RNs at any point of practice will have the opportunity to continue to excel in the care provided to our patients.
Elizabeth DelSignore MS, RN Instructor Worcester State University, Staff Nurse Massachusetts General Hospital
Michelle Page, DNP, RN, Nursing Program Administrator at Worcester State University
References:
1. Keating, S. B. (2015). Curriculum Development and Evaluation in Nursing. Springer Publishing Company
2. Smiley, R. A., Ruttinger, C., Oliveira, C. M., Hudson, L. R., Allgeyer, R., Reneau, K. A., Silvestre, J. H., & Alexander, M. (2021). The 2020 National Nursing Workforce Survey. Journal of Nursing Regulation, 12 (1), S1-S96. https://doi.org/10.1016/S2155-8256(21)00027-2
3. Farmer, P., Gerardi, T., Thompson, P., & Hoffman, B. (2018). Academic Progression in Nursing (APIN): Final program summary and outcomes. https://nepincollaborative.org/wp-content/uploads/2018/03/FINAL-APIN-REPORT.pdf
4. Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing Health. The National Academies Press. https://doi.org/10.17226/12956
5. Aiken, L. H., Cimiotti, J. P., Sloane, D. S., Smith, H. L., Flynn, L., & Neff, D. F. (2012). Effects of nurse staffing and nurse education on patient deaths in hospitals with different work environments. Journal of Nursing Administration 42 (10 supplement), S10-S16. https://www.ncbi. nlm.nih.gov/pmc/articles/PMC6764437/
