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The theoretical and practical training

provided to nurses with the purpose to

prepare them for their duties as nursingcare professionals.

Experienced nurses and other medical

professionals are the ones who impart this

education and experience to nursing

students.

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The traditional focus of nursing education was

to teach the knowledge and skills that would

enable a nurse to practice in the hospital setting. However, as nursing responds to new scientific

knowledge and technological, cultural,

political, and socioeconomic changes in society,nursing education curricula are revised to meet

the needs of nurses working in changing

environment.

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Educational programs available for nurses

include practical or vocational, registered

nursing, graduate nursing, continuing education,and in-service.

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unlike the historically untrained or poorlytrained practical nurse, who had unlimited andunsupervised freedom to practice, the presentpractical nurse is often a hybrid. Todayspractical/vocational nursing student is beingtaught basic skills during the education programs.

After licensing, the LPN/LVN is permitted toperform complex nursing, as delegated by theregistered nurse and allowed by the nursingpractice act.

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Practical nursing, the most basic level of nursingpractice, began with industrial revolution of the late1800s.

To meet labor workforce during this time, manypeople moved from rural areas to urban areas.Women needing employment often provideddomestic services, including those associated withcaring for the sick.

To support the skills of this new healthcare provider,in 1892 the Young Womens Christian Associationlocated in Brooklyn, NY, offered the first formal

practical nursing course.

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they work under the supervision of registered

nurses.

The practical nurse is responsible for stablepatients and patients with common health

problems.

They also are responsible for collecting andreporting abnormal data, providing bedside care

and health teaching

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The practical nursing education programs are often

offered in community colleges. Most programs are

12 to 18 months in length, and graduates of these

programs complete a state practical exam (NCLEX-

PN) prior to being employed.

For some individuals, this short course of study is a

stepping stone to pursuing advance nursingeducation.

It also allows them to work as a practical nurse while

obtaining further education.

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Diploma nursing (originally known as hospital

nursing) began during the latter part of the 19th

century with a growth in hospitals.

Knowledge of asepsis partially spurred hospitals

growth and precipitated a demand for more nurses.

Training of hospital nurses at this time was based on

an apprenticeship model where nursing studentsprovided service (direct patient care) in exchange for

a few educational lectures, room and board and a

monthly allowance.

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The apprenticeship model flourished because it

offered women an opportunity for a vocation, it

improved care of the sick and decreased the costof nursing service in hospitals while student

nurses provided patient care services for a

minimal allowance.

Despite the benefits of the apprenticeship model,

it underwent criticism from

nursing education leaders.

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Goldmark (1923) in particular emphasized that the

training needs of students and the service needs of

hospitals were incongruent.

She wrote that when theneeds of the sick must pr

edominate; the needs of education must yield(Go

ldmark, p. 195).

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To balance the academic needs of nursing student

s with their need for clinical

experiences, Dr. Richard Olding Beard advocatedfor university education for nursing students.

He contended that university education would eli

minate the

incongruence between the hospitalsservice need

s and the educational needs of students.

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In1909 Beard began a nursing program at the University of Minnesota. This program is often heraldedas the first baccalaureate nursing program.

However, it closely resembled diploma educationbecauseeven though nursing students met university

standards for admission and coursework, they wererequiredto work 56 hours a week on the hospital ward (Bullough & Bullough, 1984).

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Following Dr. Beards efforts, the National League for

Nursing Education (NLNE) made numerous attempts to

redesign diploma nursing education programs. In 1917, 1919,19

27, and 1937 the NLNE published Standard Curriculum for

Schools of Nursing.

This report encouraged diploma programs to decrease students

time working on the ward and to increase their education by of

fering 3years of course work in the sciences

and clinical experiences caring for diverse

populations (e.g., medical surgical, pediatric, and obstetric patie

nts).

