Challenges in Nursing Education

Posted: January 5th, 2023

Challenges in Nursing Education

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Challenges in Nursing Education

Nursing education is a process of formal training and learning in the in the practice and science of nursing. The education entails the functions and roles in the physical assistance of patients, and a fusion of diverse disciplines that enhances the patient’s return to good health and helps sustain it (Institute of Medicine 2011). Specifically nursing education pays attention to educating those working or aspiring to work in the health care sector about the appropriate ways to give proper healthcare to patients. Nursing education informs nurses about effective ways for administering different medications, to examine or diagnose patient and give best services (Institute of Medicine 2011). The primary objective of nursing education is to develop the nursing profession. Nursing education clarifies the professional roles. Nursing education has its roots in Europe in the 1830s when a German, Theodor Fliedner started a small health facility and a training center known as the Order of Deaconesses (Institute of Medicine 2011). Various notable people in the field of nursing, including Florence Nightingale who is acknowledged as the initiator of modern health practices, underwent formal training at Fliedner’s facility. The initial training facilities in the U.S. were established in the early 1870s in Boston and Philadelphia, and both were under the administration of major hospitals in the respective regions (Institute of Medicine 2011). Nursing schools have continued to increase in number over the years, and today one does not have to struggle or move over long distance to achieve nursing training. Nevertheless, the nursing education experiences some challenges that derails the achievement of the targeted goals and objectives. States have adopted a range of measures to mitigate the challenges in an attempt to improve nursing education, but more may have to happen to achieve the best results.

Challenges in Nursing- Education

Challenge One – Challenges in Providing Online Education

Nursing trainers in the modern times have at their disposal a wide range of options, including simulators, models, curricula, and techniques as well as other contemporary technological innovations which makes it possible and easy teach or train students and impart clinical skills and knowledge from thousands of kilometers away. The growth and development present several constraints; some which are peculiar to Internet-based operations and not known a couple of decades ago (). The questions many ask are; how one manages to effectively coach or teach from a distance, how the trainer can ensure that the student on the other side of the computer or other smart devices is actually who appears on the other end, and whether such an approach to training is affordable (). In order to appropriately train present and future health students and practitioners, the contemporary nurse trainer must have adequate knowledge and command of the clinical aspects of the idea or skill being transmitted, but also must be conversant with the various techniques of delivery for that content. Face-to-face lecturing still play vital roles in nursing education, but the approach is now being substituted by various knowledge delivery components to help kindle the education process and encounter and show students how to appropriately implement new information and knowledge (). Educational practices and approaches will continue to transform as new techniques and innovations are identified and implemented.

Health practitioners and learners must acknowledge that nursing education is transforming as fast as health practice itself. IOM (Institute of Medicine) and the American Nursing Association (ANA) are clear on their stand that nursing education must undergo significant advancements in order to prepare future practitioners for collaborative and effective clinical practice. While paying attention costs, access, and needs, future nurses will have to consider both clinical skills and advanced practices such as a working competence of financial aspects and considerations for not only the client, but also the facility which the nurse is serving (Institute of Medicine 2011). The IOM recommends that while qualifying with Bachelors of Science in nursing (BSN) would not mitigate all of the future clinical and educational expectations, it would expose future health workers to non-health related fields that would provide the chance to gain a wider knowledge foundation of healthcare and its effects in society. Institute of Medicine (2011) further informs that the BSN is essential, but also suggests that that professionals get specialty certification as proof that they engage in lifelong learning. Institute of Medicine (2011) have addressed not only the need to continuously apprise nursing education, but also to take into consideration the quick transformations of information concerning the human gene and how practitioners can best inform and enlighten clients in this tremendously sensitive field of healthcare, and to infuse the knowledge into in daily practice. Williams et al. (2011) have gone ahead to argue that genetic education should be available in all nursing curricula and the existing programs be reviewed thoroughly to include genomic information. The inclusion is likely to be a significant change bearing in mind that barely a decade ago, the discussion of genomic issues and possible effects were restricted to counselors or physicians with advanced experience.  

