The long-awaited Carnegie Foundation for the Advancement of Teaching’s report on nursing education (Benner, Sutphen, Leonard, & Day, 2009) has been released, calling for radical transformation of nursing education. Among the 26 recommendations is one that will draw a huge sigh of weariness, as it has been the source of contentious debate for nearly half a century. (It need not be named, and we must move on!) Most are essential to improving the quality of nursing practice and the well-being of the people we serve.
The report highlights three paradigm cases of exemplary teaching, practices that can narrow the ever-widening practice-education gap and that can help students integrate across the high-end apprenticeships of knowledge, skilled know-how, and ethical comportment. Drawing on these cases, four major shifts in teaching practices are called for (Benner et al., 2009, p. 89):
- From a focus on covering decontextualized knowledge to an emphasis on teaching for a sense of salience, situated cognition and action in particular situations;
- From a sharp separation of clinical and classroom teaching to integration of classroom and clinical teaching;
- From an emphasis on critical thinking to clinical reasoning and multiple ways of thinking that include critical thinking; and
- From an emphasis on socialization and role taking to an emphasis on formation.
Clearly, such a transformational change will require a significant program of faculty development for those already engaged in teaching and a new look at graduate education, specifically how our graduate program enrollments and requirements align with the needs for a well-prepared faculty of the future. Do we have the capacity to educate the number of nursing faculty that we need now and in the immediate future? Do our program requirements for clinical expertise align with what will be needed for teaching nurses of the future? Do our programs provide for course-work and practice in the kind of teaching highlighted in the Carnegie Foundation report? The short answer to each of the questions above is no.
But let’s go a little deeper, starting with the numbers. The nearly 1,000 community college programs in the country, including those that are now offering the bachelors’ degree in nursing, clearly require a minimum of a masters’ degree in nursing. And for the nearly 700 baccalaureate and higher degree programs, the doctorate is the preferred degree. There are currently 158 doctoral degree programs in nursing; of these, 66 are Doctor of Nursing Practice (DNP) degrees and 92 are research focused. In the 2007–2008 academic year, among American Association of Colleges of Nursing (AACN) member schools, 17,247 students graduated from master’s programs and 917 graduated from doctoral programs (61% research focused, 49% practice focused) (AACN, 2009a). Given the proliferation in numbers of DNP programs, this proportion is likely to reverse in the relatively near future.
These numbers have not and will not keep pace with the demand. A recent survey of baccalaureate and higher degree programs revealed more than 800 vacancies for the 2009–2010 academic year (AACN, 2009b). This number does not take into account the likely higher number of vacancies in the nearly 1,000 community colleges in the United States.
Our current research-focused doctoral programs cannot keep pace with the likely rate of retirements—even if those of us considering retirement work well into our 70s. The average age of faculty is increasing; the average age of professors stands at slightly older than 59 years, with assistant and associate professors not far behind. The practice doctorate may be a viable alternative, but it is not clear that its current conception is aligned with what prospective faculty need to learn. And for the 1,000 community college programs that will continue to provide a significant portion of prelicensure education, either alone or in partnership with baccalaureate programs, the need for a strong and relevant graduate education will continue. Current data suggest the number and focus of graduate programs in nursing cannot keep up with the need for well-qualified faculty; however, further workforce analysis in this area is needed.
What kind of clinical expertise do our faculty need? The Carnegie Foundation report provides some guidance here:
- Clinical expertise across the three apprenticeships—advanced clinical knowledge (specifically, extensive of the health issues and care needs of a particular population), skilled know-how, and ethical comportment.
- Skill in clinical judgment and attunement to ethical issues, and the capacity to articulate these areas of expertise.
- A deep understanding of the enduring concepts of the discipline and flexibility and creativity in helping students use those concepts as anchors for the many details they must learn during their undergraduate programs.
However, if one follows O’Neil’s (2009) arguments about the likely changes in a transformed health care system, new kinds of clinical expertise will be needed. He suggested that traditional nursing competencies, such as care management, patient education, public health intervention, and transitional care, will dominate in a reformed health care system, as it inevitably moves toward emphasis on prevention and management over acute care. But O'Neil (2009) pointed out that:
These traditional competencies must be reinterpreted for students into the settings of the emergent care system, not the one that is being left behind. This will require faculty to not only teach to these competencies but also creatively apply them to health environments that are only now emerging.
The graduate education outlined in the AACN draft master’s essentials and in DNP requirements does not align adequately with what our future faculty need. The focus is on preparation for today’s advanced practice roles of nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist, each with extensive practicum requirements in new roles—not the knowledge and skills that graduates of our prelicensure programs need to learn. Advanced health assessment, pathophysiology, and pharmacology continue as core requirements in the new master’s essentials, but as population needs change, so should what defines the core of our graduate clinical education. Perhaps more foundational for nurses who wish to teach prelicensure students would be courses organized around population-based assessment, epidemiology, the care needs of older adults, chronic illness management, health behavior change, family caregiving, and transitional services.
