PROGRAMS FOR NURSING EDUCATION & NURSING SERVICEISSUES, CONCERNS AND TRENDS IN NURSING EDUCATIONAND NURSING SERVICE

Presented to:

MA. LUISA S. PARREAS, RN, MN, EdD

In Partial FulfillmentOf the Requirements for the Course PRINCIPLES AND METHODS OF NURSINGMANGEMENT AND ADMINISTRATION

By:

LEVY MARIE A. DURAN, RN

June 7, 2015

NURSING EDUCATION AND NURSING SERVICE PROGRAMS

Undergraduate Programs:LPN to BSN Programs

Programs for RNsRN to BSN Programs RN to MSN Programs Master's Degree Programs

Clinical Nurse Leader Programs Doctoral Programs

ISSUES, CONCERNS, TRENDS IN NURSING EDUCATION AND SERVICE

Nursing is in the midst of revolutionary changes. How are these changes affecting the profession todayand how are they likely to affect it in the future? As we move forward, nursing will continue to evolve. But some of the basics wont changebasics such as advocating for patients, seeing how all the pieces fit together for the patient and, most importantly, caring for the patient as a human being.

I. Portability and mobility According to Tim Porter-OGrady, RN, EdD, Portability and mobility are the cornerstones of technotherapeutic interventions, The growth in freestanding clinics, ambulatory care centers, and other nonhospital settings supports his view. Technology will extend patients lives. Many Americans are aging in place, with communities finding ways to support older people in their homes. Futurist Andy Hines, MS, says, Baby boomers are going to want to avoid institutions for themselves and their parents. These forces mean that much of the patients healing takes place where nurses dont typically deliver round-the-clock carethe home. Unfortunately, most nurses have been educated in a hospital-based model, which doesnt mesh with todays trends. Porter-OGrady urges us to remember that patients dont necessarily benefit from a hospital stay. There is a direct line from length of stay to increased morbidity and mortality. Hines remarks, Theres a shift away from institutional care toward individual responsibility, and a move from hospitals and nursing homes to retail, kiosks, and home. He adds that consumers want more personal control over their healthcare, so we can expect more self-diagnostic tests and innovative ways to deliver care. Hospital-based nurses also need to focus on helping patients make the transition to where theyll be healingat home.

II. Evidence-based practice EBP is one reason facilities designated as Magnet hospitals by the Magnet Recognition Program have been so successful: Theyve set up systems that foster evidence-based care, bringing improved patient care and nurse satisfaction. EBP also serves as the foundation for the disease management work done by nurse practitioners (NPs) and many other nurses.

III. Emphasis on safety and quality Patient safety and quality of care are two trends that have benefited nursing. Rebecca M. Patton, RN, CNOR, cites the National Quality Indicator Database as an example of a program thats tracking nurses impact on patient care outcomes. This database of nurse-sensitive indicators, with data from almost 1,000 hospitals, is one of several that show nurses importance in the delivery of safe, high-quality care in every setting. Because of the quality push, healthcare workforce leaders may see more pay for performancepayment by third-party or government payors based on the quality of care delivered by the facility.

III. High times for high-tech The explosion of medical technology has led to myriad lifesaving and life-enhancing inventions, including spare body parts ranging from knees to thumbs and dramatically improved sensors and diagnostics. Hines says medical devices are getting more precise, user friendly, and cost effective. Heres a rundown of a few areas where technology is making a big impact.

Genes and stem cells. Researchers are linking more and more diseases to genes, with tremendous implications for educating patients about their conditionsand tremendous potential for ethical dilemmas regarding genetic testing.

Robots in the OR. Computer-assisted surgery has moved to the next level. Robots have elbowed their way onto the operating-room bed and into the perioperative team. Although too expensive to use for every surgery, robots have proven their mettle in complex procedures and those that require manipulation in a tight area. Of course, robots wont replace surgeons or nurses, but they can enhance their abilities. Robots also can free up nurses to spend more time with patients. And, given our aging population and the extension of lives through medicine and technology, nurses will need every means of support possible.

