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The article argues that the time has come to change California's 1960 Master Plan for higher education by permitting the California State University (CSU) to award the doctorate in selected professional programs. The article also addresses the inadequacies of the joint doctorate as the means to remedy degree or credential creep; the CSU's focus on securing permission to grant the Ed.D. rather than other professional doctoral degrees; and the dominant role played in the State by the CSU relative to the UC in master's level education. Subsequently, the article considers why degree and credential creep occurs and explanations for the changes going on in physical therapy and audiology; and it explores other fields where degree changes are in flux. (Contains 6 notes.)

Careful use of technology in education may enhance the ability of the nursing education profession to educate nurses for practice, prepare future nurse educators, and advance nursing science. To take full advantage of technology, several factors must be addressed. Superior distance education programs require substantial institutional financial investment, and program developers must consider coordination of services, hardware requirements, and ways to lower costs across state lines. Questions of intellectual property and copyright cannot be ignored. Technology-mediated teaching strategies can change the way teaching and learning occurs, and these strategies may change conventional thinking about how the quality of educational programs is assessed. It is already apparent that distance education technology has provided some nursing schools an advantage in recruiting students and is increasing competition among institutions. An appendix contains guidelines for the use of distance technology in nursing education. (Contains 16 references.) (SLD)

This position paper of the National Advisory Council on Vocational Education is written in response to the American Nurses' Association's (ANA) proposal, which calls for reducing a four-level system to two levels of nursing: the professional nurse, who would be required to have a bachelor of science degree in nursing, and an assistant technical nurse, who would have an associate degree in nursing and work under the supervision of the professional nurse. Among the findings of the council concerning the issue of entry-level nursing reported in the paper are (1) there is no conclusive evidence that the proposal will result in improved health care services; (2) implementation of the ANA position would eliminate the diploma nurse and the licensed practical nurse; (3) diploma nurse training programs, licensed practical nurse training programs, and associate degree programs currently offer viable options to persons desiring a career as a nurse; (4) all four types of nurse training programs produce valuable members of the health care delivery system; (5) implementation of the ANA position would increase the cost of health services; and (6) implementation of the ANA proposal would result in disfranchisement of career opportunities for and discrimination against several disadvantaged and special populations. Positions of health and relevant educational associations with respect to the proposal are appended. (LRA)

The National Advisory Council on Nurse Education and Practice (NACNEP) convened the Expert Workgroup on Diversity to advise the NACNEP on development of a national agenda for increasing workforce diversity. The workgroup's 18 members developed recommended goals and actions covering the following broad themes: (1) enhance efforts to increase the recruitment, retention, and graduation of minority students; (2) promote minority nurse leadership development; (3) develop practice environments that promote diversity; and (4) promote the preparation of all nurses to provide culturally competent care. The following were among the specific goals recommended: (1) increase the number of minority faculty in nursing programs over the number reported by the American Association of Colleges of Nurses for 1997-1998; (2) improve the evaluation and accountability for the outcomes of programs funded to increase diversity in nursing; (3) reduce social isolation of minority nurse leaders by increasing opportunities for professional development activities focusing on development of support systems; and (4) create and maintain workplace environments and employee support programs that promote and document recruitment, retention, and advancement of minority nurses. (The bibliography lists 25 references. Information about the workgroup's establishment and operation is appended along with a list of workgroup members.) (MN)

This paper discusses factors emerging from the health care reform movement that will shape health care service delivery in general and nursing practice and education in particular. First, cost concerns will increase moves toward managed competition which will, in turn, create changes in service use patterns. These patterns seem overall to tend toward decreased demand for professional nursing staff. These patterns will also eventually see nurses emerge with markedly different employment roles. One such role is likely to be a reshaped clinical nurse specialist role with nurses sometimes substituting for physicians. The current discontinuity between nurse practitioners' education and hospitals' desires to employ advanced practice nursing clinicians has seen a growing trend toward on-the-job training for acute care practice or toward development of acute care nurse practitioner training programs. One of the most important effects of health reform on nursing may be the need to define workforce supply in very different ways resulting in different workforce management and planning. Finally the paper argues that current and future medical research in genetic engineering will dramatically change health care decision-making, a change which nurses must be educated to handle. (JB)

