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KEYWORDS Summary In this paper, I reflect on what can be learned by engaging in future
Nursing education; thinking within our discipline, and what implications the results of that thinking
Trends; may have for the development of nursing education. Recognizing the marvelous
Nursing profession; diversity of perspective within our discipline with regard to what will and ought
History of nursing to be our future mandate, it seems reasonable to search for some grounding in what
might ensure that we enter that future wisely. We all know that change is a funda-
mental characteristic of all future projections, and yet that insight seems a weak
justification for failure to plan. Nurse educators hold a particular obligation to
ensure that they are preparing the professionals who will take that future forward.
Although we have always recognized that they must nurse for today with an eye on
tomorrow, it is inordinately difficult to come to some agreement on how we can best
bridge that gap within our educational programs and strategies. Toward this end, I
draw on lessons that can be drawn from our professional history as a rich and vibrant
context to propose some key issues for that future theorizing.
c 2006 Elsevier Ltd. All rights reserved.
This article appears in a joint issue of the journals Nurse Education Today Vol. 26,
No. 8, pp. 614621 and Nurse Education in Practice Vol. 6, No. 6, pp. 306313.
0260-6917/$ - see front matter c 2006 Elsevier Ltd. All rights reserved.
Nursing education: Key issues for the 21st century 615
future wisely. We intuitively understand that look- corporate structures have been undergoing unprec-
ing beyond what we can immediately grasp be- edented upheaval, and social institutions such as
comes an imperative if we are to withstand the the university are exploring new mechanisms for
forces of change and cling on to what we in nursing relevance and accountability. Within our various
hold most dear. And we recognize that whatever health care systems, there have been massive glo-
our trepidations, that future will still unfold with bal shifts in professional autonomy, public engage-
its own commanding trajectory. ment, and system redesign (Romanow, 2002). With
We who carry the torch for nursing education our colleagues across the full range of health disci-
hold a particular responsibility for our part in this plines and social policy sectors, we have begun to
future thinking. Our core business is the prepara- realise that 10% of the worlds health problems re-
tion of the next generation of nurses so that they ceive 90% of the worlds health resources and that
might take their rightful place in a world order that this is no longer defensible (Global Forum for Health
we can only begin to comprehend. We craft knowl- Research, 2004). Our tolerance for a have/have not
edge frameworks, conceptualizations, and theoret- world is rapidly shifting as we realise the inherent
ical structures so that an infinite set of new ideas and immediate global impact of economic inequi-
will arise out of the mist and take shape in the ties on such shared problems as epidemics.
world of nursing practice. In this paper, I argue that There has also been a corresponding reflexivity
what guides us is not simply our capacity to project within academic medicine that seems unprece-
the details of that future but rather, more impor- dented within our lifetime. The International Cam-
tantly, to learn from our past. Drawing on our paign to Revitalize Academic Medicine (ICRAM)
philosophical foundations, the values and ideals Project (Tugwell, 2004) involves stakeholders rep-
upon which this nursing profession is grounded, resenting academia, business and industry, govern-
we find substance that can help us reflect upon ment and policy makers, journal editors, patients,
what and who we are, and how we might carry that professional associations, students and trainees.
ontological essence into the future. In this context, Operating through a core working party of 20 med-
I propose what I consider to be key issues for nurs- ical academics representing 14 countries, its expli-
ing education as we embark upon the coming cen- cit mandates are to (1) redefine the core values of
tury key issues for all of us to grapple with in and contribute to the evidence basis for academic
our quest for ensuring that the core values inherent medicine; (2) develop strategy around reformed
in nursing of the past find purchase within the diz- academic medicine, and (3) stimulate a public de-
zying possibilities of our collective future. bate on the future (International Working Party to
Promote and Revitalise Academic Medicine,
A time for reflection 2004). Toward those ends, the project has gener-
ated scenarios depicting what the world might look
A century change is a natural and important time like and how academic medicine might move for-
for reflection and reconsideration. With half of ward toward leadership rather than reactivity
the millenniums first decade now past, we recall (Clark, 2005). Among the observations arising from
with humour how frightening it was when we made analysis of the common features of these scenarios
that transition from 1999 to 2000, sure that all of are the suggestions that: academic medicine will
our computer-based society would fall apart with have to put more effort into relating to its stake-
the digital adjustment, and also worried that, hav- holders; that it will also have to become more glob-
ing lived all our time in years beginning with the ally minded; that while teamwork will be
digits one and nine, that we would not know how increasingly important, individuals will also have
to feel this new millennium. Having now found to shine and to flourish; that teaching, researching,
our way into it, we discover that in most aspects improving, leading and providing service will con-
it is not all that different from the decade that tinue to be important, but expecting individuals
went before. We still struggle with the same health to be equally competent in them will be recognized
care reform issues, still worry about impending as increasingly impractical; that competition
nursing shortages, and still battle with the same among academic institutions is likely to increase;
funding agencies to consider nursing educational and that academic institutions will need to become
scholarship a viable form of research. increasingly businesslike and more adept at using
Coincident with this same millennium transition, media (paraphrased from Clark, 2005).
