Nursing education: current themes, puzzles and paradoxes.

It would be tempting to declare that transformation of nursing education in the current context of faculty shortages and other scarce resources as Mission Impossible. But I believe that the opposite is true. It is my sense that the rapid changes in healthcare, the shifting population needs and the acute nursing shortage have catalyzed fundamental change, perhaps the most profound in the 50 year history of WIN. The first steps of that transformation are becoming increasingly apparent as nursing faculty begin to challenge their long-standing, taken-for-granted assumptions; as they set aside differences and their internecine warfare of the entry-into-practice debates; as they begin stronger and deeper collaborations with their clinical partners. We won't see the evidence of these changes in the literature for a while, because they are just getting started. There's not a lot to report yet. Here are some examples of the changes afoot: The Oregon Consortium for Nursing Education has resulted from unprecedented collaboration between community college and university faculty, with an eye to develop a standard, competency-based curriculum to prepare the "new" nurse, and to improve access to a seamless baccalaureate curriculum. The first students were enrolled in nursing courses in fall, 2006 on 8 campuses--the four campuses of OHSU and 4 community colleges, with additional community college campuses admitting students in '07 and '08. In this curriculum, fundamentals of nursing have been redefined as evidence-based practice, culturally sensitive and relationship-centered care, leadership and clinical judgment, with these concepts and others introduced early and spiraled throughout the curriculum. Through a 2-year faculty development program, faculty leaders in the OCNE partner programs have taken to heart the many lessons about learning, intentionally attending to content selection that will help reduce the volume while focusing on the most prevalent. Instructional approaches have been tremendously changed, with an emphasis on case-based instruction, integrating distance delivery technologies, and using simulation, drawing on best practices in the development of these approaches (Billings, et al., 2001; Issenberg, et al .2005; Jeffries, 2005). OCNE leaders obtained funding from Kaiser Permanente Northwest to begin the long, collaborative, consensus building process to transform clinical education. Evaluation has and will continue to be an integral part of this work, with an eye to adding to our collective knowledge of best practices in nursing education. We see evidence of similar efforts, mostly state or regional, in order to build on prior alliances, acknowledge geographic particularities, and respond to local needs in many other parts of the country, from Hawaii to New Jersey, Texas to Montana. The nursing shortage has been a primary catalyst. It has captured the interest of potential funders, individual donors, foundations to the Federal government. The keys are collaboration and a collective voice for nursing, a willingness to work through long-standing and divisive issues, and most importantly, a moral commitment to the populations we serve.