The baccalaureate degree in nursing as an entry-level requirement for professional nursing practice

Accessibility in health professions education: The Flexner Report and barriers to diversity in American physical therapy

Health professionals do not reflect the broader racial/ethnic diversity of the United States. Historical barriers to accessing health professions education have played a major role in initiating and perpetuating these disparities. Sociologists of professions have highlighted the role of educational reform in professions' efforts to enhance their status, but have overlooked the central role of government bodies in facilitating or impeding these strategies. The Flexner Report (1910) enhanced the status of medicine, but only after state medical boards adopted its recommendations, leading to the closure of half of the nation's medical schools and limiting opportunities for marginalized populations to enter the medical profession. Physical therapy leaders have espoused Flexner's precepts in seeking to advance their field's professionalization. In doing so, they consistently overlooked the more insidious impacts of Flexnerian approaches on student and practitioner diversity. This article examines how physical therapy's Flexnerian ambitions disrupted its parallel efforts to increase the field's racial/ethnic diversity. I argue that physical therapy leaders' focus on enhancing their profession's status and indifference toward facilitating educational access and mobility played a significant role in the field's racial/ethnic homogeneity. To increase practitioner diversity in the future, especially following the 2023 US Supreme Court decision (600 U.S. 181) restricting race conscious affirmative action, health professions must do more to address barriers to student access. This will involve moving away from the Flexnerian model and pursuing approaches that have helped more diverse and inclusive health professions, like nursing, to achieve greater educational opportunity and mobility.

Exploring the availability of specialist health workforce education in East and Southern Africa: a document analysis

Background

Specialist health professionals improve health outcomes. Most low-income and middle-income countries do not have the capacity to educate and retain all types of specialists across various health professions. This study sought to explore and describe the opportunities available for specialist health professions education and the pathways to becoming a specialist health professional in East and Southern Africa (ESA). Understanding the regional capacity for specialist education provides opportunities for countries to apply transnational education models to create prospects for specialist education.

Methods

A document analysis on specialist training programmes for health professionals was conducted in twenty countries in ESA to establish the capacity of specialist education for health professionals. Data were collected from policy documents, grey literature and websites at the country and institution levels.

Findings

We found 288 specialist health professions education programmes across ten professional categories in 157 health professions education institutions from 18 countries in the ESA are reported. Medical and Nursing specialist programmes dominate the list of available specialist programmes in the region, while Kenya, South Africa and Ethiopia have the highest number of specialist programmes. Most included specialist programmes were offered at the Master’s level or as postgraduate diplomas. There is a general uneven distribution of specialist health professions education programmes within the ESA region despite sharing almost similar sociogeographical context and disease patterns. Current national priorities may be antecedent to the diversity and skewed distribution of specialist health professions programmes.

Conclusion

Attention must be paid to countries with limited capacity for specialist education and to professions that are severely under-represented. Establishing regional policies and platforms that nurture collaborations towards specialist health professions education may be a proximal solution for increased regional capacity for specialist education.

Towards increased relevance: context-adapted models of the learning organization

Purpose

– The purposes of this paper are to take a closer look at the relevance of the idea of the learning organization for organizations in different generalized organizational contexts; to open up for the existence of multiple, context-adapted models of the learning organization; and to suggest a number of such models.

Design/methodology/approach

– The suggested context-adapted models are deduced from works arguing that not all aspects of the idea of the learning organization should be adopted by organizations in some certain generalized organizational contexts.

Findings

– The idea of the learning organization needs to be reformulated, to some extent, to become fully relevant for public organizations, safety organizations, human service organizations and knowledge-intensive organizations.

Research limitations/implications

– To achieve a more inclusive contingency model than presented in this article, there is a need for further research examining the (full) relevance of the original learning organizational model for organizations in various certain generalized organizational contexts.

Practical implications

– Organizational actors could use one of the suggested context-adapted models fitting their particular organizational context as a starting point when considering adopting the learning organization.

Social implications

– Several adaptations suggested originate in social concerns.

