Nursing Education and Curriculum Model for Graduate & Master Program
Curriculum Models for Graduate Programs In Nursing Education
Graduate nursing education is experiencing a major paradigm shift in response to health care, societal, and professional demands. There is a shortage of nurses prepared with advanced degrees to serve in administrator, educator, nurse scientist, and advanced practice roles.
With national calls to increase the number of nurses with advanced practice preparation and doctoral preparation (American Association of Colleges of Nursing [AACN], 2006; Institute of Medicine [IOM], 2010; National League for Nursing [NLN], 2013), much attention is being placed on the curriculum models that nursing has historically used to prepare nurses with graduate degrees.
This chapter discusses the evolving nature of U.S. graduate nursing education,
curriculum models for master’s and doctoral programs, and faculty preparation
for teaching in graduate programs, and concludes with future trends that will
continue to influence the development of graduate programs in nursing.
Historical Development of Graduate In Nursing Education
An understanding of the development of graduate education provides a solid foundation for discussion of the current changes taking place. Graduate education in nursing began to develop early in the twentieth century. Initially, graduate education was reserved for those nurses who worked as supervisors or administrators.
Today, graduate education is expected for nurses who want to practice at an advanced level as a nurse practitioner (NP), clinical nurse specialist (CNS), nurse anesthetist, midwife, educator, researcher, or administrator.
Curriculum models that facilitate nurses achieving graduate degrees at an earlier stage in their professional careers are emerging to meet the growing demand and maximize their contributions to nursing and health care over the life of their career.
In addition to preparing nurses for advanced clinical care positions, nursing graduate education programs also offer curricula that specifically prepare nurses in areas such as informatics, education, and administration.
Although these are not roles that prepare nurses to provide direct care, they are necessary roles to improve systems so that others can deliver safe, quality patient care across settings. These roles increasingly require specialized knowledge and skills beyond a basic nursing education.
This preparation can be a focused specialty area in a
master’s, doctor of philosophy (PhD), or doctor of nursing practice (DNP)
program, or can be courses that are added to a specialty area preparing nurses
to be advanced practice registered nurses (APRNs).
History of Master’s Programs in Nursing Education
In 1960 only 14 graduate programs in nursing existed to prepare faculty to teach in schools of nursing (Egenes, 2009). Rutgers University offered the first nursing master’s degree, and the focus was a clinical specialist in psychiatric nursing.
The demand for master’s programs in nursing grew in the areas of research, teaching, administration, and clinical practice areas in response to societal needs for nurses with advanced preparation in theory and research so that they could improve practice and increase the level of competence.
As enrollment in master’s programs increased, the focus of master’s programs shifted from functional specialization (educator, researcher, and administrator) to an emphasis on clinical areas (CNS). This enabled a growth in application of knowledge to improve care (Egenes, 2009).
The Nurse Training Act of 1964 recommended federal funding to develop graduate programs in nursing. By 1970, graduate nursing programs began to proliferate. Role preparation at this time included the CNS, educator, researcher, and administrator. As the popularity of the CNS increased, fewer nurses selected the role of researcher, educator, or administrator.
As this trend grew, programs preparing educators and administrators at the master’s level were either eliminated or relegated to supporting courses for programs focused on preparing the CNS (Egenes, 2009). The NP role developed during this same period as a means to provide primary care to underserved populations at a lower cost.
The first program was developed at the University of Colorado in 1965. Initially, NP programs were designed and implemented through continuing education programs and resulted in a certificate.
By 1970, NP preparation
primarily occurred in graduate nursing programs. A new addition to these
programs included developing skill in political activism to influence
legislative changes needed to allow NPs to practice to the full scope of their
preparation. This effort to influence legislators to make changes in state laws
so that NPs can practice to their full scope continues today (Egenes, 2009;
Fairman, 2014).
Development of a New Master’s Program In Nursing Education
The Clinical Nurse Leader
The clinical nurse leader (CNL) role emerged as a master’s level generalist prepared to develop methods of improving patient outcomes, coordinating and promoting evidence-based practice, and promote client self care and decision making.
The intended emphasis for this role was for clinicians whose focus was to engage in outcomes based practice using quality improvement strategies (American Association of Colleges of Nursing [AACN], 2013). CNLs are prepared to deliver care to specific populations and to collaborate with others providing care to a group of patients.
The Veterans Administration was one of
the first organizations to hire CNLs as a means to provide safe, quality, and
cost-effective care to patients (American Association of Colleges of Nursing [AACN],
2013; Keating, 2011b).
The development of the CNL role has not been without controversy. As the CNL role was first introduced, some questioned the need for this new role because CNSs also were prepared to deliver care to populations. However, as the CNL role has become better understood, the differentiation of the two roles has become clearer.
The CNS is recognized as an advanced practice nurse who is an expert clinician in a particular specialty or subspecialty of nursing practice. The CNL works at the microsystem level to manage and coordinate client care while the CNS designs, implements, and evaluates patient specific and population-based programs of care.
Ultimately, the CNL works in partnership
with the CNS, and both contribute to the delivery of safe, efficient, effective,
quality care.
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