IV. Nursing workforce As recently as 2004, a national survey found that 82% of nurses thought there was still a nursing shortage. Thats consistent with others perceptions: Earlier that same year, 81% of physicians perceived a nursing shortage where they admitted patients. In 2005, 74% of hospital chief nursing officers and 68% of chief executive officers also perceived a shortage. According to Peter Buerhaus, RN, PhD. Clearly the nursing shortage isnt as intense as in 2001 and 2002, but it has by no means gone away. But Buerhaus thinks were experiencing the calm before the storm. In April 2006, the American Hospital Association reported a vacancy rate of 8.5% in nursing job openings. In his experience, vacancy rates of 9% usually indicate a shortage. He points out that the demand for nurses is rising, with only slow increases in supply, and that nurses earnings flattened in 2004 and 2005.

A. Greying nurses Whether or not theyre satisfied with their jobs, nurses will continue to spot grey hairs in the mirror as they age. The physical workplace environment will need to be adapted to keep older nurses in the workforce. We need their experience, says Burnes Bolton, but we need to take the burden out of care. Technology can help accomplish this. As the core of the nursing workforce nears retirement, younger nurses are entering the profession, creating intergenerational teams. Nurses of different age-groups need to understand and accept each others perspective and appreciate what everyone brings to the team.

B. Other factors affecting the nursing workforce Physician shortages. A shortage of physicians will increase the demand for NPs. The sense is that the physician shortages are severe, says Buerhaus, and these shortages arent likely to end any time soon. As the demand for healthcare keeps growing, were going to need NPs in huge numbers, and they could take over much of what medicine does today in our lifetime.

Foreign nurses. Buerhaus foresees more foreign nurses working in the double or triple todays number. He speculates that by 2020, as much as 25% of our nursing workforce may have received their nursing education outside the United States. Hines agrees that foreign nurses are here to stay. Common standards are needed for the emerging global workforce. At the same time, Patton cautions that using foreign-educated RNs must not detract from the need to offer all nurses a better work environment.

Staffing ratios. Will legislated ratios play a role in the upcoming demand for nurses? Aiken and Buerhaus say no. Aiken believes legislated ratios will never dominate because most of the institutions in this country are in the private sector; few are government owned. However, she does think legislation on public reporting will become more commonand these reports may include ratios. She predicts hospitals will increasingly move to better staffing as a result of the evidence. Buerhaus warns, If ratios catch on and become federally mandated, it would lead to the demise of the nursing profession. The public would lose trust because they wont really see better outcomes; the science isnt there to show it.

Healing spaces, empowered nurses. Although nurses work environments are improving, more needs to be done. Hospitals already are working on reconfiguring rooms so nurses dont have to walk so far and supplies are easily accessible. Some have gone a step further, creating healing spacesquiet areas with calm colors, meditation rooms, and gardens. Some hospitals are working to make the environment more personally satisfying by offering mindfulness retreats and posting affirmation messages that nurses can read while on duty. Still others have adopted caring models that refocus nursing delivery on caring.

Seeking a balance. Hines predicts the power will shift from the healthcare institution to the individual nurse as nurses seek to balance work and personal life work. The schedule and quality of life for many nurses is dreadful, he says. You have these long, tiring shifts of 12 hours on your feet, and lots of on-call and overtime. This runs counter to the social trend toward a greater work-life balance. Right now, the institutions have power over the nurses, but that could shift as nurses realize the opportunities outside the institutional setting.

V. Can technology help get nurses back to the bedside? Nurses spend less than 40% of their time on direct patient care, says Burnes Bolton. Technology can help turn that around. Burnes Bolton points out that some devices already in use are aimed at reducing the time nurses spend hunting and gathering and communicating multiple times in getting or giving information to team members. These products include tools nurses wear to improve communication and monitor patients remotely, and tools that help nurses and other team members get the information they need to make decisions. Many of these devices have forcing functions, such as built-in safety checks used on smart infusion pumps. Smart technology is used in many other ways as well. Some beds detect blood flow in the patients legs and alert the nurse to possible deep vein thrombosis. Special patient vests collect physiologic data and transmit it to a healthcare workers personal digital assistant. Smart technology also is being used to promote medication safety. These communicating and data-gathering devices allow nurses to interpret information and spend more time with patients. But all of this technology has a downside: Many of these products dont talk to each other.

VI. Facing the faculty shortage Lancaster believes that in the next 5 to 10 years, nursing schools will face a worsening crisis, with enrollment increasing as more faculty members retire. Faced with this situation, schools are looking for options. More and more advanced practice nurses in hospitals are participating in the education of students, says. This partnership benefits both the students and the clinicians, who believe it keeps them on top of their game. Some schools are developing certificate programs to help nurses prepare to be faculty members. These nurses have a shared teaching/clinical position or alternate periods between practitioner and teacher. Schools will continue to rely on practice partners for help in educating students, Lancaster says.

