The goal of nursing education, for all of its programs, is educating nurses in the major clinical areas of nursing. The objective has been to prepare students to practice immediately following graduation. To accomplish this, nursing curriculums have included or "covered" all major clinical areas: medical nursing, surgical nursing, pediatrics, maternity, mental health and psychiatric nursing, and, in the baccalaureate programs, community health nursing. An attempt is made through practical clinical instruction to develop, in every student, the skills of practice.
In this attempt to "cover" the expanding body of nursing knowledge, the content is delivered in concentrated form, often through lectures, teaching aids, and handouts. The education is focused on the acquisition of what has become a vast body of information. Clinical instruction helps students apply this knowledge to the solution of nursing care problems but may be limited by the perception and the reality of accreditation and state board requirements that all students must rotate through all clinical areas. Thus, most students do not have the opportunity to develop depth in any area, and few new graduates leave their educational program believing they have acquired clinical competency in the area in which they choose to practice following graduation.
There is growing pressure for curriculum change in schools of nursing because of mounting evidence that the traditional lock-step curriculum, in which every student takes the same courses, shares similar clinical experiences, may not be effective. Curriculum changes that would allow students to at least partially individualize their program of study are being promoted by two major and appropriate groups: students and employers of nurses.
Today students of nursing are considerably more heterogeneous than in the past. They are increasingly of both genders, seeking a second career, and older. As smoother articulation between programs has taken place, large numbers of students have had prior experiences in some aspect of nursing. Students are asking for the opportunity to concentrate their experiences in fewer nursing areas to be more competent in the clinical area in which they choose to practice on graduation.
Employers of nurses have long asked nursing education to package clinical offerings in tracks along practice themes. Nursing remains the only health discipline that even attempts to prepare its graduates for first level positions immediately following graduation. Unless a supervised clinical education program following graduation (commonly called residency) is required for practice, some other means of helping the student to master the clinical, psychomotor, and cognitive skills must occur. Concentration in an area of practice during the undergraduate years may provide this help to students.
During their clinical experiences students develop a sense of commitment to clients and patients and apply their knowledge and skills in helping individuals and families toward attaining and promoting health. Also, in the clinical area, students master current information and techniques and learn to be active, independent, self-directed learners with the ability to identify, formulate, and solve problems; to grasp and use basic concepts and principles; and to gather and assess data rigorously and critically.
It is clear that providing increased experience in fewer clinical settings may be necessary to help students accomplish the in-depth problem solving skills to manage clinical situations. The nursing curriculum should provide this opportunity to its students.