1. Fulton, Janet S. PhD, RN, ACNS-BC, FAAN

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We teach as we have been taught. This adage is adapted from "we parent as we have been parented." The adaptation fits because teaching is a lot like parenting. If the child apple doesn't fall far from the parent tree, the student apple doesn't fall far from the faculty tree. And so it is that today's nursing practice reflects the experiences of generations of teaching by faculty who came before.

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How much has nursing education changed over the years? All indications suggest that nursing education is catching up with the digital age. Back in the day, audiovisual media included movies shown on film projectors (remember those black-and-white spots in the trailers?) and filmstrips accompanied by narration on a 331/3 long-playing record. Manikins for teaching skills were little more than large versions of the plastic dolls little girls received for birthday presents. Each student waited for a turn to satisfactorily demonstrate a skill and be "checked off" as able to perform the skill during clinical rotations in the hospital. Now, teaching includes high-definition classrooms connected virtually and simulation labs with real-time recording and facilitated debriefing. No one can argue that this is not progress, though I offer the observation that the current obsession with PowerPoint lectures is sometimes little more than filmstrips with recorded narration. Teaching strategies that engage students in interactions like simulations and case studies are far superior to the old lecture format and help students understand that practice is situational and contextual, there is more than one way to achieve an outcome, and often the best choice falls short of intentions.


The teaching of nursing skills has made great strides, yet we have not moved the needle very far in teaching leadership, as noted by the Institute of Medicine in its call for nurses to achieve higher levels of leadership in health care.1 Could our reticence to move forward in leadership be because we are teaching as we have been taught? Too many faculty still reward students for conformity, compliance, and acquiescence. These were important qualities for nurses taught by faculty in an era when women-and nursing is predominantly women-were not encouraged to speak out or stand up-that is, to be leaders.


Subtly, well-intended faculty members are perpetuating a message of valuing doing over thinking. I once asked senior students in a seminar to identify when they would not follow a hospital policy. "Never," was the unified response, "because we must follow hospital policy at all times!" "Really," I asked, "even if it resulted in patient harm?" How is it that a nursing program was graduating students so married to doing what they are told that they were unable to entertain the notion that there are times when the status quo, be it policy or not, can result in patient harm?


For nurses to be leaders in health care, I'll suggest 2 topical areas that should be added to nursing curricula: curious thinking and risk taking. Educators focus on critical thinking, and it is important for providing students with skills for thinking through a problem and arriving at a logical answer. In contrast, curious thinking is about discovering problems. Curious thinkers are able to juxtapose contrasting information for the purpose of discovering and shaping the problem. Curious thinkers are more intrigued by the questions than the answers. Every important discovery is first preceded by an important question. Curious thinkers discover important questions. Leaders are curious thinkers.


Leaders are risk takers. They are intellectually and emotionally capable of taking a road less traveled and will willingly navigate the wilderness. The unknown isn't frightening- it's exhilarating! Neither nursing education nor practice has ever been too supportive of nurse risk takers. We are, however, quite good at reinforcing conformity. And collectively we have become somewhat of an expert group on singling out for criticism those who don't conform. Sadly. For the future, let us find ways to teach and support reasoned risk takers.


Curious thinking combined with risk taking leads to innovation. For nurses to be leaders engaged in innovative work for the next decade and beyond, we need to be as committed to teaching the disruptive behaviors of curious thinking and risk taking as part of our professional comportment as we are to knowledge and skill acquisition. Moving nursing education in this direction will require a lot less money than high-fidelity simulation but much more self-reflection by faculty and a concerted effort to move away from teaching some of what we were taught.




1. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press; 2011. [Context Link]