It happened. Health care reform is here. It will affect patient care, and it will affect nursing practice. Also promising to affect nursing, although lacking the public attention of health care reform, is a revolution in nursing education. The Carnegie Foundation's report, Educating Nurses: A Call for Radical Transformation, offers poignant insights into today's nursing education practices and calls the redesigning of nursing education an urgent social agenda.1 Carnegie has a long history of examining professional education, beginning with The Flexner Report in 1910. Most recently, it examined medical and now nursing education.

The investigative team, led by Dr Patricia Benner, collected data from multiple nursing education programs including associate degree, hospital diploma, bachelor, second-degree bachelor and second-degree master's programs. The 3 major conclusions were as follows: (1) nursing's educational systems effectively form professional identity and ethical comportment in students; (2) clinical practice experiences are powerful learning opportunities for students, yet the disconnect between education and practice is leaving students unable to adequately address ever increasing demands in clinical practice; and (3) nursing programs are not effectively teaching science, humanities, and technology.1 The implications for nursing education are just beginning to be recognized, and although the totality of the report is impressive and significant, it is the second conclusion regarding clinical experiences that should be of greatest interest to clinical nurse specialists (CNSs).

Soon to be gone are the days of clinical education as most of us have known it, with 1 instructor supervising 10 students on a large medical-surgical unit. In this model, students are disconnected from the wisdom of the staff and waste a lot of time waiting for the instructor to help with tasks such as passing medications, changing a dressing, or administering a tube feeding. The instructor is expected to be knowledgeable about patients' conditions and be proficient with the latest technology on the unit, the latter of which requires investing hours in obtaining system-level clearances to access medical records and medications. Likewise, students spend precious clinical time learning to use agency-specific systems and devices only to repeat the exercise the next semester when they rotate to a new setting. How are faculty to keep up with individualized hospital systems? What is a student really learning in a clinical rotation? Students need clinical role models practicing interdisciplinary care, integrated thinking, and ethical decision making in the context of a clinical setting. No longer can students write care plans they do not implement to fulfill an academic objective because they cared for the patient only a few short hours. Students need to evaluate the outcomes of their care and gain confidence in professional judgment. We need a model where students are imbedded in a clinical setting and where clinical settings are learning environments with faculty serving as trusted coaches, mentors, and resources and not 1-day-a-week guests. How do we make this shift? Clinical nurse specialists, you are clinical nursing experts. You must get involved in helping craft a new paradigm for nursing education.

Here are some suggestions for beginning the journey. First, be informed. Read the Carnegie report. Discuss the implications of findings and recommendations with other CNSs. Put the topic on the agenda of your CNS affiliate meetings. Find ways to engage local nursing faculty in the discussion. Create or join partnerships for education that foster collaboration among CNSs, faculty, and administrators. Crafting major changes in education in a time of faculty shortage will take all of us. Clinical nurse specialists represent significant intellectual capital within the profession. Highly educated, intellectually able, and occupying positions within health care agencies, CNSs are in a prime spot to partner with faculty for the redesign of clinical education. Be available and be engaged. Bring creativity, energy, and insight to addressing nursing education at the unit, agency, and community level.

Our educational system is in crisis. It must evolve along with health care reform, and CNSs should be visibly contributing to efforts to revise clinical experiences for students. Send a letter to the editor with your thoughts and suggestions for addressing the findings in the report, and include your plans and initiatives for creating a new educational experience for students.

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