And what about preparation for teaching? Both the AACN-proposed essentials for masters’ degree programs (AACN, 2010) and the DNP essentials (AACN, 2006) acknowledge that coursework in teaching is appropriate for students who wish to move into faculty roles. But this is only a figurative footnote in documents focused on advanced practice preparation or roles for leadership in health systems. Only 20% of the 92 research-focused doctoral programs require a teaching practicum (Minnick, Norman, Donaghey, Fisher, & McKirgan, 2010), whereas 77% require a research practicum. This is not surprising, given the intent of these programs, nor unlike what other disciplines do. But it does not bode well for having a faculty ready to lead or even embrace the transformative changes recommended by the Carnegie Foundation study.
The National League for Nursing’s 2005 Core Competencies of Nurse Educators was an important start to the exploration of what it takes to be an effective teacher and member of the professoriate. It is time to reexamine those competencies in light of all that we have learned in the past few years about excellent teaching practice through studies such as those by the Carnegie Foundation study of nursing education (Benner et al., 2009); the recent work of Ken Bain (2004); studies of learning (Bransford, Brown, & Cocking, 2000); and beginning research in emerging pedagogies in nursing, such as narrative pedagogy (Diekelmann & Diekelmann, 2009), simulation, (Harder, 2010), case-based learning (Yuan, Williams, & Fan, 2008), and new clinical education models (Ard & Valiga, 2009; MacIntyre, Murray, Teel, & Karshmer, 2009).
The preparation of new faculty must be brought into the foreground of our discussions. For those nurses who wish to advance to the nurse educator role in an academic setting, and not to an advanced degree focused on specialized practice, we need to rethink the current AACN definition of advanced practice that does not acknowledge this role. Should we fail to act now to better recruit and adequately prepare the next generation of nurse educators for what is surely to be transformative change in our prelicensure nursing education programs, we may find ourselves wondering, “Where have all the faculty gone?” and “Who will be left to educate and mentor our young to ensure that we continue to respond to the societal need for well-qualified nurses?”
Christine A. Tanner, PhD, RN, FAAN
Janis P. Bellack, PhD, RN, FAAN
- American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. Retrieved from http://www.aacn.nche.edu/DNP/pdf/Essentials.pdf
- American Association of Colleges of Nursing. (2009a). 2009 annual report: Advancing higher education in nursing. Retrieved from http://www.aacn.nche.edu/Media/pdf/AnnualReport09.pdf
- American Association of Colleges of Nursing. (2009b). Nursing faculty shortage fact sheet. Retrieved from http://www.aacn.nche.edu/Media/pdf/FacultyShortageFS.pdf
- American Association of Colleges of Nursing. (2010). Draft: The essentials of master’s education in nursing. Retrieved from http://www.aacn.nche.edu/Education/pdf/DraftMastEssentials.pdf
- Ard, N. & Valiga, T.M. (Eds.). (2009). Clinical nursing education: Current reflections. New York, NY: National League for Nursing.
- Bain, K. (2004). What the best college teachers do. Cambridge, MA: Harvard University Press.
- Benner, P., Sutphen, M., Leonard, V. & Day, L. (2009). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass.
- Bransford, J.D., Brown, A.L. & Cocking, R.R. (Eds.). (2000). How people learn: Brain, mind, experience and school (Expanded ed.) Washington, DC: National Academies Press.
- Diekelmann, N. & Diekelmann, J. (2009). Schooling learning teaching: Toward narrative pedagogy. Bloomington, IN: iUniverse Books.
- Harder, B.N. (2010). Use of simulation in teaching and learning in health sciences: A systematic review. Journal of Nursing Education, 49, 23–28. doi:10.3928/01484834-20090828-08 [CrossRef]
- MacIntyre, R.C., Murray, T.A., Teel, C.S. & Karshmer, J.F. (2009). Five recommendations for prelicensure clinical nursing education. Journal of Nursing Education, 48, 447–453. doi:10.3928/01484834-20090717-03 [CrossRef]
- Minnick, A.F., Norman, D., Donaghey, B., Fisher, L.W. & McKirgan, I.M. (2010). Defining and describing capacity issues in U.S. doctoral nursing research programs. Nursing Outlook, 58(1), 36–43. doi:10.1016/j.outlook.2009.10.001 [CrossRef]
- National League for Nursing. (2005). Core competencies of nurse educators with task statements. Retrieved from http://www.nln.org/facultydevelopment/pdf/corecompetencies.pdf
- O’Neil, E. (2009). Four factors that guarantee health care change. Journal of Professional Nursing, 25, 317. doi:10.1016/j.profnurs.2009.10.004 [CrossRef]
- Yuan, H., Williams, B. & Fan, L. (2008). A systematic review of selected evidence on developing nursing students’ critical thinking through problem-based learning. Nurse Education Today, 28, 657–663. doi:10.1016/j.nedt.2007.12.006 [CrossRef]