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 Last modified Dec. 2, 2004  

Welcome to 2005: A New Era for Nursing Education

If you were applying to work as a nurse about a century ago, the job qualifications might have looked like this: “Tall and strong…suppleness of movement…graceful carriage (‘nothing is more distasteful in a sick-room than a suspicion of clumsiness’)…and a soft and evenly modulated voice (‘harsh notes jar on the
ears of sensitive patients’).” Those were all among the prerequisites listed in Ambulance Work and Nursing, a British handbook published in 1895.

Qualifications for a career in nursing have, of course, advanced immeasurably since then – and continue to do so. As the health care environment evolves, so too should the entry-to-practice educational requirements for all health care professionals. This is the case for Ontario’s nurses. Starting in 2005, new RNs will require a baccalaureate degree in nursing, and community college practical nurse programs increase to a two year diploma.

It has taken 131 years to get to this stage. Canada’s first school of nursing was formed at the General and Marine Hospital in St. Catharines, Ont. in 1874, and
became known as The Mack Training School. Nursing education used the hospital-based and apprenticeship model for several generations. Only in the 1960s and 1970s did we start to see a shift to an academic model.

“The entry-to-practice competencies were redefined in 1998 to meet the needs of a more complex health care environment. We then needed to increase the level of
basic nursing education to ensure new nurses entering the profession could meet these competencies,” says Kathie Conlin-Saindon, RN, Education Consultant at the College of Nurses of Ontario.

The baccalaureate and diploma programs have coexisted for years as the basic preparation for RNs. The time had come to make the degree program mandatory. A corresponding change will be made for the practical nursing education — requiring a change to a diploma from a certificate.

“We’ve moved from a task focus to a profession that includes critical thinking, problem solving, evidence-based practice and research,” says Conlin-Saindon. “The complexity of clients, the complexity of the environment, the collaborative relationship with an interdisciplinary team, the role of the nurse within the team — all of those things have changed dramatically. And that’s what has triggered the changes to what’s required of any entry-level practitioner.”

What will the new education requirements mean to the people who have to institute them, to the profession, to tomorrow’s graduates and to the public?
Think of how a nurse’s scope of responsibilities has changed, says Dr. Carole Orchard, RN, Director and Associate Professor, School of Nursing, University
of Western Ontario. Nurses are addressing not just specific health problems, but the underlying causes and prevention. They are dealing not only with the
physical needs of patients, but with the psychosocial needs of patients and their families. They are also going into community settings to confront the social and
environmental issues that have an impact on health. It all requires a far broader educational preparation than in the past, says Dr. Orchard.

In every way, nursing is more complex than ever before, agrees Kathleen MacMillan, RN, Executive Director, Office of Nursing Services, First Nations and Inuit Health Branch, Health Canada.

“We need to produce nurses for a different focus on health care,” says MacMillan, who was Ontario’s Chief Nursing Officer when the BScN requirement was approved by the Ontario government. “There’s an increased emphasis on primary care and public health, and on more autonomous, knowledge-based practice. It’s a more complex environment technologically. And patients are better informed.”

MacMillan says it all adds up to the need for nurses who are simply better prepared and more knowledgeable. She adds that new basic education requirements will help nurses be ready to assume other roles during their careers,
such as advanced practice roles and roles in education, policy, administration and research, without the barriers they now experience.

There’s nothing wrong with how Ontario’s current RNs and RPNs have been educated, says Conlin-Saindon, pointing out that existing nurses won’t need a BScN or a diploma to keep their membership.

The advantage of experience

That’s because many nurses already have the benefit of years of experience. Those who’ve been working for some time have had the advantage of experience and exposure, and continual learning and growth, because of our professional requirements,” Conlin-Saindon says. “New practitioners, entering into a complex system, need a certain educational foundation. They don’t have the luxury of waiting years to gain the experience.”

For CNO, the transition to new entry-to-practice requirements has meant a busy year. Paulette Blais, Entry to Practice Implementation Coordinator, says there has been an increase in application activity, particularly from internationally-educated applicants. Many are trying to meet their education and other requirements (e.g. language fluency, immigration issues) and register by
December 31, 2004.

