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Position Statement:
As health care shifts from a fragmented
system of disparate providers and payers into integrated
managed systems, nurses and other health professionals are
encountering tremendous changes. The environments in which
nurses practice are becoming increasingly diverse, and the
skills required to practice in these settings are becoming
increasingly specific to the services offered and the patients
served. Advances in health-related technologies call for
enhanced knowledge and application of computing and other
technical skills. Nurses are faced with complex ethical
dilemmas created by rationing-of-health-care decisions and
research advances such as the human genome project. Practicing
nurses must continue to update their skills as their work
environments adapt to reforms in health care delivery. Further,
nurses' practice will be influenced by changes in the regulatory
system that will accompany multi-state recognition of licensure.
Over the years, the nursing educational
system, through multiple entry and exit routes, has prepared
nurses for the variety of settings in which health care is
delivered. The nursing educational system must continue to
produce the most qualified and prepared nurses to deliver
cost-effective and quality care. Nurse educators must continue
to analyze health care trends and create flexible curricula
that provide individuals with the skills and knowledge needed
for diverse settings. Further, nurse educators must continue
to offer continuing education for nurses as they fine-tune
skills for new settings.
Educational mobility in nursing is the vehicle
by which nurses and aspiring nurses gain new knowledge and
skills through formal and informal educational offerings.
Educational mobility serves the public, the profession, and
the individual nurse. Educational mobility should continue
to focus on promoting high standards, maintaining the quality
and integrity of baccalaureate and graduate programs, while
emphasizing the attainment of program outcomes. The focus
of higher learning should be on the socialization of students
to new professional roles and the knowledge and skills needed
for these roles.
Educational mobility options should respect
previous learning that students bring to the educational environment.
To this end, educational mobility encompasses diverse approaches
to continuous, life-long learning for nurses and for individuals
aspiring to nursing as a profession. Baccalaureate and higher-degree
programs in nursing should build on knowledge and skills attained
by learners prior to their matriculation in formal educational
programs. Higher education in nursing should be offered using
creative and flexible approaches that are incorporated into
curricula and reflect consideration of individual student
learning needs.
Definition
Educational mobility -- a process
by which individuals complete formal and/or informal educational
offerings to acquire additional knowledge and skills. To the
extent possible, educational mobility should build on previous
learning without unnecessary duplication of that learning
and be focused on outcomes.
Background
The history of nursing education in the U.S.
revolves around meeting health care needs of people within
the context of the times and events. Today, nursing education
continues to offer three primary avenues to licensure -- the
diploma, the associate degree, and the baccalaureate degree.
In addition, some nursing educational programs offer master's
or doctoral programs leading to licensure.
Despite the differences in educational requirements
and outcomes for these initial licensure programs, RNs with
differing educational backgrounds continue to be employed
in settings that do not differentiate role responsibilities
based on educational preparation. Many factors have contributed
to the syndrome of "a nurse is a nurse is a nurse,"
including economic and practical realities. Most employment
settings compensate nurses equally, without regard for educational
preparation, since these settings do not require RNs to work
in differentiated capacities. In addition, the chronic shortages
of RNs have contributed to the practical reality of employing
RNs in similar capacities despite educational background.
With the explosion of knowledge in health care
and the enormous changes in health care delivery systems,
employers of nurses can ill afford to employ RNs who do not
possess requisite knowledge and skills for new and emerging
settings. Various sites have developed and tested differentiated
practice models, in which nurses are hired into associate
or primary roles depending upon their educational and experiential
backgrounds.1 Indeed, the American Organization
of Nurse Executives, the National Organization for Associate
Degree Nursing, and the American Association of Colleges of
Nursing contributed to the development of a model for differentiated
nursing practice, based largely on the Healing Web project.
2
Although there continue to be multiple entry
and exit opportunities for nursing education, little is known
about the numbers of nurses with different educational backgrounds
needed for the emerging health care system. From the quadrennial
survey conducted by the federal Division of Nursing in 1996,
the following describe RNs in the U.S.:
- There are more than 2.5 million RNs in the
U.S., and almost 83 percent are employed in nursing.
- The average (mean) age of RNs is 44.3 years.
- Ten percent of RNs (246,363 of 2,558,874)
represent racial/ethnic minorities.
- Of employed RNs, 58.4 percent have less
than a BSN as the highest nursing-related educational credential.
Almost 32 percent have a baccalaureate degree in nursing,
9.1 percent are master's-prepared, and only 0.6 percent
are doctorally prepared.
- The projected number of graduates from basic
educational programs is predicted to remain essentially
stable through 2020, with the majority continuing to graduate
from associate-degree programs.
- Sixty percent of employed RNs are working
in hospital settings, 17 percent are employed in community
or public health settings, and 8 percent are employed in
nursing homes or extended care facilities.3
These data indicate that educational mobility
opportunities will abound in the foreseeable future, both
at the undergraduate and graduate levels, to increase the
numbers of graduates in general and specifically from racial
and ethnic minorities. Baccalaureate and higher-degree programs
in nursing should continue to include and expand educational
mobility undergraduate and graduate curricular options.
Recommendations
Approaches to educational mobility should:
- be designed to attain and maintain educational
integrity and program quality;
- enhance the socialization of students as
members of the profession of nursing, as well as, foster
achievement of personal goals and needs of individuals;
- focus on the attainment of outcomes that
reflect a higher level of knowledge, skills, critical thinking,
problem solving, social interaction, and effective professional
citizenship;
- consider flexible admission criteria while
focusing on exit criteria and standards; and
- include collaborative programs, where possible,
for articulation and broader use of existing statewide and
regional articulation models.
Implementation Guidelines
The following strategies are offered to AACN
members for implementing the recommendations in appropriate
settings:
- Continue to implement creative/innovative
educational designs and delivery approaches that facilitate
learning, including offering courses via distance learning
technologies;
- Incorporate flexibility in curriculum design
and methods of delivery to accommodate students with varied
educational and experiential backgrounds;
- Encourage pilot projects that involve innovative
admissions criteria, curriculum design, and methods of instructional
delivery; · Share "models that work" in regular
program sessions;
- Encourage research on the products of articulated
nursing programs;
- Increase communication with secondary education
to appropriately identify individuals who can pursue the
baccalaureate degree in nursing as the entry level; and
- Create and share incentives for educational
mobility at the baccalaureate and higher-degree levels,
including scholarships and working collaborations with care
delivery systems.
AACN Task Force on Educational
Mobility
Cynthia E. Kielinen, EdD, Task Force Chair
Chair
Department of Nursing
Towson University (MD)
Joan L. Creasia, PhD Dean
College of Nursing
University of Tennessee -- Knoxville (TN)
Timothy M. Gaspar, PhD Dean
College of Nursing & Health Sciences
Winona State University (MN)
Karen L. Miller, PhD Dean
School of Nursing
University of Kansas (KS)
Christine Talmadge, PhD Chair
Department of Nursing
California State University -- Long Beach (CA)
References
1 American Association of Colleges
of Nursing, American Organization of Nurse Executives, &
National Organization for Associate Degree Nursing. (1995).
A Model for Differentiated Nursing Practice. Washington,
DC: American Association of Colleges of Nursing.
2 Koerner, J.G., & Karpinuk,
K.L. (1994). Implementing Differentiated Nursing Practice.
Gaithersburg, MD: Aspen.
3 Moses, E.B. (1997). The Registered
Nurse Population: March 1996. Washington, DC: U.S. Department
of Health and Human Services, Division of Nursing.
(Approved by AACN Membership: October 25,
1993)
(Updated and Revised: March 30, 1998)
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