Nursing education is evolving to accommodate new generations of nurses, says this nurse educator.
Amidst one of the largest workforce shortages in healthcare history, CNOs are looking for ways to recruit new graduate nurses now more than ever.
Many health systems are partnering with nursing schools and other academic institutions to help raise the next generation of nurses and create pipelines into the industry. CNOs need to stay up to date on the current state of nursing education to maximize the potential of incoming new graduate nurses.
There are several reasons for the nursing shortage, and according to Dr. Jason Dunne, chief academic officer at the Arizona College of Nursing (AZCN), the American Association of Colleges of Nursing (AACN) anticipates that 1,000,000 nurses will retire by 2030.
“At the same time, I think our population is aging and living longer, creating higher demands for nurses,” Dunne said, “and in recent years, the pandemic only exacerbated the situation, and many nurses opted to leave the profession early, unfortunately.”
Additionally, the Bureau of Labor Statistics (BLS) expects the nursing workforce to expand by 6% over the next 10 years, Dunne explained. Nurses are also experiencing high levels of burnout, which is also causing them to leave the profession.
“The other piece that’s near and dear to my heart is nursing school enrollment is not keeping pace with the demand for new nurses,” Dunne said. “So even with the high interest in the profession, many qualified applicants across the country are just not being admitted because there’s not enough spots for nursing program applicants.”
Several factors are blocking students from enrolling in nursing programs, according to Dunne, including funding from the federal and state governments, and clinical availability. Nursing schools also struggle with recruiting faculty, specifically those who have at minimum a master’s degree.
“As students progress to the nursing program, they actually need clinical experiences and health systems to hone skills and be competent, so those are not as readily available as we’ve been moving forward,” Dunne said. “It sounds like a perfect storm as you think about the future of nursing.”
Preparing career-ready nurses
Nursing schools must provide the proper curriculum for new graduate nurses so that they can enter the clinical environment equipped with the necessary skills for modern nursing.
To Dunne, there are a number of qualities that nurses must learn to ensure career longevity.
“One of the things that’s top of mind for me is critical thinking skills, which really forms the basis of how we approach situations in terms of analysis, integration, [and] prioritization,” Dunne said, “and that forms the foundation of this term called clinical judgment, which is an essential component of safe clinical practice.”
Nurses also need to understand the burnout risks associated with the position. According to Dunne, 52% of nurses are considering leaving their current position due to insufficient staffing. To combat burnout, it is essential that nurses learn self-care.
“[Nursing educators must help] new nurses understand what [self-care] means and really intentionally build it into a nursing curriculum,” Dunne said, “so folks out of the gate are understanding how to take care of themselves, [and] how to fill their cup.”
New graduate nurses must have an awareness and appreciation for patient diversity as well, said Dunne, since the world is diverse and culturally rich.
“That creates a level of complexity for nursing that nurses need to possess cultural competency,” Dunne said, “meaning having the skills and abilities and skillset to really take care of patients and their families from a variety of cultural backgrounds and settings.”
Communication and multitasking are other key components for new nurses as the industry continues to evolve.
“You don’t have to change careers to change your job,” Dunne said. “There’s so many diverse opportunities for nurses, you may get tired of one spot, [but] there’s so many opportunities for nurses to pursue other experiences.”
Evolving with new generations
CNOs also must be aware of how nursing education is changing to accommodate the viewpoints and expectations of new generations. The integration of technology has shifted nursing education just as much as it has revolutionized the rest of the healthcare industry.
Dunne explained how the use of high-fidelity simulation and new mannequins alone has shifted nursing education tremendously by mimicking human situations and experiences. Online learning, virtual reality, AI, and virtual science labs are also on the rise, which warrants an increase in data literacy education.
“Having these experiences for our students allows them to engage in patient care scenarios in a safe environment,” Dunne said, “really helping them to build the necessary clinical judgment skills that are essential for safe practice.”
Competency-based education is a concept that has gained momentum, according to Dunne.
“Now it’s [about] the demonstration of specific competencies, [and if] students are gaining the learning they need as they move forward,” Dunne said, “and many programs actually tailor education experiences to the individual student needs where they are.”
Interprofessional education has become front and center as well. Working with other members of the healthcare team has proved to be extremely beneficial, Dunne explained.
“Learning alongside each other, understanding roles [and] responsibilities as you get out into the healthcare world really helps to create great patient outcomes,” Dunne said.
Mental health and a focus on holistic patient care are also priorities in current nursing practice, along with the idea of lifelong learning. Generational differences also need to be addressed in nursing education, since new nurses prefer more collaborative and technological approaches to learning, Dunne explained. There is also a much stronger focus on ethics and social justice, in both nursing education and patient care.
“Healthcare continues to evolve and become more complex,” said Dunne, “so we’ve got to keep pace in order to provide safe, effective care to our patients.”
Bridging the gaps
To fill spots in nursing programs, nursing schools need to tailor the academic experience to better suit the students as they move through the curriculum, Dunne said. Academic institutions must provide resources and remove obstacles, and remember that being a student is not as traditional as it used to be.
“The folks that we serve, they have families, jobs, children, other priorities, and it’s really important for nursing schools to help students navigate life so they can be successful academically,” Dunne said. “If we don’t help them build those life skills, academics is not even on the priority list.”
Nurse educators need to see the whole student, Dunne explained, and align their program’s mission values with the social justice values that nursing students care about.
