No matter how they were educated, most if not all nurses can tell you that the math is off.
The U.S. spends almost 20 percent of its GDP on medical care. Its health outcomes stubbornly remain worse than other wealthy countries and many middle-income ones as well.
Now, by reimagining that education, the Johns Hopkins School of Nursing has begun the process of prepping nurses ready not just to see the problem but to fix the entire equation. It means “transforming nursing education into a responsive, adaptive, competency-based system that allows diverse learners from any background to succeed,” as Dean Sarah Szanton, PhD, RN, FAAN, and Executive Vice Dean Robert Atkins, PhD, RN, FAAN, Anna D. Wolf Professor for faculty affairs, write in the Stanford Social Innovation Review.
Nurses, filling the largest percentage of health care jobs—and as the most trusted profession in the U.S. for 20-plus years running—are an obviously good place to start.
Atkins and Szanton also lead the team behind “Reimagining Nursing Education: Leveraging Competency-Based Education, Artificial Intelligence, and Simulation for a Diverse and Practice-Ready Workforce” (Nursing Outlook). The rest of the groundbreaking group: Associate Professor Kristen Brown, DNP, CRNP, CPNP-AC, FAAN, associate dean for simulation and immersive learning; Associate Professor Shawna Mudd, DNP, MBA, CNE, FAAN, associate dean for academic affairs; and Associate Dean Deborah Baker, DNP, AG-ACNP, NEA-BC, FAAN, senior vice president for nursing for the Johns Hopkins Health System. (Kimia Ghobadi, John C. Malone Assistant Professor at the JHU School of Engineering, is also a co-author.)
These leaders together know the nursing path from classroom to clinical practice to research and policy. With decades of experience, they helped pave it and patch any potholes along the way.
The idea isn’t a 180-degree pivot for nursing education. About 60 percent of 4 million U.S. nurses work in hospitals, providing crucial, specialized care aimed at the immediate treatment and stabilization of patients. This means most of the workforce is trained for hospital work. It’s a reactive approach to health, prioritizing the treatment of disease and illness while doing little to address social determinants of health, such as educational and economic status.
What if, Johns Hopkins Nursing leaders asked, education could be focused “upstream”? Why not train students to provide community-oriented nursing—preventive, chronic, and restorative care of individuals in their homes and communities—and address social determinants of health and health inequities? In other words, you could keep people from becoming so sick that they need inpatient stabilization in the first place. Hospitals remain essential but less short-staffed and community health improves.
Competency-based System
A shift of health care from hospitals to community sites means nurses better prepared to attend to the needs of an increasingly diverse U.S. population. Admitting diverse learners, individually calibrating learning to their skills, on their own timeline, and training them in communities is a key to success.
According to the American Association of Colleges of Nursing, about 80 percent of registered nurses are white and nearly 90 percent are women. Meanwhile, studies show that trust grows and health outcomes can improve when patients see caregivers with similar backgrounds. Easing that conundrum means reaching communities of talented potential learners who might struggle to balance strict school schedules with outside work/family needs or who might be put off by a lack of people who look like them—ill at ease with a traditional white, female, test-and-checklist education.
Thus a shift to competency based education, or CBE, which prioritizes students’ mastery of real-world, core competencies over grades on a test. They learn a skill, then practice it until their proficiency is clear and demonstrable. Learners move faster through material they find easy and more slowly, with more coaching, through topics they struggle with. Students have ownership of and responsibility for their learning.
CBE builds on the proven success of simulation training, which allows students to experience and grow from failure as well as success in a safe space before they practice on human patients. Artificial intelligence also has an important role, but it is not a future of robots or robotic teaching, insists Szanton. AI will allow faculty to mold curriculum to match the educational and scheduling needs of any and all students.
Add existing programs like the Outside Track, which relocates student clinicals to outpatient and other non-traditional spaces, and you’ve got a program rebuilt “to prepare practice-ready nurses for as many diverse nursing roles as possible,” Atkins explains. And curriculum can be flexed to meet challenges that appear on the horizon.
Can Do, Must Do
This does not mean lowered standards of education—or the end of tests. It’s just that students in a CBE program must prove they excel at more than taking tests.
Importantly, it isn’t only students who must adjust. Faculty trained in traditional methods will need to learn along with the student body, growing as coaches as well as instructors. That process, too, is well under way. And timing matters: Cohorts already enrolled will complete the excellent Johns Hopkins Nursing education they began but might look over their shoulders at what they’re missing. In all things nursing, communication is key. And success, insist Szanton and Atkins, is a must.
“If we, as a nation, can achieve the goals we have outlined—of admitting diverse learners, individually calibrating their learning to their skills, on their own timeline, and training them in communities—we will have gone a long way toward improving the health of this country.”