As this issue of JNE hits your desk, you are no doubt in the throes of the new academic year, readying for a new class of students, meeting, idiscussing, debating, perhaps heatedly, with colleagues about the next round of changes in the nursing curriculum, worrying that what we teach today will be totally irrelevant even tomorrow. Several articles in this issue will add to your worries, and provide fodder for your deliberations.
Patricia Manuel and Lena Sorensen report a survey of major Massachusetts hospitals and long-term care agencies about changes in nurse staffing, and the effect on practice. Their study confirms the conversations on NURSENET, the studies and press releases by ANA, and some of the deep-seated fears of nurses everywhere: nurses are being laid off in record numbers, their responsibilities assigned to unlicensed assistive personnel, with little or no evidence to date that the quality of care can be maintained under restructured practice. While these findings are not new, their implications for education are yet to be fully worked out. Manuel and Sorensen offer some important suggestions.
To their list of implications I would add some. Most predictions suggest that the declining job market for RNs is temporary, and that there will be increasing positions in community-based practices. Such practice is much more than moving clinical experiences to the community; rather it requires a renewed emphasis on health and healing, working within a community to identify health concerns and resources to meet those concerns, action which recognizes the relationship between social issues and health - in short a very different view of nursing practice than what might be required for acute care. The November 1995 issue of JNE will be devoted to community-based practice, offering innovative models for educational experiences in the community.
Few would argue that critical thinking and decision making should be central to our curriculum, and Manuel and Soreneen's suggestions for active learning approaches are well justified. Yet we have much to learn about critical thinking, its particular meaning within our discipline, the extent to which one develops skill in it, or might simply have their disposition toward it enhanced, the proper relation between the skills of critical thinking and the facts that fuel the critical thinking engine. Prior issues of JNE devoted to critical thinking have begun to address these issues. Look for more in the coming year.
The wish for our graduates to be job-ready is not new, but is more clearly felt now, given the tight job market, and scarce resources to put into orientation programs for neophyte nurses. I think that the level of our graduates' clinical skills can only be modestly improved by tinkering with clinical practice; rather I think we need to radically rethink our basic conception of clinical practice as the instrumental application of scientific knowledge to the problems in practice. Nursing curricula like other professional programs are lodged in the modernist views of knowledge and theory (Wills, 1995, p. 60), teaching our students knowledge first, action later. The post-modern critique challenges virtually all of our taken-for-granted assumptions that undergird our curriculum design. JNE would welcome manuscripts that challenge traditional notions of practice and offer radically different conceptions and approaches for clinical learning.
It is also true that we can't wait for the dust to settle on institutional restructuring in order to make curriculum changes. If we've not already done some significant revision in response to predicted and actual practice changes, our programs are already woefully out of date. The need for a responsive curriculum (not really an oxymoron, although some have said that changing a curriculum is like moving a cemetery), has never been more acute. Our traditional curriculum processes, coupled with principles of faculty governance and requirements of regulatory bodies frequently require a lead time of 18 months to 2 years to bring about significant program changes. Such lead time is untenable in the kind of dynamic (or unstable) environment we are now in. We need new curriculum development models that preserve the best of faculty governance, and outcome-based decision making, while making it possible to have a program truly responsive to rapid changes.
And finally, in the midst of the Whitewater of change, we dare not attempt to adopt a value-neutral stance of responsiveness. Every faculty has the obligation to be clear and upfront about what they see as the sustaining and unassailable values in nursing - especially those which may not figure in economic models that view nursing as a cost center, the patient as a consumer, and healthcare as a commodity.
- Wills, J.E. (1995). The post-postmodern university. Change, 27(2), 59-62.