California State University, Fullerton | www.titanmag.com | titanmagazine@fullerton.edu
California State University, Fullerton | www.titanmag.com | titanmagazine@fullerton.edu
Florence Nightingale made history in the 19th century by single-handedly transforming nursing from a lowly occupation to a noble profession.
How disappointed the founder of modern nursing would be if she were alive today. She would be reading headlines like: “Hospital Nursing Shortage Reaches Critical Stage,” “A Crisis in Nursing Threatens Patients,” and “Care Is Compromised by State's Nurse Shortage.”
But, being an activist and an educator, she would no doubt take on the challenge of building the ranks of the nation's nursing corps—and seek colleagues who share her commitment to strengthening the profession through innovative education.
She would find them in Cal State Fullerton's Department of Nursing, which offers the only campus-based baccalaureate nursing program in Orange County. The department has earned a reputation for innovation as it has become a leader in using technology to develop distance education programs and forming educational partnerships with health-care providers and other learning institutions.
Under the leadership of Christine L. Latham, professor of nursing and chair of the department since 1998, the total number of nursing students has jumped from 35 to 353 in just four years. Students come from throughout California, as well as other states, and each graduate represents a step toward solving a nursing shortage that–as the headlines say–has reached crisis proportions.
The American Hospital Association estimates that 126,000 nurses are needed to fill vacancies at U.S. hospitals, and the nation is expected to face a shortage of more than 400,000 registered nurses by 2020. Yet, according to Latham, there also is a shortage of the educational programs and resources essential to meeting the critical need for qualified nurses.
“Over the next 10 years, many nurses will retire, and new nurses are not entering the field at a rate that will replace them,” notes Linda Leach, an assistant professor of nursing who is a member of the Healthcare Association of Southern California's Nursing Shortage Task Force as well as the board of directors of the Association for California Nurse Leaders (ACNL). “This is a huge supply problem.”
Also contributing to the nursing shortage is job burnout resulting from such factors as heavy workloads, lack of prepared support staff and inadequate wages.
Among the solutions nurse leaders are pushing for are: recruiting more men and minorities into the profession, increasing salaries and incentives, lowering nurse-to-patient ratios and subsidizing training or continuing education. Also high on the agenda is expanding the capacity of baccalaureate programs.
That's where Cal State Fullerton comes in. There is a movement in the nursing profession to require a bachelor's degree for all entry-level positions. This is now required only in certain specialties, including public health, occupational health and school nursing.
But groups such as the ACNL believe more education is needed in all areas of practice to prepare for the demands of today's complex health-care system.
Cal State Fullerton offers accredited bachelor's and master's degrees in nursing programs that prepare students to be leaders, as well as caregivers. The master's program includes concentrations in several specialty areas that address the personnel shortages local hospitals now face: nurse administrators, nurse anesthetists and family nurse practitioners.
Raymond Hussain, who worked as a surgical and intensive care nurse before enrolling in the nurse anesthetist master's program, says more education leads to upward mobility and better pay for nurses–benefits that give them strong incentives to stay in a profession that far too many are leaving.
Earning advanced degrees also helps liberate nurses from their antiquated but persistent image as caregivers whose primary duties are emptying bedpans and giving sponge baths.
“The job is much more technical and specialized than that,” observes Jacquie Maple, a recent graduate who was promoted to her current position as charge nurse in the operating room at Irvine Regional Hospital and Medical Center while she was earning her bachelor's degree at Cal State Fullerton.
“In the operating room, we work with lasers and computers and video equipment. It's challenging because you have to stay current on the latest technology. We have to continually learn new things.
If more people understood that, I think more people would go into nursing.”
While nurses like Hussain and Maple pursue a level of knowledge that is becoming increasingly important to achieving success and satisfaction in health care, legislators at both the state and national level have introduced bills to help relieve the nursing shortage. A key component of these measures is increasing educational opportunities to prepare more people for entry-level, as well as management positions, and for practice in a wide range of medical specialties.
Cal State Fullerton students get this preparation in an academic environment that is connected closely to the health-care industry. Latham, who directed the Nursing Institute at Cal State Los Angeles before coming to Cal State Fullerton, worked as a hospital nurse for more than a decade, mostly in critical care. In fact, all of the department's professors are registered nurses. Their collective experience represents almost every major medical specialty, and they keep up with changes in health care and current issues through involvement in professional organizations.
Cal State Fullerton's nursing program was designed in the early 1970s to educate licensed nurses who have associate degrees from community colleges or hospital diplomas and want to earn bachelor's degrees to expand their career options.
