ISSN (impressa): 1414-8145
Volume 4, Número 2, Mai/Ago - 2000
E-mailCONFERENCE
Nursing education and career opportunities in the USA
Educação em enfermagem e oportunidades de carreira nos Estados Unidos da América
Educación en enfermería y oportunidades de la carrera en los Estados Unidos de la América
Carolyn F. Waltz
PhD, RN, FAAN. Professor and Associate Dean for Academic Affairs University of Maryland School of Nursing
ABSTRACT
This lecture was presented in 1999 in the Anna Nery School of Nursing during a visitation program organized by the EEAN and Rio de Janeiro's Partners of the Americas. Nursing education and career opportunities for both male and female were pointed out in the USA health care system and finally, the trajectory of the University of Maryland School of Nursing, undergraduation and graduation programs were highlighted.
Keywords: Nursing - Education
RESUMO
Esta conferência foi apresentada na Escola de Enfermagem Anna Nery em 1999, durante um Programa de visitas organizado pela EEAN e o Partners of the Americas do Rio de Janeiro. Destacaram-se a Educação em Enfermagem, oportunidades de carreira para enfermeiras e enfermeiros no Sistema de Atenção à Saúde nos E.U.A e, finalmente, a trajetória da Escola de Enfermagem da Universidade de Maryland e seus programas de graduação e pós-graduação em Enfermagem.
Palavras chave: Enfermagem - Educação
RESUMEN
La Conferencia fue presentada en la Escuela de Enfermería Anna Nery en el año de 1999 durante un Programa de visita organizado por la EEAN y los Compañeros de las Américas de Rio de Janeiro. Se destacaron la educación de enfermería y las oportunidades de la carrera de enfermeros y enfermeras en el sistema de atención a la Salud en los EUA y por último la trayectoria de la Escuela de Enfermería de la Universidad de Maryland y sus programas de graduación y postgrado en Enfermería.
Palabras claves: Enfermería - Educación
Nursing education in the USA and the career opportunities nurses have in the USA health care system are exemplified by those of the University of Maryland, School of Nursing. The School is one of the oldest and largest in the United States with approximately 1500 currently enrolled students. The School, located on an academic health center campus in Baltimore, Maryland, is housed in a state-of-the-art high-tech building that has its own nurse-managed health center as part of the building's design, classrooms, an auditorium, and learning and research laboratories with unparalleled technological features.
The School of Nursing's history in many ways parallels the history of nursing education in the USA. The University of Maryland School of Nursing was established in 1889 by Louisa Parsons, a student of Florence Nightingale. Ms. Parsons was a British military nurse who was highly decorated for her valor. Ms. Nightingale is considered the founder of modern nursing practice as a reformer and educator. She created the Nightingale Fund Training school for nurses at St. Thomas Hospital in London in 1896. Louisa Parsons was a graduate of the Nightingale School. In 1896 she became the first Superintendent of Nurses at the University of Maryland School of Nursing.
Several significant leaders of nursing education at the School had close ties to Florence Nightingale. For example, Annie Lee who became the first student to enter training in 1889 and to graduate in 1892. Class sizes at the many schools of nursing established at that time were typically small, witnessed by the class of 1905 whose entire school enrollment was 55. Another military nurse, Elisabeth Collins Lee also a graduate of the University of Maryland School of Nursing received high honors for her bravery during the first World War. Ethel Palmer Clark was an outstanding 1906 graduate of the University of Maryland whose contribution to the development of nursing science must be emphasized. She was one of the seven founders of Sigma Theta Tau in 1922.
The University of Maryland School of Nursing started as a hospital-based diploma program and became university-based in 1955 when it began offering the Baccalaureate degree. A Baccalaureate degree is now the accepted requirement for entry level practice as a professional nurse in the USA. Since its inception more than 100 years ago, the University of Maryland School of Nursing has been a pioneer in nursing education and instrumental in shaping the profession. Today, the School of Nursing continues this tradition through its mission to advance the science of nursing through research; provide leadership and promote excellence through its professional, graduate and continuing education programs; and to engage in clinical practice and service of the highest quality.
Current challenges facing nursing education in the USA include a significant nursing shortage particularly for acute care and home care professionals. Such shortages can negatively impact patient care and are costly to the health care industry. Other challenges include the growing diversity of career options for women and the persistent perception of nursing as a trade versus a profession that contribute to the lack of new individuals entering the field and the increased diversity in nursing students who are more varied in age, race, country of origin and prior educational and occupational background than ever before. Students are older, many have degrees in other fields prior to entering nursing, are typically employed in full time careers and are raising families which places additional time demands and constraints on their educational experiences.
Trends positively impacting the ability to recruit nurses for the shortages include the opportunity for nurses to practice in a variety of clinical settings, in addition to the hospital, the dramatic increased opportunities for masters prepared advanced practice nurses, the emergence of careers in care management and case management, and the interest by biotech, information technology and pharmaceutical companies in hiring skilled nursing professionals.
