Educational Preparation for Nurses: A Critical Analysis

Much has been said in recent years about educational preparation for nurses, and specifically about whether an academic degree is preferable to a diploma when preparing students to meet the competencies of a new graduate. In Canada, “The Canadian Nurses Association (CNA) believes that the competencies required by new registered nurses to meet client needs are most effectively and economically achieved through university level baccalaureate education” (CNA, 2002). The CNA contends further that, “The goal of having a baccalaureate requirement for entry into nursing has been adopted throughout Canada by all provincial and territorial nurses’ associations.

The decision was taken based on trends affecting health care in Canada and the changing role of the nurse”. Nevertheless, explicit endorsement of this position in two Canadian provinces (Alberta and Quebec) and three territories (Yukon, Northwest Territories, Nunavet) remains elusive and optional (diploma programs for nursing education remain open), and in some cases quite perplexing (British Columbia) as the inception of college-based applied degrees takes place.

Currently, the education debate in nursing and resulting position statements on appropriate educational requirements and qualifications for entry into nursing appear to support academic preparation for nurses. At the heart of this implied preference however, are recurring themes and core narratives regarding efficiency, economy, shifting trends, and/or changing roles. Indeed, the exclusion of all reference to intellectual inquiry from a disciplinary perspective, conceptions of nursing science, and issues of theory, practice, and values in nursing in this debate is disconcerting, worrisome, and far from the goal of academic nursing scholarship and practice. Without doubt, time and economic commitments as well as changing health trends and roles have huge implications for students and educational institutions and must be con- sidered in any discussion of access to education and recruitment within the field of nursing.

These issues however, lack relevance for nursing qua nursing as a field of study, research, and practice. Moreover, failure to mandate a basic academic qualification for entry into nursing opens the door for differing educational institutions to offer diverse qualifications for the preparation of new graduates, compounding the struggle of eliminating multiple levels of entry into nursing. Furthermore, there can be little doubt that reducing arguments for appropriate and adequate education in nursing to social conditions provides the impetus for that education to be determined and imposed by governments, health and/or education administrators, as well as an array of professionals educated in other disciplines.

All too frequently, proposed changes to nursing education are set out as quick fix solutions to the fiscal and economic woes of healthcare. A perusal of related editorial features and letters in our newspapers from lay persons and other professionals–most notably physicians.

Understanding Ourselves as a Profession In our own experiences as nurse teachers, students, researchers, and practitioners, we have come to understand nursing as a practice profession and academic discipline. In order to substantiate this claim, we would like to unpack the language embedded in this statement and examine the notions of profession and discipline respectively. To begin, we submit that many people confuse the terms profession and discipline and use them interchangeably. There are however, numerous authors in nursing who stress the importance of understanding and considering the differences between and relationships among these concepts in shaping theevolution of nursing (Cody, 1997; Donaldson & Crowley, 1978; Parse, 1999, 2001b; Schlotfeldt, 1989).

A brief review of the literature aimed at locating the origins of professions revealed considerable information related to the Flexner Report. First published in 1910, the Flexner Report (Flexner, 1915) was designed to secure the dominance of allopathic practitioners who were prepared within university-based programs of education and guided by natural science research. Pursuant to his report, Flexner identified several criteria he believed were required for the establishment and legitimation of a profession.