Question

Debate the wisdom and feasibility of setting the master's degree as the minimum marker for the professional segment of the nursing continuum. Given the 20/20 hindsight gained from the debacle of the 1965 Position Paper, how would you advise national nursing organizations to go about changing this definition, if it were to be changed?

Answer 1

Because the curriculum focused on illness, students learned to meet the needs of ill patients, to work with the hospital’s nursing and ancillary staff, and to accommodate to the hospitals’ medical and nursing routines. Hospital schools produced a steady stream of new graduates whose transition from senior students to new graduates was seamless. New graduates required little orientation and many graduates practiced in the settings where they completed their training.

There were many schools who reported that they are considering offering the DNP degree. They described the response of schools of nursing to the DNP proclamation as spreading like a wild fire, who served on the AACN task force, described the DNP degree as a relevant idea.

The AACN also noted that many schools offer hybrid programs leading to either the DNP or the traditional PhD courses. Most schools have not begun to phase out their specialty oriented, master’s degree, advanced practice programs although some schools are converting these programs into DNP programs. The majority of nurses with advanced degrees are prepared at the master’s level.

The group that developed the first position paper on nursing education implemented this plan in the hands of the ANA leadership which was not in a position to directly influence nursing faculty. Representing and speaking for nursing, hospitals so shaped public opinion that nursing practice became almost synonymous with hospital practice.

Their most direct influence occurred on hospital units where practice standards and protocols set the template for the study and practice of nursing. Major nursing organizations and deans of nursing, who document the difficulty in recruiting and retaining a diminishing group of faculty, started giving hospitals and hospital nurses more significant roles in the education of students of nursing. Faculty at all levels of nursing recognizes that access to particular patient populations is essential for implementing the curriculum. Nurses assumed responsibility for additional patient care services because of reductions in ancillary staff. When hospitals demand for nurses was disproportionate, hospitals also experienced their first real competition for professional nurses. Ambulatory clinics, day surgery centers, home care, and skilled nursing facilities, expanded because sick persons were not admitted or were discharged soon after admission.

Students in associate degree programs completed two, three or four year programs and joined the work force more quickly. Data obtained from the most recent National Sample Survey of Registered Nurses show pre and post licensure educational patterns of registered nurses. Nursing was judged to be too demanding, too undervalued, and too unrewarding. The female dominance of the profession challenged young men and feminists. When the deans of nursing adopted their position paper on graduate education, the enrollment and the staffing patterns had changed again.

Professional and financial autonomy and career advancement are directly correlated with higher education. The level of education that has given nurses and clinicians more autonomy, professional control, and income has been a master’s degree in primary care or a clinical specialty and certification in a field of advanced practice.

The IOM committee was unable to document the relationships of organizational restructuring and staffing patterns on the quality of care in hospitals. The National Commission on Nursing had derived themes from public hearings about professional practices, held in regions of the country, status and image of nursing, interface between education and practice, effective management of nursing resources, relationships among nursing, medical staff, and hospital administration, and the maturing of nursing as a self determining profession

Diminishment of the nurse force is a concern of the entire healthcare delivery system. Unlike previous shortages, major nursing and health organizations have also identified the shortage of teachers as a major component in resolving the nursing shortage. However, you view the 1965 Position Paper as a mandate for a more educated nurse force to enhance patient care, the goal has not been achieved. In the past decade, deans of nursing have been preoccupied with the under educated nurse and place on the health team. Registered nurses lack the educational credentials of persons in the business, investor, and insurance communities that now play significant roles in healthcare decisions.