Besides, critical care practitioners also require intense training before graduating taking into account that many nurses would work in a critical care setting immediately after completing their post-graduation challenges. There is widening expectations that these care givers should be vested with basic knowledge and skills to operate in a health facility, but also equipped with the capacity to effectively learn and incorporate new information pertinent to health care practice. A pre-graduation care program has been issued as a possible remedy (Gallagher, Rice, Tierney & McKinney 2011). The course takes two days and is in the form of a workshop where clinical experts take change of the process. Gallagher, Rice, Tierney, and McKinney (2011) learned from their research that such a program significantly elevate the confidence of a nursing trainee’s capacity to identify and take actions to transform the depreciation of a client’s clinical status. Such kind of training is entirely necessary even if the learner does not intent to major in critical care. The increasingly critically ill patients of today fused with the inherent hardships of handling patients with different and sometimes severe condition make the capacity to think critically and take action particularly essential.

An emerging concern is that many nursing education practices in the modern time still rely on time-tested and old fashioned techniques such as lectures fused with either web-based or Internet-enhanced content. Handling an online course, contrary to the views of some, can involve a lot of work, and may present other challenges. Nonetheless, an unobstructed transition to this approach to teaching must proceed with some form of speed as the new realities of health practice unfold (Gallagher, Rice, Tierney & McKinney 2011). Nurse educators and trainees must be able to shift from traditional forms to mobile and flexible courses created to achieve the goals of a more robust and effective nursing society (Gallagher, Rice, Tierney & McKinney 2011). Precaution must also be taken in the regulatory aspect that emerging nursing programs and online training facilities as well as nurse trainers providing these courses meet the required regulations by graduating competent and safe nurses and by upholding required accreditations and regulations.

Present Constraints

An example of a current obstacle to nursing students is the continuing transition from traditional brick and mortar instruction methods to web-based programs. There is little doubt that online training is here to stay. The merit of Internet-based nursing education is clear; it permits flexibility to perceive nurse trainers and course content in an asynchronous way, meaning that learning takes place virtually through online platforms and through well-prepared resources, without physical presence of instructors as opposed to synchronous learning, which is a two-way distance or web-based learning happening in real time with an instructor (Cleveland-Innes & Campbell 2012). Online learning are now becoming a fundamental aspect of nursing education. Younger learners may have a considerable advantage in using the online platform as they might have encountered a number of technological innovations while growing up while relatively older leaners are more probabily to be technologically inexperienced (Cleveland-Innes & Campbell 2012). The discrepancy can make older leaners to feel secluded and detached. A vital aspect to consider to diminish the disengagement is proper orientation to online-learning environment prior to training or lessons with adequate opportunities to include the faculty in more conventional formats if there are any identified hindrances.

The other challenges is that whereas social media is increasingly becoming a vital aspect of online learning, some nurse educators and trainees are yet to embrace the innovation. Cleveland-Innes and Campbell (2012) inform that the proliferation and impact of social media must be viewed as part and parcel of nursing education. Cleveland-Innes and Campbell (2012) assert that with all the challenges associated with social media it is here to stay. Cleveland-Innes and Campbell (2012) further argue that as a possible avenue for transmitting modern trends and information in nursing education, trainers and students must consider several key measures when utilizing such avenues or using them to acquire new information. For instance, they must overcome the perception that using social media is a waste of time, and must see the value of using the interactive platform for educational purposes. Both trainers and trainees must also have interest in social media and view it as a possible avenue for enhancing nursing education (Cleveland-Innes & Campbell 2012). It is also important to take time and learn how the innovation works to prevent a scenario where lack of knowledge and awareness on how the technology works deter some people from using it for educational purposes.

Notable Concerns

Even as the call to embrace and overcome the constraints associated with online nursing education, it is imperative to consider certain critical issues and take appropriate measures to address pressing concerns. First, while there are many papers addressing the need for instructors to alter their approaches to teaching, there are only a few publications and researches that give more convincing and concrete descriptions and examples of precisely how that should appear, and more essentially how the transformations can be appropriately put into action (Cleveland-Innes & Campbell 2012). There is substantial information on web-based content and how online learning and web-based information compares and contrasts with a brick and mortar method, and also about faculty inadequacies (Cleveland-Innes & Campbell 2012). Another concern is the need to adopt more effective and rapid online curricula as well as escalating rate of approvals of emerging nursing initiatives, but there is scarce information regarding how to appropriately assess the initiatives for their effectiveness and utility in the training and empowerment of new nurses (Cleveland-Innes & Campbell 2012). Also of great interest is the absence of enough information about the proliferation of inappropriate and ineffective nursing courses which threaten not only trainees, but also potential clients.

