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Task force to make recommendations on nursing entry level
Legislation
Task force to make recommendations on nursing entry level Recommendations on the education preparation for the practice of nursingwill be forthcoming from the American Nurses' Association's (ANA) National Conference on Entry into Nursing Practice. These recommendationswill be presented to the ANA Board of Directors and the Commission on Nursing Education prior to the ANA Convention in June. The conference was held Feb 13 and 14 in Kansas City, Mo. The Commission'sTask Force on Entry into Professional Practice will compile the recommendations and according to the task force's chairman, Lorene Fischer, strongly recommend that there be a "continuing approach to this critical issue" and that the issue have "some action behind it and a time frame." More than 300 nurses attended the conference sponsored jointly by the Commission on Nursing Education, chaired by Hazle Blakeney, and the Commission on Nursing Services, headed by Jannetta MacPhail. AORN was represented by Dorris Davis, program specialist in continuing education. The conference was the result of a resolution at the 1976 ANA Convention calling for a meeting on the position paper issued by ANA in 1965 that stated: Education for all those who are licensedto practice nursing should take place in institutions of higher education. Minimum preparation for beginning professional nursing practice at the present time should be a baccalaureate degree education in nursing.
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Minimum preparation for beginning technical nursing practice at the present timc should be associate degree (AD) education in nursing. 0 Education for assistants in health service occupations should be short, intensive preservice programs in vocational education institutions rather than on-the-job training programs. In her opening remarks, Fischer cited four major assumptions underlying the conference and basic to understanding the directions and presentations of the participants. 1. ANA continues to affirm its position that basic nursing education should take place in institutions of higher education. 2. The Association is committedto increasing and improving utilization of nurses from baccalaureate and higher degree programs in nursing. 3. The Association is committedto continue to develop strategies to facilitate nursing practice at levels that are congruent with the education and experience of nurses and with the health care needs of society. 4. Currently, the Association is committed to mandatory licensure for nursing practice but there is no position that supports the use of licensure as the strategy to redefine nursing practice. In summarizing the recommendations from the discussion groups at the conference, Fischer noted that recurrent themes continued to appear throughout the reports. One is that there ought to be a clearer identificationof the two kinds of nursing. There is a need for clarification of the competencies to be expected, she said, and a need to define the goals for two types of nurses. She pointed out that the recommendations showed clarification that one 0
AORN Journal, April 1978,V o l 2 7 , No 5
level of education should be the baccalaureate but less definition of the other kind of education. In the recommendations, Fischer saw an increased need to make available and accessible more programs for baccalaureate education as well as more programs for registered nurses. A frequent request in the groups' recommendations was for various kinds of studies on manpower, nursing education, nursing practice, and ratios, Fischer commented. Another recurrent theme was a "request for increased use of flexible patterns to provide baccalaureate education." Some people felt this concern "should go on to a systematic approach to education and include master's and doctoral education," she said. Some groups reported a need for increased coordination between nursing education and nursing service in the development of the studies and kinds of programs and practice efforts, Fischer commented. Although faculty development is a serious issue, according to Fischer, the need to develop faculty resources was "infrequently stated." She pointed out that there are groups of persons who feel licensure is the mechanism by which to promote change while others view change being accomplished through a more comprehensive, holistic approach. Other isolated comments by various groups questioned whether the baccalaureate level as the entry level into professional practice is far too low a level to consider, whether the master'sor doctoral level should be the entry level, or whether practical nursing should be the entry level. From these comments, Fischer stated, "So the question of what constitutes entry level into nursing is not so well accepted as I might have thought prior to the conference." The small group sessions were divided into the following interest areas: professional and legal definitions; the use of legal mechanisms to stimulate change; competencies of graduates-various levels of basic education programs; nursing resources and distribution; ratios of various levels of resources: career mobility of all levels of nursing personnel (impact of entry decision on Affirmative Action): impact of resolution on entry on the cost of health care reimbursement; curriculum innovations and changes in nursing education sys-
