Reflection & Dialogue #6 - Master's Education in Nursing, June 2010

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Masters Education in Nursing 
June 2010 

Introduction

The window of opportunity for nursing to be a significant player in a reformed health care system will close without the indispensable workforce of masters- and doctoral- prepared nurses in education and practice. There are significant questions about how masters education should prepare nurses for specialty roles so that they can successfully deliver advanced practice nursing care in that system. Concerns about proposed changes to masters and doctoral education in nursing — in particular the call to generalist practice at the masters level — have been growing. 

Recognizing the urgent need to provide an inclusive forum for a full exchange of ideas about this critical issue, in April 2010 the National League for Nursing gathered participants from across the entire nursing community representing public and private schools of nursing, nursing organizations, advanced practice nursing roles, and practice environments to consider a collaborative way forward. The voice for nursing education, from LPN through doctoral preparation, the NLN utilized its core values of caring, integrity, diversity, and excellence to promote an inclusive atmosphere and provide an opportunity to understand divergent thinking and develop transformative strategies. 

Voices from the Conference on Masters Education

Every program does not have to be the same. There are multiple ways to prepare nurses to meet the escalating demands for patient care. The call for one voice for the nursing profession can only be achieved through collaboration among practice, education, and the consumer centered on meeting patient care needs now and in the future. What is good for patient care is a diverse workforce of advanced practice nurses prepared in numbers and specialty roles sufficient to meet health care needs.
  • Now is not the time to exercise a restrictive control of education development. Our educational approaches to developing a cadre of advanced practice nurses shouldnt be an "either/or" situation, e.g., a doctorate as the only avenue to advanced practice. Nursing must stay true to its core purpose — meeting the health care needs of the people by providing safe, quality care. Existing masters programs have capably demonstrated the ability meet this high standard.
  • Now is not the time to rapidly lengthen the only route to advanced practice nursing education which may not be in the best interest of our patients. Masters-prepared nurses are poised to assume an important role in a reformed health care system and provide site-specific primary care. APRNs have been providing care in underserved areas and communities, both urban and rural, for decades with quality outcomes.
  • Robust data are needed to make evidence-based decisions about workforce projections to meet future practice imperatives. Though faculty teach students to avoid making assumptions or implement practice strategies until they have data, the nursing education profession stands on the precipice of a new singular educational road to advanced practice unaware of its possible impact on an overburdened and at times inadequate health care system.
  • An appreciation of the discipline of nursing is imperative as new specialized roles for advanced practice nursing emerge. Masters preparation for nurse educators and for nurse administrators, for example, does not preclude the need for graduates to merge the advanced practice role of nurse educator or nurse administrator with point of care knowledge and expertise. Advanced practice nurses must have in-depth clinical knowledge of nursing practice; similarly, both part- and full-time faculty must have an in-depth knowledge of nursing education and nursing practice.

Considerations

  • Time and focus are critical. While there is ample evidence that the nursing professions knowledge and skills havent been used optimally in the existing health care system, the current addition of masters education to the polarizing debate about qualifications is draining. It refocuses the professions talent and energy away from the opportunities for nursing to be acknowledged as a major leader in meeting the health care needs of the public. Nursing must not be distracted from its core mission of providing safe, quality patient care and of stepping forward when the nation, through its legislative structure, has identified nurses as primary providers of care services. 

  • Challenged to reconfigure an inadequate system of care, over the last decade the nursing profession has reconsidered advanced practice educational preparation to meet the demand for increased knowledge and skills and has called for and developed:

    • New models of care to manage complex chronic co-morbidities, moving to a non-traditional approach to case management using multiple intersecting systems of care (OSullivan, Carter, Marion, Pohl & Werner, 2005) and parity with other allied health professions who have expanded their masters degree programs and created practice doctorates, recognizing that parity for nursing is not simply a matter of status but a necessary credential for credibility in leadership and policy positions (Lenz, 2005)
    • Nurse-managed health centers to serve as safety net providers for underserved populations, extending the range of primary care services offered by nurse practitioners in autonomous practice settings (Hansen-Turton & Kinsey, 2001)
    • Reformed masters curricula, recognizing that nursing may be under-credentialing its advanced practice graduates to the point where they far surpass requirements for masters programs in other clinical disciplines (Lenz, 2005)

  • There is growing apprehension among deans and directors that advanced practice graduates who work as full- and part-time faculty but are not educated in pedagogy, evaluation, and educational theory cannot engage meaningfully in nursing education research or make evidence-based contributions to nursing education reform. Schools of nursing are making decisions about their masters and doctoral programs without data and without national discussion. The ability to pause and reflect about possible consequences to the nations health care system and its global implications is critical for nursing. 