Challenge Two – Rapid Educational Changes

The nursing practice is becoming more demanding, which requires both educators and learners to readjust their approaches to fit into the highly demanding work environment. Institute of Medicine (2011) refers to the finding by IOM that the Patient Protection and Affordable Care Act (ACA) that became effective in 2010 under Obama’s reign, as well as an escalating intricate and technical hospital environment has created the need for health workers to assume more functions and responsibilities, which they may not be prepared to handle. In other words nursing education of the past years is being substituted by education which is deemed more technically-focused, aimed at using evidence-based practices, and also focused on utilizing concept-based instructional techniques. In addition, modern teaching and learning processes require both instructors and learners to display competency expectations such as collaboration, teamwork, leadership and management, and informatics. Cleveland-Innes and Campbell (2012) inform that while new practices and technology are usually expected to simplify work practices, they also require the formation and application of new competencies. Cleveland-Innes and Campbell (2012) further claim that the transformation, in itself, evoke an emotional reaction, and more fundamentally, may impact on the entire learning process. The constraint for nursing tutors is to quickly reexamine and if necessary come up with new lesson plans and curricula which mitigate or address the new requirements.

Challenge Three – Faculty Shortages

Inadequate staffing in nursing is not a new phenomenon. Connolly and Wilson (2008) inform that the issue of nursing shortage became dire as early as 2002 but the situation is not improving, despite an increasing number of trainees who qualify from different training facility each year. One of the primary concerns facing nursing trainers is that remuneration rates are significantly higher in the clinical or acute care setting. Consequently, many people with advanced knowledge in health care delivery would want to serve in health settings to earn higher returns leaving few qualified personnel to oversee nursing education. Another reason contributing to staff shortage is the ongoing wave of retirements, which deprive nursing education of 250 to 300 qualified personnel annually (Connolly & Wilson 2008). The lack of adequate staff impact the nurse student in several substantial ways. One of the most obvious effects of faculty shortages is it restricts the number of trainees who can be admitted to a nursing course for fearing that the teacher to student ratio  is not going to balance (Connolly & Wilson 2008). Another adverse effects of faculty shortages is that it reduces the availability of needed classes causing increased competition for space in learning environments and possible postponements in graduation. Various training facilities have tried to adopt several strategies to overcome such shortages by embracing various options. One possible remedy that many training centers deploy is a unit-based whereby advanced practice nurses and clinical nurse practitioners share some roles and aspects of nursing education. The option looks appropriate from an operational perspective because both are clinical experts who are in a position to relay needed content. Connolly and Wilson (2008) conducted a study to examine how training facilities make use of advanced practice nurses and clinical nurse practitioners in training practices and discovered that they were highly underutilized in fostering nursing education. One outstanding hindrances to implementing the use of specialists from both areas is absence of motivation from management, and increased roles and responsibilities with an increase in remuneration. Another possible reason for not utilizing both specialists is the persistent nursing shortage, which makes it hard if not impossible to serve multiple or substituting roles.

Challenge Four – Gaps in Achievement Levels

Guskey (2007) identifies differences in the levels of achievement of diverse groups of learners as an issue that has caused great concern for educational and political leaders for many years. President Lyndon Johnson had noted how the gaps in achievement levels impact on students, especially those from poor backgrounds, and initiated a program dubbed “War on Poverty” in the mid-1960s to address the inequalities affecting educational practices (Guskey 2007). Over the years, researchers have learned the significance of recognizing and minimizing the achievement gaps. One of the most significant figures in this areas was Benjamin Bloom (1913-1999) who provided valuable insights into how to reduce achievement gaps of different groups of learners (Guskey 2007). Bloom and his colleagues worked on a series of researches to find out the variations in school learning. Although their findings revealed that many components outside of learning environment impact how effective students learn, the scholar concurred that instructors have a significant impact. Nursing schools and training facilities today encounter some of the issues that Bloom and his graduate colleagues identified in their study (Guskey 2007). For instance, whereas most teachers in nursing schools tend show very little variations in their instructional activities, and that most tutors teach all their of their learners in much the same manner and offer all students with equal opportunity and time to learn, not all teachers embrace similar approaches, which make some learners to feel secluded. Some tutors may pay considerable attention to learners from particular races, while others may focus on those who perform well in class (Guskey 2007). Nevertheless, such distinctions affect performance and continue to widen gaps in achievement levels. It is the reason why Bloom recommended that to achieve better outcomes and minimize distinction in learner achievement, instructors would have to embrace variations in their teaching style while bearing in mind that learners vary in their aptitudes and learning style (Guskey 2007). Consequently, those in charge of nursing education should embrace differential teaching approaches to appropriately address the learning needs of all learners.

