Journal of Nursing Administration:
Departments: Letter to the Editor
The following letter from the Council on Graduate Education for Administration in Nursing was sent to the chair of the American Association of Colleges of Nursing's Task Force on the Essentials of Master's Education in Nursing and comments on areas in the proposed requirements for all master's education in nursing that cause concern as they are applied to the nurse management/leadership role.
CGEAN Responds to Essentials of Master's Education in Nursing
The Council on Graduate Education for Administration in Nursing (CGEAN) (http://www.cgean.org/) is an organization comprised primarily of faculty who teach in nursing and healthcare administration/leadership programs and nurse leaders who are concerned about the graduate preparation of individuals who lead nursing services. Our nursing curricula are guided by the American Nurses Association's Scope and Standards of Practice for Nursing Administration and the American Organization of Nurse Executives' competencies for nurse managers and executives. Credentialing of our graduates is optional and can be achieved through the American Nurses Credentialing Center or through the American Organization of Nurse Executives Credentialing Center.
We appreciate the opportunity to provide official feedback from our organization on the draft document, Essentials of Master's Education in Nursing (http://www.aacn.nche.edu/Education/pdf/DraftMastEssentials.pdf). The stated vision for master's nursing education encompasses how CGEAN sees the role of nurse managers and executives. Managing complex information, coordinating care experiences, using technology, and assisting patients to manage a complex system of care, plus several other requirements, comprise the core of what nurse managers and administrators are expected to execute on a regular basis. We applaud the American Association of Colleges of Nursing (AACN) in taking on the task of creating a document to address the varied roles inherent in graduate education. We are limiting our comments to the strengths of the documents and to the areas that cause concern as we attempt to apply the essentials to the nurse management/leadership role. These are areas that cause concern in relation to our organization's strategic plan, which includes serving as the voice of nursing administration education.
We support AACN's view that "nursing practice interventions include both direct and indirect care components" (p34). Further, the focus of much of the work of the indirect care component relates to the ability to "impact safe, quality care in a variety of settings and functions" (p34). However the indirect role seems to be discussed as primarily at the microsystem level. Graduate preparation for management and administration must also educate for practice at the mesosystem and macrosystem levels. These definitions provide the context of care for these practitioners who are charged with insuring the care of the healthcare delivery system. Practitioners in this focus area must have additional coursework related to the assessment and management of complex system problems.
That view of support for indirect care roles, such as those of manager and administrator, seems in conflict with the requirements set forth in Essential I and X. For example, Essential I identifies that "nurses at this level base care delivery upon advanced knowledge in health assessment, pathophysiology, and pharmacology and on advances in genetics and genomics"(p3). This statement is detailed further in Essential X, which states: "All master's degree nursing graduates will have additional graduate-level content that builds upon an undergraduate foundation in health assessment, pharmacology and pathophysiology" (p38). This statement goes on to identify that what is preferred is three separate courses in these content areas. In common credit allocation systems, this would constitute 9 credits in areas that are not the focus of a manager or administrator role. This emphasis on these three-course content areas is most appropriate for clinical, direct-care education. That is not the focus of nurses who choose a formal leadership career by pursuing graduate preparation for management or administration. The inclusion of these courses would either lengthen the program and make it less attractive for students seeking these types of careers or diminish the intensity of the content needed to produce well-qualified nurse leaders in care settings. Either outcome could discourage nurses from pursing graduate education in nursing. At a time when external expectations, such as through The Joint Commission and the Magnet Recognition Program, are identifying advanced preparation in nursing, we hope that educational expectations would not discourage attainment of education in nursing.
Essential X, unlike the first nine essentials, contains an extra paragraph after the list of what the program prepares graduates to do (p38) and then lists "Integrated Learning Strategies," which are labeled as examples in other sections. Because this inserted paragraph seems inharmonious with the intent of the document elsewhere, it causes concern regarding what the curriculum for nursing leaders must include.
Additionally, we find the glossary extremely helpful in interpreting the intent of the essentials. Perhaps the addition of the terms "administration," "leadership," and "management," could provide the same clarity for the indirect care aspect with which we are concerned as has been provided for other aspects of the document.
We were not so presumptive as to offer specific language for any of our areas of concern. We do, however, stand ready to help evolve this important document for further consideration.
Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FAAN