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The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year. Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles-including limits on nurses' scope of practice-should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care. In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.
The nursing shortage in California has prompted legislators to propose solutions that may be well intentioned but fail to recognize the complexity of the issues they are trying to address. In April 2005, the Academic Senate convened a nursing task force, comprised of community college nursing faculty from across the state, to examine the issues raised by outside groups, respond to these issues, and provide possible remedies. The task force organized the information collected around six questions: (1) What are the barriers to recruiting nursing students? (2) What are the barriers negatively impacting nursing education on the campuses of California Community Colleges? (3) What are the barriers making it difficult for students to complete their course of study? (4) What makes clinical placement for nursing students so difficult? (5) Why do students leave nursing programs? Why is there such a high attrition rate? (6) Once students complete their studies and enter the profession, why do so many nurses leave within a short period of time? The responses and possible remedies reflect the diversity in nursing programs across the California Community College System and the complexity of trying to find single solutions that work for all colleges. In some areas, there is general agreement, such as the need for adequate numbers of full-time faculty to provide supervision and participate in program development, or the challenge of finding adequate slots for clinical placements. In other areas, responses differ greatly, as with respect to enrollment criteria and use of the Associate Degree in Nursing (ADN) Model Prerequisites Validation Study (Phillips, 2002). The remedies proposed in the paper are those of the task force and not official positions of the Academic Senate. The paper concludes with recommendations that echo longstanding positions of the Academic Senate within the context of nursing education in the California community colleges. (Contains 5 footnotes.).
The Origins and Rise of Associate Degree Nursing Education offers an analytical history of the beginnings and development of associate degree nursing (ADN) programs and the role of the caregivers it produces in the health care system. Nurses may be trained in two-, three-, or four-year programs, but all are eligible to take the accreditation examination to be licensed as registered nurses (RNs). The question of distinguishing between "professional" nurses from bachelor programs and "technical" nurses from the associate degree programs has become an important and controversial issue in nursing. Advocates have long contended that the associate degree nurse is vital to the American health care system. This study, funded by the W. K. Kellogg Foundation, confirms this view. In recent years the Foundation has invested more than $6.1 million in the development of the ADN, awarded by junior and community colleges. Many participants in the ADN projects for the Kellogg Foundation have noted that, despite the importance of the ADN and the controversy about its place in nursing education, the literature is scattered and hard to identity. The Origins and Rise of Associate Degree Nursing Education and the companion bibliography will provide much-needed information to educators, hospital and nursing administrators, nursing leaders, and public policy makers--all of whom must cope with the growing nursing shortage and increasingly difficult issues in health policy and administration.