Nursing Education

To place nursing education into perspective, it is helpful to reflect on the health care environment and the role of the nurse in that environment. The health care landscape in the United States has been changing at an unprecedented rate. Nursing education also has undergone changes to keep pace and to prepare leaders who are highly educated and technically sharp decision-makers and clinicians. What is most noteworthy, however, is not that change has occurred but rather that the rate of change since 1980 has been greater than during similar periods. Factors driving the transformations include new medical and technological advances, new health care delivery systems, and expanded roles for nurses.

Nurses are the largest single group of health care professionals but they do not practice in isolation. Rather they are an integral part of health care teams, institutions, and systems. As health care continues to move outside the hospital, the demand for nurses who can function across systems and direct a continuum of care is rising. The changing health care environment has not only changed the role of the nurse, it has also affected the supply–demand ratio. Hospitalized patients have multiple health problems, are more acutely ill, and are discharged sooner. This has increased the demand for nurses in acute care institutions at the same time that more nurses are needed in home and community settings. Given trends that emphasize health promotion and disease prevention, the need for acute and chronic care is skyrocketing.

The Federal Division of Nursing predicts that by 2010, the growing demand for nurses with bachelor of science in nursing (B.S.N.) and master of science in nursing (M.S.N.) degrees will outstrip the supply and that by 2020, the demand for B.S.N. and M.S.N. graduates will grow nearly twice as fast as the expected increase in the workforce. The predicted need for nurses is sobering, yet it is important to acknowledge that the impending crisis is not solely numbers based. The question is not only how many nurses will be available, but more importantly, will their educational preparation be appropriate to meet future health care needs. Based on the Federal Nursing Division's data, the answer is to increase the number of bachelor's, master's, and doctorate-level nurses.

Bachelor of Science in Nursing Degree

In 1996 the American Association of Colleges of Nursing affirmed nursing's place in American higher education by stating that the minimum educational requirement for professional nursing is the bachelor of science in nursing (B.S.N.) degree. B.S.N. programs are offered by four-year colleges and universities. Most generic B.S.N. programs are four academic years, although some students who have other responsibilities may choose to extend their programs. The term generic refers to a program designed for students studying nursing for the first time. By comparison, some B.S.N. programs have degree completion tracks for registered nurses (RNs) and licensed practical nurses (LPNs) who have completed basic nursing programs in hospitals or community colleges. Some programs also offer tracks for individuals with bachelor's degrees in other majors. B.S.N. programs must be approved by the state board of nursing.

A B.S.N. degree enables graduates to not only launch a successful career in nursing, but also to appreciate a more meaningful life. Therefore, the curriculum includes courses in nursing as well as the arts and sciences. Because the B.S.N. graduate is prepared as a generalist, nursing courses include both theory and clinical experiences and in most specialty areas, such as adult, community, maternal-child, pediatric, psychiatric, and critical care nursing. In some B.S.N. programs, students enroll in nursing courses at the freshman or sophomore level with courses in the major along with arts and sciences integrated throughout the program. In other programs, nursing courses are concentrated at the junior and senior levels. The number of credit hours required for a B.S.N. degree usually ranges from 120 to 130. Upon completing the degree, graduates are eligible to take the National Council Licensing Examination (NCLEX) to become licensed as a registered nurse. By law, nurses must be licensed to practice in the state where they work.

A strong background in science, mathematics, and verbal skills is needed to succeed in nursing. The admission process varies among institutions but typical criteria include: official transcripts with a minimum grade point average (GPA) of 2.0; SAT or ACT Assessment score, and TOEFL (Test of English as a Foreign Language) for foreign students; essay; and letters of recommendation. Some B.S.N. programs admit students directly into the major. Others admit students initially to the institution and require students to apply for admission to the major after completing prerequisite courses including the sciences.

Master of Science in Nursing Degree

Whereas bachelor's degree graduates are generalists, master's degree graduates are specialists. The master of science in nursing (M.S.N.) degree program prepares graduates to be advanced practice nurses (APNs) with in-depth theory and practice in a clinical specialty. Some M.S.N. programs combine both clinical and functional roles (e.g. education, administration, case management). However, the American Association of Colleges of Nursing (1996) concluded that the clinical role should be the primary focus for all master's programs.

