Christine A Tanner

Transforming Prelicensure Nursing Education: Preparing the New Nurse to Meet Emerging Health Care Needs

The Carnegie Foundation for the Advancement of Teaching joins a chorus of calls for transformation of prelicensure nursing education (Benner, Sutphen, Leonard, & Day, 2009). Citing the shift of significant responsibility to nurses for managing complex medical regimens, as well as the increasing complexity of community-based practices, Benner and colleagues concluded that nurses entering the field are not equipped with the essential knowledge and skills for todays practice nor prepared to continue learning for tomorrows nursing (p. 31). They found: a) weak curricula in natural sciences, technology, social sciences, and humanities, and in developing cultural competency; b) weak classroom instruction and limited integration between classroom and clinical experiences; c) limited strategies in helping students develop habits of inquiry, raising clinical questions, seeking evidence for practices; d) faculty and student perception that students are ill prepared for their first job and dissatisfaction with the teaching preparation of current nursing faculty; and e) multiple pathways to eligibility for the licensure examination, with tremendous variability in prerequisites, curricular requirements, and the quality of offerings.

From beginner to expert: gaining a differentiated clinical world in critical care nursing.

The purpose of this study was to further explicate the Dreyfus Model of Skill Acquisition in the practice of critical care nursing. For this analysis data were used from a sample of 105 nurses practicing in the adult, pediatric, and newborn intensive care units of eight hospitals in three metropolitan areas. The data were composed of group interviews in which nurses gave narrative accounts of exemplars from their practice and close observations and intensive personal history interviews of a subsample of nurses. Two interrelated aspects were found to distinguish four levels of practice, from advanced beginner through expert. First, practitioners at different levels of skill literally live in different clinical worlds, noticing and responding to different directives for action. Second, a sense of agency is determined by ones clinical world and shows up as an expression of responsibility for what happens with the patient.

Diagnostic Reasoning Strategies Of Nurses and Nursing Students

This study described and compared the cognitive strategies of diagnostic reasoning used by junior nursing students (n = 15), senior nursing students (n = 13), and practicing nurses (n = 15). Verbal responses to three videotaped vignettes provided the data. Findings suggested that diagnostic reasoning processes of both nurses and nursing students can be described by a general model developed from studies of physicians. Subjects activated diagnostic hypotheses early in the encounter and used systematic information gathering to rule in and rule out hypotheses. With increased levels of knowledge and experience, there was a trend toward more systematic data acquisition and greater accuracy in diagnosis. The number of hypotheses activated, the earliness with which they were activated, and their diagnostic accuracy were task-specific components of the process, but selection of data-acquisition strategies appeared to be more generalizable across cases.

The Oregon Consortium for Nursing Education: a response to the nursing shortage.

The Oregon Consortium for Nursing Education (OCNE) is a statewide coalition designed as a long-term solution to the nursing shortage and in response to the need for a new kind of nurse to care for Oregons aging and increasingly diverse population. It is an effort to increase capacity in schools of nursing by making the best use of scarce faculty, classrooms, and clinical training resources in the delivery of a standard curriculum on 13 campuses, including 8 community colleges and the 5 campuses of the OHSU School of Nursing. This article describes the development of OCNE, including infrastructure development, creation of the shared curriculum, redesign of clinical education, faculty development, and plans for evaluation. If OCNE is successful in achieving its goals, it holds substantial policy implications for the development of nursing education systems, design of curricula, use of simulation as a component of clinical education, and delivery of clinical education.

Reflections on the Curriculum Revolution

For me, the curriculum revolution means opening up new possibilities for the ways in which we educate our students. It means a new consciousness about the place of nursing in responding to the health-care needs of our nation. It means coming to terms with the conflicts and contradictions that we as educators have felt for at least the last decade; these conflicts lie in our understanding of the crisis in health care and the demands on us to educate caring, critically thinking nurses who can safely practice in both todays world of high-tech disease care and tomorrows world of true health care. The curriculum revolution means healing our wounds from the divisive issues of the past, and joining together in charting our future.

Predictors of Patient Satisfaction With Telephone Nursing Services

Patient satisfaction has been shown to be a factor in clinical outcomes, health care quality, and patient follow-through. Thus, a high level of satisfaction is a desired outcome of patient care. This article examines predictors of patient satisfaction with telephone nursing services among a sample of 1,939 respondents, using a conceptual model derived from the literature and preliminary work. The study was conducted in medical offices and call centers of a large national health maintenance organization. Calls were taped and content coded and then matched with caller questionnaire data. In the final multivariate predictive models, patient health status; caller ratings of expectations met by the nurse for listening, clarity, and collaboration; and nurse competence were the strongest predictors of satisfaction. Consistent with the literature, findings suggest that nurses should expand interpersonal communication skills, and systems should reduce barriers to effective listening, clarity, and collaboration with callers.

Research in Nursing Education: Assumptions and Priorities

The purposes of this study were: to identify assumptions about the nature of research in nursing education, and to identify and rank order critical research questions regarding nursing education. The Delphi survey technique was used with 121 nurse educators responding to three survey rounds. The panel concurred with the assumptions that research in nursing education can and should meet criteria for scientific merit, should not be viewed as secondary in importance to nursing practice research, should emphasize the clinical nature of nursing, and needs to be less fragmented. Priorities for research included the following topics: integration of research findings into nursing curricula, development of problem solving skills, approaches to clinical teaching, and level of practice of graduates of different basic preparations.

Association of Faculty Perceptions of Work–Life With Emotional Exhaustion and Intent to Leave Academic Nursing: Report on a National Survey of Nurse Faculty

The current and projected nurse faculty shortage threatens the capacity to educate sufficient numbers of nurses for meeting demand. As part of an initiative to foster strategies for expanding educational capacity, a survey of a nationally representative sample of 3,120 full-time nurse faculty members in 269 schools and programs that offered at least one prelicensure degree program was conducted. Nearly 4 of 10 participants reported high levels of emotional exhaustion, and one third expressed an intent to leave academic nursing within 5 years. Major contributors to burnout were dissatisfaction with workload and perceived inflexibility to balance work and family life. Intent to leave was explained not only by age but by several potentially modifiable aspects of work, including dissatisfaction with workload, salary, and availability of teaching support. Preparing sufficient numbers of nurses to meet future health needs will require addressing those aspects of work-life that undermine faculty teaching capacity.

Tool Development for Measuring Caller Satisfaction and Outcome with Telephone Advice Nursing

Caller descriptions and evaluations of their experiences with telephone advice services provide unique information that correlates highly with objective measures of quality and can help interpret data from other sources. An author-developed questionnaire assessed caller outcomes of telephone nursing advice. In Phase I an iterative, purposive sample of 40 callers was interviewed by phone. An emergent design was used to develop questions, analyze constructs of interest, and test questions for a draft caller questionnaire, which was tested in Phase II. Responses to the questionnaire provided information about caller characteristics, advice call characteristics, and nurse practice behaviors that caused the authors to further revise the questionnaire. The resulting tool provides feedback to advice nurses about the outcomes of their practice and information to design orientation and development programs and support fund allocation decisions.

A model for examining predictors of outcomes of telephone nursing advice

Although telephone advice nursing is the fastest-growing nursing specialty, useful information to guide managers’ decisions about how best to structure and support advice services to achieve desired outcomes is unavailable. We identified issues and variables relevant to outcomes of telephone advice from the perspectives of callers, nurses, and the system. Subsequently, we derived a model for studying factors affecting nursing advice outcomes that will help managers identify modifiable factors to improve outcomes of care.