As nurse educators, we continue to navigate our way forward, realigning nursing education practices to address clinical and population health care challenges further complicated by an ongoing pandemic. I am continuously inspired by the energy, innovation, and enthusiasm displayed by academic leaders, educators, and students as they adapt to new ways of teaching and learning. Nurse educators, as agents of change, embrace opportunities to permanently transform nursing education to prepare an agile, confident, and competent nursing workforce to meet the global health care needs of diverse populations.
A few lessons learned during the pandemic include the adaptability of nurse educators to implement rapid redesign of program delivery, expanded experiential clinical models, and integration of technology. The pandemic highlighted why the nursing profession must be dynamic, agile, and able to respond quickly to address the most pressing health care needs. We uncovered gaps in our health workforce and shined a spotlight on the extent of structural racism, health inequity, and limited access to affordable quality care in our nation.
These discoveries create a heightened awareness of the urgent needs of our health care system and expand opportunities for nursing education. Nurses are central to the mitigation of these issues and the provision of health care in public health, as well as health promotion in primary and acute care settings. Nurse educators and leaders–as agents of change–can embrace the challenge and harness the spirit of innovation ignited by the pandemic. There is no doubt, nursing education and clinical preparation must change to meet the complex care health care needs of our nation.
Nursing education is at a pivotal point and is challenged to deliver effective and efficient programs of study to prepare nurses, at all academic levels, as competent practitioners across the health care continuum. Academic change agents are needed to create bold, visionary, and transformative plans that push the boundaries of time-honored education traditions and shift the cultural norms of the future. Health care is not confined to a hospital building; it has expanded to include telehealth, technology-supported health innovations, and an emphasis on the social determinants of health (SDOH) and community prevention.
Nursing education is at a pivotal point and is challenged to deliver effective and efficient programs of study to prepare nurses, at all academic levels, as competent practitioners across the health care continuum. Academic change agents are needed to create bold, visionary, and transformative plans that push the boundaries of time-honored education traditions and shift the cultural norms of the future.
Ongoing implementation of successful alternative models of nursing education is important given the current realities facing nursing. Nurses are in short supply, which further limits access to clinical sites, preceptors, and clinical educators. While applications to nursing programs are at a record high, low retention rates for new nurses continue to plague our profession, with estimates of around 33.5 percent leaving the profession within the first two years of employment (Johnson, 2018). The cause is a confluence of factors that include poor preparation for the realities of nursing practice and the continuation of a traditional but outdated nursing training model (Spector, 2015). Despite efforts to quickly graduate new nurses, study results indicate a steady decline of preparation, competence, and readiness for practice over the past nine years, with fewer than 10 percent of new graduates demonstrating entry-level competence for practice (Kavanagh & Szweda, 2017; Kavanagh & Sharpnack, 2021).
Benchmarks for success need to move beyond program pass rates, certification, and licensure exams to include outcome performance measures of essential practice competencies. Academic norms such as established clinical hours, cohort models, reliance on exam scores, isolated skills check-lists, and content delivery methodologies need to be examined and correlated with measurable demonstration of performance outcomes and competence. Diverse learners can progress at their own pace, mastering competencies to seamlessly advance in their programs. Students who excel can opt to focus on specific areas of clinical practice, research, transition into graduate programs of study, or opt for early program completion. Graduates will be better prepared to transition into practice competent to provide quality care.
The longstanding hyper-focus on acute care clinicals at the expense of community, person-centered care, and SDOH needs to realign with the realities of health care and address practice gaps. Establishing partnerships with community-based agencies will expand opportunities to develop competence in health promotion, address gaps in community-based care, and allow a focus on vulnerable populations and SDOH. The focus on population-based health care will prepare nurses for expanded career opportunities beyond acute care and improved transition of care delivery models.
To address comprehensive health care needs across all populations and settings, the vision of health care for the future needs to place nurses at the center of health systems redesign. Innovative care delivery models will be a step toward radical reform by equally partnering with community and acute care organizations in the shared preparation of the future nursing workforce. Implementing a time-variable, competency-based clinical learning model will permit students to advance at their own unique pace and experience nurses’ full roles and responsibilities across health care environments (Josiah Macy Jr. Foundation, 2017). It will permit a greater emphasis on SDOH, nursing’s role in promoting cultural literacy, and responsible cross-cultural care.
A competency driven, shared academic-health-care partnership model has the potential to gradually replace the traditional model of clinical nursing education in the future. The tradition-bound model is no longer sufficient to adequately prepare nurses with the complex skills required to safely transition into a dynamic health care environment. A partnership model offers opportunities to bridge health care delivery gaps by creating a novel yet realistic, sustainable, and cost-effective program that prepares students to enter the nursing workforce as competent and confident providers.
To achieve this goal, a paradigm shift in the level of collaboration between academia and practice partners needs to occur. Both parties need to share responsibility for preparing a diverse nursing workforce. In this paradigm shift, students are viewed as assets to the organization and collaborate as members of the health care team. Students work collaboratively with members of the team, increasing responsibilities as they demonstrate continued growth in knowledge and competence. Student progression is individualized and not limited by course and semester boundaries. Knowledge progression and skills for application to practice could be delivered and evaluated using novel approaches augmented by technology that engages the learner in authentic, brain-based immersive experiences (Forneris, 2020; Forneris & Fey, 2018).
Preparing the future workforce using time-variable, competency-based education operationalized through a shared academic–health care agency partnership model offers an alternative approach to advancing nursing education. Implementation of this type of model will require collaboration of leaders across all levels of health care and a major paradigm shift to shared accountability for cocreating an educational model to prepare the future health care workforce. Research programs and resources must be allocated toward competency assessment, evaluation, and validation measures. Ultimately, a time-variable, or simply starting with a rigorous competency-based education model, offers the potential to reshape nursing education for the next generation of nurses and promote retention of a qualified, confident, competent, agile, and diverse nursing workforce.
Forneris S. G. (2020). Makerspace mindset at the NLN [headlines from the NLN]. Nursing Education Perspectives
, 41(5), 322–323. 10.1097/01.NEP.0000000000000726
Forneris S. G., Fey M. (Eds.) (2018). Critical conversations: The NLN guide for teaching Thinking
. National League for Nursing.
Johnson N. M. (2018, December 14). Why good nurses leave the profession. Minority Nurse. https://minoritynurse.com/why-good-nurses-leave-the-profession/
Josiah Macy Jr. Foundation. (2017). Achieving competency-based, time-variable health professions education
[2017 Annual Report]. https://macyfoundation.org/assets/reports/publications/macy_monograph_2017_final.pdf
Kavanagh J. M., Sharpnack P. A. (2021). Crisis in competency: A defining moment in nursing education. OJIN: The online journal of issues in nursing
, 26(1): Manuscript 2. 10.3912/OJIN.Vol26No01Man02
Kavanagh J. M., Szweda C. (2017). A crisis in competency: The strategic and ethical imperative to assessing new graduate nurses’ clinical reasoning. Nursing Education Perspectives
, 38(2), 57–62. 10.1097/01.NEP.0000000000000112
Leighton K., Kardong-Edgren S., McNelis A. M., Foisy-Doll C., Sullo E. (2021). Traditional clinical outcomes in prelicensure nursing education: An empty systematic review. Journal of Nursing Education
, 60(3), 136–142. https://doi.org/10.3928/01484834-20210222-03
Spector N. (2015). Clinical education and regulation. In Ard N., Valiga T. (Eds.), In Clinical nursing education: Current reflections
(pp. 181–198). National League for Nursing.