"By three methods we may learn wisdom: First, by reflection, which is noblest; second, by imitation, which is easiest; and third by experience, which is the bitterest."
--Confucius
As Nurse Educator celebrates 40 years, the Rx for Deans column is moving into its 10th year. This anniversary brings time for both reflective reasoning and looking ahead. What changes have transpired over the course of this column? Do they appear cyclic? What, if any, are new trends projected in deans' and directors' roles in higher education? This article uses strategic reasoning in generating the topics included in this column.1
Reasoning Back: The Past
The areas of concentration or "rubric" for the Rx for Deans columns have been the following: survival tips, common issues, challenges, opportunities, implementing change, and maintaining stability. In the ongoing categorization of column topics according to these 6 thematic categories, the column editors found that 24% addressed challenges, 22% addressed common issues, 20% addressed survival tips, 17% addressed implementing change, and 13% addressed opportunities, with only 4% of the 54 topics the past 9 years addressing the theme of maintaining stability.
The likely reason why implementing change topics have not been addressed more often is that the topic areas for implementing change tend to necessitate longer than the word limit for this department. Furthermore, change topics also tend to involve controversy requiring more discussion than the space permitted or another topic seemed more timely for readers.
The 2 column editors created a list of possible column topics when they first began and tried to address topics by prioritizing them by most pressing and extent of relevancy to readers. The use of a topic list for the column continues with 26 topics presently on the current list.
Nursing Education Today
Many topics discussed in the first 3 years continue to be relevant today. Time management, closet skeletons that accompany all deanships, and finding helpful ways of supporting faculty research have ongoing presence. The need to do more with fewer resources presents a recurring thread across topics. Nonetheless, there are clear changes and trends that have occurred over the last decade and will continue to influence the role and activities of deans and directors in the future.
The nursing faculty and practice shortage predictions in the early 2000s by the American Association of Colleges of Nursing (AACN) called for measures to address an aging faculty and practicing workforce. The severe competition and shortfall in clinical placements impinging on enrollments and dwindling budgets to support hiring additional faculty continue. Although enrollment numbers have increased, AACN2 continues to project a nursing workforce shortage due to retirements in education and practice. Use of simulation for part of the clinical experience, creation of Dedicated Education Units that incorporated clinical nursing staff as faculty, and use of Centralized Application Services, with pilot projects such as the West Texas Nursing Education Portal that affords prospective students the opportunity to be selected by schools that continue to have openings for admission, have been identified as partial solutions.
During this same time, the Institute of Medicine (IOM) issued reports via the Quality Chasm series to address concerns pertaining to patient safety. In 2003, the IOM called for common educational competencies for health professionals.3 The IOM areas were as follows: delivering patient-centered care, working as part of interdisciplinary teams, practicing evidence-based care, focusing on quality improvement, and using information technology.3 This sparked new reform in curricula. Nursing education embraced use of simulation to teach how to work in teams to promote patient safety. Nurse educators incorporated the electronic medical record and other technologies in foundational skills laboratories. Informatics became a part of undergraduate curricula.
The IOM 2010 Future of Nursing Report challenged nursing to increase the number of bachelor's-prepared nurses to 80% and double the number of doctorally prepared nurses while facilitating nurses working to the fullest extent of their scope of practice.4 States are gradually removing barriers to practice.5 To date, there has been an increase from 49% to 51% registered nurses practicing with bachelor's degrees; the increase in doctorally prepared nurses has been significant with doctor of nursing practice (DNP) professional degrees but less in numbers earning doctor of philosophy (PhD) academic degrees.
Another report that prompted change in nursing education was the Interprofessional Education Collaborative 2010 report calling for core competencies for collaborative practice.6 This report challenged health professions to work together and create shared curricula, much easier said than done given regulatory and accreditation issues. Nonetheless, since 2010, several regulatory bodies have begun the work of creating an agreed-on set of competencies that recognizes that some shared educational experiences will most likely foster the IOM core competencies of working in interprofessional teams and focusing on quality improvement and patient safety.
The last pronounced catalyst for change has been the call by the public for more flexible education, resulting in blended and online courses. The US Department of Education (DOE) issued a 2010 report on the evidence to support best practices in online education. This report focuses on K-12 because more than 1 million students have already taken online courses.7 The DOE found that few studies had been conducted on online education in this age group, students in general performed slightly better in online than in face-to-face classes, and generally, online instruction did not affect student outcomes.7 Campus Technology reported that the number of students taking online courses increased by 96% from 2008 to 2013.8 Nursing education uses this technology extensively.
Looking Ahead: The Future
In looking ahead, many of the topics are cyclic and not new trends. Patient safety, quality care, dwindling resources, faculty shortages, and even student enrollment challenges are ongoing and longstanding problems. Yet how deans and directors of nursing have responded to these has changed. Aligning education and practice is moving back to disciplinary roots; using technology in practice now as a trend in education is changing how nurse educators teach. Having more interprofessional education is one that many educators have wanted for a long time. Without regulators willing to join in this interprofessional movement, it was not possible to achieve to a full capacity. Deans and directors must keep abreast of the reports that propel change and determine how best to flex nursing education, support faculty, and maintain quality education.
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