Author Affiliation: Executive Director, Perioperative Nursing and Clinical Services, Brigham and Women's Hospital, Boston, Massachusetts.
Correspondence: Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (Jvitello@partners.org).
Educating Nurses: A Call for Transformation,1 the book many of us have been waiting for, was written by 3 nurses (Benner, Day, and Leonard) and an anthropologist/historian of medicine (Sutphen) and outlines their recommendations for redesigning nursing education to meet current and future needs of patients along the healthcare continuum. This book is one in a series of studies known as the Preparation for the Professions Program for the Advancement of Teaching, whereby the education of lawyers, clergy, engineers, and physicians was also explored. The purpose of examining the work of these varied professions was to determine the signature pedagogies of professional education, compare and contrast educational methods, and ascertain both how to educate for competence, integrity, and professional judgment and how to teach complex skills.
The Carnegie Foundation National Nursing Education Study, conducted by the authors and funded by the Carnegie Foundation, is this book's basis, presenting information related to 9 site visits to entry-level nursing programs, interviews, observations, and surveys of faculty and students. From the evidence gleaned from this study, it was apparent that nursing education needs reform.
The book's authors readily admit that nursing education is fragmented, standardized lectures in colleges focus on "information transfer“ instead of assisting students to learn what is salient in particular professional practice situations, and there is a practice-education gap among some faculty preparing students that must be remedied. The authors argue that the 3 greatest challenges to nursing education are finding a more effective approach to teaching the knowledge base, assisting students to apply that knowledge effectively in their practice, and developing ethical comportment in all teaching and learning settings. The authors suggest 4 paradigm shifts that must occur to address the challenges:
1. Shift from a focus on covering decontextualized knowledge to an emphasis on teaching for a sense of salience, situated cognition, and action in particular patient situations.
2. Shift from a sharp separation of clinical and classroom teaching to an integration of classroom and clinical teaching.
3. Shift from an emphasis on critical thinking to an emphasis on clinical reasoning and multiple ways of thinking that include critical thinking.
4. Shift from an emphasis on socialization and role taking to an emphasis on formation where nurses' professional identity is constituted by the meanings, content, intents, and practice of nursing rather than imitating or being socialized into their nursing role. It requires skilled know-how and embodied capacities to act in practice situations when the patient's well being is at stake. In other words, formation is teaching students how to be a nurse rather than doing nursing!
These authors suggest significant structural changes because of the depth and breadth of the requisite knowledge needed to care for patients with increasingly complex needs. These proposed changes include (1) making the baccalaureate degree in nursing the entrance into practice (no surprise to many who have been trying to achieve this for way too long!), (2) increasing the number of second-degree baccalaureate and master's programs, (3) requiring a postgraduate year of internship in a clinical setting, (4) reaching agreement on a set of clinically relevant prerequisites, (5) recruiting a more diverse faculty and student body to reflect the population served, (6) introducing prenursing students to nursing early in their education, (7) broadening the clinical experience, (8) providing more financial aid for students at all levels, (9) preserving postclinical conferences and small patient care assignments, and (10) redesigning the ethic curricula so that students learn ethical comportment and notions of good that are central to the nursing profession.
This book calls for radical transformation of the education system that prepares new nurses. It has profound implications for leaders in clinical services as the education of nurses has an effect on the entire healthcare system. Our challenge is make sure that a large cadre of clinical services leaders is at the table along with other stakeholders, such as academic educators and national nursing organizational leaders, as the transformative changes suggested in this book are addressed.
1. Benner P, Sutphen M, Leonard V, Day L. Educating Nurses: A Call for Transformation
. San Francisco, CA: Jossey-Bass; 2010.