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Running head: EDUCATING THE FUTURE OF NURSING
Educating the Future of Nursing: Adapting to the Changing Healthcare Environment
Jessica L. McClusky
Ferris State University
EDUCATING THE FUTURE OF NURSING
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Abstract
There have been dramatic changes in the healthcare environment in recent years, with the
majority focused on the quality of provided care. The development of quality and safety
initiatives, as well as knowledge of patient population changes, role in system decision making,
advances in information technology, and new policies and regulations affecting hospitals is vital
to success in the nursing profession. Nurse educators can support and guide students toward this
success through use of progressively complex simulation use focusing on QSEN competencies
and skills. A mentoring program for students with a nurse leader in the community will help
students understand their role in advocacy for the profession and develop a comfort level with
letting their ideas be heard.
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Educating the Future of Nursing: Adapting to the Changing Healthcare Environment
It is no secret that to be a successful member of the nursing profession, a nurse must
commit to a lifetime of learning. Recent years have seen dramatic changes in the healthcare
arena, and nurses must work to evolve their teaching and practices to satisfy new requirements
and consumer demands. The development of quality and safety initiatives, as well as awareness
of the changing environment of the nurse will help the profession to evolve seamlessly. The
purpose of this paper is to give an overview of the Quality and Safety Education for Nurses
(QSEN) initiative, to discuss the impact of the changing healthcare environment on nursing
education, and to describe methods of incorporating these in to nursing school course design.
Quality and Safety Education for Nurses
In 2003, the Institute of Medicine (IOM) requested that nursing education included a
focus on interdisciplinary teamwork and various quality measures (Cronenwett, 2012). From
this, the QSEN initiative was born. Funded through the Robert Wood Johnson Foundation,
QSEN focuses on increasing nursing care quality and safety through the use various
competencies in the areas of patient-centered care, teamwork and collaboration, evidence based
practice, quality improvement, safety, and informatics. While the initial focus in 2005 was on
undergraduate students, the initiative was expanded with the addition of graduate level
competencies in 2007 (QSEN, n.d.).
QSEN focuses on the improvement of safety at both the level of individual performance
and also system effectiveness (Barnsteiner, 2011). The competencies are designed to provide
nurses with the education needed to improve the quality of the systems where they work
(Warren, 2011). To aid with this, each competency in broken down in to the knowledge, skills,
and attitudes (KSAs) necessary to be effective (QSEN, n.d.).
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QSEN has been developed over the span of three phases. Phase I defined the six
competencies as listed above. Five were provided from the IOM, with safety being added by
QSEN faculty (Warren, 2011). In 2007, Phase II funded 15 pilot schools to begin including the
competencies in their nursing curriculum. Finally, Phase III, beginning in 2008, focuses on
development of faculty and resources to sustain the continued expansion and success of
incorporating the KSAs into pre-licensure and graduate curricula (Warren, 2011). The
effectiveness of this initiative will depend on how well nurse educators are able to instill the six
competencies and their KSAs into nursing students in the current healthcare environment.
Changing Healthcare Environment
Changes in the healthcare environment in recent years can cause many challenges for the
field of nursing. First, the patient population is changing and expanding rapidly. Advances in
technology and medications have allowed for a longer life expectancy, increasing the prevalence
of chronic diseases and associated morbidities (Hegarty, Walsh, Condon, & Sweeney, 2009).
Additionally, the demographics of the United States are becoming more diverse, requiring the
nursing profession to be well versed in culturally competent care (Heller, Oros, & DurneyCrowley, 2000). Healthcare is also becoming a consumer-driven environment with patients who
are informed and demand the highest level of care. To adapt to this, the nurse must understand
that the patient is becoming more involved in his or her own care and decision making (Hegarty
et al., 2009). Patient education and exploration of options are vital to keeping the consumers
feeling involved (Heller et al., 2000).
In addition to the patient population becoming more diverse, the nursing profession is
seeing a wider range of demographics as well, both in age and race. Commonly, a nursing
student is seeking nursing as a second degree, and is raising a family and working a full time job
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during the duration of school. These students have higher expectations for their education, and
also require and expect flexibility to allow for their family and job (Heller et al., 2000).
