Various types of nontraditional mobility programs were initiated in the 1970s (Lenburg, 1975) and have evolved over the past four decades (Benjamin-Coleman et al, 2001). Resisted for more than 20 years by more tradi- tional educators and organizations, mobility programs now are commonplace. The AACN and NLN websites attest to the growing number of programs that offer some form of flexible, alternative program, in addi- tion to position statements on technology in nursing education, distance-learning, and online programs.
This well-developed trend is based on the success of these programs, the documented needs of students, the nursing shortage, and the expansion and acceptance of electronic learning technology (Shovein et al, 2005).
Distance or mobility programs include those for LPN
or LVN to ADN and BSN; diploma and ADN gradu- ates to BSN and MSN; and BSN to MSN and doctoral programs. Almost all use some form of Internet-based courses, and some are entirely online. Some require periods of intensive on-campus classes or assigned clin- ical experiences with preceptors (see Table 3-2).
The most controversial but pace-setting distance- learning program in nursing was developed under the New York Board of Regents as “the external degree pro- gram.” Initially named the NY Regents External Degree Program (NYREDP), it later was renamed Excelsior Col- lege. Its ADN program, initiated in 1972, and the BSN, in 1976, were fully accredited by the NLN shortly thereafter, albeit with considerable difficulty. This innovative college provides quality degree programs in many disciplines for adult learners underserved by traditional programs by using assessment methods to document prior learning and theory and performance examinations to validate current knowledge and competence. The nursing programs enroll thousands of students and are accessible regardless of geo- graphic location; the students primarily are LPNs or RNs, some of whom also have other degrees or health-related certificates. Early studies documented their competence in the workplace (Lenburg, 1990). It initiated a master’s degree program in 2000 with two specialty options. Over the years, many nursing programs have accepted and modified the distance-learning and assessment approach originally developed by the NYREDP and continued as Excelsior College. The integration of electronic learn- ing technology with assessment methods makes nursing degrees accessible to an increasing number of nurses seek- ing additional preparation (see Table 3-2).
Career ladder programs designed as “1 plus 1” or
“2 plus 2” options have been offered for many years by some schools and through several statewide programs.
Multiple mobility programs are available for LPNs to obtain an ADN degree, such as one offered by the New York Coalition for Education Mobility (2004). RN to BSN programs are available in approximately 600 schools as of 2011 (AACN, 2012). In addition, some 165 programs admit ADN graduates into MSN programs (AACN, 2012). With the shortage of nurses and nurse educators, some schools are finding ways to streamline RN to BSN programs.
Changes in social, political, financial, and philosophic trends; the extensive use of communication and learning technology; verified success from past experiences; and the continuing shortage of nurses have combined to make education mobility and distance-learning opportunities
55 CHAPTER 3 Contemporary Trends in Nursing Education
a necessity and a reality nationally and internationally.
Whereas the NLN continues to support all levels of edu- cation programs, the AACN and other organizations vigorously support the BSN for “entry into practice”
and the professionalization of nursing (IOM, 2010). In 2003, the New York State Board of Nursing approved a proposal that would require future graduates of diploma and ADN programs to earn a BSN degree within 10 years to be eligible for renewal of licensure; as of this writing, it has not been passed. The New York Organization of Nurse Executives supports this effort and describes the rationale for it on its website (NYONE, 2006).
In October 2010, the IOM released The Future of Nurs- ing: Leading Change, Advancing Health, which provides a blueprint for transforming the nursing profession.
A key message of this IOM report was that nurses should achieve higher levels of education and training through
an improved education system that promotes seamless academic progression. A variety of innovative strategies that include online education and simulation as well as consortium programs will need to be increased to create a seamless pathway from ADN to BSN, ADN to MSN and BSN-DNP and PhD. This will effect the needed transformation of nursing education (IOM, 2011).
The escalating nursing shortage and the aging of the current nursing workforce and nurse educators have prompted more schools to offer flexible mobil- ity options and types of programs. Some target poten- tially underrepresented groups, such as men, minority groups, and those with existing academic degrees. The most rapidly growing are the accelerated, fast-track, or second-degree programs, designed for non-nurses with other degrees. In 2011, the AACN reported 235 accelerated BSN programs and 63 accelerated master’s
BOX 3-1 SELECTED ORGANIZATIONS RELEVANT TO NURSING EDUCATION: GENERAL DESCRIPTION AND PURPOSE
American Academy of Nursing (AAN) —The organization of leaders in all facets of nursing: practice, education, administration, research, organizations, and govern- ment; the think tank of the profession; promotes advancement of all aspects of nursing; publishes posi- tion papers, conference proceedings, and documents to advance nursing.
