Nursing Education and Professional Organizations in the US

Introduction and Objective

The objective of this paper is to examine whether national professional organizations — specifically the American Association of Colleges of Nursing (AACN), the American Nurses Association (ANA), the American Organization of Nurse Executives (AONE), and the National League for Nursing (NLN) — have advanced or hindered efforts to unify the nursing educational system. This paper further relates the policies and activities of these four organizations to the role and expectations of a professional organization, defines the nature of their membership and policymaking bodies, and evaluates the effect of those bodies on entry-level higher education.

A secondary focus considers clinical professions such as medicine, dentistry, pharmacy, and audiology, which require pre-professional education in a four-year liberal arts and science undergraduate program. In these disciplines, the first degree for professional education begins at the master's or doctoral level. Preparation for pharmacy, for example, now requires a six-year doctoral program. This paper addresses whether a similar approach represents a viable solution for initiating a unified system of entry-level nursing education, and offers a proposal in response.

The American Association of Colleges of Nursing (AACN) recognizes that the shortage of faculty in schools of nursing with baccalaureate and graduate programs is a continuing and expanding problem. Over the past several years, the deficit of faculty has reached critical proportions as the current faculty workforce rapidly approaches retirement and the pool of younger replacement faculty shrinks. The United States is presently experiencing an unprecedented shortage of registered nurses, a shortage expected to persist because of increasing demand for healthcare as baby boomers approach retirement and the nursing workforce continues to age (American Association of Colleges of Nursing, 2005).

The AACN identifies three primary categories of challenge for the future of nursing.

Primary Workforce Challenges in Nursing

1. Increasing Demand

Demand for nurses has exceeded supply in certain patient care specialties, such as critical care, cardiac, neonatal, and perioperative nursing. Demand is particularly acute in some geographic regions, partly due to the maldistribution of nurses across the United States — Massachusetts, for instance, has twice the number of nurses per capita as California. There is also intensified demand for baccalaureate-prepared nurses with skills in critical thinking, case management, and health promotion across inpatient and outpatient settings, as well as increased demand for culturally competent nurses with knowledge of gerontology and long-term care due to rapidly changing population demographics (American Association of Colleges of Nursing, 2005).

2. Slow Growth in Supply

The supply of new nurses has declined with falling numbers of applicants to schools of nursing. Faculty shortages make it difficult to expand student enrollment, a highly competitive labor market draws strong candidates away from health professions careers, and inaccurate media portrayals of nursing discourage young people from choosing it as a career (American Association of Colleges of Nursing, 2005).

3. Aging of the Nursing Workforce

The current nursing workforce is estimated at nearly 2.7 million, with an average age of 45.2 years; approximately 2.2 million are employed full- or part-time, with an average age of 43.3 years. The largest cohort of currently practicing nurses will be in their 50s or 60s within the next decade, with many expected to retire or reduce their hours. The average age of nurses is increasing at more than twice the rate of all other occupations in the U.S. workforce, and the number of nurses under age 30 decreased by 41 percent between 1983 and 1998 (American Association of Colleges of Nursing, 2005).

Scopes, Standards, and the Magnet Program

The AACN also notes that the Magnet Hospital study published in 1983 gave nursing leaders greater insight into the characteristics that attract and retain professional nurses in the national healthcare system. The investigation, conducted by the American Academy of Nursing of the American Nurses Association, examined hospitals nationwide known for successful nurse recruitment and retention (American Association of Colleges of Nursing, 2005).

The foundation for the Magnet Nursing Services program is the Scopes and Standards for Nurse Administrators (ANA, 1995). The American Nurses Association states that this program provides a framework to acknowledge excellence in four areas: (1) nursing services management, philosophy, and practices; (2) adherence to standards for improving the quality of patient care; (3) leadership of the chief nurse executive and competence of nursing staff; and (4) attention to the cultural and ethnic diversity of patients, their significant others, and care providers (American Association of Colleges of Nursing, 2005).

As the healthcare environment has grown more complex, the need for robust clinical experiences to support students and graduates in their transition has increased correspondingly. Also notable are differentiated nursing practice models — models of clinical nursing practice defined and distinguished by level of education, expected clinical skills or competencies, job descriptions, pay scales, and participation in decision-making (American Association of Colleges of Nursing, 2005).