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Overview and Summary: Nursing Education: Philosophical Perspectives on Current Challenges

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F. Patrick Robinson, PhD, RN, ACRN, CNE, ANEF, FAAN

Citation: Robinson, F.P., (January 31, 2021) "Overview and Summary: Nursing Education: Philosophical Perspectives on Current Challenges" OJIN: The Online Journal of Issues in Nursing Vol. 26, No. 1, Overview and Summary.

DOI: 10.3912/OJIN.Vol26No01ManOS

Higher education finds itself at an unprecedented point in its long and illustrious history. Commentators have identified its current status as a crisis (Blumenstyk, 2020), meltdown (Shaulis, n.d.), and freefall (Russell, 2020). While such hyperbole is alarming, current trends suggest that the future of higher education cannot and will not look like its past (Alexander, 2020). Current trends are unsustainable. Take, for example, just one factor, cost. Using constant dollar amounts, tuition (excluding room and board) has risen an average of 358% for all institution types combined over the past 30 years and 42% in just the past decade (National Center for Education Statistics, 2019). The price of college is increasing at a rate that is over eight times faster than that of wages (Maldonado, 2018). Given that the average student loan debt now exceeds $30,000 for recent college graduates (Kerr, 2020), a considerable portion of Millennials and Gen Zs’ incomes will be devoted to paying down debt for decades (Whistle, 2019). A generation in deep debt does not bode well for a healthy economy.

The cost of higher education should be covering its production; however, two other trends are driving institutions to financial failure. Total fall undergraduate enrollment for all institution types combined peaked in 2010 and has continued to decline every year with a dramatic 4.4% decrease from fall 2019 to 2020 (National Center for Education Statistics, 2019; National Student Clearing House, 2020). Added to this is the fact that in efforts to honor their commitments to expanding college access and attract students from the shrinking applicant pool, institutions are offering on average a discount of 52.6% for first-time undergraduates (National Association of College and University Business Officers, 2020). The result is that an estimated one-third of private 4-year colleges are considered at high financial risk (Thys, 2020), and the prominent bond rating agencies have issued a negative outlook for the higher education sector (Seltzer, 2020).

Nursing Education, as a discipline within the sector, has additional headwinds to confront. The American Association of Colleges of Nursing (AACN) reports that 80,407 qualified applicants were denied acceptance into baccalaureate and graduate nursing programs in 2019 primarily due to insufficient faculty and clinical sites as well as budget constraints (AACN, 2020). Furthermore, despite decades of calls for nursing education reform, consistent data suggest that the vast majority of newly graduated RNs do not demonstrate entry-level competencies nor readiness to practice (Kavanagh & Szweda, 2017). The most recent practice analyses by the National Council of State Boards of Nursing (NCSBN) highlight the increasingly complex clinical judgments that newly licensed RNs must make (NCSBN, 2015; 2018), suggesting that without educational reform, the academic-practice gap may widen.

The COVID-19 pandemic has served as an accelerant to all these trends. A recent survey suggests that one-third of prospective college students are reconsidering higher education, mainly due to financial issues (Lane Terralever, 2020). The significant drop in fall 2020 enrollments, described by one commentator as astonishing, was fueled primarily through pandemic-related issues: financial, fear of contagion, lack of desire for remote learning, and decreases in international students (St. Amour, 2020). Nursing education saw widespread interruption in clinical learning opportunities (NCSBN, 2020) and migration to unfamiliar (to many) learning technologies, including virtual clinical simulation (Fogg et al., 2020). The results from this author’s observations have been increased levels of stress among students (also driven by personal financial instability) and worsening moral distress (Ganske, 2010) among faculty.

The preceding forms the backdrop for this topic of OJIN: The Online Journal of Issues in Nursing. In choosing a focus on philosophical perspectives on current challenges in nursing education, responding authors were asked to not only identify and explicate relevant challenges but to also analyze them in relation to fundamental truths (ontology), knowledge development (epistemology), or what ought to be done (ethics). It is of significance that work on this issue began long before the start of the COVID-19 pandemic. However, all but one of the authors discussed the negative intersection of their articles’ main challenge with the pandemic. One article focuses on the impact of the pandemic.

