Curriculum Development Issues in Nursing Education

Nurses make use of wide-ranging theories, models, knowledge, and skills in nursing practice. Both their skills and knowledge are gained from diverse methods — a few are "hidden" from practice. However, all sources of knowledge and skills ought to be assessed for quality and relevance, and should they fail to meet national standards, they ought to be discarded. Knowledge in the nursing profession helps nurses achieve the goals of patient care, since it reinforces what they do daily. Knowledge classifies and distinguishes nurses when compared with the related but distinct roles of doctors or physiotherapists, and helps to distinguish nurses from support-care workers and even lay carers. Knowledge, therefore, is what differentiates the nursing profession, since possessing a "distinctive form of knowledge" classifies a profession within a society. Curriculum consequently holds a significant place within nursing education (Hall, 2005).

The development of curriculum concerning nursing education faces considerable problems, in that the nursing profession must continue to stay abreast of the changes that take place in the healthcare sector in order to ensure the continuous delivery of safe, high-quality, and effective healthcare with a patient-centric approach. As such, curricula must be relevant not only to current trends but also anticipatory of and responsive to changes that may arise in the future. To remain up to date, new entrants to the nursing profession must be adequately equipped and educated with appropriate and relevant competencies, skills, knowledge, and attitudes, which may not always be readily available. The nursing practice of the 21st century faces several challenges, such as an increasing number of hospitalized patients who are both older and more seriously ill, which drives up the cost of healthcare and creates the need to stay updated on recent improvements in medical technology and knowledge.

An existing shortage of nurses complicates these challenges further, along with a rapidly aging workforce, inadequate nursing faculty members, and predictions of deepening shortages in nurse availability. Additionally, new models of general healthcare delivery are being created that will affect both care delivery and the workforce. To keep pace with an ever-changing healthcare delivery system, nurse educators are required to continuously assess and revise the educational approaches, curricula, and programs used to educate both new and practicing nurses. As a major component of the healthcare workforce, the nursing profession must remain current to ensure the continuous delivery of safe, high-quality, and effective patient care.

To stay updated, there is a clear need to train and equip new nurses with the right skills. In order for policymakers and educators to plan adequately for the future, the first necessity is an assessment of the requirements of the future workforce, as determined by the working environment and its expectations. Based on this evaluation, the primary goal of nursing educators will be to create educational techniques and curricula that prepare nurses to occupy those positions and fulfill those roles.

Policymakers can encourage these efforts by ensuring that the requirements of the healthcare system are being met through adequate resource allocation to supply the workforce required to train and educate future nurses. In the context of curriculum development in nursing education, one major issue is that graduates often believe they possess the required knowledge to perform well. However, managers and preceptors have reported that while graduates possess adequate knowledge of important skills required for practice, they often lack certain hands-on competencies — such as how to accurately insert an intravenous line, use healthcare information technology, chart patient information, and carry out other relevant interventions and tasks they could have practiced while in school or during clinical training (NACNEP, n.d.).

These are challenging times to work in the healthcare sector. Significant changes in the system are affecting care across every healthcare practice setting. Some of these changes include financial pressures, uncertainty about the direction of healthcare reform, regulatory agency mandates to improve patient safety and quality, looming workforce shortages, and an increasing number of patients. These changes challenge resource allocation decisions and negatively affect the working environment. Nevertheless, these same forces can open up opportunities for nurses and the broader nursing profession — including a stronger voice for nursing in healthcare policy, increased employment opportunities, and an improved image for both nurses and the profession. The stress experienced in today's workplace falls squarely on nurses' shoulders with respect to care (Tomajan, 2012).

The health of any nation is adversely affected by a shortage of nurses. Higher staff nurse ratios are associated with reductions in negative patient outcomes. Educational institutions find it very difficult to attract qualified Advanced Practice Registered Nurses (APRNs) who are willing to serve in faculty roles. The demand for APRNs in both diverse practice settings and educational institutions has simultaneously increased, but educational organizations are at a disadvantage due to their inability to offer competitive compensation packages. Constrained budgets lead to compressed salaries throughout higher education systems, which widens the gap between salaries available in clinical practice and those offered in teaching positions.

When APRNs enroll in PhD programs, they frequently graduate only to face the stark reality of the tenure process in research-driven educational institutions. The emphasis placed on faculty roles in conducting research and generating research revenues reduces the availability of PhD-prepared APRN faculty to directly supervise APRN students. One common result is that the primary responsibility for APRN clinical education falls on faculty who are ineligible for tenure and whose salaries are substantially lower than those of APRNs in clinical practice. Educational institutions that lack well-developed faculty practice models face additional barriers in encouraging and retaining the faculty needed to maintain licensure and certification while simultaneously meeting the criteria for tenure and teaching (Fitzgerald, Kantrowitz-Gordon, Katz, & Hirsch, 2011).

Internal plans are those that can be undertaken within nursing educational programs and their host universities, while external plans are those reflecting engagement with other organizations, including other nursing education programs and healthcare systems. A shortage of faculty — stemming from multiple converging factors — hampers the expansion of high-quality nursing education programs. These include supply-side challenges related to the nursing shortage itself and to competitive factors that reflect, among other things, the comparatively high cost of educating graduate nurses relative to the income potential of nurse educators. The internal efforts of educational institutions to strengthen and develop concerted partnerships have the potential to reduce faculty shortages and make more clinical resources available for APRN education (Malone, 2011).