Nursing and Nursing Education Public Policies and Private Actions (1983) / Chapter Skim
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CHAPTER V EDUCATION FOR ADVNACED POSITIONS IN NURSING
CHAPTER V EDUCATION FOR ADVNACED POSITIONS IN NURSING
Pages 133-156
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From page 133... ...
Advanced Education for Nursing Administration The committee found a widespread conviction among administrators of hospitals and long-term care facilities that their nurse administrator colleagues could make the delivery of care more cost effective if they had better grounding in financial management and in the human resource management required at all the levels of administration in which they currently serve, i.e., from head nurse positions through nursing service administrators.* Reciprocally, testimony indicated that nurse administrators should be able to contribute to executive management decisions beyond nursing services.
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From page 134... ...
If this group was removed from the computation of the proportion of individuals in "top nursing administration" with advanced degrees, the proportion of all "top nursing administrators" holding master's or doctoral degrees might be appreciably less. Although the committee would not argue that the majority of nurses who work in supervisory or administrative positions need the skills and knowledge acquired in formal graduate degree programs, there is general agreement that a scarcity exists of nurses with advanced education.
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From page 135... ...
Advanced education in management is one of the few areas with substantial financial payoff for students, because nursing service administrators in large institutions command the highest salaries in nursing. This suggests that the financing of such training be a cooperative endeavor in which greater weight is given than in other fields of graduate education to the motivations for institutions and individual nurses to share in costs.
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From page 136... ...
As of June 1982, 19 states required master of science degrees in nursing as the minimal degree for senior faculty in all programs, and two states required directors of schools of nursing to hold a doctoral degree.5 If one agrees that the faculty required to teach master's and doctoral students should hold doctoral degrees and that those who teach baccalaureate students should also possess advanced degrees, indications of scarcity are suggested by the fact that of the approximately 20,000 full-time nursing faculty in 1980, only 7 percent held a doctoral degree; 68 percent had a master's degree. The proportion of nursing faculty with doctorates does not compare favorably with other disciplines.
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From page 137... ...
and in the biomedical sciences (about 16 percent) .12 The doctoral degrees in nursing (D.N.S.
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From page 138... ...
In 1980, about 24,000 such specially trained nurses provided clinical support to hospital nursing services, of whom about 5,700 were nurse practitioners. Approximately 7,000 other nurses with clinical specialties were in same type of community health work, of whom almost 4,500 were nurse practitioners or nurse midwives.15 Such nurses receive their special training in a variety of ways, sometimes in staff development programs in an individual institution, sometimes in joint cooperative programs between hospitals or other health care institutions and schools of nursing, and sometimes in graduate degree programs of schools of nursing with arrangements for clinical experience at one or more practice institutions or with practitioner preceptors.
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From page 139... ...
For example, certificate programs generally require 8 1/2 months of additional nurse education and average about 6 months of subsequent clinical preceptorship. Master's programs for nurse practitioners require somewhat over 15 months of education and average about 3 1/2 months of such preceptorship.18 Nurses pursuing graduate education in advanced clinical practice usually choose an area of concentration.
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From page 140... ...
The responses of nurses with master's or doctoral degrees to the 1980 national sample survey confirmed the occurrence of this phenomenon. Close to half of the 19,800 respondents who were employed in nursing education reported that clinical practice had been the primary focus of their advanced degrees.
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From page 141... ...
Coupled with efforts to provide sufficient economic and noneconomic rewards in the work setting, investments in graduate education can have a significant payoff in developing nurses who are versatile in addressing deficiencies in the organization and delivery of nursing care. The Need for More Nurses With Graduate Education Current Supply Although the growth in the number of nurses with some form of graduate training has accelerated in 1980, as noted earlier, only about 5 percent of all RNs in 1980 held master's or doctoral degrees.
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From page 142... ...
Assisted by Nurse Training Act funds, the number of doctoral programs located in nursing schools or departments, where such degrees are granted, grew rapidly during the decade of the 1970s. The National League-for Nursing collects information about doctoral education only from programs located in nursing education departments or schools.