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Hospitals that continue to support diploma programs

maintain this educational option because these progra

ms supply the nurses needed in their hospitals,they provide a geographically accessible program for

some students, they offer a

nursing degree in a short length of time, and they

often offer tuition remission.

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To meet the educational needs of diploma students,

many of these programs collaborate with colleges and

universities to offer students options to obtain associat

e and baccalaureate degrees.

Additionally, it is important to note that despitethe reasons for the decline of diploma programs menti

oned earlier, some studies

suggest that diploma nurses are as competent in resear

ch, leadership, and critical thinking as graduates from

other undergraduate nursing programs (Clinton,Murre

lls, & Robinson, 2005).

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Thus, for now it seems that diploma programs,

though having experienced a turbulent history, are p

ersisting and will continue tobe a valuable asset to the nursing profession.

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Community college/associate degree nursingprograms, which arose in the early 1950s, were thefirst and only educational programs for nursing that

were systematically developed from plannedresearch and controlled experimentation.

Several trends and events influenced thedevelopment of these programs.The Cadet Nurse Corps

The community college movement

Earlier nursing studies

Dr. Mildred Montagsproposal for an associate degree.

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The Cadet Nurse Corps of the US waslegislated and financed during the WW II

to provide additional nurses to meetboth military and civilian nursing needs.The corps proved that qualified nursescould be educated in less time than the

traditional 3 years.

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After the WW II, the number ofcommunity colleges in the US grew

rapidly. The low tuition and open-doorpolicy of these colleges made highereducation more accessible to all byoffering the first 2 years of a 4year

college program.

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EARLIER NURSING STUDIES Studies of nursing education, such as the

Goldmark report in 1923, the committee on the

grading of schools of nursing in 1934, and theBrown report in 1948, also had a significant

influence on the development of 2 year

programs. The recommendations in all of these

reports supported independent schools of nursingin institution of higher learning separate from

hospitals.

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In US, associate degree programs were startedafter Mildred Montag published her doctoraldissertation in 1951, the Education of NursingTechnicians, which proposed a 2 yeareducation program for RNs in the communitycolleges.

Dr. Montag made the suggestion as a solution tothe acute shortage of nurses that came aboutbecause of WW II. She conceptualized anursing technician or bedside nurse able toperform nursing function broader than those ofthe practical nurse and smaller in scope thanthose of the professional nurse.

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The first associate degree in nursing (DN)program started at Columbia UniversityTeachers College in 1952 under the

direction of Mildred Montag. In 1978, the ANA proposed a resolution that

associate degree programs were no lonerto be considered terminal but part of acareer upward-mobility plan.

Today many students enter an associatedegree program with the intention ofcontinuing their education in nursing to thebaccalaureate or higher level.

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The first school of nursing in a universitysetting was established at the University ofMinnesota in 1909. this programs

curriculum, however, differ little from a 3year hospital program.

It was not until 1919 that the University ofMinnesota established its undergraduatebaccalaureate degree in nursing. Most of

the early baccalaureate programs were 5years length. They consisted of the basic 3year diploma program in addition to 2 yearsof liberal arts.

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Today baccalaureate nursing programs arelocated in senior colleges and universities andare generally 4 years in length. The curriculaoffer courses in the liberal arts, sciences,humanities and nursing.

The usual degree awarded is a Bachelor ofScience in Nursing (BSN).

Because of changes in the practice

environment, the nurse who holds abaccalaureate degree is beginning toexperience greater autonomy, responsibility,participation in institutional decision makingand career advancement.

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Most graduate programs are conducted bydepartments within the graduate school of auniversity, and the applicant must first meet

requirements established by the graduate school. The applicant must be a registered nurse license.

The applicant generally must hold abaccalaureate degree in nursing from an

approved college or university. The applicant must have letters of

recommendation form supervisors, nursing facultyor nursing colleagues indication the applicants

ability to do graduate study.

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The growth of university nursing programsencouraged the development of graduatestudy in nursing.

