a result of the economic downturn and the relative stability the health care sector offers. The number of applications to entry-level baccalaureate programs increased by more than 70 percent in just 5 years—from 122,000 applications in 2004 to 208,000 applications in 2009 (AACN, 2010). While nursing schools across the country have responded to this influx of interest, there are constraints, such as insufficient numbers of nurse faculty and clinical placements, that limit the capacity of nursing schools to accommodate all the qualified applicants. Thus, thousands of qualified students are turned away each year (Kovner and Djukic, 2009).

A variety of challenges limit the ability to ensure a well-educated nurse workforce. As noted, there is a shortage of faculty to teach nurses at all levels (Allan and Aldebron, 2008). Also, the ways in which nurses during the 20th century taught each other to care for people and learned to practice and make clinical decisions are no longer adequate for delivering care in the 21st century. Many nursing schools have dealt with the explosion of research and knowledge needed to provide health care in an increasingly complex system by adding layers of content that requires more instruction (Ironside, 2004). A fundamental rethinking of this approach is needed (Benner et al., 2009; Erickson, 2002; IOM, 2003, 2009; Lasater and Nielsen, 2009; Mitchell et al., 2006; Orsolini-Hain and Waters, 2009; Tanner et al., 2008). Additionally, nurses at all levels have few incentives to pursue further education, and face active disincentives to advanced education. Nurses and physicians—not to mention pharmacists and social workers—typically are not educated together, yet they are increasingly required to cooperate and collaborate more closely in the delivery of care.

The education system should provide nurses with the tools needed to evaluate and improve standards of patient care and the quality and safety of care while preserving fundamental elements of nursing education, such as ethics and integrity and holistic, compassionate approaches to care. The system should ensure nurses’ ability to adapt and be flexible in response to changes in science, technology, and population demographics that shape the delivery of care. Nursing education at all levels needs to impart a better understanding of ways to work in the context of and lead change within health care delivery systems, methods for quality improvement and system redesign, methods for designing effective care delivery models and reducing patient risk, and care management and other roles involving expanded authority and responsibility. The nursing profession must adopt a framework of continuous, lifelong learning that includes basic education, residency programs, and continuing competence. More nurses must receive a solid education in how to manage complex conditions and coordinate care with multiple health professionals. They must demonstrate new competencies in systems thinking, quality improvement, and care management and a basic understanding of health policy and research. Graduate-level nurses must develop even greater competencies and deeper understanding in all of these areas. Innovative new programs to attract nurse faculty and provide a wider range of clinical education placements must clear long-standing bottlenecks in



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