Nursing has always been considered a highly established profession with solid job security for many, even in the midst of troubling economic conditions. In fact, a recent US News and World Report’s list of the Best 100 Jobs shows both nurse and nurse practitioner in the Top 10.  And it’s a respected profession as well: A 2013 Gallup poll showed 82 percent of Americans rate the ethical and honesty standards of nurses as “high or very high,” the highest of all professions.

Yet despite talk of an impending nursing shortage over the next few years, some believe there is an even bigger crisis looming, one that stems from the very heart of the career — education.  Quite simply, nursing students are not as prepared as they should be for the “real world” of nursing and patient care.

This skills deficit is all-encompassing. There is a lack of the basic technical skills, such as physical assessment and emergency response. But the equal lack of “soft skills,” such as critical thinking, problem recognition, prioritization and recognition of urgency, and communication with physicians, is just as alarming.

Perhaps the most unfortunate part is these serious gaps aren’t being caught early on in the nurse’s education. As a result, we’re seeing many young professionals get far enough down the nursing education path that when they reach the clinical phase of their education, it is too late to catch up and too onerous for supervising nurses to help them.

A Lack of Education

This lack of education isn’t just affecting entry-level nurses. In fact, many nurses are not learning the in-demand skills that can help them take their career to the next level. For example, there is an increased demand for nursing administrators in hospitals, labs, and other health care settings. These nurses get competitive salaries and also receive a number of other benefits. Yet a study published in The Joint Commission Journal on Quality and Patient Safety, well before the implementation of the Affordable Care Act showed many new nurses entering the profession felt “poorly” or “very poorly” prepared by their nursing education programs to implement quality improvement measures; these are duties demanded of nurse administrators and ones that will be in higher demand as ACA takes full effect.

Of course it’s not as though these issues have arisen independent of the dramatic changes in the overall health care and nursing landscape. To be sure, today, the complexity of patient care is exponentially greater than it was five years ago, due to technological advances in care, decreased length of patient stay, and rapidity of change. This has undoubtedly changed the way nurses should—and need to be—learning. And what they should be learning is how to provide quality patient-centered care, where doctors, nurses, and other hospital personnel work together as an integrated team to make sure the patient has the best outcome and experience possible.

One of the barriers to achieving this level of care is that although there is far more complexity to the state of nursing today and more educational material to be covered in the same amount of time, clinical education is still being conducted as it was in the 1960s. Then, nursing education consisted of all of the familiar courses, such as anatomy and physiology, pharmacology, and medical-surgical nursing. The difference was that typically after six months of school the students were actually in charge of nursing divisions, which allowed them to be immersed in the clinical arena rather quickly.

By contrast, today many nursing school faculty simply don’t have the clinical skills that are being demanded of their students following graduation. Instead, they have concentrated on nursing theory rather than the practical aspects of actually dealing with doctors and patients, which doesn’t help their students post-graduation. And, as is the criticism with the education system overall in this country, many feel that nursing schools are simply gearing their programs to teach students to take tests—in this case NCLEX (National Council Licensure Examination).

Improvements in Nursing Education and Skills

With millions of previously uninsured Americans ready to join the patient population in the next two years, it is more critical than ever to ensure our nurses are in the position to provide the best possible service.

Here is how we might accomplish this goal:

Establish nursing residency programs. It’s a model that works extremely well for physicians, so why not for nurses? In fact, the Institute of Medicine’s recent report, “Future of Nursing: Leading Change, Advancing Health,” recommends residency programs to aid the transition from education to practice.  Given the increasing role many nurses are playing in health care, it would appear to be a logical next step.

Increase clinical competence. Nursing schools will benefit from a curriculum that focuses on real-life applications rather than just abstract classroom learning, as well as increasing interdisciplinary education and the skill set to work as a team. This would entail hiring faculty with a solid mix of clinical and academic skills and experience. The idea is to bring in the best of both worlds—instructors who can speak from personal experience about the conditions or situations they are teaching.

Create better academic/clinical synergies. We must remember that our nursing students will in fact one day be interacting with real-life patients. Therefore, classroom content needs to be tied seamlessly to clinical content and the focus has to shift from technical skills to sound clinical judgment  — and in the words of former professor emerita Patricia Benner (Department of Social and Behavioral Sciences at the University of California, San Francisco), “shift to thinking in action” and then finally to application.  Interestingly, nursing graduates also crave better academic/clinical synergies.  Across the board, nurses who graduated from undergrad programs not only requested more clinical time for students but also suggested that clinical assignments be more realistic.  For example having students watch over six to seven patients at a time rather than one or two.

Establish partnerships. Nursing schools and health care organizations should consider collaborative partnerships to create dedicated education units that can provide a more realistic immersion into the clinical environment. This could involve hybrid partnerships, where the clinical faculty members are actually the clinical nurses working at the bedside. It could also include specialty-specific fellowships where students are enculturated in the clinical setting.

The decline in nursing skills didn’t happen overnight, and it will take some time to fix. A collaborative effort focusing on a combination of academic instruction and real-life applications – and a focus on both the technical as well as “soft” skills – will be crucial to getting our nurses back on track and ready to properly serve the patients and families that so trust and respect them.

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