Nursing and nursing education research have been plagued by decades of calls for better quality research. Demands include more multisite studies, larger samples, more funding, and university support (Broome & Fairman, 2018). In the case of research in nursing education, we need more doctorally prepared researchers (Munoz, 2022; Oermann & Kardong-Edgren, 2018), and we need to generate more evidence to support how we educate nurses (Oermann, 2018). National funders support clinically focused research but rarely research in nursing education (Oermann & Kardong-Edgren, 2018), despite the potential strong impact of innovative education on patient care outcomes.
Unfortunately, all these factors - the small pool of nurse scientists conducting research in nursing education, a scarcity of research funding, the large proportion of nursing programs housed in non-research-intensive institutions, and the limited value placed on educational research - have contributed to the current underdeveloped state of the science to support academic nursing education, a problem lamented by leaders in the field for years (Oermann & Kardong-Edgren, 2018). The nursing education community needs to harness the power of existing data held by institutions nationally, educational testing vendors who support the nursing education community, and regulators and accreditors of nursing education programs to advance the science of nursing education.
However, nursing education is missing some basic foundational components to improve the quality of its research. We lack a consistent national strategy for reporting and maintaining accurate contact and program information from schools of nursing. In a recent study, a contact list of deans and directors obtained from two national nursing organizations resulted in limited participant response because many contacts and email addresses were inaccurate. The follow-up list elicited only a slightly greater response than the first. Again, there was limited participant response because of inaccurate contact information. Based on a less-than-hoped-for response, the research team turned to the tedious task of investigating websites of individual nursing programs to gain accurate information. This strategy did not dependably provide the needed information and was very labor intensive. One researcher learned that a listed program director had been deceased for seven years! Compounded by the pandemic, the resulting response rate was inevitable despite the various efforts of the research team.
This system presents a major obstacle to exploring and researching best practices and comparing student outcomes. As we stand on the brink of the Next Generation NCLEX(C) launch, we must commit to improve systems that allow for large accurate data sets. Large data sets will lead to more accurate, rigorous findings and inform best practices reflecting quality education, readiness for practice, and potentially impacting patient outcomes.
Looking outside nursing education for other models that would facilitate collection of data for comparison, we found that the American Association of Medical Colleges (AAMC) uses a student records system that holds national student data collected by all medical schools (AAMC, 2022). It is a program accreditation requirement and provides medical schools with an avenue for benchmarking data reenrollment, progression, and retention information. The system is Internet-based and secure and can be updated regularly. Reports can be generated as needed, and it is not dependent on program directors. A system such as the AAMC's allows for accurate information with a process to maintain the integrity of the data and could easily require review and maintenance of up-to-date program contact information in addition to student data.
This can be accomplished in one of two ways for nursing education: Accrediting bodies could require that accurate information be shared and stored in a national repository, or the National Council of State Boards of Nursing (NCSBN) could be the holder of such information. Regardless of who collects and stores the information, accountability for updated and valid information is essential. A side benefit of student tracking is that data of students who transfer between programs would be captured; in addition, the two intermediate levels of communication currently required would become unnecessary.
In the past several years, the NCSBN developed a template for data collection that is optional for boards of nursing (BONs) to use for annual reports; nearly half of BONs have implemented it (N. Spector, personal communication, March 1, 2022). The template includes information about faculty, administration, and student classroom and clinical experiences similar to the information that many BONs already collect. The NCSBN analyzes the information to report aggregate data. Participation in this project by BONs would allow for analysis and comparison of data and give BONs the opportunity to compare their data and outcomes in aggregate or individually. An accountability feature would most certainly foster use of the form. Currently, only aggregate data are released to the public. Policy changes would be needed for BONs to release their specific school information. Alternatively, exploration of other pathways or models for collecting program and student data may be needed.
Another consideration is for accrediting bodies to be holders of the data repositories and share the information for research. Several years ago, the requirement of national accreditation for all nursing programs was discussed as an initiative, one that aimed to improve the quality of programs and support BONs. In fact, the 2021 NCSBN Model Rules call for all nursing programs to be accredited by a national nursing accrediting agency (NCSBN, 2021). Although most BSN programs are accredited, fewer than 50 percent of associate degree programs are accredited (NCSBN, 2022). Complexities such as a requirement of legislation in some states have perhaps hampered the progress of moving this forward.
Quality data, including accurate databases, are imperative to close the academic-practice gap and advance the science of nursing education. For example, the literature suggests waning competence of nursing graduates (Kavanaugh & Sharpnack, 2021), likely related to the growing complexity of patient care. How we address this issue must be evidence based. The primary purpose of the NCLEX is to assess graduates' ability to make safe entry-to-practice-level decisions. Hence, if a national student database is not possible currently, it is logical to entrust primary data collection to the NCSBN from which the NCLEX originates.
Without accurate information for meaningful research, the outcome studies necessary to reform and improve nursing education efforts will result in empty reviews without scientific evidence (Leighton et al., 2021; Oermann, 2018). Response rates for national studies could be vastly improved with an accurate leadership database fostering collaboration. In turn, nursing leaders in education could promote multisite, rigorous studies to build a repository of outcomes.
An upstream systems approach to this problem is vital to promote the advancement of nursing education and ultimately patient safety. Practice, education, and regulatory bodies must work together strategically to create a path for data to be collected and shared. Together, a national solution can be achieved, and true advancement of the profession can happen.
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