State Strategies to Combat the Challenges

State agencies have adopted various strategies to address the identified challenges with the objective of enhancing nursing education and ensuring that those who qualify are competent enough to give appropriate health care services. The adopted measures is an indication that state authorities appreciate the need to nurture nurse students in the most suitable way, and acknowledge that adequate guidance presents a better chance to graduate students who are able to perform a wide range of clinical practices without encountering significant threats. Even though some of the adopted measures seem to yield good results, it is necessary to consider more effective techniques that would do away with the current challenges affecting nursing education. Nonetheless, failing to take quick and effective measures could result in a scenario where nursing students graduate without particular skills that are essential in the way they ought to perform their duties.

Strategies to Combat Challenges with Online Education

Legislators in various states acknowledge the importance of online learning, and come up with regulations that they believe will provide both educators and learners the chance to enjoy the convenience of web-based learning. The regulation in Arkansas, for example, advocates for the formation of a digital learning environment that provides the chance to access quality digital educational content and web-based integrated programs (Center on Online Learning and Students with Disabilities 2021). Regulators in Arkansas call for the formation of well-formulated digital content formed to achieve the requirements of each learner, and also to come up with content that achieves or surpasses the curricula specifications or measures set by the State Board of Education (Center on Online Learning and Students with Disabilities 2021). Legislators in Arizona also come up with regulations that they believe will improve online learning throughout the state. The team in charge of creating regulations for online learning in Arizona, for example, direct that all learners should take at least a single digital learning program before graduating. Regulators in Arizona inform that the State Board of Education shall not regulate the number of e-programs for which a learner may get credit either through a public or private learning facility (Center on Online Learning and Students with Disabilities 2021). These regulations together with others play vital roles in ensuring that learners, including nursing students have the chance to engage in online learning practices, which has many merits.

Strategies to Address Educational Changes

States embrace curricula reviews as a suitable approach for ensuring trainers and trainees cope with emerging educational changes. The Accreditation Commission for Education in Nursing promotes the interests of nursing education through many ways, including ensuring that the courses and curricula nursing trainers and students follow reflect modern changes (ACEN 2020). The ACEN play key fundamental functions in accrediting programs, and usually ascent to teaching structures that capture the changing educational needs (ACEN 2020). In addition, being part of the ACEN accreditation provides the chance to come up with programs that encourage the provision of quality nursing programs.

Strategies to Mitigate Faculty Shortage

Several statewide programs are available to mitigate the shortage of nurse instructors in the U.S. For instance, the Maryland Higher Education Commission reported in June 2020 that it would give approximately $29.4 million in funding to 14 nursing schools to promote the efforts to advance the number of nurse instructors and level of education (AACN 2021). Hawaii, for example, was the fourth state in the country to come up with a legislation that seeks to minimize the issue of faculty shortage, with an innovative approach that utilizes the tax code in an attempt to enhance their numbers (AACN 2021). The regulation by the Hawaii government provided about $1.6 million each year to offer up to five one thousand dollars credit cards for each tutor. Other states that have adopted similar approaches include Colorado, Maryland, and Georgia. In another effort to enhance faculty shortage, the Jonas Philanthropies declared in 2012 that it would support various doctoral nursing students in more than 85 nursing schools through its Jonas Nurse Leaders Scholar Program (AACN 2021). The initiative that targets all states in the U.S. is one of the largest initiatives looking into the issue of faculty shortage, especially for doctorally trained nursing instructors. Jonas has collaborated with the American Association of Colleges of Nursing (AACN) to enhance the practice, and to facilitate how the program impact on all the 50 states (AACN 2021). The AACN also came up with an idea in 2010 that it hopes will mitigate the issue of faculty shortage in nursing education. It expanded the NursingCAS program, which is the country’s centralized application initiative for RN courses, to encompass graduate courses in nursing. One of the chief motives for initiating NursingCAS was to make sure that all vacant positions in nursing schools are occupied to effectively address the needs of advanced practice registered nurses (APRNs), registered nurses (RNs), and the entire nurse faculty (AACN 2021). Such statewide initiatives continue to play critical functions in alleviating the faculty shortage that has serious implications on nursing education.