Originality/value

– In contrast to most previous works on the learning organization, this paper adds to the existing literature by proposing several context-adapted models of the learning organization.

Professional excellence and career advancement in nursing: a conceptual framework for clinical leadership development

Increasingly, stakeholders in the health care community are recognizing nursing as key to solving the nation's health care issues. This acknowledgment provides a unique opportunity for nursing to demonstrate leadership by developing clinical nurse leaders to collaborate with the multidisciplinary care team in driving evidence-based, safe quality, cost-effective health care services. One approach for nursing success is standardizing the entry-level education for nurses and developing a uniform professional development and career advancement trajectory with appropriate incentives to encourage participation. A framework to guide and provide scientific evidence of how frontline nurses can be engaged will be paramount. The model for professional excellence and career advancement provides a framework that offers a clear path for researchers to examine variables influencing nurses' professional development and career advancement in a systematic manner. Professional Excellence and Career Advancement in Nursing underscores professional preparedness of a registered nurse as central to leadership development. It also describes the elements that influence nurses' participation in professional development and career advancement under 4 main categories emphasizing mentorship and self-efficacy as essential variables.

Preparing the nursing workforce of the future

Nurse shortages coupled with the need for national healthcare reform present a challenge. We are not preparing enough nurses nor are we preparing nurses with the right skills to fully participate in a reformed healthcare system. Historical forces in nursing education have resulted in multiple levels of entry into nursing practice and an inadequate nursing workforce. Today's environment of expanding knowledge, the call for interdisciplinary healthcare delivery teams, and evidence of the relationship between nurse education and improved patient outcomes strongly indicate the need for nurses prepared at the baccalaureate level. Requiring a baccalaureate degree for entry into nursing practice, and as the initial degree of nursing education would prepare nurses earlier for graduate education and the much needed roles of educator, researcher and advanced practice nurse. The nursing profession should take the lead in advocating for educational policies that would adequately prepare the nurse workforce of the future.

Histories of nursing: The power and the possibilities

This article challenges the dominant paradigm of understanding the history of nursing as only that of relative powerlessness. By moving away from the stance of educators deeply concerned about the inability of the profession to gain control over entrance requirements and into the realm of practice, we use examples from our own work to discuss alternate histories of power. We acknowledge historical circumstances of invisibility and gender biases. But we argue that when we look at the history of practice, we see as much evidence of strength, purpose, and successful political action. Finally, we call for an acknowledgement of the rich and complex nature of the many different histories we can tell in nursing. And we suggest that an admitted inability to advance in one area of the discipline has not meant an inability to move in others.

Establishing Consensus About the Baccalaureate Entry-to-Practice Policy

This article is based on the results of a qualitative study examining educational reforms in New Brunswick, Canada, during the 1980s. Using the province of New Brunswick as a case study, three issues related to the baccalaureate entry-to-practice policy are examined. First, the process of upgrading nursing education to a baccalaureate degree and the conflict this change created between the Nurses Association of New Brunswick and the New Brunswick Nursing Union are described. Second, the reasons leaders of the professional nursing organization desired to upgrade nursing education are examined, and third, the issues underlying the conflict over nursing education are discussed.

Preregistration Nursing Education in Australia, New Zealand, the United Kingdom, and the United States of America

The debate concerning nurses' diverse entry into practice was enlivened in 1995, when the American Nurses Association reaffirmed its contention that a baccalaureate degree was necessary for professional nursing practice. This debate may be informed by an appreciation of the educational routes taken by other countries that have changed from hospital-based to college-based nursing education. This paper describes and analyzes preregistration nursing education in Australia, New Zealand, the United Kingdom, and the United States, from the late nineteenth century to the present. Nurses in Australia and New Zealand are currently educated entirely at the baccalaureate level. In the United Kingdom, nursing education is in the process of becoming completely university-based, resulting in a diploma or degree. In the United States, the majority of nurses graduate from two-year associate degree programs. This level of education, briefer than in the other countries described, potentially limits nurses' professional contributions.