Philosophical Challenges Explored in this Issue

In Faculty Formation: Philosophical Perspectives, Issues, and Considerations, Young and Godfrey argue the need for faculty formation. Formation is not a new lens through which to view orientation or socialization; these remain critical. Instead, formation focuses on psychological development in the transition from practice to academe, including agency, commitments, and meanings about nursing education. The authors root much of their analysis in what is now considered the seminal work of the Carnegie Foundation for the Advancement of Teaching (Benner et al., 2010). They discuss multiple strategies to foster faculty formation, including mentorship and robust communities of practice. Academic leaders are urged to invest in faculty formation as a critical approach to influence the profession's future.

Kavanagh and Sharpnack continue their work related to practice readiness of newly graduated RNs in Crisis in Competency: A Defining Moment in Nursing Education. In this piece, they posit that innovations in healthcare such as artificial intelligence, robotics, and virtual reality provide evidence that the nursing practice environment is evolving more rapidly than nursing academe. Consequently, new nurses may be less prepared to practice effectively than in the past. In support of this, they report on their 2020 aggregate data (n = 1222) of new nurses’ scores on the Performance-Based Development System (PBDS) (Del Bueno, 2005). Results indicate that only 10% of the sample scored in the acceptable range, suggesting continued declines in new nurse competency from previous years’ samples. The contributions of the current COVID-19 public health emergency to these results are acknowledged. The authors suggest that now is a tipping point for practice and academic leaders to join forces to advance nursing education commensurate with the digital age.

Telehealth has taken on new meaning amid the COVID-19 pandemic. Preparing Nurses for Roles in Telehealth: Now is the Time by Rutledge and Gustin points to the urgent and rapidly occurring need to transition to safer healthcare delivery modes as a prime motivator for nursing educators to shore up telehealth content and competencies. The authors provide a comprehensive accounting of practice situations and environments where telehealth would ensure access and be more efficient and effective than traditional modes. They suggest that nurses could emerge as the defined leaders in this evolving field and call on professional nursing organizations to upgrade telehealth standards for pre-RN licensure education.

Weberg and colleagues call for change in Disrupting Nursing Education in Light of COVID-19. The authors advance the idea that out of crisis can emerge sustainable innovation. In other words, the pandemic can create a new normal that results from the necessity to push beyond barriers and traditional thinking. Recommendations include a more substantial reliance on learning science, including the support for collaborative and reflective learning environments. Also, similar to Kavanagh and Sharpnack, there is a call for technological innovation that mirrors the reality of the contemporary practice environment. Like many of the authors in this topic, there is a call to not squander the unprecedented opportunities presented by the pandemic. The authors state, “Possibly the worst education outcome that can happen in the face of this crisis is the failure to evolve.”

Attention is turned to advance practice education in McInnis and colleagues’ The Significance of the Nurse Practitioner Preceptorship Shortage. At a time when there is an urgent need to address the lack of access to quality, cost-effective primary care, the education of nurse practitioners (NP) is limited by a shortage of preceptors. Unlike graduate medical education that benefits from a nationally coordinated effort and significant federal financial support, NP students often must find their clinical sites and rely on preceptors' goodwill and altruism to complete program requirements. As a result, many NP students cannot secure preceptors, delaying graduation or derailing degree completion. As is the ongoing theme in this journal topic, COVID-19 has acerbated the problem as practicing NPs were focused on the pandemic or, in some cases, furloughed or laid off. The authors propose thought-provoking ideas for post-pandemic NP education. For example, is there a way to mimic the process forged by leaders in graduate medical education to assure the availability of quality preceptors? Additionally, there is a call for accreditors to address the preceptor shortage by enforcing a standard that requires programs to provide qualified preceptors and clinical sites for NP students.

The disruptions to pre-RN licensure education are the focus of Innovative Solutions for Clinical Education during a Global Health Crisis. Logue and colleagues focus primarily on innovative solutions used to support students' clinical learning needs when direct patient care experiences became nonviable. The authors argue that rapid shifts in state regulatory policy were the catalyst for meeting student needs during the pandemic. Among the most significant facilitators of success was teaching remotely without seeking approval and utilizing simulation in amounts that exceeded regulations. The authors also report on implementing innovative clinical learning experiences that do involve patients. In support of Rutledge and Gustin’s ideas, telehealth learning opportunities help students achieve competencies related to planning and monitoring care in chronic illness. Furthermore, they suggest that the availability of enhanced community-based opportunities provided optimal learning experiences related to emergency preparedness and crisis management.

