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The dwindling numbers of nursing faculty at U.S. colleges and universities are aggravating our nursing shortage. One idea that's been proposed as a way of encouraging more nurses to become educators is the BSN-to-PhD program: a direct route from the baccalaureate to the doctorate that would prepare nurses for a faculty position in less than 10 years. While the idea may seem logical, it will not serve students or the profession well.
I've taught nursing at various times during my 33 years as a nurse. Early on, I made the mistake of accepting a one-semester assignment teaching pediatrics-a clinical area in which I had never practiced and possessed relatively little knowledge. The students knew that my experience in pediatrics was only theoretical. I felt like an impostor. That assignment fueled within me the dual commitment to never again teach outside my areas of expertise and to always maintain a nursing practice while teaching.
According to the American Association of Colleges of Nursing (AACN), while enrollments in entry-level baccalaureate programs increased by 8% between 2001 and 2002, some 5,283 qualified applicants to baccalaureate and higher-degree programs were turned away because of "insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints."
Without question, there is a need for solutions to the problems in producing and retaining nursing instructors. See position papers by the National League for Nursing, http://www.nln.org/slides/speach.htm, and the AACN, http://www.aacn.nche.edu/Publications/WhitePapers/FacultyShortages.htm, for proposed solutions.
There is an allure to the BSN-to-PhD idea. In physics and biology, a continuous route to a doctorally prepared educator has long been an option, producing many faculty under age 30 who have three or four decades of teaching ahead of them. Proponents of a comparable option for nurses argue that the current path to the doctorate limits the number of years they can teach. Nursing faculty tend to get an associate's or bachelor's degree first and practice for several years before returning to school for a master's degree. They then practice for several years more as advanced practice nurses before completing the doctorate through part-time study-particularly if they have families who need their salaries. According to the AACN, by the time they are ready to enter tenure-track professorships, they are, on average, 46.2 years old and have only about two decades in which to teach.
But unlike biologists and physicists, nurses serve patients. What would nurse educators prepared via the BSN-to-PhD route really know about clinical nursing practice? How could they teach the subtleties of hands-on care that are apparent to an experienced nurse-how to know simply by looking at a patient that his condition is deteriorating? Or how to motivate a postoperative patient to get out of bed for the first time? Would generations of student nurses really benefit from three or four decades of teaching from a nurse who's not at a proficient or expert level of practice?
Proponents note that not all faculty must teach clinical courses; instead, they argue, some faculty spend much of their time conducting research. But researchers who haven't practiced are unlikely to investigate the concerns that are important to practice. We already have too much research that fails to address what clinicians-and patients-need.
The Institute of Medicine's 2003 report Health Professions Education: A Bridge to Quality concludes that we must transform the ways we teach health care professionals if the quality of care in this nation is to improve. One problem identified is "a lack of faculty and faculty development to ensure that faculty will be available at training sites and able to teach students new competencies effectively." We can meet this challenge by transforming the educational system to ensure that clinically competent faculty are valued. BSN-to-PhD programs could work if extensive clinical practice is required. Without it, the purpose of nursing education is undermined.
We must support clinically competent faculty.
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