we have seen considerable reflective reinvention In highlighting what our colleagues in academic
within many of societys institutions (Inayatullah medicine consider the real imperatives, these obser-
and Gidley, 2000). National governments have been vations reflect many of the issues about which aca-
rapidly cycling from left to right and back again, demic nursing should also be profoundly concerned.
616 S.E. Thorne
also have to ensure that it comes well prepared more highly acute all the time. Instead, many
with humility; each of these fields is enormous, nurses will necessarily be shifting attention toward
vast, and complex, and oversimplifying them would the burden of chronic illness, whether we encoun-
ultimately disserve us in meeting those objectives. ter it in hospitals, ambulatory clinics, or in commu-
We must not only remain credible to ourselves, but nities. And this shift will not simply involve a new
to an increasingly sophisticated and critical audi- orientation to skillsets, but also to undoing those
ence of interprofessional team members, public structures and processes we have put into place be-
policy decision-makers, and health care consum- cause the assumptions inherent in acuity (patient
ers. So that delicate balance between confidence passivity, professional expertise and so on) have
in what we do know and reverence for what we become part of the problem in chronic illness care.
do not and cannot know will have to be a hallmark We will also be increasingly learning to work with
of that knowledgeable nursing workforce of the unregulated care workers, coping with new pres-
future. sures such as the generic Health Care Worker
that has cropped up in some jurisdictions, and
working more effectively with the meaningful hu-
Evidence man social groupings that we historically related
to as if they were all nuclear families.
One prominent aspect of disciplinary knowledge in
which we will need to steer a radical shift has to do
with what it means to make claims related to evi-
Global context
dence-based practice. The language of evidence
will increasingly shape policy and resource alloca- We are also fully aware that nursing education can
tion, and so we need to be collectively conversant no longer afford to prepare practitioners for highly
with it and to have a strong cadre of our member- specialized local settings to meet immediate work-
ship who speak that language fluently. In particu- force needs. We all know that nurses will move
lar, we need to move, quite quickly, beyond our around, that settings will change even if they do
current conceptualization that we have done jus- not, and so we must prepare for a global world
tice to this concept by teaching nurses to read a re- and a world of complexity. More importantly within
search paper. That specific element is like the this context, we need to shift our attention from
well-known Sufi Parable of the Blind Born teach- training nurses who primarily think about local con-
ing nurses to privilege a single angle of vision on a ditions toward educating practitioners who have
particular problem, often without really knowing the big picture thinking that allows them to
that there are multiple angles that ought to be con- think globally. This new generation will have
sidered in order to understand the nature of the to face the mobility of the world, and the intercon-
phenomenon we are attempting to engage with. nectedness that entails. For example, no longer
What the knowledgeable nursing workforce will de- will it be reasonable to consider certain diseases
mand is a more collective capacity to understand to only exits there because there is now
and collaborate with research integration and syn- here.
thesis processes in order to begin to work those dis- Beyond the practical reasons that this is
tinctive perspectives into a more integrated whole. becoming an imperative, there are moral impera-
And that kind of analysis will not be happening at tives pointing us toward recognition that this is
the front line of nursing or at the neophyte scholar the right thing to be doing. Taking up those
level, but more collectively within our specialty moral challenges, we want to shift our attention
groupings and substantive academic communities. from thinking of nurses as being good corporate
It will be work that we none of us can do inde- citizens to thinking of them as being exemplary
pendently, and we must learn to do it as a global citizens. We need to wrestle with such
discipline. challenges as how to nurture a service ethic with-
in a me first generation. We need to learn how
Local context to prepare nurses who have a fully embedded
sense of the economic implications of health
Another shift needed in this new world is from the and illness, of what causes ill health, of what
orientation of knowing how-to-do and moving to- drives health service, and of what sustainable im-
ward the skills associated with how-to-ensure-it- pacts they can envision. And we need to create
is-done. We know that there will be fewer nurses strategies to guide nurses who will work effec-
focusing their everyday practice on high acuity tively within an increasing diversity of worldviews
although it is of course important and getting even and perspectives.
