Educating nurses: a call for radical transformation-how far have we come?

Three years ago, thee Carnegie Foundation for Advancement of Teaching National Nursing Education Study launched Educating Nurses: A Call for Radical Transformation (hereafter referred to as Educating Nurses or the Carnegie Study) (2009) as part of Carnegie’s Preparation for the Professions Program. Since then, it has been met with enthusiastic responses, many of which are examples of curricular and pedagogical changes in schools of nursing in the United States and Canada. The 3-year point is a good time to stop and refl ect on the progress in upgrading and transforming nursing education. I hope this editorial will further the dialogue and encourage more systematic, formal evaluations of the infl uence of the national Carnegie Foundation studies of education in the professions, in general, and in nursing, in particular, including these questions: How are we doing in closing the practice–education gap, and how are nurses being better prepared to meet today’s complex health care needs and improve the health of society? How are we doing in preparing students in (a) the cognitive apprenticeship; (b) the practice apprenticeship and clinical reasoning; and (c) ethical comportment and formation? My co-authors on Educating Nurses: A Call for Radical Transformation (2009) and colleagues, Molly Sutphen, Vickie Leonard, and Lisa Day, who continue to present in national and international conferences and consult with schools of nursing, have reported back exciting news on innovative responses to the fi ndings and recommendations of Educating Nurses. In addition, four major collaborative partners—the American Association of Colleges of Nurses, the National Council of State Boards of Nursing, the National League for Nursing, and Sigma Theta Tau—have been actively engaged in efforts to disseminate and implement the Carnegie Study recommendations (Educating Nurses). Educating Nurses has now been translated into Norwegian and Japanese and is currently being translated into Korean; these translations are creating lively cross-cultural dialogues, even during the translation phases. The following are impressions of the infl uence of the study and actual examples of innovations. Several states, including Arizona, Minnesota, Michigan, and Washington, have implemented initiatives to transform nursing education, infl uenced by the Carnegie Study. An increasing number of baccalaureate programs, including the University of Pennsylvania’s program, have introduced nursing seminars in the fi rst 2 years of college to help students begin forming their nursing identity, character, and skills and better understand how the prerequisites and general education requirements will be used in their nursing practice. The fi rst-year and second-year students are introduced to clinical assignments to help them begin to develop their nursing clinical imagination, formation of habits of thought, and skilled know-how and to better understand how the prerequisites in the sciences and humanities are relevant to nursing practice. These fi rst 2 years are being used to upgrade and enrich the natural and social sciences for the current levels of scientifi c knowledge required in nursing practice. Many schools of nursing are engaged in curriculum revisions in response to the evidence presented in Educating Nurses. For example, the University of Pennsylvania is now in the fi rst year of implementation of a new curriculum that seeks to integrate nursing practice use of science in the fi rst 2 years of prerequisite science courses. For example, Health Assessment is integrated into the Anatomy and Physiology course. I observed the nurse faculty team teacher demonstrate how knowledge of anatomy and physiology of bone joints is integral to Health Assessment. The Chemistry course introduces students to relevant unfolding case studies enabling them to use newly gained knowledge on diffusion of gasses in a case of Decompression Sickness (DCS, or Bends) experienced in deep sea diving, as well as fl uid shifts between intracellular and extracellular spaces, acid-base balance, and other conditions. Pathophysiology and Pharmacology are taught together to integrate knowledge acquisition and knowledge use in relation to drug actions and interactions and in order to introduce students to assessing patients’ responses to medications. Many innovations are being seen in clinical education, as a result of the work of Drs. Christine Tanner, Paula GubrudHowe, and Mary Schoessler and their colleagues in the Oregon Consortium for Nursing Education, as well as the Carnegie Study, as faculty bring new approaches to their clinical assignments. For example, faculty have developed clinical assignments with an in-depth integrative learning focus, rather than total patient care. Clinical groups may be assigned to patients with similar clinical problems, such as each student being assigned to hemodynamically unstable