tem in a time of transition; faculty development in time of transition (faculty resources, manpower changes); and building internal cohesiveness to strengthen nursing and to achieve common goals. Verle Waters, assistant dean of Health Sciences and Services, Ohlone College, Fremont, Calif, was keynote speaker. She participated in developing the ANA 1965 position paper and also in a study in California differentiating the nursing functions of baccalaureate degree graduates and associate degree graduates. Entitling her talk, "Progress of the Nursing Profession in Implementing the 1965 Position Paper," Waters concentrated on three areas: progress in implementing the process in the system of education, in the work world of nursing, and within the profession itself. Within the system of education, Waters stated, "Preparation of registered nurses has significantly moved from the hospital diploma school setting into the collegiate setting." She cited the 2- to 3-year collegiate nursing program as the major event in R N education, adding, "In less than 20 years, this program has moved from an interesting experiment to a dominant position in nursing education." The major event in practical nursing programs has been that the course of history "has been in direct contrast to the position espoused in the paper." As for baccalaureate programs, Waters stated, there has been a steady but not spectacular rise in graduations. "Nursing neither planned nor predicted the rise of AD programs," according to Waters, who attributed their success to "incredibly persistent individuals who were committed to getting a nursing program established." These initiators were not nurses but college presidents, teachers, or hospital administrators. Substantial progress has been made in differentiating the subject matter in associate degree and baccalaureate degree programs. However, Waters said, "Our progress for crystalizing curriculum goals and content for professional nursing practice is impeded by abstract and archaic arguments about whether technical education can be a base for professional education or whether liberal arts must be included." In the work world, the speaker said, "The unique professional nursing role as sketched
d-+ AORN Journal, April 1978, V o l 2 7 , N o 5
87 1
in the position paper has substance, promise, and conviction. However, the role dims as it moves out of the language of education and into the language of nursing service. It continues to lose precision as it moves through many settings." Waters noted that important changes in the work world since the position paper, such as in primary care, are indicative of the professional growth in the nursing role. She concluded that the "position paper's premise that there is a direct relationship between the level of education and the level or type of nursing practice is not yet generally sanctioned or supported in a work world." Progress within the profession has been hindered by powerful, ideological, and actual barriers that restrain nurses who decide to obtain the baccalaureate degree, according to Waters. She drew applause when stating, "Our individual inconsistency is our collective ambiguity." She said that though "bridges are being built, the hiatus between nursing education and nursing service continues to be a source of strain and deserves our best thinking." Waters concluded, "We are prone to blame the difficulty on one another-on the enlightenment of nursing service directors, on the ivory tower vision of education, on the profusion of licensed practical nurses, on the clinically inept AD graduate, on the overeducated BS graduate. ANA must provide the leadership and direction." During the conference, several reports informed the participants of work being done that has bearing on entry into practice. Inez Hinsvark, project director of the ANA credentialing study in nursing, spoke on the use of academic degrees as a credentialing mechanism. Jannetta MacPhail reported on the Commission on Nursing Services' current work, and lngeborg Mauksch, chairman of the ANA Congress for Nursing Practice, talked about certification. A report of a survey on state nurses associations' activities regarding entry into practice was given by Pamela Cipriano, a member of the task force. Reports also were heard about activities of state nurses associations in New York, Ohio, Oregon, and Tennessee. Representatives of selected nursing groups reported on their groups' activities during a session moderated by Carrie Lenburg, a
874
member of the task force. Patricia Ann Evans spoke for the American Association of Colleges of Nursing; Sylvia Hart for the National League for Nursing; Lori Sumner, National Student Nurses Association; Patricia Haase and Audrey Spector, the Southern Regional Education Board; Jo Eleanor Elliott, Western Interstate Commission on Higher Education; and Elinor Stanford, Division of Nursing, US Department of Health, Education, and Welfare. The conference was attended by representatives from 30 state nurses associations. Invitations also had been sent to specialty nurses groups, nursing organizations, ethnic groups, regional nursing groups, government, Councils of the National League for Nursing, and other individuals interested in the entry into practice question.