American Association of Colleges of Nursing (AACN)—
The organization of deans and directors of baccalaure- ate and higher-degree nursing programs; establishes standards for programs concerned with legislative issues that pertain to professional nursing education;
publishes the Journal of Professional Nursing, The Essentials of Baccalaureate Education (2008), and other related documents pertaining to the BSN and higher-degree education.
American Nurses Association (ANA)—The major national nursing organization concerned with a broad scope of practice issues; standard of practice, scope of prac- tice, ethics, legal, and employment issues; a federa- tion of state nurses associations; publications relate to an array of practice issues and standards.
Commission on Collegiate Nursing Education (CCNE)—A subsidiary of the AACN with responsibility for estab- lishing and implementing standards and criteria and for accreditation of baccalaureate and graduate degree programs in nursing.
National Council of State Boards of Nursing (NCSBN)—The organization of all state boards; coordinates licensure
activities on a national level; creates and administers licensure examinations (NCLEX); developed computer- ized licensure examinations; works with other organi- zations to promote nursing standards and regulations and establish interstate licensure protocols.
National League for Nursing (NLN)—The national organi- zation of nurse educators, with long-standing commit- ment to four types of basic programs (LPN, diploma, ADN, and BSN); includes lay citizens concerned with nursing and health care on its board. NLN also has councils for nursing informatics, research in nursing education, wellness centers, and multiple types of print publications. Initiated a certification program and examination to certify excellence of nursing educa- tors; also established the Centers for Excellence for nursing programs that meet designated standards.
NLN Accreditation Commission (NLNAC)—Formed in 1997 as a subsidiary of the NLN with responsibility for establishing and implementing standards and criteria and for accrediting all types of schools of nursing.
National Organization of Nurse Practitioner Faculties (NONPF)—An organization of nurse practitioners in multiple specialties; sets national standards and crite- ria for programs and certification.
National Student Nurses Association (NSNA)—A national organization of statewide student nurse associations;
concerned with education and career issues; pro- vides student perspectives to other national nursing organizations.
56 UNIT 1 The Development of Nursing programs available at nursing schools nationwide. In addition, 33 new accelerated baccalaureate programs were in the planning stages, and 10 new accelerated master’s programs were also taking shape. For a list of accelerated nursing programs, visit http://www.aacn.
nche.edu/Education-Resources/APLIST.pdf.
Trends and issues that influence nursing education make it even more important to comply with qual- ity standards that emphasize competency outcomes.
Changes in number, diversity, and qualifications of students and shortage of faculty and finances make it necessary to develop more efficient and effective learn- ing strategies for on-campus and distant students.
Although mobility and electronic options are more convenient, they present issues. In addition to learning
to access multiple digital resources, students also need discipline and determination to pursue courses and clinical learning when a teacher is not physically present or accessible. Regardless of methods, they must achieve required competencies in spite of other responsibilities and learn to integrate critical thinking, reflective judg- ment, and evidence-based practices in patient care. In contrast to previous decades, organizations and schools now require more creative, responsive programs and expect more documented competence from students and faculty (Box 3-1). Although these trends pose chal- lenges for nursing students, faculties, and employers, they move nursing toward more competent professional practice and improved patient safety (Boyer, 2008; Len- burg et al, 2009).
S U M M A R Y
This chapter presented 10 major trends and related issues in nursing education programs and an overview of mul- tiple types of nursing programs. They have a significant influence on the content, learning process, and evaluation methods used in all types of programs and have influenced the development of new degrees and majors. They have had a remarkable effect on the persistence of various types of programs for entry into practice and on the increasing acceptance of diverse mobility and distance-learning pro- grams. Regardless of the type of program, most students now use the Internet to access courses, electronic databases, and other learning resources and integrate evidence-based practice and critical thinking. As students integrate current
trends and attempt to resolve issues, they create the trends for the next generation; they are participating in nursing history in the making. The most profound trend in nurs- ing education is learning to learn, to reason, and access relevant resources to solve problems. As Alvin Toffler wrote, “The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn.”
Additional resources are available online at:
http://evolve.elsevier.com/Cherry/
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