Overhauling Nursing Education

Laura A. Stokowski, RN, MS

Disclosures

January 28, 2011

In This Article

Nursing education is a sizzling hot topic right now. Maybe this is fitting, for 2010 was the centenary of Florence Nightingale's death, and she was the founder of the formal nursing school. The whole profession of nursing is under the microscope, as hundreds of experts and stakeholders study where nursing fits in and where it's going in the era of healthcare reform. However, the foundation of any profession, including nursing, is how its newest members are educated. This article will explore several questions about nursing education, and discuss the recommendations from the recent Future of Nursing reports[1,2] to address these issues.

  • What's missing in nursing education?

  • Are there better ways of teaching/learning?

  • What does future hold for nursing degrees (including the associate's degree)?

  • Does nursing education prepare nurses for practice?

The Rise of "Modern Nursing" Education

If you had just been accepted to nursing school near the end of the 19th century, your nursing courses would be designed to teach you these fundamentals of nursing care:

  • The dressing of blisters, sores, burns and wounds; the application of fomentations, poultices, cups, and leeches;

  • The administration of enemas;

  • The management of trusses and appliances for uterine complaints;

  • The best method of friction to the body and extremities;

  • The management of helpless patients: making beds, moving, changing, giving baths in bed, preventing and dressing bedsores, and changing positions;

  • Bandaging -- and making bandages, rollers, and splints;

  • Preparing, cooking, and serving delicacies for the sick;

  • Practical methods of supplying fresh air, warming and ventilating sick-rooms;

  • Keeping all utensils perfectly clean and disinfected; and

  • Making accurate observations and reports to the physician of the state of secretions, expectoration, skin, pulse, appetite, temperature, delirium or stupor, breathing, sleep, condition of wounds, eruptions, formation of matter, effect of diet or of stimulants or medicines.

This was the proposed curriculum for a school of nursing opening in Chicago in 1882.[3] This curriculum would take a little more than 2 years to learn, during which you would work 7 days a week, 12 hours a day, with 1 afternoon off per week. You would work without pay, essentially as free staff for the hospital; your "salary" was your education. After work in the evenings, you would attend lectures given by physicians or supervising nurses on subjects such as obstetrics, surgical emergencies, anatomy, physiology, electricity, materia medica (pharmacology), bathing, and massage. Exams on these lectures would be given periodically. However, the overall program emphasized practice over theory -- with practice commanding a 90% share of your time.

This, or something very like this, was how nurses were "trained" at the beginning of the era known as "modern nursing." Nursing education followed an apprenticeship model, wherein students took care of patients under the supervision of more senior nurses.

Nursing education received a much-needed boost in 1917 when the National League for Nursing Education published their first standard curriculum for schools of nursing.[4] A more recognizable nursing curriculum, it was organized around the familiar categories of medical nursing, surgical nursing, obstetrical nursing, nursing care of children, and so forth. Student nurses would still have to learn cookery, hospital housekeeping, and massage, but they would also receive classes in ethics, psychology, professional issues, and history of nursing, and could take electives in public health or administration. The underlying theme of the curriculum was that nursing was a profession.

With the appearance of college-affiliated nursing programs and the baccalaureate degree, nursing students had the benefit of an entire university or college with which to supplement their education. For the most part, however, the core nursing curriculum continued to revolve around the traditional medical specialties of medicine, surgery, obstetrics, pediatrics, and mental health.

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