In 1953, the newly established National Leaguefor Nursing encouraged educators to developprograms for masters degrees in nursing. Themajor emphasis of the programs was to beresearch and specialization for teaching andadministration.

The first clinical masters degree (inpsychiatric nursing) was offered at RutgersUniversity in New Jersey in 1954.

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Today masters programs generally takefrom 1.5 to 2 years to complete. Degreesgranted are the master of arts (MA),

master in nursing (MN), and master ofscience in nursing (MSN).

Masters degree programs provide

specialized knowledge and skills thatenable nurses to assume advance rolesin practice, education, administrationand research.

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Doctoral programs in nursing, which awardthe degrees of doctor of philosophy (PhD),doctor of nursing science (DNS) or nursing

doctorate (ND), began in the 1960s in theUS.

These programs further prepare the nursefor advance clinical practice education,administration and research.

Before 1960, nurses acquired doctoraldegrees in such related fields aspsychology, sociology, physiology andeducation.

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In 2004, the American association of collegesof nursing approved a move to prepareadvance practice nurses (nurse practitioners,nurse anesthetist, nurse midwives and clinicalnurse specialist) at the doctoral level-awardinga doctor of nursing practice (DNP).

Content and approach vary among doctoralprograms. Some focus on the usual clinicalareas, such as medical-surgical nursing andothers emphasize such nontraditional areas astranscultural nursing.

Some programs emphasize theorydevelopment but all emphasize research.

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Thank you!

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As noted previously, in 1943 Isabel Stewart remarked

that efforts to redesign

diploma nursing education included experimenting with

new nursing education models. One model was associat

e degree nursing education.

It began in response to the post-

World War II nursing shortage and it gained momentumfollowing the Ginzberg Report (1949), which suggested

that in comparisonto a 4year nursing program it would b

e more efficient and economical forcolleges to offer a 2-

year course of study in nursing.

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Ginzberg believed that not all nurses needed

baccalaureate education to provide patient care.

Nurses could be prepared to provide safe and

competent patient care in less time than

baccalaureate education, which would provide a

feasible solution to the nursing shortage.

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It was at this time that Mildred Montag (1951) descr

ibed how 2year associate degree nursing programs,

housed in community colleges, could prepare reg-istered nurses (RNs) as semiprofessionals.

This group of RNs would meet the

demand for nurses by acquiring enough nursing skill

and judgment to provide

nursing care, but not the expert skill and judgment

of baccalaureate-prepared nurses.

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Further study by Montag (1959) suggested that

nurses prepared with anassociate degree were performing similarly to staff nurses prepared with baccalaureate degrees.

Moreover, those within the nursing profession

believed that,with the exception of preparation

in leadership and public health, nurses with anassociate degree provided outstanding bedside nursing care (Smith, 1960).

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Indeed there were many advantages to associate

degree nursing education and these advantages

remain present in todaysassociate degree nursingprograms.

Nevertheless, at the height of thisprograms

success,in 1965, theAmerican Nurses Association (ANA)published a position paper stating that those

licensedto practice nursing should be prepared in institut

ions of higher education (universities).

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It also stated that the minimum

preparation for the professional nurse should be a

baccalaureate degree. In other words, the position paper equated

professional nursing with baccalaureate education.

This potentially meant that associate degree

prepared nurses could not practice as registered

nurses unlessthey had licensure requirements that

were different from baccalaureate-pre-pared nurses.

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Current research suggests that baccalaureate

prepared nurses are associated with improved

patient outcomes,that hospitals prefer to hire baccalaureate-prepared nurses, and that magnet

hospitals have a higher percentage of baccalaureate

prepared nurses (Graf, 2006).

This is not to say that associate degree nursing progr

ams (like many diplomaprograms) will disappear.

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However, these studies do indicate mobility

programs(discussed later in this chapter),

through which associate degreeprepared nursesobtain baccalaureate and higher degrees in

nursing, will take on even greater

significance than they have in the past.