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From page 143... ...
current rates of labor force participation by nurses with master's and doctoral degrees will continue, and (3) financing of graduate nursing education from all the major sources that have contributed in the past to increasing the supply will also suffer no major dislocations.*
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From page 144... ...
Nurses With Doctoral Degrees In 1980 there were 4,100 RNs with doctoral degrees. Taking the conservative estimate from the 1980 national sample survey, almost 3,000 (72 percent)
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From page 145... ...
estimates of master's and doctoral nurses that would be required by 1990 to meet its staffing criteria, there would be a tremendous gap between these numbers and the projected supply. TABLE 28 Comparison of the Study' s Proj ected Supply of Employed Registered Nurses With Graduate Degrees in 1990 With DHHS Estimates of Need Derived From Judgment-of-Need (WICHE)
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From page 146... ...
By contrast, state government support and loans for doctoral students appear to have been negligible. Federal Support Programs Of the total $1.6 billion appropriated under the Nurse Training Act and National Research Services Award Program between 1965 and 1981, $70 million went for general institutional support of advanced nurse training and $206 million for nurse traineeships in master's and doctoral programs (Appendix 2~.
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From page 147... ...
. Advanced nurse training grants and contracts are made to collegiate schools of nursing to plan, significantly expand, or maintain programs to prepare nurses at the graduate level -- whether as administrators, teachers, or clinical specialists.
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From page 148... ...
Without these funds, in all likelihood the numbers of full-time students would have been reduced, thus slowing the increase in the number of these nurses coming into practice. In addition to the advanced nurse training grants and the nurse traineeship program, unknown proportions of the funds allocated under the NTA to programs for nurse practitioners and special project grants, as well as student loans, supported nursing students enrolled In grac uate programs.
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From page 149... ...
Nevertheless, there is such an obvious gap between the present supply and educational capacity of the system on the one hand and even conservative estimates of future advanced positions required on the other, that existing program capacity and sources of student support at the graduate level should be expanded. In examining the future need for nurses, the committee identified problems that cannot be resolved merely by increasing the supply of nurses with basic education, but may be alleviated by increasing the supply of nurses with advanced education.
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From page 150... ...
To increase the nation's supply of nurses with advanced degrees, public and private universities with graduate programs must expand and strengthen their nursing education faculties. In the face of the current shortage of academically qualified nurse faculty with expertise in fields relevant to nursing, such as management, the behavioral and basic sciences, and research methodology, deans of schools of nursing could draw faculty from appropriate schools and departments in their universities or neighboring institutions both to fill immediate needs and to help build future teaching and research capabilities.
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From page 151... ...
On the other hand, most committee members believe that fellowships, awarded on the basis of scholarly excellence and the promise of fundamental contributions to the knowledge base, should not carry the same kind of obligation. RECOMMENDATION 8 The federal government should expand its support of fellowships, loans, and programs at the graduate level to assist in increasing the rate of growth in the number of nurses with master's and doctoral degrees in nursing and relevant disciplines.
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From page 152... ...
Thus, federal support of nurses to obtain non-nursing graduate degrees will not assist in meeting the intent of Recommendation 8 of this report or other recommendat ions related to it. Until recently, doctoral programs in nursing were limited in number, and nurses had little option but to pursue doctoral degrees in disciplines external to but related to nursing despite the additional time and expense involved to make up course deficiencies.
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From page 153... ...
Nursing doctoral students need the flexibility of obtaining fellowship support to study with nursing faculty of their choice who can serve as mentors within the students' specialization area. Many of these graduates with advanced nursing preparation will in turn enter academic nursing to teach nursing students, while also strengthening the theoretical and clinical application bases of the discipline of nursing.
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From page 154... ...
From national sample survey of registered nurses, November 1980.
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From page 155... ...
From national sample survey of registered nurses, November 1980.
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From page 156... ...
Third report to the Congress, February 17, 1982: Nurse Training Act of 1975 . Hyattsville, Md.: Health Resources Administration, 1982.
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