Olson provides a framework for the development of an ethical work environment in academic nursing. In Envisioning an Ethical Climate in Nursing Education Programs, she uses the Code of Ethics for Nurses (American Nurses Association, 2015) to propose values and behaviors that will promote an ethical and civil workplace and help students prepare for ethical professional practice. The need for such a climate is urgent as data from practice suggests a relationship between ethical climate and intent-to-leave a position. Thus, it is possible that working in climates that do not reflect the values inherent in the Code is a factor in the worsening of the nursing faculty shortage. Furthermore, this author suggests that the framework of the Code could be a central component of faculty formation planning, as discussed by Young and Godfrey.

Lastly, Keating and colleagues discuss global nursing education and the need for nursing faculty development. Open educational resources (OER) are the focus of Global Nursing Education: International Resources Meet the NLN Core Competencies for Nurse Educators. The nursing shortage is global and is a barrier to achieving the United Nations Sustainable Development Goals (SDG) (United Nations, 2015). Driving the nursing shortage everywhere is the faculty shortage. However, challenges are heightened in low to middle-income countries as resources are not available to educate faculty. The article describes the Nurses International-Open Educational Resources (NI-OER) as a world-wide initiative to deliver free high-quality educational resources to support nursing education. The authors curate a wide variety of resources from the NI-OER that faculty can use to support the development of the NLN core competencies. They suggest that by fostering the development of these competencies in nursing faculty, progress can be made to achieve the SDGs.

Conclusion

From the work of the authors in this OJIN topic, multiple conclusions can be drawn. First, while challenges in nursing education may seem recalcitrant, the COVID-19 pandemic has demonstrated that rapid change is possible. The sustainability of such change is yet to be determined. Second, courageous and ingenious work is being done by leaders in nursing education to chart a bold new future that will include technological innovation, pedagogical reform, foresight thinking, and ethical reform. Finally, what remains constant is the commitment of the academic nursing community to the profession's future by focusing on students’ success and well-being. The journal editors invite you to share your response to this OJIN topic addressing Philosophical Perspectives in Nursing Education either by writing a Letter to the Editor or by submitting a manuscript which will further the discussion of this topic which has been initiated by these introductory articles.

Author

F. Patrick Robinson, PhD, RN, ACRN, CNE, ANEF, FAAN
Email: probinson@arizonacollege.edu

F. Patrick Robinson is currently the Provost & Senior Vice President of Academic Affairs at Arizona College. On his journey to the provost’s office, he has served in multiple academic nursing leadership positions, including roles as department chair and dean. An award-winning educator and scholar, he presents, writes, and consults on academic entrepreneurship, innovation, and leadership development. Among his proudest achievement is his distinguished record of service to the HIV/AIDS nursing community.

References

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Blumenstyk, G. (2020, September 30). The edge: Remember when we thought higher ed was 'in crisis'? The Chronicle of Higher Education. https://www.chronicle.com/newsletter/the-edge/2020-09-30

Del Bueno, D. (2005). A crisis in critical thinking. Nursing Educations Perspectives, 26(5), 278-282.

Fogg, N., Wilson, C., Trinka, M., Campbell, R., Thomson, A., Merritt, L., Tietze, M., & Prior, M. (2020). Transitioning from direct care to virtual clinical experiences during the COVID-19 pandemic. Journal of Professional Nursing, 36(6), 685-691. https://doi.org/10.1016/j.profnurs.2020.09.012

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Maldonado, C. (2018, June 24). Price of college increasing almost 8 times faster than wages. Forbes. https://www.forbes.com/sites/camilomaldonado/2018/07/24/price-of-college-increasing-almost-8-times-faster-than-wages/?sh=26266a5366c1

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Thys, F. (2020, May 8). One third of private 4-year colleges are at high risk financially, model predicts. Edify. https://www.wbur.org/edify/2020/05/08/higher-education-financial-crisis

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© 2021 OJIN: The Online Journal of Issues in Nursing
Article published January 31, 2021

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