nursing education and nursing practice in the united states
TRANSCRIPT
Nursing Education and Nursing Practice
in the United States
Susan LaRocco PhD RN MBA
Professor
Curry College
Registered Nurses in the United States
3.06 million (2008)
85% are employed in nursing (2.6 million)
854 employed RNs per 100,000 population
62% of employed nurses work in hospitals
Median age of employed nurses is 46 (up from 38
in 1988)
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Educational Preparation
Three major educational programs:
associate degree from community college
diploma from hospital training program
baccalaureate degree from college or university
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Associate Degree (ADN)
2-3 years
based in a community or technical college
most frequent initial education – 45% of all nurses
basic sciences (anatomy, physiology, microbiology,
chemistry)
nursing courses – medical, surgical, pediatrics, maternity,
psychiatric nursing
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Diploma
usually 3 years
based in a hospital
initial education for 20% of all nurses
basic sciences and nursing courses
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Baccalaureate Degree
usually 4 years
based in a college or university
initial education for 34% of all nurses
basic sciences and nursing courses
liberal arts courses such as psychology, literature,
philosophy, sociology, history
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Number of Nursing Schools in US
Year 1981 2008
Total number of programs 1401 1773
Associate degree 715 1023
Diploma 303 69
Baccalaureate 383 681
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Changes Over Time
Associate degree programs began in the 1950s
in 1980 64% of all nurses were educated in diploma programs
only 3% of nurses that graduated since 2004 were educated in a diploma program
average age at graduation for all graduates has increased from 24 (1984 or earlier) to 31 (for 2005 or later)
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Typical Baccalaureate Curriculum
Anatomy and physiology
Chemistry
Microbiology
Human growth and
development
Pathophysiology
Pharmacology
Concepts of nursing
Medical surgical nursing
Pediatric nursing
Community health nursing
Maternity nursing
Mental health nursing
Evidence based practice (research)
Professional practice (synthesis)
Liberal arts such as sociology, history, philosophy, English literature, psychology, history
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National Council Licensure Exam (NCLEX-RN)
all graduates take the same exam
computer adapted
75 to 265 items long
multiple choice and alternate item format
questions written at the application level according to Bloom’s Taxonomy of Cognitive Domains
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Licensing Done by the States
states determine eligibility to take the test
in 2011 – almost 145,000 US educated nurses took exam for the first time
(57% were graduates of associate degree programs)
pass rate for US educated first time takers was 88%
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Internationally Educated Nurses
Total 165,500 in US
50% are from the Philippines
in 2007 – almost 34,000 internationally educated nurses took the NCLEX-RN
in 2011 – less than 10,000 international candidates for NCLEX
(first time pass rate 34%)
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Masters Degrees Doctoral Degrees
Nursing education
Nursing administration
Nurse practitioner (adult, pediatric, acute care, geriatric)
Clinical nurse specialist
Clinical nurse leader
Certified registered nurse anesthetist
Nurse midwife
PhD – research focused
DNP – clinical practice
focused
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Higher Education in Nursing
The Future of Nursing:
Leading Change, Advancing Health
Report issued in 2010 by the Institute of Medicine (IOM) of the National Academies
Based on a 2 year study
Goal: assess and transform the nursing profession
Four key messages
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The IOM Messages
Nurses should practice to the full extent of their education and
training
Nurses should achieve higher levels of education and training through
an improved education system that promotes seamless academic
progression
Nurses should be full partners, with physicians and other health care
professionals, in redesigning health care in the US
Effective workforce planning and policy making require better data
collection and improved information infrastructure
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Two Major Recommendations for
Nursing Education
Increase the proportion of nurses with a baccalaureate
degree to 80% by 2020
Approximately 50% now have BS or higher degrees
Double the number of nurses with a doctorate by 2020
In 2008 there were approximately 28,370 nurses with
doctoral degrees (1.3% of all nurses)
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6 quality and safety competencies for nurses developed from a 2003 Institute of Medicine Report
1. Patient Centered Care
Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs.
2. Teamwork and Collaboration
Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
Quality and Safety Education for Nurses (QSEN)
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QSEN continued
3. Evidenced-Based Practice
Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
4. Quality Improvement
Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.
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QSEN continued
5. Safety
Minimizes risk of harm to patients and providers through
both system effectiveness and individual performance.
6. Informatics
Use information and technology to communicate, manage
knowledge, mitigate error, and support decision making.
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Trends in Nursing Education
Increased focus on patient education and management of
chronic conditions
Inclusion of genetics and genomics in the curriculum
Simulation to enhance technical and critical thinking skills
Focus on quality and safety
Increased emphasis on interprofessional
education/teamwork
Distance learning – online courses
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Advanced Practice Nurses
Nurse Practitioner (NP)
Nurse Midwife (CNM)
Nurse Anesthetist (CRNA)
Clinical Nurse Specialist (CNS)
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Nurse Practitioners (NP)
began in 1965
scope of practice is regulated by individual states
focus on: family care, pediatrics, geriatrics, adult health,
women’s health, psychiatry, neonatology, or acute hospital
care of adults and children
provide primary care, including prescribing medications
158,300 in US (89% employed in nursing)
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Nurse Midwives (CNM)
scope of practice is regulated by individual states
18,500 in US (84% employed in nursing, only 42%
of employed NMs are working as NMs)
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Clinical Nurse Specialists (CNS)
Approximately 59,000; number is declining
Educated to provide direct care and leadership in
care for a specific group of patients (such as
oncology, cardiac)
Many are in other roles, such as administration,
faculty, or quality assurance
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