International lessons on nurse education

1 November 2012

KATHY HOLLOWAY and BRONWYN HEDGECOCK report back on some of the themes and findings presented at the Fourth International Nurse Education Conference (NETNEP 2012) held recently in Baltimore, USA.


How are nurses best prepared to meet the predicted challenges of rapidly changing healthcare systems and escalating health demand is a question that many international (and national) nursing leaders have been pondering.

Responses have included the Institute of Medicine (IOM) releasing a report two years ago about the future of nursing that discussed innovation in nurse education. Later that same year, the Robert Wood Johnson Foundation launched The Future of Nursing: Campaign for Action that is also helping to spur changes in nurse education, particularly in the USA.

In June this year, I joined delegates from over 35 countries (including colleagues from across New Zealand) to attend the Fourth International Nurse Education conference in Baltimore. A rich, eclectic mix of papers, workshops, and seminar opportunities were facilitated by academics, clinicians, student nurses, and researchers addressing a range of issues inherent in contemporary nursing education, research, and practice.

Using the framework of “what’, ‘how’, and ‘where’ to teach, I have summarised a few of the relevant presentations from the four-day conference that fit into that framework.

What to teach (or ‘what students should learn’)

The clinical skills curriculum was the focus of University of Wollongong in presenting research relating to clinical skills taught and assessed across all Australian undergraduate programmes. There were originally 1300 skills identified, then through a Delphi process, they were refined down to 275 different skills across 21 areas. The tool developed is to be used by programmes to evaluate their curricula to meet registration requirements and is planned to be rolled out this year and next year.

How to teach

There is great interest internationally in a longitudinal research project begun in 2010, funded by the National Council of State Boards of Nursing, evaluating replacement of clinical time with simulation in undergraduate programmes. I attended a ‘fringe’ event to discuss the place of simulation in summative assessment that foreshadowed the first results being published this year. In August 2011, new nursing students in ten programmes were randomised to one of three study groups: control, 25 per cent simulation, or 50 per cent simulation. Students will remain in their assigned study group for all of the core clinical courses in their nursing. This is a fascinating project, with much potential interest for New Zealand and Australian nursing educators.

Where to teach

Differing clinical education models were discussed such as academic partnerships, dedicated education units, community partnerships in aged care, and the challenges of preceptorship. The core theme remains the need for strong functional partnerships between service providers and education to support workforce development.

Another thought-provoking presentation was from researchers at the Austin State University, Texas on the predictive factors for success for a nursing programme. This ten-year study (of over 10,000 students) identified that poor reading comprehension had the highest predictive score by far, with maths and anatomy and physiology knowledge next. The research team has developed resources to support students to develop in these areas, which underlined for me the importance of foundation studies to position students for success.

In summary, the conference affirmed for me that nursing educators share many of the same challenges regardless of global location. There is recognition by many colleagues that

Patricia Benner’s clarion call for radical transformation in nursing education is urgent and there is potential in international collaborations to synergise learning.

The final keynote speaker, Professor William Lauder (editor of Journal of Advanced Nursing), urged us to consider nursing as a complex intervention. Complex interventions are defined (by the European Academy of Nursing Science) as “activities that contain a number of component parts with the potential for interactions between them which, when applied to the intended target population, produce a range of possible and variable outcomes”. This is the world we must prepare the nursing workforce for and educational curricula need to develop system thinkers who can deliver ethical, skillful, and compassionate care.


‘Changing the landscape for nursing and healthcare education: evidence-based innovation, policy, and practice’ was the title for this international nurse educators’ gathering, where the conversations were collaborative, enquiring, and energising. Presented below is a brief summary of some of the themes and points of interest raised at this international conference.

The key note speaker, Professor Michael Bleich from Oregon Health & Sciences University, discussed the need for international clarity of nurse’s roles and encouraged us to engage in new ways to better meet the needs of our patients. In all aspects of nursing, critical thinking must move to critical action. Nurse educators were urged to be innovative to better meet workforce demands, evaluate and review economic realities, be analytical and take a public perspective, integrate better via inter-professional education opportunities, and to communicate standards and expectations clearly. The work of Edgar Morin, a contemporary French philosopher, was introduced, and his work, Seven complex lessons in education for the future, was indeed complex. (This essay on the education essentials of the future can be found on UNESCO’s website.)

A consistent message of the conference was that the patient voice, and that all key stakeholders, must be heard for successful outcomes, and message that research development is needed in nursing education. Small-scale, descriptive studies that lack theoretical foundation and are not extended into an international context were criticised, especially when globalisation and an international workforce are important factors to consider in order to meet current and future workforce needs.

This theme was somewhat reflected in the National League for Nursing promoting the Certified Nurse Education Examination and others validating competency assessment tools for nurse educators. The learning needs of nurse educators teaching international students were also discussed. Examples of inter-professional education, the use of problem-based learning and simulation utilising rich narrative via multimedia, and dedicated education units were all prominent in the programme. Practice development perspectives were also included several presentations from Australia and England that focused on their experiences of establishing units, with the promise of further evaluation to follow.

A topic with immediate relevance to patient care was the finding by Julie-Anne Harris and colleagues from the University of Southern Queensland, Australia, who identified a theory/practice gap between the ‘five rights’ framework (used to underpin safe administration of medication) and the informal safety strategies nurses actually apply in practice that are currently invisible in the literature. Interestingly, the ‘five rights’ framework is not underpinned by any theory.

It was a long way to travel and yet worthwhile for the revelation that nursing education in New Zealand both reflects and is consistent with international trends and challenges. Publication and engagement at an international level is to be encouraged.

(A footnote: reflecting on a visit to the Smithsonian Museum of Native American Indians, the evidence suggests the indigenous population survives and thrives, although the conference did not include acknowledgement or involve the local indigenous community.)

***Dr Kathy Holloway is dean of the Faculty of Health at Whitireia Community Polytechnic. Bronwyn Hedgecock is a professional teaching fellow, at the University of Auckland’s School of Nursing.***