VII. Globalization and the Internationalization of EducationEvolving technologies are transforming both the formal and informal acquisition of knowledge. Information is accessible electronically; and people with common interests, e.g., students, researchers, and innovators, exchange knowledge freely via the Internet. The development of a knowledge economy has made intellectual capital a valuable possession. Consequently, knowledge production through education has become an increasingly competitive industry (World Bank, 2002, 2008). Education has become a business in the globalized world and is seen as both an investment and an export commodity. Educational entrepreneurs invest in students as they serve those seeking higher education credentials. When education is marketized, the concepts of business become more pronounced, as noted when learners are viewed as customers rather than participants.

VIII. Exporting of Education

A. Throughout AcademiaThere is a worldwide demand for higher education due to the increasing labour market needs for highly skilled workers, such as nurses. The United States (US), Britain, and Australia are the three leading exporters of higher education, but other developed countries also play a part (Bollag, 2006, Shepherd, 2007). In the US, education and training rank among the nations top service exports (Lenn, 2002; Lewin, 2008). Exported educational services are delivered in various ways: (a) as students travel abroad to receive their education; (b) as education is delivered to them through distance learning; and (c) as educational institutions from one country provide onsite classes in another country, often through establishing branch campuses and/or franchises (King, 2006; Knight, 2006; Machado dos Santos, 2000). Colleges and universities in developed countries engage in various partnerships. Some partnerships involve mutually beneficial exchanges of faculty and students. In other arrangements, faculty members from one university are contracted as instructors or consultants to establish new departments in an overseas institution.

B. Exporting of Education in NursingDespite international differences in nursing education and practice, a number of mechanisms allow nurses to migrate throughout the world. In some source countries, there is a deliberate policy of educating nurses for export. This investment in human resources can result in generous remittances to the home country. A strategic method of profiting from surplus human resources is to prepare migrants to find jobs abroad and contribute to the economy of their home country through remittances to family members. In developing countries, educated but underutilized workers are among the first to migrate when opportunities become available to them (Abella, 1997; Baumann, Blythe, Rheaume, & McKintosh, 2006; Blythe & Baumann, 2008). In the 1950s, the Philippines began to prepare nurses for export, mainly to the US (Brush & Solchalski, 2007; Choy, 2004). Educated in English with American-based curricula, Filipino nurses have migrated to the Middle East and throughout the developed world. The Philippines Overseas Employment Administration has reported that nearly 88,000 nurses left the Philippines between 1992 and 2003, but this may be an underestimate (Perrin, Hagopian, Sales, & Haung, 2007). Following the example of the Philippines, the Indian government also supports the export of nurses (Healey, 2006, Thomas, 2006). The importance of this nurse export business is reflected in the rapid growth of nursing schools in India (Thomas, 2006). Many groups profit from this nurse migration. Khadria (2007, p. 1433) describes this process in India as business process outsourcing. It includes a comprehensive training-cum-recruitment-cum placement for popular destinations like the United Kingdom (UK) and the US through a proliferating agency system. China and Korea are beginning to follow a similar path (Fang, 2007). The large population and growing tertiary education markets will facilitate this production of nurses for export.IX. Current Standards and Harmonization in Transnational Nursing Education A critical issue in transnational nursing education is the absence of a body that has international authority to monitor educational standards worldwide, even though some attempts have been made to establish international standards that reconcile standards with cultural diversity. There is also a lack of internationally sanctioned mechanisms for making comparisons among programs in different countries. The latter is particularly important because educational institutions that wish to be major international players need accreditation to attract students and to promote quality education. There is, however, a strong history of accreditation within countries. Accreditations for professional programs are strong but are largely in country. For example, the US and Canada have well established systems of voluntary accreditation in higher education (Eaton, 2006). National accrediting organizations assure common standards and expectations. These organizations are often called upon by other countries to send teams to adjudicate accreditation status for foreign programs. Examples of established nursing accreditation programs are the National League for Nursing Accrediting Commission (NLNAC) and the American Association of Colleges of Nursing (AACN) in the US; and the Canadian Association of University Schools of Nursing (CAUSN). The NLNAC accredits nursing programs of all levels, while the AACN accredits baccalaureate programs for nurses who will be entering nursing with a baccalaureate degree. It advocates the baccalaureate as the minimum educational requirement for professional nursing practice (AACN, 2000).The European Union has paid considerable attention to addressing the problem of reconciling cultural diversity with standards. In 2001, the Lisbon Recognition Convention Committee adopted a Code of Good Practice in the Provision of Transnational Education (Council of Europe, 2008). In a more direct attempt to reconcile diversity and standards, a component of the Bologna process, titled Tuning Educational Structures in Europe, has examined structures such as curricula. This document is intended to promote points of reference, convergence, and common understanding as the basis of curricula that would lead to the development of common key competencies, while protecting the rich diversity of European education (Marrow, 2006).Additional attempts to establish standards for transnational education include the Guidelines on Quality Provision in Cross-Border Education prepared by the United Nations Educational, Scientific, and Cultural Organisation (UNESCO) and the Organisation for Economic Co-operation and Development (OECD) (Davies & Wong, 2006). However, students who require acceptable credentials must themselves exercise great caution because there is always the potential for fraud or exploitation. The Council of Europe (2008) advises potential students to be extremely vigilant about spurious claims of endorsement in stating, We wish to make it clear that the Council of Europe does not recognize or in any other way bestow legitimacy on any higher education institution, program or provision.

