Nurse education consists of the theoretical and practical preparation of nurses for professional practice. It is provided to student nurses by experienced nurses and other health professionals who are qualified or experienced educators, traditionally in a type of professional school known as a nursing school or college of nursing.
Pre-qualification education is typically offered at the diploma or bachelor’s degree level. Depending on the country, programs may prepare students for general nursing or a specialty such as mental health nursing or pediatric nursing. Nurse education commonly continues after graduation through post-qualification courses in specialist subjects such as postoperative care.
Historical background
Nurse education was traditionally delivered through an apprenticeship, often undertaken in religious institutes such as convents by young women (although there has always been a proportion of male nurses, especially in mental health services). Over time an emphasis on evidence-based practice has replaced the more ritualistic practical training structure with a more academic pathway.
Early development In 1859, Valérie de Gasparin and her husband Agénor de Gasparin opened the first nursing school in the world in Lausanne, Switzerland.
Florence Nightingale was one of the pioneers in establishing the idea of nursing schools from her base at St Thomas' Hospital, London in 1860 when she opened the 'Nightingale Training School for Nurses', now part of King's College London. Her intention was to train nurses to a qualified and specialized level, with the key aim of learning to develop observation skills and sensitivity to patient needs, then allow them to work in hospital posts across the United Kingdom and abroad. Her influence flourished and nursing is now a course taught at a number of British universities.
In 1873, the Bellevue Hospital School of Nursing, of New York City, was founded. It was the first school of nursing in the United States to be founded on the principles of nursing established by Florence Nightingale. The School operated at Bellevue Hospital until its closure in 1969.
Some other nurses at that time, notably Ethel Gordon Fenwick, were in favor of formalized nursing registration and curricula that were formally based in higher education and not within the confines of hospitals.
Rebecca Strong OBE (1843–1944) started a Preliminary Training School for Nurses at the Glasgow Royal Infirmary in 1893. She had been working as a Matron there since 1879. This 'block apprenticeship' programme had separate classroom based teaching and practical periods on the wards. Two courses were arranged in conjunction with the Professors of St. Mungo's College - a three-month course consisting of elementary Anatomy, Physiology and Hygiene. If these exams were passed a second course was given which consisted of Medicine, Surgery and Practical Nursing. The prospective nurse was then able to enter the hospital with this theoretical knowledge. Strong was supported by the pioneering surgeon Sir William Macewen.
Eva Luckes, Matron of The London Hospital (1880–1919) was mentored by Florence Nightingale, and was her friend and disciple.Anthony, Grainne (2011), 'Distinctness of Idea and Firmness of Purpose. The Career of Eva Luckes; A Victorian Hospital Matron.' (Unpublished Master of Arts dissertation, London Metropolitan University, 2011).Rogers, Sarah (2022). 'A Maker of Matrons'? A study of Eva Lückes's influence on a generation of nurse leaders:1880–1919' (Unpublished PhD thesis, University of Huddersfield, April 2022)Eva Luckes was another innovator in nurse training and education and introduced the Preliminary Training School concept to England in 1895. This was adopted as an element of mandatory training programme following the 1919 Nurse Registration Act. Eva Luckes produced over 470 matrons who filled posts at home and abroad, including three who filled the top positions in Military Nursing, Ethel Becher, Sarah Oram and Maud McCarthy. Luckes's other matrons also spread her style of "Nightingale nursing" to voluntary hospitals and infirmaries both in the provinces and London. They included Annie McIntosh, Matron of St Bartholomew's Hospital, 1910–1927.
Academicisation and independent nursing schools In 1909, the University of Minnesota offered the first university based nursing program. It offered the first Bachelor of Science in Nursing degree and graduated the first bachelor's degree educated nurse. Yale School of Nursing became the first autonomous school of nursing in the United States in 1923.
The first international postgraduate courses for nurses in the UK commenced in 1920. This was a joint initiative with the League of Red Cross Societies, The College of Nursing, the International Council of Nurses, The University of London, the Rockefeller Foundation and nursing leaders in North America. The first course was on public health nursing with a course on Hospital Administrators and Teachers in Schools of Nursing commencing in 1925. The course ran for one year at King's College for Women, Campden Hill, London before moving to Bedford College for Women.
In November 1955, a World Health Organization (WHO) study group on the education of nurses met in Brussels and made several recommendations, including that "At least one experimental school of nursing be set up in each country." In the UK, the first department of Nursing Studies at the University of Edinburgh was established in 1956, with a five-year integrated degree programme introduced in 1960. Several other universities across the UK during the 1960s. In 1974 La Trobe University commenced the first nursing course in Australia.
