Reforming nurses: historicizing the Carnegie foundation's report on educating nurses.

Certainly no form of education can make for thoroughness or can fully fit for business of life that does not recognize an equal training in this great trinity-mind, body, and soul.-Isabel Hampton Robb, 19031In 2009, the Carnegie Foundation for the Advancement of Teaching published the long awaited Educating Nurses: A Call for Radical Transformation. In keeping with several other recent studies of the education of lawyers, clergy, engineers, and physicians, also funded by the Carnegie Foundation, Educating Nurses surveys existing systems of professional nursing education and identifies areas for development.2Educating Nurses calls for a complete restructuring of nurse education in the United States. The study's author and lead researcher, Patricia Benner, found current nursing education practices inadequate to meet the growing demands of clinical practice.3 Nurses now work with increasingly complex patient scenarios, rapidly changing technology, and in environments pressed by external changes.4 Multiple educational routes into professional nursing practice complicate the problem. Nurses prepared at the diploma, associate, and bachelor levels are all eligible for Registered Nurse licensure. The study calls for nurses to be educated at the bachelor level, recommending that many practicing nurses return to school and pursue a bachelor's degree through well- designed and supported articulation programs.However, Benner argues, before the current nursing educational system can be restructured, educators must understand the goal of nursing education. Drawing heavily on the foundation's own A New Agenda for Higher Education: Shaping a Life of the Mind for Practice, Benner concurs that future professionals need to meet practical and professional challenges with what the foundation identifies as "insight, technical know-how, and discerning moral comportment."5 Benner transforms these concepts into the three domains that should characterize professional nursing education and practice: "knowledge," "skill know-how," and "ethical comportment."6 Nursing educators who embrace these conceptual domains, or "apprenticeships," and challenge their students to integrate all three in practice, Benner argues, will adequately prepare their students for professional life after graduation.But Benner and her colleagues are not the first to theorize about transforming nurse education. From the time the first formal training schools appeared on the health care landscape in the late 1800s, nursing educators have grappled with the challenge of creating a uniformly educated workforce. In fact, more than a century before the Carnegie Foundation formulated its three apprenticeships, nursing educators and contributors to the earliest issues of the American Journal of Nursing (AJN) acknowledged a similar educational triad essential to successful nursing education and practice. The language was different: Early 20th-century educators used words such as "theory," "manual dexterity," and "character." But the intent was similar. As Isabel Hampton Robb wrote in 1903, the "great trinity"-the mind, the body, and the soul-remains of central concern to nursing education and practice.7Despite decades of external change and transformation, the central domains of nursing education that nursing leaders envisioned at the turn of the 20th century remain impressively salient. There does seem to be a stable core of values and attributes that contribute to the development of a professional nurse, although how these might be expressed changes with the times, technology, and context. The similarities between Benner's apprenticeships and the objectives of nursing educators in the early 1900s give rise to several questions. In what ways did nursing educators establish the concepts of theory, manual skill, and moral character in nursing school curriculum? How did the curriculum in early training schools reflect their dedication to the domains of nursing practice and the elevation of the nursing profession? …