Once in the workforce, there has been a rise in the amount of involvement the bedside
nurse has in decision making. In order to be effective with this new responsibility, the nurse must
have leadership skills and knowledge about effective advocating for themselves, their coworkers,
and their unit (Tomajan, 2012). As the largest professional group within healthcare, it is
imperative that nurses develop these skills to effectively influence patient care (Tomajan, 2012).
Information technology (IT) has been rapidly advancing and is increasingly present in the
patient care world, whether it is through electronic medial records, computer provider order
entry, or even the ability to quickly and efficiently find information on diagnoses, drugs, or
treatments. Especially with the mentioned growing diversity in the nursing profession, it is
important that all nurses are taught and continue IT competency (Hegarty et al., 2009).
Finally, another large change is the effect of healthcare policy and regulation on the
hospitals. Reimbursement programs are becoming dependent on quality care and standards,
making nurses the front lines to determining the amount of reimbursement a hospital will be
given (Heller, 2000). For example, the Centers for Medicare and Medicaid Services (CMS)
provides incentive payment based on the “meaningful use” of the electronic health record as it
relates to various core measures. The responsibility falls on the nurses to fulfill this requirement
fully and accurately to receive the payment (CMS, 2013).
Impact on Nursing Education
While it is clear that the healthcare realm is experiencing change, it is the job of the nurse
educator to adapt to those changes to allow new nurses to have the highest chance for success in
both their own positions but also for the nursing profession as a whole. With the emerging
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viewpoint of patient as informed consumer, nurse educators need to modify their teaching
approach. According to Barnsteiner (2011), traditional nursing care has focused solely on the
patient individually, while having a lack of delivery system focus. Today, it is important that
patient care is seen through the lens of this whole system in order to provide a truly patientcentered care experience. This is where a program like QSEN can be used to help guide faculty
to broaden to a system focus (Barnsteiner, 2011).
The changing demographics of the nursing student also present a challenge for nursing
faculty. Faculty must be prepared to deal with a more mature student with multiple job and
family obligations. This requires educators to provide a more flexible schedule to accommodate
these needs. Additionally, second-degree students have high expectations for their education, and
will demand the most up-to-date teaching styles available (Heller et al., 2000). This challenges
faculty to provide successful simulations and effective clinical experiences on a routine basis.
As discussed, when the nurses enter the workforce, they will begin to be asked to be
involved in decision making on a more frequent basis. To be successful with system leadership,
the nurses must have baseline leadership and advocacy skills. This can start to be introduced in
the university setting, however this is an area of opportunity for the clinical nurse educators.
According to Tomajan (2012), one of the best ways to learn leadership skills is through
mentoring. The clinical educators’ responsibilities now go beyond teaching new skills and
updating staff on policies. Mentoring nurses to become successful advocates and leaders is now
vital to the advancement of the nursing discipline.
The IT advancements of the recent years will pose a challenge to both educators at the
university level as well as in clinical areas. Proficiency with technology is now a vital skill to
function efficiently and properly in the hospital today. Additionally, technology provides much
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faster care, whether it is through test results or consultations. Patients will expect this same pace
from the nursing staff, who will need to learn the benefits of using technology to their advantage
(Hegarty et al., 2009). Additionally, the IT advancements cause a new level of expertise needed
for clinical educators. Nurses nearing the ends of their career may not be as familiar or
comfortable with computers or technology as a whole. It is imperative that those in the clinical
arena not only learn about developing technology, but also need the ability to teach it to those
who do not have a baseline familiarity (Hegarty et al., 2009).
Finally, changes in healthcare policy and reform provide yet another emerging area of
importance for future nurses. With current healthcare reform, an understanding of political
arenas and ways to involve themselves is necessary. This is a relatively newer topic in nursing
schools, however, the importance of it cannot be dismissed. Educators would benefit from
becoming involved personally in political reform, as new mandates will directly affect nursing
care (Heller et al., 2000). Additionally, as reimbursement programs become more prevalent, this
will need to be added in to undergraduate curricula, as it will largely affect the way they provide
care. This just adds yet another area of expertise for the nurse educator to stay up-to-date on.