Several other state initiatives exist to address the issue of faculty shortage, which is a major concern affecting nursing education. The Robert Wood Johnson Foundation, for example, compiled and released the Charting Nursing’s Future report that provides more information about various collaborative efforts aimed at nurse faculty inadequacies in various American states (AACN 2021). One of the major recommendations by the foundation is that all nurses should complete a BSN course within their first decade of licensure to ensure that they are competent enough to serve in various capacities, including being a tutor (AACN 2021). Besides, scholars in various states come up with literature that address the issue of faculty shortage, which provides a suitable chance to mitigate the issue that continue to affect nursing education. For example, Jillian Aldebron and Janet Allan came up with a publication in 2008 where they examine the various approaches for easing the countrywide nursing faculty shortage, and give recommendations on how to make the remedies more effective (AACN 2021). Overall, the scholars advocate for increased academic innovations, elevated educational collaboration, improved funding, and increased advocacy (AACN 2021). Such initiatives are crucial in alleviating the issue of faculty shortage, and stakeholders are confident that more such initiatives will emerge in future to completely deal with the challenge.  

Strategies to Combat Gaps in Achievement Levels

States develop various policies to advocate for equal access to education, and also adhere to some of the regulations formed by the federal government to prevent possible segregation in education due to differences in achievement levels. For instance, the Economic Opportunity Act (EOA) of 1964, which facilitated the formation of the Head Start initiative provides valuable guidance on the need to embrace learners without paying much attention to the achievement gaps (Guskey 2007). The federal legislation introduced by President Johnson provides valuable guidance to states in the way it becomes easy to enhance employment, health, education, and general individual and societal welfare, especially for impoverished Americans (Guskey 2007). States also adhere to the No Child Left Behind program that was started by the federal government in 2001 to ensure that students in all learning facilities regardless of school or course get the chance to learn regardless of their outcome. The regulations requires learning facilities to give achievement outcome differently for various disability, language, ethnicity, and poverty subgroups (Guskey 2007). All these regulations urge states to act in such a way that if the achievement gaps among various groups of learners are identified, then learning and training institutions must take adequate measures to mitigate them. States also embrace other approaches in their provision of nursing education to reduce the possible effects of performance gaps. For example, most American states set benchmarks and monitor progress as frequently as possible to ensure that learners move on the same page, and those who experience significant challenges receive some help to allow them overcome their problems (Guskey 2007). Stakeholders in various states also hold seminars and meetings where they share tips on how to engage all learners regardless of the varying gaps in achievement. Such meetings inform nurse educators the significance of personalizing learning processes, and the need to utilize topics and texts that are relevant to the students’ needs (Guskey 2007). The adopted measures play key critical functions in creating a learning environment where learners get the chance to gain necessary information and skills regardless of their level of performance.

Conclusion

The study identifies various challenges affecting nursing education, and describes the attempts by states to address and overcome the constraints. One of the major challenges affecting nursing education is that both educators and learners face considerable challenges using web-based learning techniques. The constraint deters instructors and learners from exploring some of the most effective practices that would ease the education process. A particular concern is that some nurse educators and trainees still employ inadequate mechanisms in the way they use social media avenues for their learning processes. The deficiency denies participants in nursing education the opportunity to enjoy the effectiveness and flexibility that come with such interactive avenues. Nevertheless, state administrations embrace several techniques to mitigate the challenge with the primary approach being creating policies to foster online learning. Another challenge affecting nursing education is constant changes happening in the field, which makes it difficult for both educators and learners to cope with fast emerging requirements.  Educators must come up with teaching programs that reflect evidence-based practices, and must design their work to reflect changing dynamics. Trainees, on the other hand, have an obligation to abide by new operational methods and ensure that they reflect the newly acquired information or clinical practices to their operations. Some of the changes are demanding and difficult to cope with, and require additional effort to achieve the best outcomes. The third concern the paper identifies to be a challenge to nursing education is faculty shortage, which makes it difficult to administer larger number of learners and also reduced the number of available lessons. A number of programs are already underway to address the matter at the state level, and stakeholders are optimistic that the adopted programs will yield good results. The ACEN reviews nursing programs from time to time, which makes it possible to include emerging changes and concepts. The fourth challenge facing nursing education is variations in achievement gaps that affect how nurse students get the chance to proceed with their studies and make significant contribution during the learning process. Even though some instructors understand the need to treat all learners as being the same regardless of their performance, others need to follow teachings by Bloom who argued for the need to focus on all learners regardless of their performance levels to attain the best outcomes. States seek to address the discrepancy by adhering to both federal and state policies aimed at achieving sameness in the way learners get instructions regardless of their performance.  States also engage nurse educators in a series of training and seminars where they learn about various ways for incorporating everyone in the learning process.

References

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