This essay looks at training nurses in British Columbia (Canada) to be critical thinkers through the use of nurses' narrative notes of patient care. The paper argues that the registered nurse can use the Nursing Process, a nursing problem solving framework that relies on the nurse's ability to think logically, to critically reflect on care provided and to ensure safe practice. The Process is a five-step thinking framework based on a nursing assessment of patient needs in which subjective and objective data are collected. The data are analyzed, the problem is identified, and plans are created for resolution of the problem. The validity of the goals and the outcomes of the interventions are evaluated in the final step of the process. Each phase should be reflected in the patient care record. Teaching strategies that promote critical thinking skills in nursing students can be designed also as a means to promote self-evaluation. Analytic writing exercises based on the narrative nursing notes written by the student are used to facilitate independent learning. Students who are given opportunities to reflect on the nursing notes they have recorded can begin to recognize the imperfections in their thought processes and eventually to become independent critical thinkers capable of assuring the provision of safe, quality patient care. (JB)

Over the years, the nursing educational system has prepared nurses for the many settings in which health care is delivered. As health care shifts from a fragmented system of disparate providers and payers to integrated management systems, nurses and other health care professionals are experiencing tremendous changes. The nursing education system must continue to produce the most qualified nurses to deliver cost-effective and quality care. Educational mobility in nursing is the vehicle by which nurses and aspiring nurses gain new knowledge and skills through formal and informal educational offerings. Educational mobility should continue to focus on promoting high standards, maintaining the quality and integrity of baccalaureate and graduate programs, and emphasizing the attainment of program outcomes. The focus of higher learning should be on the socialization of student to new professional roles and the knowledge and skills needed for those roles. Educational mobility must encompass diverse approaches to continuous, life-long learning for nurses and those planning to become nurses. Higher education in nursing should be offered using creative and flexible approaches that are incorporated into curricula and reflect consideration of individual learning needs. Some strategies are suggested to implement these objectives. (SLD)

In response to the growing trend of using unlicensed assistive personnel (UAP) in hospitals, a study was conducted of faculty of associate degree nursing programs in New Jersey to determine which professional tasks they considered inherently safe for registered nurses to delegate to UAPs. A check-list survey was distributed to 104 faculty members at 13 nursing programs in the state, receiving responses from 48 teachers representing all 13 colleges and the major areas of nursing practice. An analysis of responses revealed the following: (1) among traditional tasks, those declared unsafe to be delegated by 50% or more fell into the categories of assessment and safety, emphasizing bacteriological, chemical, mechanical, and emotional safety; (2) only 10 out of 97 traditional tasks were deemed unsafe; (3) 55 of the traditional tasks garnered 90%-100% approval for delegation, while the 12 tasks that received 100% approval involved unit supportive tasks not directly involving patient care; (4) a total of 87% of 53 non-traditional tasks were deemed unsafe to delegate to UAPs; (5) for the non-traditional tasks, all 19 items dealing with asepsis were deemed unsafe by respondents, as were all 17 items dealing with safety and 10 items related to assessment; (6) the highest approval rating for a non-traditional task was using a UAPs report of patient temperature as the basis for administering an antipyretic; and (7) 56% of the faculty felt that UAPs should be certified and 65% desired state registration. (Contains 46 references.) (A cover letter and the survey instrument are appended.) (MAB)

Information technology has developed to the point of providing a means to manage nursing and related health-care data effectively for nursing administrators, educators, practitioners, and researchers. Therefore, the newly recognized area of nursing informatics is important to the nursing profession as a whole. Nursing informatics is defined as the integration of computer and information science into nursing-practice settings to enhance client care and the profession. Nursing schools and health settings, in which nurses must prepare for or function in their nursing roles, must fully utilize the nursing informatics capabilities currently available. Technologically enhancing nursing will ultimately improve client care. (Contains 4 references.) (Author/SLD)

This report was prepared in response to a mandate by the Texas legislature to study issues relating to the nursing shortage in Texas, career mobility among the various nursing programs, and collaboration among schools in geographic proximity. The data from the study were drawn from five public hearings, a survey of 60 nursing program directors, and discussions of the Nursing Study Committee. The study examines nursing education and licensing in Texas, including licensed vocational nurses, registered nurses, and advanced nursing degrees. The report analyzes the nursing shortage in Texas, Texas nursing programs' efforts to meet that shortage, the nursing faculty shortage, the impact of educational mobility on the shortage, and the changing population of nursing students. The Committee makes recommendations to the Texas Legislature, the Texas Higher Education Coordinating Board, the Board of Nurse Examiners and the Board of Vocational Nurse Examiners, and colleges and universities. Appendices contain the authorizing legislation for the study, minimum faculty qualifications for nursing programs, and statistical data on number of advanced degrees conferred in nursing, registered nurses employed in nursing by highest degree, and staff vacancy rates. (21 references) (JDD)