To prepare everyone for the change, CNO’s extensive communications effort has included writing to over 11,000 applicants who had open applications on file; sending notices with application materials; running articles in Communiqué and The Standard; and providing updates on CNO’s website. Registration staff have also been providing advice and directing applicants to resources all year long.

The educational changes have prompted CNO to review several issues regarding registration, including proposed regulatory amendments to smooth the transition,
and policy work on international credential assessments and the evidence of safe practice requirement.

Naturally, CNO has worked closely with nursing educators at Ontario’s colleges and universities to provide advice on the competencies associated with the new education requirements. Blais says that CNO has also been consulted on the development of new educational opportunities. These include programs to help
internationally educated nurses to cross the “bridge” from college to university, and the redesign of refresher and reentry educational programs.

Challenging beliefs

Although CNO can provide advice, it’s up to the institutions to tailor their curricula to the new requirements. At the University of Western Ontario, for example, that has led to a significant transformation.

“We’ve shifted our educational philosophy underlying nursing education from behaviorism to humanism,” says Dr. Orchard. “The latter facilitates students to challenge their fundamental beliefs about themselves and nursing. It develops strong capabilities within the students to reason through situations they find themselves in, and find ethical and safe solutions. Behaviorism restricted teaching
to only that which was observable. In reality, the value of the nurse in our communication age is the knowledge she or he brings to each client situation. In nursing education today, we also talk about the client being not only an
individual, but the family and the community in which the individual resides.”

In 2005 and beyond, MacMillan says that graduates will be better equipped to do the types of things that can have a profound impact on clients and the system as a whole.

“They’ll be able to access, interpret and apply research knowledge better. Advocate for clients better. Negotiate the system. Be change agents in place of ‘worker bees.’ And think and act more independently. There is also evidence that degree-prepared nurses are more likely to stay in nursing, to be more satisfied with their work and less frustrated, and that better educated people, in general,
cope with stress better.”

How do the changes to entry to practice enhance the public’s right to excellence in nursing care? Dr. Orchard says nurses will be viewed as “knowledge workers”, able to analyze and act quickly in routine and unexpected situations.

MacMillan agrees the changes will be beneficial. “Clients who have better educated nurses are more likely to achieve better outcomes in fewer contact hours.”

“Thus, the benefits are economic and system-oriented, as well as nurse and client-focused. There’s likely to be a more even standard of nursing services, so clients will be better able to predict expectations for nursing care. This
will improve client satisfaction. Nurses will also have an improved ability to navigate the system and advocate for clients through better knowledge. This creates a culture of inquiry, and improves safety. We’re moving from a technical, task-focused approach to care to one of professional service and accountability.”

Nurses are already respected health care professionals, but some educators think the new requirements will boost the image of professionalism.

“University preparation helps to level the playing field for nurses in the multidisciplinary team approach to patient care,” says Rosemary Watkins, RN, Coordinator, Practical Nursing Program, Humber Institute of Technology and Advanced Learning.

“Nurses with an enhanced knowledge of the sociology of health are better equipped to navigate the system and provide unique, individualized care to their clients.”

As for RPNs, Watkins calls the two-year diploma program a “much-needed initiative.” She says she hopes that health care institutions will recognize the enhanced scope of practice and allow these nurses to work to their full potential.

“Often this is not the case, which can be detrimental to the public. Unregulated health care providers are often hired when the skill and expertise of RPNs is needed.”

Over time, suggests MacMillan, the degree and diploma requirements will affect everything from the nature of the workplace to how nurses view their role.

“The work environment will need to adapt to accommodate the ‘new nurse’,” MacMillan says. “Nurses will expect better access to technological support, professional development and continuing education; more input into organizational decision making that affects practice; a more reasonable workload; and time to think and plan. Employers will have to compete for nursing intellectual capital by providing supportive work environments.

“MScN students are also much more interested in health policy, and how they can influence change at the organizational and political levels. The health system
and the public’s view of nursing will shift from ‘helpers’ to ‘shapers.’ Students will see themselves as shaping the system — not just working within it."

Written by Stuart Foxman, Freelancer.

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