Most master's students select one of four tracks or primary roles: clinical nurse specialist (CNS), nurse practitioner (NP), certified registered nurse anesthetist (CRNA), or certified nurse midwife (CNM). The CNS is an APN with expertise in theory and research-based clinical nursing practice. In addition to clinical practice, major roles of the CNS include teaching, research, consulting, and management, all within an area of specialization, such as acute care, adult health, community health, critical care, gerontology, maternal-child, mental health, neonatology, oncology, pediatrics, or women's health. The NP is an APN who is a primary care provider to individuals and families in multiple settings. Originally developed to function as a physician extender, the NP role has evolved to incorporate a more holistic nursing approach to illness prevention and health promotion. NPs assess, diagnose, treat, prescribe, monitor, and refer patients as appropriate. The CRNA works closely with a physician and administers anesthesia in hospitals and outpatient settings. The CNM manages routine obstetrical cases. APNs have a collaborative agreement with a physician.

Although M.S.N. programs offer a wide choice of clinical specialties, most curricula include core courses such as statistics, research, professional role, concepts and theories, health policy, ethics, and economics. Other required courses include advanced study in physiology and pathology, pharmacology, and health assessment. The number of clinical hours is program specific but ranges between 500 and 750 are common. M.S.N. programs may require a thesis or other culminating project, and a comprehensive examination. The number of credit hours required for the M.S.N. degree typically ranges from 36 to 48. Although the master of science in nursing (M.S.N.) is the degree awarded most frequently, some institutions award a master of nursing (M.N.), a master of science (M.S.), or a master of arts (M.A.) degree. The difference is more a function of institutional organization, not the graduate nursing curriculum.

The admission process is institution specific but typical admission criteria include the following: official transcript verifying a B.S.N. degree from an accredited program with a minimum GPA of 3.0; undergraduate courses or demonstrated competency in health assessment, statistics, and informatics; practice in nursing; Graduate Record Exam (GRE), Miller Analogy Test (MAT), or TOEFL for foreign students; letters of recommendation; résumé; and an essay. The above discussion assumes that a M.S.N. applicant has a B.S.N. degree, but it is possible for nurses with no bachelor's degree or a non-nursing bachelor's degree, and for individuals with no background in nursing to be admitted into some graduate nursing degree programs.

After completing a master's degree or postmaster's certificate, CNSs and NPs may take national certifying examinations such as those offered by the American Nurses Credentialing Center (ANCC) providing their programs included the requisite content and hours in a clinical specialty. This credentialing system further demonstrates nursing's everincreasing standards and commitment to excellence.

Doctoral Degrees in Nursing

The quality of nursing education has increased further as evidenced by the fact that doctoral degree programs in nursing, and even postdoctoral programs, have become an integral part of American higher education. Prior to 1960 there were no doctoral programs in nursing. During the 1960s nursing was added as a minor to other Ph.D. degree programs. It was not until 1970 that Ph.D. programs in nursing emerged, but the number of programs has increased significantly. At the beginning of the twenty-first century, there are more than seventy-five doctoral programs in nursing leading to a Doctor of Philosophy (Ph.D.) or a Doctor of Science in Nursing (D.N.S., D.S.N., or D.N.Sc.) degree.

Both the Ph.D. and D.N.S. degree programs focus on research and "prepare students to pursue intellectual inquiry and conduct independent research for the purpose of extending knowledge" (American Association of Colleges of Nursing, 2001b, p. 2). Stated differently, doctoral programs in nursing enhance the scientific foundation for nursing theory and practice. A research-focused doctoral degree prepares graduates for a variety of positions within higher education, health care, government, and the private sector, such as educator, researcher, administrator, and advanced practice. Career options for nurses prepared at the doctoral level are virtually limitless.

Directed toward preparing graduates for a wide range of scholarly pursuits, most doctoral programs require courses in history, philosophy, and theory of nursing; informatics; research; and in related issues from health care ethics to economics. However, curricula do vary depending upon philosophy, faculty expertise, and other resources. Other requirements include a dissertation, oral defense, and comprehensive examination. The number of credit hours required for the doctoral degree is institution specific.

Criteria for admission to a doctoral program are similar to those for a master's program. Typical criteria include an official transcript verifying a M.S.N. degree with a minimum GPA of 3.0; a strong foundation in statistics; GRE score; practice in nursing; curriculum vitae; letters of recommendation; essay; and interview by a faculty committee.

Higher education is a lifelong investment. Undergraduate and graduate students should investigate several programs to determine which one correlates best with their academic and clinical interests and career goals. Students also should carefully assess multiple institution and program characteristics, especially accreditation status. Colleges and universities are accredited by nationally recognized, regional accrediting associations. Undergraduate and graduate nursing programs may apply for specialty accreditation by the Commission on Collegiate Nursing Education (CCNE) or the National League for Nursing Accrediting Commission (NLNAC). Although accreditation is voluntary, it demonstrates an institution's and program's commitment to continuous improvement and quality education.