KAREN OTT MAYER

UT staff members are busy reviewing students' files during the first day of interviews for the 2007-2008 nursing class.

As the shortage of nurses persists across the country, healthcare professionals and educators continue to search for answers.

At the University of Tennessee Health Science Center's (UTHSC) College of Nursing, the faculty has been working several years on the comprehensive plan which has become known as The College of Nursing 2010 Plan.

Donna Hathaway, PhD, RN, dean of the UTHSC College of Nursing, understands all too well the local situation. "I believe that Shelby County has the highest nursing shortage in the entire state," she insisted.

Unlike the shortages found today, during the mid-1990s the five Memphis area schools of nursing were graduating enough nurses. Hathaway pointed out that during that time, UT Methodist was asked to reopen the baccalaureate program and transition professional entry programs to master's-level programs.

Hathaway has played an important role nationally for the last two years. She was part of a task force in 2005 and chaired the American Association of Colleges of Nursing (AACN) committee that completed work in October 2006. "I feel extremely privileged to sit in this particular spot at this critical time," said Hathaway. "Our target goal for 2008 is to admit students into master's-level programs, and at the same time, we will transition MSN students to DNP."

National focus on the subject of nursing education increased when the AACN published a position paper that recommended schools of nursing transition family nurse practitioners to doctorate levels. The recommendation covered nurse practitioners, certified nursing midwives, certified nursing anesthetists and clinical nurse specialists.

The 2010 Plan involves several phases beginning with the implementation of a clinical nurse leader option in the master's program. Following will be the initiative to move master's-level advanced practice nursing options to the Doctor of Nursing Practice (DNP) option.

In keeping with UT's pioneering legacy, the school was the first in the country to graduate students with a practice doctorate starting in 1999.

The tide of change, however, cannot be argued. In 2004, there were only two DNP programs ready to open. Eighteen months later, 20 programs were admitting with nearly 200 institutions considering the degree. Today, more than 160 schools are following suit.

Nursing shortages aren't the only factor driving the change. One reality is that the healthcare environment itself is dictating the educational needs. "Healthcare has become incredibly complex. We have patients living longer with multiple chronic conditions and hospitals with very complex procedures and systems. What we need nurses to do today is a lot more complex than when I went through nursing school," said Hathaway.

Paula Spears, RN, corporate director of professional practices and advancement with Methodist University Hospital, supports seven hospitals in the areas of clinical practice, clinical education, clinical evaluation and research.

"We agree that we need highly educated nurses. Patients have more chronic illness that expands across lifespan. We have gotten better at saving people, but the care is more complex," said Spears.

While some insist the need for entry level nurses is so great that advancing degree programs isn't the answer, Hathaway explained the goal is to provide all levels of nurses. "We need a full spectrum of nurses," she insisted.

Not everyone is on board with the program changes and Hathaway herself has addressed national audiences. "There is push back," she admitted. "One comment by physicians is that they just need bedside nurses and that's where the focus needs to be."

But Hathaway believes that nursing and medicine are two different yet complimentary professions, and that physicians will benefit from a new level of partnership with highly trained nurses. Spears' experience is the same.

"We're in a learning mode," she said. "We're hearing questions about what does this mean or how does this affect me? The questions are being asked and they are good."

Other reasons exist as to why programs are evolving. More students are professionals who are entering nursing with degrees in unrelated fields; nursing programs are focused on individuals with degrees.

UT is currently in the midst of reviewing curriculum, eliminating redundancies and adding courses. Spears noted that revision is needed. "If you take a multi-tiered track, there is redundancy and time loss," she said.

Hathaway explained the current trend is also a result of decisions made a decade ago. "Nursing educators caved to the idea of taking foundational science coursework out of degree programs and shortening programs of study," she said. The result is that nursing educations suffered.

Spears added that more and more research shows that having enough nurses isn't the only factor to consider. "It's about the right number and the right qualified nurses," she said.

Having strong clinical leaders and nurses who can access information is more important, according to Spears. "We're heading exactly in the direction we need to go in," she said. "Advancing education doesn't affect the direct delivery of care."


May 2007