“We at Arizona College sponsor students to be part of the National Black Nurses Association, the National Association of Hispanic Nurses,” Dunne said, “and we just want to create a culture where students are engaged and active members of the learning process.”
For CNOs, partnering with nurse educators and academic institutions to create pipelines into the industry is an essential component of sustaining the nursing workforce, Dunne stated.
“I believe schools need to work closely with clinical partners to ensure that curriculum and training aligns closely with the needs of the workforce,” Dunne said. “Nursing education, programs, [and] schools need to keep pace, so our students are workforce relevant.”
AZCN offers a BSN program at 20 campuses across 13 states, and is designed to prepare students for their careers as registered nurses. At each of these campuses across the country, they have community advisory boards that include the healthcare partners in each campus’ local community.
“These advisory boards are essential to creating those synergies between academic teams and the practice teams,” Dunne said, “to ensure lines of communication are open and also that we’re able to be responsive to the needs of our practice partners [with] how quickly health and health information [are] changing.”
Nurse residency programs, joint faculty appointments, mentorship between academia and practice, scholarships and grants, and tuition reimbursement programs are all ways that academic institutions and health systems can partner to recruit and retain more nurses.
Lastly, Dunne recommended that nurse educators and nurse leaders come together to be the unified voice and advocate for the nursing profession.
“As we know, nursing is a trusted profession,” Dunne said, “and we really need to continue to advocate for the needs of our nurses, short term as well as long term.”
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Many nurses have ethical concerns about generative AI, along with worries about job displacement and the potential loss of human touch and connection with patients. For CNOs and other nurse leaders, implementation is another big concern.
It's critical that CNOs incorporate AI into workflows in a way that will help nurses and patients, and not become a hinderance. According to Robbie Freeman, vice president of digital experience and the chief nursing informatics officer at Mount Sinai Health System, nurses need to have a seat at the table during decision making to make implementation go smoothly.
"One of the things that I think will be important as we start to see AI make its way into patient care is that our care team members, our nurses, have a seat at the table," Freeman said, "and that their voice is included in how we design these AI products, understand how they work, and then implement and ensure that it's a seamless experience."
At Mount Sinai, Freeman said they take a co-design approach to decision-making surrounding AI products, meaning that everyone sits down together at the table, including data scientists, engineers, and frontline team members, to design the best product that will work for everyone.
"Some of our best ideas come from our frontline team and our nurses," Freeman said. "Anyone in our organization can submit a request for an AI concept or idea, and we have many examples where the frontline team has sent us an idea, we would scope it out together, and where it makes sense, we would partner, develop, and bring it to life."
The goal is to help reduce the burden of documentation and improve the ability to keep patients safe while delivering high quality care, Freeman explained.
"I think when done in the right way, we can do a lot," Freeman said, "but we want to make sure that the key is having the nursing voice at the table along the way."
"It was inspired by the five rights for medications," Freeman said, "so we took that, and we wanted to look at it through the lens of AI."
Freeman said the authors came up with five things that are important to consider while implementing AI. Leaders should first identify the right objective, meaning the problem they want to solve with AI.
"[Make] sure that [it's] really clear why you're using the tool and the problem that you're solving," Freeman said.
Second, CNOs need to consider the right approach, while making sure that the AI will be integrated into the workflow and that the approach makes sense. Third, CNOs must have the right competency on the team that will be using the AI, and make sure that the team members understand the "why."
"We don't want to just blindly follow the output of an AI model," Freeman said, "because we really look at this as an augmented intelligence tool and it's not going to ever replace our clinical decision-making."
Fourth, the right data is critical. CNOs need to understand how the data is sourced and interpreted by asking questions about how the AI was trained. Fifth, any implemented AI tool must have the proper safeguards.
"We [need to] make sure that we've tested it prospectively, we understand how it works, we've checked for bias, and that we've ensured that those steps were taken before it gets used for clinical care," Freeman said.
For nurse leaders
The goal of this framework is to empower nurse leaders with a set of high-level questions to ask before they implement an AI product, according to Freeman.
"If this was written for an audience of data science experts, we may get into some more technical discussions on hyperparameter tuning, or the way things are working under the hood," Freeman said, "but we tried to keep it at the business leader [and] clinical leader perspective to make sure we're at least addressing those big boulders."
However, health systems still should utilize those teams to work on the details, Freeman recommended.
"[As organizations] think about their AI governance structure, they need to have teams that can do that deeper dive into the very technical evaluations around the model," Freeman said, "like performance and how you're going to measure that over time, and watch for performance drift, and other considerations."
"This was really through the lens of a nurse manager or nurse leader," Freeman said, "and it's not meant to replace organization-wide, overarching, robust governance processes that are also critical."
Taking action
To move forward with AI implementation, Freeman recommended that CNOs ask about AI governance and make sure that nurses have a voice at that table. Nurse leaders should have a voice in any tools that are used at the point of care by the frontline nursing team.
"I think the CNO plays a really important role there advocating for the nursing team, advocating for the safe and ethical use from the patient perspective as a patient advocate, and ensuring that they have a voice within the governance process," Freeman said. "I think that organizations who do that well are going to be really well positioned to realize a lot of value from their use of AI."
CNIOs can also be a great partner for CNOs, Freeman explained, since they can help with communication between the technology teams and the clinical teams.
"I would encourage our CNOS and chief nurse executives to lean on their CNIOs and their nursing informatics team members who can play a really important role here," Freeman said.
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