Nursing PhD consortia: a model for maximizing scarce resources.

Doctoral (PhD) education in nursing is costly and requires scarce resources: qualified faculty, qualified students, research funding, and infrastructure. This article discusses the development and implementation of a five-school consortium for delivery of an established PhD in Nursing Science program throughout north Florida. Factors that contributed to the success of the Consortium, including communication, history of shared work, collaborative approaches, and a formal agreement, are described. Challenges, such as maintaining curricular integrity across settings and selecting web-based formats, are considered. Results to date have been a viable consortium with a 4-year history, three PhD consortium graduates, 22 PhD students enrolled via the consortium, and success in attracting both federal and private funding. Consortia are proposed as a strategy for the effective use of limited resources, and suggestions are provided for the development of successful consortium models capable of delivering high-quality PhD nursing education.

Preparing nurses for the 21st century: reenvisioning nursing education and practice.

Significant advances in biomedical science and in the complexity of health care, coupled with a worsening nursing shortage and numerous reports of unsafe and inadequate patient care, have prompted concerns about both nursing education and nursing practice. Beginning in 2000, the American Association of Colleges of Nursing (AACN) made a thorough study of nursing education, regulation, and practice issues. Input and consultation were sought from AACN members, nursing practice leaders, regulators, and other health professionals. Results of this work indicated the need for a new nursing professional, the clinical nurse leader, who could effectively coordinate, manage and evaluate care for groups of patients in complex health systems. Master's-degree education is proposed for piloting the preparation of clinical nurse leaders. Close coordination with nurse executives and administrators to develop the new education program and new models for care delivery is planned. Critical components of the pilot testing will be evaluation of the patient and nurse outcomes associated with the use of clinical nurse leaders and focused work to develop a new legal scope and credentials for them.

RN education: a matter of degrees.

Until recently, no research had been done to explore the effect of nurse education on patient care. In a study published in JAMA in September 2003, nursing researcher Linda H. Aiken, RN, PhD, led a study to determine the association between the educational levels of hospital RNs and the mortality of surgical patients. The study examined 168 adult acute care hospitals in Pennsylvania reporting a total of 232,342 surgical discharges to the Pennsylvania Health Care Cost Containment Council in 1999. The researchers also surveyed a random sample of 50% of hospital nurses who live in Pennsylvania and were registered with the Pennsylvania Board of Nursing. In all, 10,184 nurses (52% of nurses surveyed) responded. According to the survey results, the average age of respondents was between 40 and 41 years, and between 30% and 31% of respondents had earned a BSN or a higher degree. Hospital nurses who participated in the study had 14.2 years' nursing experience with a mean patient load of 5.7 per day. The researchers examined how the education of hospital nurses affected the death rates of surgical patients within 30 days of admission and death rates within 30 days of admission among patients who experienced complications. The study also took into consideration whether a board-certified surgeon performed the surgery. The types of surgeries examined included general surgery, orthopedic, and vascular procedures. The study found that years of nursing experience don't predict a patient's outcome and that patients cared for in hospitals with a higher proportion of nurses holding a BSN degree or higher have a better chance of postsurgical survival. Specifically, the study stated that "a 10% increase in the proportion of nurses holding a bachelor's degree [in hospitals] was associated with a 5% decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue." Failure to rescue was defined as "deaths in patients with serious complications." The researchers recognized two limitations to their study: the low (52%) response rate of the nurses surveyed, the examination of hospitals from only one state. The researchers concluded that although these preliminary findings raise concern over nurse education as it relates to patient outcomes, further study of nurses and hospitals nationwide would be required to make these results irrefutable.

Cultural considerations in the assessment and treatment of intrafamilial abuse.

Cultural and subcultural factors can have a marked impact upon reporting, assessment, and treatment of abuse and family violence. Values and beliefs associated with three specific rural situations--small towns, Native American reservations, and cliques of health professionals--are examined and case illustrations are presented. Recommendations are offered for refining assessment and treatment strategies in these settings.