In fall 2003, the university will extend its reach to high-school students by offering the only pre-licensure bachelor of science in nursing in Orange County. Working in cooperation with Saddleback College's associate degree program in nursing, students will take courses at both campuses and graduate with a bachelor's degree from Cal State Fullerton.
Latham says the four-year program–which could serve as a national model for collaborative nursing education–represents an accelerated alternative to the typical educational path for nurses, which often involves two to three years in an associate degree program and then several years or more of part-time study to earn a bachelor's degree while juggling work and home responsibilities.
The plan for the cooperative program so impressed Leach that she says it is one of the reasons she decided to come to Cal State Fullerton a year ago after teaching at USC for nine years.
“The university is poised to change nursing education in Orange County,” she says. “This program is a totally innovative way to give students the ideal preparation to become a nurse in today's complex and technologically advanced health care environment.”
Partnerships are a hallmark of Cal State Fullerton's nursing program. Collaborating with such entities as Kaiser Permanente of Southern California, UC Irvine College of Medicine and Memorial Health Care System in Anaheim has enabled the university to offer a number of nontraditional educational options. For example:
Since fall 2001, Cal State Fullerton has partnered with Kaiser Permanente to offer a distance education program that combines interactive videoconferencing with Internet courses at eight Kaiser sites throughout the state. The three-year program was made possible by an $802,937 grant from the U.S. Department of Health and Human Services.
Earlier this fall, Cal State Fullerton launched a new distance education program funded by the U.S. Department of Labor with videoconferencing sites at Riverside Community College, UCI Medical Center, St. Joseph Hospital in Orange and Anaheim Memorial Medical Center.
Also new this semester is a master's degree program offered in collaboration with the UC Irvine College of Medicine to educate family nurse practitioners.
A year ago, a master's degree with a nurse anesthetist concentration was introduced in partnership with Kaiser Permanente, giving students access to the clinical expertise available through Kaiser's 25-year-old School of Anesthesia.
A master's degree in nursing administration also was added last year to prepare nurses for middle management and executive positions. Students are mentored by nursing administrators in the region.
Of all these programs, the distance learning initiative probably has attracted the most attention for its innovative approach to nursing education.
“Students don't have to come to CSUF; the program goes to them,” says Jo-Anne Andre, director of nursing distance education. “Most of our students work full-time and have families, and many say they would not be able to attend school if a large portion of the program wasn't on the Internet. This makes it possible for them to do their course work at home while their children are asleep.”
Students go to designated sites at Kaiser facilities and other participating hospitals one night a week for two-way interactive video conference courses led by Cal State Fullerton professors. Nurse educators assist students at each site. The rest of the course work is done via the Internet. The program thus offers the flexibility of online learning while giving students opportunities to network with classmates and nurse educators.
Whether students attend classes via the Internet or on campus, they acquire the confidence and skill to participate in decision-making in any health care environment. “Our students tell us they feel more confident sitting on committees and making contributions. They develop the leadership skills necessary to make a difference,” Latham says.
Maple says her education at Cal State Fullerton has helped her meet the demands of a leadership role that involves such responsibilities as conflict resolution, staffing, budget issues and equipment purchases, as well as leading weekly staff meetings. “You directly apply what you learn in the classroom to the clinical setting,” she says.
Ultimately, Latham notes, this kind of education will give nurses a greater opportunity to influence their work environment and create conditions that will motivate more people to enter–or remain in–the profession.
“We give greater attention in the classroom to economics and quality improvement, because this is a greater part of the nurse's role than it was in the past,” Leach says.
Nursing has come a long way since Florence Nightingale's day, and the field continues to change at a rapid pace. However, the basic motivation that draws people to nursing remains the same as it was a century ago. As Raymond Hussain explains: “I chose nursing because I wanted to take care of patients. I wanted to be there to help. I love connecting with patients, helping to ease their anxieties and their families' anxieties before surgery.” (He offers another powerful argument for becoming a nurse: “It's the only profession where you're allowed to work in pajamas,” he says, referring to the surgical “scrubs” that most nurses now wear.)
Both faculty and students in Cal State Fullerton's program are optimistic about the future of nursing, but they also worry about how patients might suffer if the nursing profession doesn't get the infusion of personnel that it needs quickly enough.
“I'm concerned that the health care needs of California aren't going to be met,” Leach says. “We need more resources to help more people become nurses. Unless we do that, all the people who need nursing care aren't going to get it.”
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