AORN Journal, April 1978, V o l 2 7 , N o 5
Dora B D'Amico Associate editor
Task force to make recommendations on nursing entry level Recommendations on the education preparation for the practice of nursingwill be forthcoming from the American Nurses' Association's (ANA) National Conference on Entry into Nursing Practice. These recommendationswill be presented to the ANA Board of Directors and the Commission on Nursing Education prior to the ANA Convention in June. The conference was held Feb 13 and 14 in Kansas City, Mo. The Commission'sTask Force on Entry into Professional Practice will compile the recommendations and according to the task force's chairman, Lorene Fischer, strongly recommend that there be a "continuing approach to this critical issue" and that the issue have "some action behind it and a time frame." More than 300 nurses attended the conference sponsored jointly by the Commission on Nursing Education, chaired by Hazle Blakeney, and the Commission on Nursing Services, headed by Jannetta MacPhail. AORN was represented by Dorris Davis, program specialist in continuing education. The conference was the result of a resolution at the 1976 ANA Convention calling for a meeting on the position paper issued by ANA in 1965 that stated: Education for all those who are licensedto practice nursing should take place in institutions of higher education. Minimum preparation for beginning professional nursing practice at the present time should be a baccalaureate degree education in nursing.
870
3
Minimum preparation for beginning technical nursing practice at the present timc should be associate degree (AD) education in nursing. 0 Education for assistants in health service occupations should be short, intensive preservice programs in vocational education institutions rather than on-the-job training programs. In her opening remarks, Fischer cited four major assumptions underlying the conference and basic to understanding the directions and presentations of the participants. 1. ANA continues to affirm its position that basic nursing education should take place in institutions of higher education. 2. The Association is committedto increasing and improving utilization of nurses from baccalaureate and higher degree programs in nursing. 3. The Association is committedto continue to develop strategies to facilitate nursing practice at levels that are congruent with the education and experience of nurses and with the health care needs of society. 4. Currently, the Association is committed to mandatory licensure for nursing practice but there is no position that supports the use of licensure as the strategy to redefine nursing practice. In summarizing the recommendations from the discussion groups at the conference, Fischer noted that recurrent themes continued to appear throughout the reports. One is that there ought to be a clearer identificationof the two kinds of nursing. There is a need for clarification of the competencies to be expected, she said, and a need to define the goals for two types of nurses. She pointed out that the recommendations showed clarification that one 0
AORN Journal, April 1978,V o l 2 7 , No 5
level of education should be the baccalaureate but less definition of the other kind of education. In the recommendations, Fischer saw an increased need to make available and accessible more programs for baccalaureate education as well as more programs for registered nurses. A frequent request in the groups' recommendations was for various kinds of studies on manpower, nursing education, nursing practice, and ratios, Fischer commented. Another recurrent theme was a "request for increased use of flexible patterns to provide baccalaureate education." Some people felt this concern "should go on to a systematic approach to education and include master's and doctoral education," she said. Some groups reported a need for increased coordination between nursing education and nursing service in the development of the studies and kinds of programs and practice efforts, Fischer commented. Although faculty development is a serious issue, according to Fischer, the need to develop faculty resources was "infrequently stated." She pointed out that there are groups of persons who feel licensure is the mechanism by which to promote change while others view change being accomplished through a more comprehensive, holistic approach. Other isolated comments by various groups questioned whether the baccalaureate level as the entry level into professional practice is far too low a level to consider, whether the master'sor doctoral level should be the entry level, or whether practical nursing should be the entry level. From these comments, Fischer stated, "So the question of what constitutes entry level into nursing is not so well accepted as I might have thought prior to the conference." The small group sessions were divided into the following interest areas: professional and legal definitions; the use of legal mechanisms to stimulate change; competencies of graduates-various levels of basic education programs; nursing resources and distribution; ratios of various levels of resources: career mobility of all levels of nursing personnel (impact of entry decision on Affirmative Action): impact of resolution on entry on the cost of health care reimbursement; curriculum innovations and changes in nursing education sys-
