requires continued growth in the science of delivering effective care for people and populations and designing health systems. Nurse scientists are a critical link in the discovery and translation of knowledge that can be generated by nurses and other health scientists. To carry out this crucial work, a sustainable supply of and support for nurse scientists will be necessary (IOM, 2010).

The research conducted by nurse scientists has led to many fundamental improvements in the provision of care. Advances have been realized, for example, in the prevention of pressure ulcers; the reduction of high blood pressure among African American males; and the models described elsewhere in this report for providing transitional care after hospital discharge and for promoting health and well-being among young, disadvantaged mothers and their newborns. Yet nursing’s research capacity has been largely overlooked in the development of strategies for responding to the shortage of nurses or effecting the necessary transformation of the nursing profession. The result has been a serious mismatch between the urgent need for knowledge and innovation to improve care and the nursing profession’s ability to respond to that need, as well as a limitation on what nursing schools can include in their curricula and what is disseminated in the clinical settings where nurses engage.

A chapter of the National Research Council’s 2005 report, Advancing the Nation’s Health Needs: NIH’s Research Training Program, focuses on nursing research; it identified factors that would likely influence its future, for example: an aging cadre of nursing science researchers, longer times required to complete doctoral degrees, increasing demands on nursing faculty to also meet workforce demands, and the emergence of clinical doctoral programs (NRC, 2005). Evaluating these and other factors will be essential to achieving the transformation of the nursing profession that this report argues is essential to a transformed health care system.

COMPETENCY-BASED EDUCATION

Competencies that are well known to the nursing profession, such as care management and coordination, patient education, public health intervention, and transitional care, are likely to dominate in a reformed health care system. As Edward O’Neil, Director, Center for the Health Professions at the University of California, San Francisco, pointed out however, “these traditional competencies must be reinterpreted for students into the settings of the emergent care system, not the one that is being left behind. This will require faculty to not only teach to these competencies but also creatively apply them to health environments that are only now emerging” (O’Neil, 2009). Emerging new competencies in decision making, quality improvement, systems thinking, and team leadership must become part of every nurse’s professional formation from the prelicensure through the doctoral level.

A review of medical school education found that evidence in favor of competency-based education is limited but growing (Carraccio et al., 2002). Nursing



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