Nursing continues to evolve
National Nurses Week celebrates you, as well as decades of changes in nursing education
National Nurses Week not only celebrates all you do, but also Florence Nightingale’s 200th birthday. So much has changed over the years, due to her efforts and those who followed her — including nursing education.
By Jennifer Mensik, PhD, MBA, RN, NEA-BC, FAAN
As an avid supporter of education, I believe everyone should continue learning, whether at a university or through online classes that you can take at home.
Training methods evolve
Over the years, as education progressed with hospital diplomas and bachelor’s programs, the need to train nurses quicker during the nursing shortage of the 1940s led to talks about three-year associate degree programs. In 1958, the W.K. Kellogg Foundation funded the successful pilot that started nursing education in community colleges, now known as associate degrees in nursing. Still, decades later, the creation of AD programs has not stopped nursing shortages. My first nursing degree was as an LPN and next was an ADN through a community college. These first steps were part of my plan to pursue a bachelor’s degree.

In 1964, the American Nurses Association House of Delegates adopted the position that a baccalaureate degree is the educational foundation for professional nursing. Keep in mind the rationale for moving from a diploma to bachelor’s degree was based on the overall development of the profession.

I had the good fortune of speaking to nurse members of the House of Delegates who were at this meeting and hearing about the conversations that led to the adoption of this position. Fast forward to 2010. The Institute of Medicine published the report, “The Future of Nursing: Leading Change, Advancing Health.” One of the goals in the report was to have nurses achieve higher levels of education, including increasing the number of RNs with bachelor’s degrees to 80% by 2020. This includes strengthening academic pathways to obtaining bachelor’s degrees.

We will not meet that goal, but based on the IOM Assessing Progress report, the country has seen a good deal of progress.
Doctoral-level nursing
Another goal of the IOM report was to increase doctoral-level prepared RNs. Doctoral-level nursing education really started to flourish during the 1960s, but this was not without controversy. As some university leadership allowed colleges of nursing to grant PhDs, others refused to allow colleges of nursing to do this, saying nursing wasn’t a science!

Even today, when people ask what my PhD is in, and I tell them nursing, most are surprised that you can get a PhD in nursing.
As an alternative to the PhD, colleges of nursing created the DNS or DNSc (Doctorate in Nursing Science, Clinical). One of the intents of this degree was to prepare nurses for doctoral-level work in clinical practice, rather than research and theory. The DNS or DNSc is considered a research degree today.
Among all professions, a doctorate degree is considered the terminal degree. For many nurses, a PhD might not have been the right terminal degree. In the early 2000s, the doctorate in nursing practice degree, or DNP, was created. The DNP is considered a terminal degree for those who choose to focus on clinical practice, whether as a nurse practitioner or nurse executive who is not in advanced practice. Nursing education has evolved so much over the last century. And of course, we have many wonderful nursing pioneers to thank for it. Much can be learned from history, and if you don’t know it, you won’t know where you are going.
About the Author
Jennifer Mensik, PhD, MBA, RN, NEA-BC, FAAN, is division director of care management at Oregon Health and Science University and instructor for Arizona State University College of Nursing and Health Innovation DNP program. She also is treasurer for the American Nurses Association. Formerly, Mensik was vice president of CE programming for A second-edition book she authored, "The Nurse Manager's Guide to Innovative Staffing," won third place in the leadership category for the American Journal of Nursing Book of the Year Awards 2017.
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