This paper attempts to place the available information on the nursing shortage in a broader context to improve understanding of some underlying issues. It considers available data on these issues to provide insights into the recurrent nurse shortage for a more rational basis for policy-making. Chapter 1 examines nurses' wages, wage growth, fringe benefits, and labor force participation rates, comparing each of them to similar information on other workers in the United States economy. Using that information, the chapter assesses conflicting interpretations of nurses' wage levels and labor supply behavior. Chapter 2 deals with nurse staffing and vacancies in hospitals; examines the origin and interpretation of data on budgeted vacant positions in hospitals, the most often cited evidence of the nurse shortage; and reviews studies of variations in staffing among hospitals for evidence of effects of shortages on hospital operations. Chapter 3 delves into determinants of the total supply of nurses in terms of factors affecting the annual numbers of entrants to nursing schools. A technical appendix provides information on estimation of starting salaries for registered nurses, regression results of a number of nursing school entrants, and specification error tests. (YLB)

As school health services are broadening, the role and scope of school nursing is changing. The paper describes challenges facing today's school nurses and nurses' roles in new health service delivery models, offering recommendations for improving and expanding school nursing services. Descriptions of several cases and model programs are included. (SM)

The uncritical designation of nursing as a science and an art creates vague images of nursing that suggest that the identity of nursing is not to be found in practice. Thinking and talking about nursing as a practice more adequately articulates the meaning of nursing as nurses encounter it. (JOW)

Proposes an alternative approach to community nursing assessment based on knowledge construction, including assessors' constructions of reality. Notes that qualitative methods such as triangulation allow for multiple viewpoints and evaluation of intangible aspects. (SK)

Fundamental features of excellent women's health care are as follows: awareness of women's lives and diversity, comprehensive life-span care, a range of services and providers, and accessibility. Policy recommendations include not limiting health care benefits to employment, focus on prevention and promotion, and expansion of advanced practice nursing. (SK)

Summarizes the results of an HIV/AIDS nursing care summit and presents recommendations for clinical practice, administration and policy, nursing education, and nursing research related to prevention and care. (JOW)

Responsible nursing practice cannot be realized under multicultural, relativist ethics. An alternate ethical basis for practice that is grounded in moderate realism is transcultural ethics, which argues that natural human needs, inherent in common human nature, can be determined empirically and what constitutes a good can be derived therefrom. (JOW)

Discusses the development of the roles of nurse practitioner and clinical nurse specialist and evaluates the strengths and weaknesses of each role in current practice and education. Concludes that inadequate justification exists for continuing both roles. (Author/JOW)

Discusses the increased use of unlicensed assistive personnel (UAP) in direct patient care delivery as a result of rising health care costs. Looks at advantages and disadvantages of having registered nurses supervise UAP and suggests that the model is not necessarily cost-effective. (JOW)

Rapid changes in health sciences necessitate frequent revision of nursing curricula. A system that prioritizes health issues by such factors as magnitude, quality of life, duration of illness, case fatality rate, and concurrent burdens can help determine essential curriculum content. (SK)

Presents a framework for multisite clinical studies based on research in 17 hospitals. Five areas of key research tasks are addressed: general systems design, public relations, human resource issues, data quality, and data management. (SK)

A professional practice model is a system that supports control over nursing care. It has five subsystems: values, professional relationships, delivery model, management approach, and compensation and rewards. Comparison of five health facilities provides guidelines for planning, implementing and evaluating a professional practice model. (SK)

Discusses what constitutes health care in society, the nature of the healer and healing, and rationing of health care. Outlines foundational values for a health care system: justice, patient autonomy, hope, and mercy, and suggests implications for health professions education. (SK)

Meta-analysis, one strategy nurses can use to influence public policy in health care, can amplify effects too small to observe in single or small studies, bring cost data to the fore, and highlight ramifications of local interest to policy- makers. (SK)

Clinical scholarship begins with reflective observation of patients but differs from clinical research. It results in knowing based on informed, intelligent, and clinically grounded analysis. It is a more appropriate approach for some kinds of problems. (SK)

The demand for baccalaureate-educated nurses continues to increase, and developed countries must accelerate their efforts with distance education. Developing countries must be encouraged and supported to respond to increased demands for well-trained nurses. (JOW)