Incorporation of Changes into Education
It is clear that the field of nursing education needs to be fluid and adapt to the changing
healthcare environment, which places a large amount of responsibility on the educators to be
aware of new or developing trends. The next challenge comes with bringing these new
developments to the classroom. Incorporating QSEN and nursing advocacy should be supported
with assignments and experiences throughout an undergraduate program.
To ensure each of the six QSEN competencies are fully understood and developed, it
would be beneficial to focus on one competency with each class or clinical rotation within the
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program. A program goal for QSEN could be that the student is able to discuss the QSEN
initiative competencies, and is able to effectively demonstrate these in the clinical arena. The use
of simulation would be most successful, as simulation has been shown to be an efficient tool
when used to teach quality and safety competencies (Shrapnack, Goliat, Baker, Rogers, &
Shockey, 2013). Simulations could build on to each other throughout the program, with the final
courses combining all of the competencies together in to increasing complex scenarios. For
example, for information technology, training domains of popular electronic health records could
be utilized for students to be come familiarized with in early courses. In later semesters, this train
domain could be used to get a history of a patient with a simulated interdisciplinary team, and
then the team could move to treating a high fidelity manikin using the most current accepted
practices.
As stated by Tomajan (2012), the best way for students to learn leadership skills and to
advocate is through mentorship from current nurse leaders. In an undergraduate program, a
mentorship relationship could be created upon admission. The student would be able to attend
meetings or workgroups with this mentor in order to see a nurse leader functioning in his or her
daily routine. Before graduation, the nursing student could begin taking part in these meetings
and workgroups, learning to be comfortable with advocating for the profession early on.
Conclusion
In conclusion, the healthcare environment is evolving rapidly in important and exciting
ways. The nursing profession will continue to play more of a role in the total care of a patient
through the health system than ever before. Because of this, it is vital that quality initiatives such
as QSEN, and recent advances in healthcare are completely incorporated in to nursing school
curricula to provide nurses with the education necessary to succeed and advance the profession.
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References
Barnsteiner, J. (2011). What students need to know about a culture of safety. The Online Journal
of Issues in Nursing, 16(3). Retrieved from http://www.medscape.com/viewarticle/
758853_3
Centers for Medicare and Medicaid Services. (2013). Meaningful use. Retrieved from
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/
Meaningful_Use.html
Cronenwett, L. R. (2012). A national initiative: Quality and safety education for nurses (QSEN).
In G. Sherwood & J. Barnsteiner, Quality and safety in nursing: A competency approach
to improving outcomes (pp. 49-64). West Sussex: Wiley-Blackwell.
Hegarty, J., Walsh, E., Condon, C., & Sweeney, J. (2009). The undergraduate education of
nurses: looking to the future. International Journal Of Nursing Education Scholarship,
6(1), 1-11. doi:10.2202/1548-923X.1684
Heller, B., Oros, M., & Durney-Crowley, J. (2000). The future of nursing education: 10 trends to
watch. Nursing & Health Care Perspectives, 21(1), 9-13.
Quality and Safety Education for Nurses. (n.d.). Competencies. Retrieved from
qsen.org/competencies
Sharpnack, P. A., Goliat, L., Baker, J. R., Rogers, K., & Shockey, P. (2013). Thinking like a
nurse: Using video simulation to rehearse for professional practice. Clinical Simulation In
Nursing, 9(12), e571-7. doi:10.1016/j.ecns.2013.05.004
Tomajan, K. (2012). Advocating for nurses and nursing. The Online Journal of Issues in
Nursing, 17(1). doi:10.3912/OJIN.Vol17No01Man04
Warren, J. J. (2011). History and impact of quality and safety education for nurses [PowerPoint
EDUCATING THE FUTURE OF NURSING
slides]. Retrieved from www.kumc.edu/documents/seeds/092811-Warren.pdf
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