In 1956, the Columbia University School of Nursing became the first in the United States to grant a master's degree in a clinical nursing specialty.
Apart from the nursing school of King's College London, the direct descendant of Nightingale's school, the University of Manchester was one of the first English institutions to offer the course at degree level. A new building for the Manchester Medical School was opened in the early 1970s and degree courses in nursing were established about the same time. Nursing education at the university expanded greatly in 1996 when a new School of Nursing and Midwifery was created by transferring the Manchester College of Midwifery and Nursing into the university's Faculty of Medicine, Dentistry and Nursing."This week / next week" (University of Manchester); 7 Oct. 1996, p. 1
Nursing education in the United Kingdom was significantly influenced by the Briggs Report of 1972. This set a new agenda for nursing and nurse education and sought to develop a career progression away from the bedside into education, management and research. In addition, the 1979 Nurses, Midwives and Health Visitors Act provided the legal mechanism for change. This saw a gradual movement away from practice-based training towards a college-based system of education, from the nurse apprentice to the supernumerary nurse.
Scope Nursing education includes instruction in topic areas. These are nursing assessment, nursing diagnosis, and nursing care planning. In the United States, nursing students learn through traditional classroom and lab instruction. Nursing education also involves clinical rotations and simulation, throughout their schooling, to develop care planning and clinical reasoning. At the end of schooling, nursing students in the US and Canada must take and pass the NCLEX (National Council of Licensure Examination) to practice. Simulation is a version of some actual instruments or working conditions designed to illustrate some behavioral dimensions of a physical or abstract system via the behavior of another system. The main goal of simulation in healthcare is to prepare students to face clinical situations, increase patients' safety, reduce errors, and improve nurses' clinical judgments. Simulation as a teaching method includes activities that mock an actual clinical environment and has been designed to illustrate processes, decision-making, and critical thinking via techniques such as role-play or instruments like educational films and models, scenarios, and case studies.
Medical simulation and hands on learning are common among nursing education practices. Some nursing schools will carry out hands on demonstrations and practice so that future nurses can learn skills like how to administer specific medications and care for specific patients such as the skills taught in an opioid care training course. While it is clear that the use of Medical simulation in nursing education is important for improving practice, patient safety, and interprofessional team skills, the balance of simulation to clinical time remains in the hands of the institutions.
Although nurses tend to spend a lot of time in nursing school doing simulation and clinical learning, they also spend time in the classroom learning about the care that they will eventually give. This includes both broad science courses as well as very specific courses such as a course specifically about how to better care for addiction patients.
Additionally, newer curriculums within nursing education are requiring future nurses to be educated on patient and workforce diversity. A large step in increasing diversity within nursing is through education. Several research studies have shown diverse patient populations cycle through hospitals on a regular basis and a patient's needs are never the same. It is a nurse's job to cater to their needs, and ensure the patient is being treated well. During their education, nurses will master the practice of engaging, communicating, and treating unique patient populations, while working with diverse coworkers.
Nursing qualifications by country United Kingdom Pre-registration nurse training and education in the UK is now via a bachelor's degree (a UK Level 6 qualification) or a 2-year pre-registration master's degree at level 7, following the phasing-out of the Diploma of Higher Education (a UK Level 5 qualification) in Nursing which was previously offered at universities and colleges.
To become a student nurse, individuals must apply through the university and Colleges Admissions Service (commonly referred to as "UCAS") to their nursing degree choices, choosing from one of the four nursing fields: Adult, Children, Mental Health and Learning Disabilities. Requirements for entry to a pre-reg nursing degree are usually five GCSEs (including mathematics, English language and at least one science subject) at Grade C or above, along with three A-Level subjects (preferably but not essentially science-based) at Grade C or above, although the majority of universities will seek higher grades due to the competition for places. Key Skills courses are generally no-longer accepted as an alternative to GCSEs, however science or healthcare-based BTEC Level 3 Extended Diplomas and Access courses are most often accepted in lieu of A-Level qualifications.
If successful following interview, the student will study a "core" first year, learning basic nursing competencies essential to all four of the above fields. It is then from second year and onwards that the degree will begin to focus on the student's chosen field. Following completion of the degree, the applicant will be registered with the Nursing and Midwifery Council (NMC) as a Registered Nurse in their field of practice, using the post-nominal RNA, RNC, RNMH or RNLD as appropriate to their degree qualification.
United States