XI. Trends and Future Directions in Harmonizing Nursing Education Internationally Nurses have existed in many cultures since ancient times (Sapountzi-Krepia, 2004). From its foundation in 1899, the International Council of Nurses (ICN) has envisioned an international federation of national nursing organizations that would ensure high standards of nursing education and practice globally. Its founders reasoned that principles governing nursing education and practice should be the same in every country (ICN, n.d.). Unfortunately in the early 20th century, as nursing established itself as a profession, globalization waned. Two world wars and the Cold War meant that the profession diversified. This resulted in a great deal of variation in the way nurses were educated. In addition to differences in education, the nursing profession varies by country in how it is regulated. In a number of countries, to protect the public, regulated professions have designated standards for their members and reinforced these standards by withholding registration from individuals lacking appropriate educational or other credentials (ICN/World Health Organization [WHO], 2005). In other countries, regulation has taken a variety of forms; and in some countries, nursing has not yet become an autonomous, regulated profession. Differences in regulatory criteria are barriers to internationalization. Where regulation occurs at the regional or provincial level, mobility within a country is an issue (WHO/Sigma Theta Tau Honor Society of Nursing [STTI], 2007). Yet data collected from the Organization for Economic Cooperation and Developments (OECDs) 30 member countries shows that about 11% of nurses in these countries are foreign educated (2007). This high proportion of foreign nurses indicates that a measure of accommodation exists among the divergent systems of education and regulation allowing nurses to practice outside their countries of origin.Although the ideal of worldwide standards for nurses promoted by the ICN for over a century remains unrealized, the forces of globalization have created an impetus for change. Education of health professionals, specifically nurses, cannot be entirely homogenous given population health issues, such as endemic diseases, along with social, cultural, and economic differences. However, standards for nursing education need to be established throughout the world to provide a guide for local services and to assure a minimum standard for important issues such as essential qualifications for nurse educators. There have been several initiatives to identify and address barriers to achieving global standards.Among the projects focusing on quality of nursing education is the recently formed Joint Task Force on Creating a Global Nursing Education Community. This initiative is designed to share information and promote quality standards. A meeting led by WHO and STTI was held in Bangkok, Thailand, in December 2006. The goal was to initiate the development of global standards for basic nursing and midwifery education and to address patient safety and quality of care issues that result from the large-scale migration of healthcare providers. Major themes included the development of global standards for program admission criteria, program development requirements, program content components, faculty qualifications, and program graduate characteristics (WHO/STTI, 2007). Aspects of globalization such as professional mobility, health sector reform, and public concern with the quality of healthcare services have led to greater interest in nursing regulation. In conjunction with WHO, the ICN has established a regulation network as both a forum for exchanging ideas, experience, and expertise in regulatory issues affecting nursing and also as a source of information and guidance to deal with emerging issues (ICN, n.d.). Conferences are held at regular intervals, with the most recent, as of this writing, held in Geneva in May, 2008 (World Health Professions Alliance, 2008).While international and national nursing bodies are focusing on international standards for nurses, more inclusive movements for educational harmonization that involve national governments are under way. One of the most significant is the Bologna process or Bologna accords. The purpose of this undertaking is to make academic degree standards and quality assurance standards more comparable and compatible throughout Europe. The process extends beyond the EU to include some 45 countries (Zgaga, 2006). Clearly, further harmonization is required. Academic records or diploma titles enable European Union (EU)nurses to register and work in any EU country. Currently, nursing programs that enable nurses to practice in the EU have been subjected to two European directives regarding the qualifications of nurses responsible for general care. Directives 77/453/ECC and 89/595/EEC stipulate that a registration program should be at least 3 years long or 4,600 hours (Zabalegui et al., 2006, p. 115). However, a survey of nursing education in the EU indicates programs take place in a variety of universities, colleges, and schools and that curricular and degree structures vary greatly (National Nursing Research Unit, 2007). Despite these differences, entrance examinations are not required when nurses migrate.The Bologna process offers the opportunity to standardize nursing education, with the bachelors degree as the entry level to the profession, and masters and doctoral degrees recognized in all EU countries (Zabalegui et al., 2006). Some European countries have already adopted a three-year bachelors degree as the criterion for entry to practice. Other countries, including some in Eastern Europe, are moving toward this standard (Krzeminska, Belcher, & Hart, 2005; Marrow, 2006). The Tuning Educational Structures in Europe project, a component of the Bologna process, builds on previous endeavours to enhance inter-university cooperation and aims to identify generic and specific competencies for nursing graduates at bachelors, masters, and doctoral levels (for additional information on these specific competencies see Gobbi, 2004). Graduates, academic faculty, and employers participated in the project, which included a method designed to make the different nursing curricula understandable across countries. The process used by these team members led to the identification of 30 generic and 40 specific nursing competences that will serve as a framework for evaluation. Zabalegui et al. (2006, p. 117) noted that within this new structure, a bachelor in nursing or nursing science will denote achievement of the specified competencies in an academic environment.While the Bologna process directly concerns Europe and its immediate neighbors, it has generated global attention because harmonization of nursing in this large geographical area will have worldwide repercussions (Zabalegui et al., 2006). It has aroused the interest of countries such as Australia and New Zealand, rival providers of educational services (Australian Department of Education, Science and Training, 2006; New Zealand, Ministry of Education 2007), as well as countries in the Far East (Zgaga, 2006). Schools of nursing in the Philippines, India, and China will need to take the stipulations of the Bologna process and the competencies identified in the Tuning project into account if they wish their graduates to be eligible to work in Europe. Other economic and political partnerships elsewhere in the world may be interested in participating or developing their own harmonization projects. While educators in North America may prefer alternative approaches to nursing education, they will need to address educational equivalences and differences in nursing education and nursing qualifications. Careful comparisons between education systems may be necessary. For example, competencies and hours of instruction or clinical practice may need to be considered when calculating equivalencies.

