Nursing Education and Nursing Practice

in the United States

Susan LaRocco PhD RN MBA

Professor

Curry College

Registered Nurses in the United States

3.06 million (2008)

85% are employed in nursing (2.6 million)

854 employed RNs per 100,000 population

62% of employed nurses work in hospitals

Median age of employed nurses is 46 (up from 38

in 1988)

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Educational Preparation

Three major educational programs:

associate degree from community college

diploma from hospital training program

baccalaureate degree from college or university

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Associate Degree (ADN)

2-3 years

based in a community or technical college

most frequent initial education – 45% of all nurses

basic sciences (anatomy, physiology, microbiology,

chemistry)

nursing courses – medical, surgical, pediatrics, maternity,

psychiatric nursing

4

Diploma

usually 3 years

based in a hospital

initial education for 20% of all nurses

basic sciences and nursing courses

5

Baccalaureate Degree

usually 4 years

based in a college or university

initial education for 34% of all nurses

basic sciences and nursing courses

liberal arts courses such as psychology, literature,

philosophy, sociology, history

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Number of Nursing Schools in US

Year 1981 2008

Total number of programs 1401 1773

Associate degree 715 1023

Diploma 303 69

Baccalaureate 383 681

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Changes Over Time

Associate degree programs began in the 1950s

in 1980 64% of all nurses were educated in diploma programs

only 3% of nurses that graduated since 2004 were educated in a diploma program

average age at graduation for all graduates has increased from 24 (1984 or earlier) to 31 (for 2005 or later)

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Typical Baccalaureate Curriculum

Anatomy and physiology

Chemistry

Microbiology

Human growth and

development

Pathophysiology

Pharmacology

Concepts of nursing

Medical surgical nursing

Pediatric nursing

Community health nursing

Maternity nursing

Mental health nursing

Evidence based practice (research)

Professional practice (synthesis)

Liberal arts such as sociology, history, philosophy, English literature, psychology, history

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National Council Licensure Exam (NCLEX-RN)

all graduates take the same exam

computer adapted

75 to 265 items long

multiple choice and alternate item format

questions written at the application level according to Bloom’s Taxonomy of Cognitive Domains

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Bloom’s Taxonomy

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Licensing Done by the States

states determine eligibility to take the test

in 2011 – almost 145,000 US educated nurses took exam for the first time

(57% were graduates of associate degree programs)

pass rate for US educated first time takers was 88%

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Internationally Educated Nurses

Total 165,500 in US

50% are from the Philippines

in 2007 – almost 34,000 internationally educated nurses took the NCLEX-RN

in 2011 – less than 10,000 international candidates for NCLEX

(first time pass rate 34%)

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Masters Degrees Doctoral Degrees

Nursing education

Nursing administration

Nurse practitioner (adult, pediatric, acute care, geriatric)

Clinical nurse specialist

Clinical nurse leader

Certified registered nurse anesthetist

Nurse midwife

PhD – research focused

DNP – clinical practice

focused

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Higher Education in Nursing

The Future of Nursing:

Leading Change, Advancing Health

Report issued in 2010 by the Institute of Medicine (IOM) of the National Academies

Based on a 2 year study

Goal: assess and transform the nursing profession

Four key messages

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The IOM Messages

Nurses should practice to the full extent of their education and

training

Nurses should achieve higher levels of education and training through

an improved education system that promotes seamless academic

progression

Nurses should be full partners, with physicians and other health care

professionals, in redesigning health care in the US

Effective workforce planning and policy making require better data

collection and improved information infrastructure

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Two Major Recommendations for

Nursing Education

Increase the proportion of nurses with a baccalaureate

degree to 80% by 2020

Approximately 50% now have BS or higher degrees

Double the number of nurses with a doctorate by 2020

In 2008 there were approximately 28,370 nurses with

doctoral degrees (1.3% of all nurses)

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6 quality and safety competencies for nurses developed from a 2003 Institute of Medicine Report

1. Patient Centered Care

Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs.

2. Teamwork and Collaboration

Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

Quality and Safety Education for Nurses (QSEN)

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QSEN continued

3. Evidenced-Based Practice

Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.

4. Quality Improvement

Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.

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QSEN continued

5. Safety

Minimizes risk of harm to patients and providers through

both system effectiveness and individual performance.

6. Informatics

Use information and technology to communicate, manage

knowledge, mitigate error, and support decision making.

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Trends in Nursing Education

Increased focus on patient education and management of

chronic conditions

Inclusion of genetics and genomics in the curriculum

Simulation to enhance technical and critical thinking skills

Focus on quality and safety

Increased emphasis on interprofessional

education/teamwork

Distance learning – online courses

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Advanced Practice Nurses

Nurse Practitioner (NP)

Nurse Midwife (CNM)

Nurse Anesthetist (CRNA)

Clinical Nurse Specialist (CNS)

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Nurse Practitioners (NP)

began in 1965

scope of practice is regulated by individual states

focus on: family care, pediatrics, geriatrics, adult health,

women’s health, psychiatry, neonatology, or acute hospital

care of adults and children

provide primary care, including prescribing medications

158,300 in US (89% employed in nursing)

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Nurse Midwives (CNM)

scope of practice is regulated by individual states

18,500 in US (84% employed in nursing, only 42%

of employed NMs are working as NMs)

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Nurse Anesthetists (CRNA)

35,000 in US (92% employed in nursing)

more than 40% are men

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Clinical Nurse Specialists (CNS)

Approximately 59,000; number is declining

Educated to provide direct care and leadership in

care for a specific group of patients (such as

oncology, cardiac)

Many are in other roles, such as administration,

faculty, or quality assurance

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Nursing – a Universal Profession

Education and practice may be

different in different countries, but one

thing is universal:

Nursing is a profession based

on a tradition of caring

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