  • Most recent HRSA data (2010) found that the RN workforce is gradually becoming more diverse. In 2008, 16.8 percent of nurses were Asian, black/African American, American Indian/Alaska Native, and/or Hispanic, an increase from 12.2 percent in 2004. These same data reveal that the number of RNs with masters and doctoral degrees increased by 46.9 percent from 2004. But despite the growing numbers of advanced practice nurses and slowly changing picture of diversity in nursing, conference participants noted that a room filled with advanced practice nurses still looks the same as it did 20 or 30 years ago and does not reflect the diversity of the US population. The need to continue to remove barriers to advance education along a continuum for all nurses remains.

Recommendations for Advanced Practice Nursing

  • Affirm that both MSN and DNP programs have value and credibility in todays health care system; support an inclusive model that does not devalue one program over another.


  • Promote MSN advanced specialty practice — e.g., nursing administration, nursing education, community health, nursing informatics — to meet regional health care needs and to provide adequate diverse numbers of advanced practice nurses for emerging practice models of care delivery, recognizing the urgency for action now in the context of the current health care reform agenda.


  • Ensure that faculty have the specialized knowledge fundamental to the advanced specialty role of nurse educator in order to teach and achieve curriculum reform.


  • Advance academic progression of nurses within the profession and develop curriculum models that are efficient and cost-effective in facilitating academic progression. Nurse educators, public policy and workforce experts, health care organizations, and all other interested parties must determine how graduate education can meet current and future demands for quality and safety and respond with new programs and pathways.


  • Use data to drive decisions about format and types of advanced practice educational programs. Devise national, multi-site studies to provide a workforce analysis that will include other disciplines as well as masters, DNP, and PhD graduates. Utilizing the power of data-driven workforce decisions is a vital part of a sound, evidenced-based approach to meeting consumer and community needs.

Recommendations for the Nursing Profession

  • Agree that learning in nursing involves an ongoing relationship between practice and education, one that does not begin with a new project or initiative but is instead intrinsic to how the profession deliberates, strategizes, implements, and evaluates its vision, encompassed by the larger health care system.

  • Redesign our nursing education and clinical institutions to be more inclusive of one another. Neither education nor clinical issues can be addressed without input from both areas if we are to fully support the work of discovery that informs both practice and education. 

  • Affirm the need for greater diversity in nursing and nursing education. Gutmann (2009) states, "without desire, there is no transformation." We must have the will to envision, create, plan, and implement that culture of inclusiveness.

Recommendations for the National League for Nursing

  • Lead national efforts to reform clinical education in prelicensure programs to advance use of clinical reasoning, systems thinking, and use of technology as a foundation for advanced practice roles.

  • Provide faculty development to transform our undergraduate and graduate programs to integrate evidence-based concepts from gerontology, genetics, informatics, quality and safety, and more; and ensure that every nurse educator, both designated undergraduate faculty as well as graduate faculty and administrators, accept the challenge (Benner, Sutphen, Leonard and Day, 2010; Broome, 2010).

  • Promote the development of accessible and affordable academic progression models that will best serve the nursing profession to prepare adequate numbers of advanced practice nurses to meet the health care needs of individuals, populations, and communities, both national and global.
Colleagues, these are our thoughts at this point, please join us in this dialogue and of course, the reflection…

  1. What future models of masters and doctoral education will embrace diverse pathways to advanced practice nursing and ensure that both MSN and DNP programs are acknowledged as necessary to meet the varied needs of todays complex health care system?


  2. What strategies to increase diversity are required for masters and doctoral education to meet the needs of a reformed multi-racial, multi-ethnic health care system?


  3. How do we develop innovative new programs, curricula, and initiatives while assuring our students that they are receiving the education that will prepare them to provide relevant and caring services that meet our countrys health care needs?


  4. How do we hold the profession of nursing accountable? How do we hold one another accountable? How do we demonstrate inclusiveness as we lead and move forward?


References

Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco: Jossey-Bass. 

Broome, M. E. (2010). Maelstrom of change: Back to the future. Nursing Outlook, 58(2): 63-65.

Gutmann, D. (2009) From transformation to transformation: Methods and practices. London: Karnac.

Hansen-Turton, T., & Kinsey, K. (2001). The quest for self-sustainability: Nurse-managed health centers meeting the policy challenge. Policy, Politics, & Nursing Practice, 2(4), 304-309.

Lenz, E. R. (2005). The practice doctorate in nursing: An idea whose time has come.Online Journal of Issues in Nursing, 10(3). 

OSullivan, A., Carter, M., Marion, L., Pohl, J., & Werner, K. (2005). Moving forward together: The practice doctorate in nursing. Online Journal of Issues in Nursing, 10(3). 

U.S. Department of Health and Human Services, Health Resources and Service Administration (2010, March). The registered nurse population: initial findings from the 2008 national sample survey of registered nurses. Retrieved June 28, 2010 fromhttp://bhpr.hrsa.gov/healthworkforce/rnsurvey/initialfindings2008.pdf      

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