As we mark the 10th anniversary of the Institute of Medicine's (IOM, 2011) landmark report, The Future of Nursing: Leading Change, Advancing Health, nurse educators have much to celebrate. We have unequivocally strengthened nursing education and established the baccalaureate degree as the expectation for our field.
While celebrating these accomplishments in the Year of the Nurse, our world was faced with the COVID-19 pandemic, which necessitated the transition of traditional on-campus nursing classes, clinical, and simulation experiences to remote learning opportunities. The pandemic also exposed the most salient issue of this decade, rampant health inequities. Lessons learned from the pandemic, especially around the social determinants of health, will need to be a focus for the next decade.
A DECADE OF PROGRESS
After the release of the Future of Nursing report (IOM, 2011), nursing education leaders set aside their long-simmering and unconstructive debate concerning the merits of a baccalaureate degree versus an associate degree. Instead, nursing education leaders at community colleges and four-year institutions collaborated to establish academic pathways to make it easier for nurses to continue their education and earn a baccalaureate degree. The results were impressive, and nurses now expect to attain a baccalaureate degree or higher (Campaign for Action, 2017). Qualitative research conducted by the Robert Wood Johnson Foundation in the form of one-on-one interviews and focus groups with nurses confirms that nurses have heard this message. Although the field will fall short of the report recommendation of 80 percent of nurses having a BSN degree by the end of this decade, systemic changes have been implemented that will result in more nurses attaining this degree.
This special issue discusses several changes, including original research articles. The article by Wendy Bowles and other members of the Ohio Action Coalition demonstrates the effectiveness of seamless academic progression models in increasing baccalaureate-prepared nurses. Research reported by Audrey Beauvais and Kathryn Phillip demonstrates the validity of the Clinical Simulation Competency Assessment Tool and will help advance competency-based assessment in education. An innovation described by Laura Goliat and the Northeast team of the Ohio Action Coalition used an assessment competency evaluation to reduce barriers for RN-to-BSN students.
The nursing field exceeded the goal the report set for doctoral students. In 2018, 33,646 nurses had doctorate degrees, compared with 10,022 in 2010 (Campaign for Action, 2020). We created and implemented the Medicare Graduate Nurse Education Demonstration Project, which showed that Medicare can effectively support the production of more advanced practice registered nurses. Nurse residency programs are on the rise, and we continue to educate a more diverse nursing workforce. This special issue describes innovations on nurse residencies by Nicole Weathers and Lori Forneris, the mentoring of diverse students by Jawanza Bundy, and advancing underrepresented nursing student success by Kupiri Ackerman-Barger and colleagues.
THE PANDEMIC'S IMPACT ON NURSING EDUCATION
At the start of the COVID-19 pandemic, nurse educators took unprecedented steps to increase simulation activities and widely adopt online education. Nurse educators quickly converted on-campus course sessions and considered alternative clinical placements to support courses and clinical and program outcomes, including simulation, distance learning, and telehealth. As nurse faculty transitioned to working remotely and becoming familiar with online learning modalities, students were forced to complete an already intensive academic experience virtually (Howard, 2020).
These rapid and evolving changes in health care and nursing education have been extraordinarily stressful for faculty and students. As this issue goes to press, nursing education programs are grappling with ever-changing guidance and the decision of whether to hold in-person classes in the fall, to continue with online learning, or to pursue a hybrid approach. An acute challenge for educators is ensuring that online education meets the requirements for articulation and licensure and that students graduate prepared to enter the frontlines adequately equipped to confront the challenges of health care. One particularly troubling (though necessary) aspect of the pandemic has been the cancellation of in-person clinical learning experiences for nursing students. In addition to enabling students to finesse their clinical skills, these clinical experiences help students develop an empathetic bedside manner, refine interpersonal interactions, and practice teamwork skills.
Another concern arising from the COVID-19 pandemic involves our new graduate nurses joining the health care system at a moment of tremendous instability and uncertainty. The transition to practice is often a challenging time for novice nurses. Nurse residency programs intended to help bridge this gap may have limited human resources to support new nurses. The current state of health care may negatively influence new graduate turnover as well as patient care. It will be essential for academic institutions to collaborate with health care agencies to support new nurses by mitigating these effects and improving professional well-being.
While the situation is challenging, the pandemic has presented new opportunities to advance the Future of Nursing (IOM, 2011) recommendations in new and creative ways. Educators are using innovative pedagogical approaches such as virtual reality, blended learning, online case studies, and other activities in new and creative ways. These educational changes may help advance nursing and nursing education.
ADDRESSING HEALTH INEQUITIES
Most importantly, the COVID-19 pandemic presents an opportunity to consider what we should be teaching nursing students to prepare them to work on the frontlines, as well as how we can rethink our education systems to be more accessible and equitable. COVID-19 has highlighted the rampant inequities in our country and our failure to create health equity. Marginalized communities that already face far too much hardship have experienced increased illness and death (Vesoulis, 2020). The risk of exposure to COVID-19 and the ability to protect oneself and one's family depend on a variety of factors such as income, access to health care, and others. The brutal killing of George Floyd at the hands of Minneapolis police officers, the unconscionably long list of black victims who preceded him, and the expressions of outrage and protests that followed underscore the need to adequately acknowledge, confront, and dismantle systems of structural racism. Educators must address these widespread inequities at their root, including in our classrooms and in our curricular content. As recommended in the Future of Nursing report (IOM, 2011), we must continue to prioritize efforts to diversify the profession.
Nursing must place health equity at the forefront of our endeavors. The Robert Wood Johnson Foundation and the National Academy of Medicine will release a second Future of Nursing report that will chart a path for our profession to help our nation build a culture of health, reduce health disparities, and improve the health and well-being of the US population in the 21st century. Originally set for release in December 2020, the report will now be released in Spring 2021 and will incorporate the lessons from the COVID-19 pandemic. The good news is that nurse educators are already incorporating the social determinants of health into their curricula, and these efforts must take on a renewed sense of urgency. This special issue contains several innovations depicting how nurse educators are redesigning education to build healthier communities.
Another priority is to augment nursing education research. The Future of Nursing: Leading Change, Advancing Health stated: "At no time in recent history has there been a greater need for research on nursing education[horizontal ellipsis]. The paucity of evidence in nursing education and pedagogy calls for additional research and funding to ascertain the efficiency and effectiveness of approaches to nursing education, advancing evidence-based teaching and interprofessional knowledge" (IOM, 2011, p. 198). A decade later, the research still lags. For this special issue, we accepted only two original articles and two Research Briefs, an indication that rigorous, robust, quality nursing research is still needed to build the science of nursing education that will appropriately prepare nurses. (A third original article, by Wendy Sarver and colleagues, was in the pipeline for a future issue of Nursing Education Perspectives and is included here as it adds to the discussion of baccalaureate education.)
As nurse educators continue to incorporate the social determinants of health into the curricula, focus on health promotion and illness prevention, and expand community engagement to address health inequities, research will be needed to evaluate the effectiveness of these changes. If nursing education remains largely online for the foreseeable future, research will need to gauge whether graduates are adequately prepared for practice upon graduation. In short, nursing education research remains vital.
This past decade has seen a revolution in nursing education. As we look toward the future, priority must be placed on preparing nurses to address the health inequities exposed by the COVID-19 pandemic and in continuing to increase the diversity of the profession. By weaving the social determinants of health and population health concepts into the curricula, increasing the number of clinical placements in the community, and conducting research on their effectiveness in addressing health inequities, nurse educators can help give everyone a fair and just opportunity for health.
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