In addition to the Carnegie and IOM reports, two other important sources called for advancement in nursing education between 2009 and 2010. Linda Aiken, PhD, RN, FAAN and her colleagues called for increased federal support for the preparation of nurses at the BSN level and higher (Aiken, Cheung, Olds, 2009). They suggested policy changes to address the growing need for nursing faculty and in the preparation of advanced practice nurses (APNs) to serve in primary care. In 2010, the Tri-Council for Nursing (an alliance of the American Nurses Association [ANA], American Association of Colleges of Nursing [AACN], American Organization of Nurse Executives, and National League of Nursing [NLN]) released a policy statement that included this language (Tri-Council for Nursing, 2010):

“Current healthcare reform initiatives call for a nursing workforce that integrates evidence-based clinical knowledge and research with effective communication and leadership skills. These competencies require increased education at all levels. At this tipping point for the nursing profession, action is needed now to put in place strategies to build a stronger nursing workforce. Without a more educated nursing workforce, the nation’s health will be further at risk.”

www.nln.org/newsreleases/tri-council.pdf

In the President’s fiscal year (FY) 2013 budget, the Obama administration included a funding recommendation for the Department of Health and Human Services for $251 million for the Nursing Workforce Development Programs that support the preparation of entry-level nurses, APNs, and nurse faculty. This was a $20 million increase from the previous budget (AACN, 2012).

The contemporaneous release of the IOM report, the Carnegie Foundation report, the Aiken findings, the Tri-Council Statement, and the FY 2013 budget represent a substantial change in the way that nurses will be educated. Their strong language with regard to the educational basis for nursing required for today’s health care environment, combined with the increase in funding for education at a time of serious economic constraints, make it necessary for even the staunchest critic of requirements for higher education for nurses to reconsider.

You are entering nursing at an exciting, challenging time. The remainder of this chapter will focus on nursing education of today and its current structures and requirements. This includes the history behind educational programs, descriptions of the various programs, and trends and future issues.

Development of nursing education in the united states

Florence Nightingale (Figure 7-1) is credited with founding modern nursing and creating the first educational system for nurses. After hospitals came into existence in Western Europe, and before the influence of Florence Nightingale, nurses had no formal preparation in giving care, because there were no organized programs to educate nurses until the late 1800s. Before this, nursing care was administered by either the patient’s relatives, individuals affiliated with religious or military nursing orders, or self-trained persons who were often held in low regard by society.

FIG 7-1 Florence Nightingale’s nurses in Scutari, Turkey during the Crimean War. Nightingale’s unstoppable spirit led to the development of education that transformed nursing.

Nightingale revolutionized and professionalized nursing by stressing that nursing was not a domestic, charitable service but a respected occupation requiring advanced education. In 1860, she opened a school of nursing at St. Thomas’ Hospital in London and established the following principles, which were considered highly innovative at the time:

1. The nurse should be trained in an educational institution supported by public funds and associated with a medical school.

2. The nursing school should be affiliated with a teaching hospital but also should be independent of it.

3. The curriculum should include both theory and practical experience.

4. Professional nurses should be in charge of administration and instruction and should be paid for their instruction.

5. Students should be carefully selected and should reside in “nurses’ houses” that form discipline and character. (Nightingale envisioned nursing as a profession only for women.)

6. Students should be required to attend lectures, take quizzes, write papers, and keep diaries. Student records should be maintained (Notter and Spalding, 1976).

Nightingale also believed that nursing schools should be financially and administratively separate from the hospitals in which the students trained. This was not the case, however, when nursing schools were first established in the United States.

The first training schools for nurses in the United States were established in 1872. Located at Bellevue Hospital in New York; the New England Hospital for Women and Children in New Haven, Connecticut; and Massachusetts General Hospital in Boston, the course of study was 1 year in length. These schools became known as the “famous trio” of nursing schools. In October 1873, Melinda Anne “Linda” Richards became the first “trained nurse” educated in the United States. By 1879, there were 11 U.S. nursing training schools. Other schools rapidly developed, and by 1900 there were 432 hospital-owned and hospital-operated programs in the United States (Donahue, 1985). These early training programs differed in length from 6 months to 2 years, and each school set its own standards and requirements. On graduation from these programs, students were awarded a diploma. The term “diploma program” was, and still is, used to identify hospital-based nursing education programs. The primary reason for the schools’ existence was to staff the hospitals that operated them. The education of student nurses was not always the primary concern.

Seven other BSN programs were established by 1919 (Conley, 1973). Most of the early BSN programs were 5 years in duration. This structure provided for 3 years of nursing education and 2 years of liberal arts. The growth in the numbers of these programs was slow both because of the reluctance of universities to accept nursing as an academic discipline and because of the power of the hospital-based diploma programs. The theoretical, scientific orientation of the BSN program was in sharp contrast to the “hands-on” skill and service orientation that was the hallmark of hospital-based diploma education.