618 S.E. Thorne
for a common vision that we all hold dear. We work tion and the running of nursing schools, that
in such different ways, with such different kinds of integration of the passion of apprenticeship and
problems. And yet, as those of us who are privi- mentorship, of creating workplace environments
leged to be in the classroom with diverse groups in which the wisdom of the seasoned practitioner
of specialized nurses who come together for the could interact with the idealism of the neophyte.
purpose of graduate education appreciate, there
is a fundamental and powerful core connection be-
tween us all that has a lot to do with where we Aligning knowledge and action in nursing
came from and how we got there. That shared education
understanding of the body, of the body in the hu-
man context, of the experience, of the nursepa- Fundamentally, then, it seems apparent that our
tient relationship, of the infinite capacity for ideas and our action vision will have to inform
human variation, and of the translation from the one another in a new form of nursing educational
general to the particular these cannot be lost praxis. While it may not be a major stretch to teach
as we shape our nursing workforce into the future about a model of praxis, we know that by far the
or we may risk losing the power of that collective best approach is to learn to model it. In order to
vision of what it means to be a nurse. And that col- move toward this capacity, we need to discover
lective vision no matter how tricky it is and has what the nursing professorate must learn to shift
always been to define it is the essence of what its knowledge and rapidly engage with the newer
we are. ideas. It seems evident that we cannot simply wait
As we move forward toward ensuring this viable for a generation to change; rather, we will have to
professional voice, we will grapple with a number develop a scholarship around how to support new
of tough questions. How can we educate nurses to- ideas, strategies and ways of thinking within nurs-
ward the capacity for a common vision? How can ing education itself. Conferences such as the Inter-
we help them balance surface self-advocacy with national Nursing Education Conference (NETNEP)
coming together toward future thinking and creat- held in Vancouver in 2006 are an excellent begin-
ing a leading a force for service to society? How can ning. We know that excitement about nursing
we help them sustain the passion for nursing within knowledge is infectious, and it seems that we ought
workplace contexts that are likely to be increasingly to try to capitalize on what we know about how
challenging? We all know that our governments are infectious processes spread most rapidly to really
facing shortages, and that employers want job catalyze significant change; we can ensure that
ready graduates. So how can we look beyond sim- we spread our enthusiasm with high doses, friendly
ply getting them ready for this context and ensure vectors, and multiple exposures.
that we are providing them with what it will take to While the complexity of nursing necessitates
stick with it and to thrive in this kind of practice that none of us can do it all and that we must diver-
world, and then ultimately to be its next change sify our foci, it also seems that we cannot afford a
agents? How can we prepare nurses who retain nursing education community in which a significant
their core essence despite an increasing diversity number of us do only teaching, and not practice,
of practice contexts, settings, and foci nurses professional service or research. Rather, a hall-
who will continue to recognize one another as mark of continuing competence within teaching
nurses? And how can we reformulate our theories should include a sustained relevance within a range
and conceptualizations so that they are better sui- of these activities. Thus we must increasingly find
ted to the social, economic and political realities creative ways to blend various combinations of
of the world in which this future nursing will occur? those dimensions so that our students are ex-
It seems to me that we need to work collabora- posed to excellent practitioners, that the knowl-
tively between the nursing education and service edge development we ascribe to does not only
leadership community to advance the contributions get translated into practice but also taken up in
of the discipline to the fundamental challenge of education. I believe that we need to work aggres-
health system reform. And because of this, the sively toward a culture of engagement, and a broad
skillset that is needed to be a really effective nurse base of what we consider scholarship that includes
educator will also shift so that we are all equally educational scholarship in all of its diversity (Boy-
comfortable in drawing knowledge from books er, 1990; Riley et al., 2002; Storch and Gamroth,
and bedsides, and we all know how to work effec- 2002). Nurse educators are not simply nurses who
tively within the academy and the health authority. have mastered practice sufficiently to oversee
After all, that is what our historic leaders under- the learning of neophyte practitioners, or those
stood that linkage between hospital administra- who have taken a graduate degree within the disci-
Nursing education: Key issues for the 21st century 621
pline, but rather they are professional experts with part must be in shaping this future. We are not
a substantive body of knowledge related to the leaving the past; we are merely bringing it with
complexities inherent in creating learning con- us into this exciting new world.
texts, guiding intellectual journeys, and igniting a
passion for what this profession embodies in its es-
sence. We therefore have an obligation to attend References
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