Nursing Education 2.0

February 20, 2023 -- Today I sat down with Sharon Goldfarb, DNP, RN, FNP-BC. We talked about nursing education, its shortcomings, and visions for improvement.

Until recently the Dean of Health Sciences at the College of Marin, Sharon is now an advisor at HealthImpact, the California Nursing and Policy center headed by Dr. Garrett Chan, which runs the Benner Institute for Teaching and Learning at my alma mater UCSF. It is a California State-funded nursing workforce development organization, billing itself as a "Revolutionary Solution to Remake Nursing Education and Support Professional Development for Nursing Educators". Sharon and I agreed that a revolutionary solution is sorely needed!

Dr. Patricia Benner is a visionary. Her 1982 publication From Novice to Expert was seminal in the industry, elucidating the nature of nursing expertise. Describing expert nurses is a first step toward developing expert nurses; it's time to take the remaining steps. Things have hardly improved in nursing education despite technology advances (especially simulation laboratories). I have written at length on why nursing education is failing. Sharon and I agreed about this. Nursing teachers don't know how to teach. Most of nursing school classroom time is wasted. Curricula are antiquated. Radical change is indeed needed! But how can it be done? Sharon explains:

Nursing education is mostly task-oriented, not critical thinking-oriented. Knowing how to do IM and subq injections doesn't help if your patient is disinformed and vaccination-hesitant. You have a different, bigger problem to solve yet you weren't taught how.

We must shift the paradigm. Teaching Med/Surg 101 isn't working; instead, we must teach Adult Health Lifestyle Management. Not Ob/Gyn but Women's Health. It's not enough to pass an NCLEX (licensing) exam, and we shouldn't be teaching toward that. We need to be smarter as educators, and as certifiers, too. At the very least, we need a next-generation NCLEX, lest we train our students to fail when they finally enter the real world.

Further, we must reach out to impacted communities, not wait for them to come to us. Sharon will be meeting patients in public events and where they live, including barrios and reservations, from HealthImpact's offices in Los Angeles and Oakland.

Today there is a big shortage of nursing educators, partly because it pays less than nursing work itself, but also because they are not taught to teach nor provided the tools to be effective.

In my own experience of nursing school, clinical rotations (working with live patients in real hospitals and clinics) were by far the most valuable part. One of HealthImpact's initiatives is the Centralized Clinical Placement System (CCPS) that sets up clinical rotations for students in hospitals, an obligation that was previously onerous for nursing schools to do for themselves. The program is making good progress. For example, every hospital in Hawaii now works with CCPS in providing placements. The rest of the country must surely follow.

Yet, more work is needed. Programs like CCPS should be supported by regulatory policy, with every hospital mandated to partner with nursing educators nationwide. And the nursing schools should do a better job of ensuring that students can do meaningful work at the hospitals where they are placed. A classic problem in nursing education for the past century is that nursing students are useless at graduation. It's only after months on the job that they become productive employees; hospitals that hire "new grads" take on expensive commitments. The schools aren't doing their job. This must change.

Today, essential topics are omitted or covered inadequately in nursing curricula. For example, every nurse today must also be a gerontologist. Every nurse must be at least competent in using computers, especially electronic health records (EHRs). In psych nursing, hallucinogens are now central in neuropsychology (Sharon was interviewed about this in an Inquiring Minds podcast that will soon be released) and here, too, nursing education needs to catch up.

In sum, much work and new thinking is needed to bring nursing education into the twenty first century. Updated curricula, teaching teachers to teach, alliances between schools and hospitals, and community-based approaches and many more initiatives are emerging. Sharon makes them happen.

-- Dan Keller RN MS, Feb. 2023


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