THOUGHTS TO PONDER:

Some nursing leaders are uncomfortable with change and struggle with transforming the system instead of serving as role models. Porter-OGrady encourages them to make it safe to discuss what nurses can stop doing and make sure theyre letting go of the right things. He urges them to model change and to discourage their staff from saying I want to do the most I can for my patients, because theres no relationship between volume and value. He believes leaders have to be comfortable with change and with being vulnerable; they have to be comfortable admitting, I dont know, but I can find out.Im not sure how well get there but Ill be with you. I wont desert you.

Burnes Bolton advises nursing leaders to work together during this crucial time. We have the attention of the federal government and organizations like the Institute of Healthcare Improvement and the Robert Wood Johnson Foundation.Our panelists express concern about a leadership gap and wonder where the next leaders will come from. While new leaders are emerging, the panelists emphasized they have the responsibility to mentor future nurse leaders. They know that the more impact they have on their profession and their colleagues, the more service they can provide to patients. Its a different way to serve, Porter-OGrady says.

REFERENCES:

Nursing education programs. (2015). Retrieved from: http://www.aacn.nche.edu/education-resources/nursing-education-programsNursing service programs. (2015). Retrieved from: http://www.americannursetoday. com/nursing-today-and-beyondTrends and Issues in Nursing. (2015). Retrieved from: http://onlinenursing.wilkes.edu/trends-in-nursing