By Marti Kessack, PHD RN HCM
Nursing is dynamic in the truest sense of the word! As the original ‘mothers of invention’ the nursing profession has a history of being visionary in the direction healthcare seems to be moving toward, and by transforming themselves to meet that need. Unerringly, the profession has thus far been preeminent in the decisions and in the directions our leaders have forecasted. With the healthcare industry having close to instantly-changing policies and regulations, nursing as a profession will most certainly continue to adapt and expand to meet this need in the future as well. These are exciting times to be in the nursing profession as well as to enter the nursing profession; however, it can be difficult to know which type of nursing degree and program to enter as a new student.
In nursing’s early days, there was a one-size-fits-all nurse and nursing curriculum. Nurses were traditionally trained in the hospital setting with some amount of teaching in the classroom. Nurses were dependent on the physician and his orders. Florence Nightingale started a nursing school in England that introduced theory into the nursing curriculum. Nightingale introduced scientific reasoning and evidence-based practice to nursing practice as well.
Nursing continued to change to meet the current requirements of the time starting with World War II and Mildred Montag developing the 2-year educated registered nurse in the Adelphi College School of Nursing (1942). Montag envisioned that this technical nurse would be an assistant to the bachelor’s prepared nurse who would be head of the nursing team. Today, Associate degree nurses number 1,299,334 in the United States.
In 1917, Columbia University in New York City was the first higher academic institution to offer a bachelor’s degree in nursing. In 2000, the American Association of Colleges of Nursing (AACN) issued a position statement defining the Bachelor of Science in Nursing (BSN) as the entry level in nursing practice to insure safety and quality of patient care. Today, BSN nurses number 960,378 in the United States.
Higher Education Nursing Degrees
Advanced degrees and certifications may be attained after the BSN degree is earned and the National Certification Licensure Exam – Registered Nurse (NCLEX-RN) is taken and successfully passed. The advanced degrees can be attained in either an academic (teaching) focus or a clinical (provider) focus. In addition to the higher education degree, specialty certifications, certificates, and board certifications can be earned.
Master of Science in Nursing (MSN)
The graduate nurse umbrella has two tracks: direct patient care and non-direct patient care foci. The non-direct patient care degrees encompass the Executive Nurse Leader, and the Informatics Nurse focus. The direct patient care degrees encompass Nursing Education, Family Nurse Practitioner, Clinical Nurse Specialist, and Clinical Leader. Graduates of either focus are eligible to sit for the certification exam in that specialty.
Executive Focus: The graduate with this degree and focus will be prepared to lead in the clinical setting. Key concepts that the graduate will learn is an understanding of organizational systems, business communication, organizational change, and leadership decision-making.
Educational Focus: The graduate with this degree and focus will be prepared to instruct in the academic setting. Key concepts graduates will learn is teaching theories and strategies, managing the classroom with diverse populations, and teaching in diverse educational settings.
Informatics Focus: The graduate with this degree and focus will be prepared to function as data analyzers and interpreters to the trending and regulations of patient care, electronic health record use and lead the staff nurses in evidence-based practice patient care. Key concepts graduates will utilize are information flow as it relates to the workforce and information technology project management.
Family Nurse Practitioner (FNP): The graduate will be able to practice as a clinical provider caring for diverse patients and their families in multi-cultural settings. Graduates will sit for the National Board Certification Exam prior to practicing as a Nurse Practitioner (NP) provider. Most FNPs will have some type of prescribing ability as well as performing specialty skills. Note: Each state determines the FNP scope of practice. The FNP may sit for the AACN Board Certification exam.
Clinical Nurse Specialist (CNS): The graduate will function as an Advanced Practice Registered Nurse (APRN) in a specialized area of a patient population. Graduates typically care for patients in Gerontology, Oncology, Cardiovascular, Diabetic, or Psychiatric and Mental Health Areas. Some CNS graduates may be allowed prescriptive-writing dependent on the state they practice in.
Clinical Nurse Leader (CNL): The graduate will function as a leader in the clinical setting with the ability to substantively direct the care for diverse specialty populations within the in-patient setting or the public arena setting. Graduates will sit for the CNL certification exam administered by the American Association of Colleges of Nursing (AACN). Note: Each organization determines the CNL scope of practice.
Doctor of Philosophy Degree (PhD): The PhD is a research-based terminal degree that focuses on conducting independent research in the field of nursing and disseminating these findings to broaden nursing science. Graduates are qualified to lead and instruct in all levels of nursing education from pre-licensure to PhD university programs. In addition, PhD graduates are qualified to lead and instruct in university nursing clinically-based programs (FNP, DNP, and others). Emphasis of this degree is academic, theory-based, and research-based.
Doctorate of Nursing Practice (DNP): The DNP is a practice-based terminal degree that focuses on evidence-based practice, quality improvement, and systems leadership. Graduates are qualified to lead and instruct in the clinical setting and the academic setting. Emphasis is on clinically-based nursing, skills-based, and evidence-based practice studies.
A Look Ahead
Healthcare will remain in flux for the foreseeable future. The nursing profession will be required to remain visionary and flexible to meet the new challenges, technologies, policies and regulations that await in the future. Emphasis will remain on quality and safety in patient care in order to receive reimbursement dollars. In order to accomplish this, new specialties will need to be realized and created to meet the future challenges.
Many universities are offering certificates in nursing specialty areas such as education, informatics, clinical leadership, nurse anesthetist, nurse midwifery, executive leadership, community nurse, gerontology, and others. The trend in our national and state legislatures has been to expand the roles of the APRN practitioner. The future national trend is to eliminate the inconsistent state policies for advanced nursing provider practice. The Institute of Medicine (IOM) and the AACN are in agreement that each nurse should be permitted to practice to the full scope of their advanced education.
Predictors of future healthcare trends have agreed the advanced clinical nurse roles will expand far into the future with new nursing specialties being created. With the current nursing shortage being experienced by the U. S., the demand for advanced practice nurse leaders will increase. Through the leadership of our current nursing visionaries, nursing will continue to transform and trail-blaze meeting new directions and roles as we have throughout our history!
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