Significant opportunities exist for schools for nursing to address these challenges and enhance contributions of nurses to education, practice, and research. Activities at the School of Nursing that mirror efforts nationwide include students in the baccalaureate program have opportunities to interact with a varied and diversified group of colleagues; some of whom are in the traditional baccalaureate option, some of whom are RNs returning to school to obtain a baccalaureate degree, and some who have degrees in other fields and are now seeking a second degree in nursing in our streamlined accelerated tract for students who enter with a degree in other field. A group of exceptionally well-qualified students who knowing they would pursue a masters degree, entered a more streamlined fact track program, enabling them to move from an RN to MS degree. In addition to taking classes with others in their option, they have ample time to work with students in other options in core courses, electives, in research and practice.
The undergraduate core curriculum provides students with courses and other learning experiences that place more emphasis on community based and population based care, incorporate more practice based approaches to learning research, and place greater emphasis on health promotion and illness prevention, and health policy, managed care, health care economics, and other organizational factors that impact upon the practice of nursing now and in the future. Baccalaureate students also have the opportunity to take courses in a specific clinical area of interest to them (i.e., an emphasis area such as critical care, oncology, gerontology, pediatrics, school health, correctional and environmental health) providing them with more in-depth knowledge and experience in a clinical area in which they think they might like to work after graduation; thereby giving them a competitive edge in the job market and/or facilitating their pursuing graduate studies in a specialty area earlier in their career. Students in the baccalaureate program are able to take graduate level courses with masters students as part of their program that they can bank and apply to graduate degree requirements when they matriculate in the masters program.
Students in the masters program can select from 20 plus specialty areas and in addition to spending time with those in their respective specialty they have ample opportunities to take core and elective courses with students in other specialties, and to work with them in research and practice activities. The masters core curriculum provides students with courses and other learning experiences that place more emphasis on community-based and population-based care, incorporate more practice based opportunities to learning research, and place greater emphasis on health promotion and illness prevention, health policy, managed care, health care financing, and other organizational factors that will impact upon the practice of nursing now and in the future.
Baccalaureate and masters students hone their clinical skills and gain confidence by learning and practicing in high-tech, cutting edge pre-clinical simulation labs with state-of-the-art equipment and intelligent manikins and with standardized patients, who are live models, prior to providing care to real patients. Students enrolled in the masters and doctoral programs, have available to them the resources of the Graduate School that include easy access to faculty and students in other disciplines; increased scholarships and financial support for the conduct of research, and travel to present at professional meetings and opportunities to serve on graduate School Committees and to plan and participate in graduate student research days and the like.
Students who are in doctoral study have the opportunity to work with renowned faculty researchers in a number of targeted research areas:
Child, Women's and Family Health
Behavioral Health/Addictions
Gerontology/Aging
Environmental/Occupational/Community Health
Emerging and Re-Emerging Infections
Cardiovascular Health
Cancer Prevention, Early Detection and Treatment
Trauma/Critical Care
Informatics
Health Policy and Health Services Research
Doctoral student research activities are also supported through the activities of the School of Nursing, Office of Research where they can access help with the design of their research, preparation of proposals for funding, statistical consultation and a whole host of activities designed to increase the quality of their research efforts.
Students in all programs have flexibility in scheduling designed to meet their needs. Specifically, they can select from a menu of required and elective courses offered at varied times during the day, evenings, and weekends in condensed time frames as well as the usual semester period. All students have increased opportunities to work with students at other program levels, across departments, specialty areas and in other schools on campus, in the University of Maryland System, regionally, nationally, and worldwide. In addition, students at all program levels have many opportunities to learn in a multitude of outstanding clinical facilities, and to participate in a number of innovative School of Nursing clinical initiatives such as Open Gates, the School of Nursing's nurse managed primary care clinical operation, the Wellmobile that tours the state giving care to those in underserved communities, in our school-based health centers in Baltimore City and/or Baltimore County, and as part of a interdisciplinary team, who deliver ambulatory care to children in the Ambulatory Pediatric Clinic located within the School of Nursing building.
Like the School of Nursing, nursing education in the USA is in a dynamic state, faced with challenges, but rich with resources to meet them and successful in doing so as evidenced by the more than 11,000 graduates of the University of Maryland School of Nursing who hold high level positions nationally and internationally where they continue to influence the course of the profession, to advance nursing science and practice.
REFERENCES
AMERICAN ASSOCIATION OF COLLEGES OF NURSING (AACN). With Demand for RNs Climbing, and Shortening Supply, Forcasters Say What's Ahead Isn't Typical, 'Shortage Cycle'. Issue Bulletin, Feb., 1998.
AMERICAN ASSOCIATION OF COLLEGES OF NURSING (AACN). 1900-2000 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. Mar, 2000.
AMERICAN ASSOCIATION OF COLLEGES OF NURSING (AACN). Defining Scholarship for the Discipline of Nursing. Position Statement, March 15, 1999.
AMERICAN ASSOCIATION OF COLLEGES OF NURSING (AACN). Educational Mobility. Position Statement, Mar. 30, 1998).
SPECIAL Report. Nursing school enrollment declines as RN demand continues to climb. Legislative Network for Nurses, v. 17, n. 5, Feb. 28, 2000.