A Brief Journey to New Model of Nursing Education

 A Historical View of New Model of Education In Nursing

New Models of Nursing Education,The History of Associates Degree Nursing Education Emerging Controversies in Associate Degree Nursing Education,Understanding Associate Degree Nursing Education Today,Bachelor of Nursing Education,Advocating for University Education,The History of Baccalaureate.

New Models of Nursing Education

The History of Associates Degree Nursing Education

    As noted previously, in 1943 Isabel Stewart remarked that efforts to redesign diploma nursing education included experimenting with new nursing education models. One model was associate degree nursing education. It began in response to the post World War II nursing shortage and it gained momentum following the Ginzberg Report (1949), which suggested that in comparison to a 4-year nursing program it would be more efficient and economical for colleges to offer a 2- year course of study in nursing.

    Ginzberg believed that not all nurses needed baccalaureate education to provide patient care. Nurses could be prepared to provide safe and competent patient care in less time than baccalaureate education, which would provide a feasible solution to the nursing shortage.It was at this time that Mildred Montag (1951) described how 2-year associate degree nursing programs, housed in community colleges, could prepare registered nurses (RNs) as semiprofessionals. 

    This group of RNs would meet the demand for nurses by acquiring enough nursing skill and judgment to provide nursing care, but not the expert skill and judgment of baccalaureate prepared nurses. Further study by Montag (1959) suggested that nurses prepared with an associate degree were performing similarly to staff nurses prepared with baccalaureate degrees. Moreover, those within the nursing profession believed that, with the exception of preparation in leadership and public health, nurses with an associate degree provided outstanding bedside nursing care (Smith, 1960). 

    Others contended the associate degree program's focus on learning rather than on service to hospitals provided educationally sound preparation for nursing practice (Lewis, 1964). Still others believed that its accessibility and affordability through community colleges made this degree inclusive. For the first time in the history of nursing education, the associate degree in nursing offered those with little access to baccalaureate nursing programs the opportunity to become registered nurses (Hassenplug, 1965).

Emerging Controversies in Associate Degree Nursing Education

    Indeed there were many advantages to associate degree nursing education, and these advantages remain present in today's associate degree nursing programs. Nevertheless, at the height of this program's success, in 1965, the American Nurses Association (ANA) published a position paper stating that those licensed to practice nursing should be prepared in institutions of higher education (universities). It also stated that the minimum preparation for the professional nurse should be a baccalaureate degree. 

    In other words, the position paper equated professional nursing with baccalaureate education. This potentially meant that associate degree-prepared nurses could not practice as registered nurses unless they had license requirements that were different from baccalaureate-prepared nurses.

    Despite these challenging circumstances, studies conducted since the ANA's position paper through the 1990s showed that, especially in hospital settings, there were unclear differentiations between nurses prepared in associate degree nursing programs and those prepared in baccalaureate degree programs (Bullough, Bullough, & Soukup, 1983; Bullough & Sparks, 1975; Haase, 1990). In fact, many studies showed registered nurses performed essentially the same in practice regardless of academic preparation. 

    Studies occurring in the 2000s, however, are beginning to present a different picture. Current research suggests that baccalaureate prepared nurses are associated with improved patient outcomes, that hospitals prefer to hire baccalaureate-prepared nurses, and that “magnet” hospitals have a higher percentage of baccalaureate-prepared nurses (Graf, 2006).

    This is not to say that associate degree nursing programs (like many diploma programs) will disappear. However, these studies do indicate mobility programs  through which associate degree prepared nurses obtain baccalaureate and higher degrees in nursing, will take on even greater significance than they have in the past.

Understanding Associate Degree Nursing Education Today

    According to the US Department of Health and Human Services Health Resources and Services Administration, National Center for Health Workforce Analysis (2006), 52.8 percent of those wishing to become nurses enter associate degree nursing (ADN) or associate degree in science (ASN) programs . 

    As a result, these programs remain one of the most feasible options of becoming an RN, and they address the nursing shortage by preparing nurses who are safe practitioners.Moreover, faculty members of ADN/ASN programs take responsibility for ensuring graduates are prepared for registered nurse roles in advocacy, leadership, professional involvement, lifelong learning, and evidence-based practice (National Organization for Associate Degree Nursing [N-OADN] , 2006).

    Clearly, the nursing profession must support such nurses in practice and the educational programs that prepare them. However, it is important to note that only 20.7 percent of associate degree nurses return to school for baccalaureate and higher degrees (US Department of Health and Human Services, 2006). 

    Because the associate degree in nursing is considered an initial entry degree into practice as a registered nurse, it is important to investigate why so few associate degrees prepared nurses return to school. Advocates of nursing education need to provide opportunities and incentives for associate degree prepared nurses to pursue further education.

Bachelor of Nursing Education

    “Very many private schools [hospital schools] of nursing still exist, but like the private schools of medicine that remain, there is hand writing upon the walls of their future. It says that their days are numbered, that "the old order changeth, giving place to the new, and"that the day of the university education of the nurse has come" (Beard, 1920, p. 955).

Advocating for University Education

The History of Baccalaureate

    Nursing Education Dr. Richard Olding Beard (quoted above), a great supporter of baccalaureate nursing education, followed the thinking of Florence Nightingale and the Nightingale Schools. Nightingale believed that nursing education should occur outside of hospitals and the medical model (Stewart, 1943). This model of nursing education would avoid apprenticeships where nursing students received less education in the principles of nursing care because they were providing long hours of service to hospitals.

    Nightingale advocated for nursing students to learn sound theory in anatomy and physiology, surgery, chemistry, nutrition, sanitation, and professionalism; to train under the guidance of ward sisters who were nurses with experience and dedication to the profession; and to be part of a system that was financially independent from hospitals (Stewart).

    The Nightingale philosophy initially succeeded in the United States when Bellevue School of Nursing in New York adopted it in 1873. However, opposition to it, which included arguments that nurses do not need to be overeducated, that hospitals needed nurses for service, and that independent Funding for nursing schools was unrealistic, maintained diploma nursing education. 

    Despite the overwhelming support for diploma schools, several nursing education leaders during the early 1900s continued to believe in university education for nurses and subsequently persisted in advocating for baccalaureate nursing education.

    For example, in 1901, Ethel Gordon Bedford Fenwick, founder of the International Council of Nurses, asserted it was time for nurses to be educated in universities where they could become skilled practitioners able to address local, national, and international health issues (Fenwick, 1901). Additionally, Dr. Beard supported leaders in nursing education who wanted higher educational standards for nurses. 

    He convinced the University of Minnesota to begin moving nursing education into higher education. In 1909 this university began its first nursing program. Though, as referred to previously, it resembled diploma programs, it did represent the beginning of a slow movement in nursing education toward baccalaureate education for nurses.