tem in a time of transition; faculty development in time of transition (faculty resources, manpower changes); and building internal cohesiveness to strengthen nursing and to achieve common goals. Verle Waters, assistant dean of Health Sciences and Services, Ohlone College, Fremont, Calif, was keynote speaker. She participated in developing the ANA 1965 position paper and also in a study in California differentiating the nursing functions of baccalaureate degree graduates and associate degree graduates. Entitling her talk, "Progress of the Nursing Profession in Implementing the 1965 Position Paper," Waters concentrated on three areas: progress in implementing the process in the system of education, in the work world of nursing, and within the profession itself. Within the system of education, Waters stated, "Preparation of registered nurses has significantly moved from the hospital diploma school setting into the collegiate setting." She cited the 2- to 3-year collegiate nursing program as the major event in R N education, adding, "In less than 20 years, this program has moved from an interesting experiment to a dominant position in nursing education." The major event in practical nursing programs has been that the course of history "has been in direct contrast to the position espoused in the paper." As for baccalaureate programs, Waters stated, there has been a steady but not spectacular rise in graduations. "Nursing neither planned nor predicted the rise of AD programs," according to Waters, who attributed their success to "incredibly persistent individuals who were committed to getting a nursing program established." These initiators were not nurses but college presidents, teachers, or hospital administrators. Substantial progress has been made in differentiating the subject matter in associate degree and baccalaureate degree programs. However, Waters said, "Our progress for crystalizing curriculum goals and content for professional nursing practice is impeded by abstract and archaic arguments about whether technical education can be a base for professional education or whether liberal arts must be included." In the work world, the speaker said, "The unique professional nursing role as sketched
d-+ AORN Journal, April 1978, V o l 2 7 , N o 5
87 1
in the position paper has substance, promise, and conviction. However, the role dims as it moves out of the language of education and into the language of nursing service. It continues to lose precision as it moves through many settings." Waters noted that important changes in the work world since the position paper, such as in primary care, are indicative of the professional growth in the nursing role. She concluded that the "position paper's premise that there is a direct relationship between the level of education and the level or type of nursing practice is not yet generally sanctioned or supported in a work world." Progress within the profession has been hindered by powerful, ideological, and actual barriers that restrain nurses who decide to obtain the baccalaureate degree, according to Waters. She drew applause when stating, "Our individual inconsistency is our collective ambiguity." She said that though "bridges are being built, the hiatus between nursing education and nursing service continues to be a source of strain and deserves our best thinking." Waters concluded, "We are prone to blame the difficulty on one another-on the enlightenment of nursing service directors, on the ivory tower vision of education, on the profusion of licensed practical nurses, on the clinically inept AD graduate, on the overeducated BS graduate. ANA must provide the leadership and direction." During the conference, several reports informed the participants of work being done that has bearing on entry into practice. Inez Hinsvark, project director of the ANA credentialing study in nursing, spoke on the use of academic degrees as a credentialing mechanism. Jannetta MacPhail reported on the Commission on Nursing Services' current work, and lngeborg Mauksch, chairman of the ANA Congress for Nursing Practice, talked about certification. A report of a survey on state nurses associations' activities regarding entry into practice was given by Pamela Cipriano, a member of the task force. Reports also were heard about activities of state nurses associations in New York, Ohio, Oregon, and Tennessee. Representatives of selected nursing groups reported on their groups' activities during a session moderated by Carrie Lenburg, a
874
member of the task force. Patricia Ann Evans spoke for the American Association of Colleges of Nursing; Sylvia Hart for the National League for Nursing; Lori Sumner, National Student Nurses Association; Patricia Haase and Audrey Spector, the Southern Regional Education Board; Jo Eleanor Elliott, Western Interstate Commission on Higher Education; and Elinor Stanford, Division of Nursing, US Department of Health, Education, and Welfare. The conference was attended by representatives from 30 state nurses associations. Invitations also had been sent to specialty nurses groups, nursing organizations, ethnic groups, regional nursing groups, government, Councils of the National League for Nursing, and other individuals interested in the entry into practice question.
AORN Journal, April 1978, V o l 2 7 , N o 5
Dora B D'Amico Associate editor