Nurse Education Today (2006) 26, 614621

Nurse
Education
Today
intl.elsevierhealth.com/journals/nedt

Nursing education: Key issues for the 21st

century q
Sally E. Thorne *

University of British Columbia, School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC,
Canada V6T 2B5

Accepted 19 July 2006

KEYWORDS
Nursing education;
Trends;
Nursing profession;
History of nursing
Summary In this paper, I reflect on what can be learned by engaging in future
thinking within our discipline, and what implications the results of that thinking
may have for the development of nursing education. Recognizing the marvelous
diversity of perspective within our discipline with regard to what will and ought
to be our future mandate, it seems reasonable to search for some grounding in what
might ensure that we enter that future wisely. We all know that change is a funda-
mental characteristic of all future projections, and yet that insight seems a weak
justification for failure to plan. Nurse educators hold a particular obligation to
ensure that they are preparing the professionals who will take that future forward.
Although we have always recognized that they must nurse for today with an eye on
tomorrow, it is inordinately difficult to come to some agreement on how we can best
bridge that gap within our educational programs and strategies. Toward this end, I
draw on lessons that can be drawn from our professional history as a rich and vibrant
context to propose some key issues for that future theorizing.
c 2006 Elsevier Ltd. All rights reserved.
This article appears in a joint issue of the journals Nurse Education Today Vol. 26,
No. 8, pp. 614621 and Nurse Education in Practice Vol. 6, No. 6, pp. 306313.

Introduction imaginal projections that are contained within

The world of future thinking in nursing is a strange
one. Reading through the marvelous diversity of
q
Initially presented as a keynote lecture at the Nursing
Education Today/Nursing Education in Practice First Interna-
tional Nursing Education Conference, May 1416, Vancouver BC.
* Tel.: +1 604 822 7748; fax: +1 604 822 7423.
E-mail address: thorne@nursing.ubc.ca.
our futuristic literature, one gets the sense of sci-
ence fiction run wild in the minds of our theorists
and practice dreamers. While exhortations of vir-
tual nursing, holographic patients, and interplane-
tary health research may seem naively fanciful
(Bunkers, 2000; Huch, 1995; Parse, 1991; Spitzer,
1998), they also invoke within us a sense that
stretching our minds into improbable possibilities
is something we must learn if we are to enter that


0260-6917/$ - see front matter c 2006 Elsevier Ltd. All rights reserved.
Nursing education: Key issues for the 21st century
future wisely. We intuitively understand that look-
ing beyond what we can immediately grasp be-
comes an imperative if we are to withstand the
forces of change and cling on to what we in nursing
hold most dear. And we recognize that whatever
our trepidations, that future will still unfold with
its own commanding trajectory.
We who carry the torch for nursing education
hold a particular responsibility for our part in this
future thinking. Our core business is the prepara-
tion of the next generation of nurses so that they
might take their rightful place in a world order that
we can only begin to comprehend. We craft knowl-
edge frameworks, conceptualizations, and theoret-
ical structures so that an infinite set of new ideas
will arise out of the mist and take shape in the
world of nursing practice. In this paper, I argue that
what guides us is not simply our capacity to project
the details of that future but rather, more impor-
tantly, to learn from our past. Drawing on our
philosophical foundations, the values and ideals
upon which this nursing profession is grounded,
we find substance that can help us reflect upon
what and who we are, and how we might carry that
ontological essence into the future. In this context,
I propose what I consider to be key issues for nurs-
ing education as we embark upon the coming cen-
tury key issues for all of us to grapple with in
our quest for ensuring that the core values inherent
in nursing of the past find purchase within the diz-
zying possibilities of our collective future.
A time for reflection
A century change is a natural and important time
for reflection and reconsideration. With half of
the millenniums first decade now past, we recall
with humour how frightening it was when we made
that transition from 1999 to 2000, sure that all of
our computer-based society would fall apart with
the digital adjustment, and also worried that, hav-
ing lived all our time in years beginning with the
digits one and nine, that we would not know how
to feel this new millennium. Having now found
our way into it, we discover that in most aspects
it is not all that different from the decade that
went before. We still struggle with the same health
care reform issues, still worry about impending
nursing shortages, and still battle with the same
funding agencies to consider nursing educational
scholarship a viable form of research.
Coincident with this same millennium transition,
we have seen considerable reflective reinvention
within many of societys institutions (Inayatullah
and Gidley, 2000). National governments have been
rapidly cycling from left to right and back again,
615
corporate structures have been undergoing unprec-
edented upheaval, and social institutions such as
the university are exploring new mechanisms for
relevance and accountability. Within our various
health care systems, there have been massive glo-
bal shifts in professional autonomy, public engage-
ment, and system redesign (Romanow, 2002). With
our colleagues across the full range of health disci-
plines and social policy sectors, we have begun to
realise that 10% of the worlds health problems re-
ceive 90% of the worlds health resources and that
this is no longer defensible (Global Forum for Health
Research, 2004). Our tolerance for a have/have not
world is rapidly shifting as we realise the inherent
and immediate global impact of economic inequi-
ties on such shared problems as epidemics.
There has also been a corresponding reflexivity
within academic medicine that seems unprece-
dented within our lifetime. The International Cam-
paign to Revitalize Academic Medicine (ICRAM)
Project (Tugwell, 2004) involves stakeholders rep-
resenting academia, business and industry, govern-
ment and policy makers, journal editors, patients,
professional associations, students and trainees.
Operating through a core working party of 20 med-
ical academics representing 14 countries, its expli-
cit mandates are to (1) redefine the core values of
and contribute to the evidence basis for academic
medicine; (2) develop strategy around reformed
academic medicine, and (3) stimulate a public de-
bate on the future (International Working Party to
Promote and Revitalise Academic Medicine,
2004). Toward those ends, the project has gener-
ated scenarios depicting what the world might look
like and how academic medicine might move for-
ward toward leadership rather than reactivity
(Clark, 2005). Among the observations arising from
analysis of the common features of these scenarios
are the suggestions that: academic medicine will
have to put more effort into relating to its stake-
holders; that it will also have to become more glob-
ally minded; that while teamwork will be
increasingly important, individuals will also have
to shine and to flourish; that teaching, researching,
improving, leading and providing service will con-
tinue to be important, but expecting individuals
to be equally competent in them will be recognized
as increasingly impractical; that competition
among academic institutions is likely to increase;
and that academic institutions will need to become
increasingly businesslike and more adept at using
media (paraphrased from Clark, 2005).
In highlighting what our colleagues in academic
medicine consider the real imperatives, these obser-
vations reflect many of the issues about which aca-
demic nursing should also be profoundly concerned.
616
A time for dialogue
The occasion of the First International Conference
on Nursing Education (NETNEP 2006), in which hun-
dreds of passionately committed nurse educators
gathered to charge up their batteries, seemed a fit-
ting time to catalyze a new focus within our collec-
tive dialogue in hopes that it would continue within
our scholarly literature. The key issues articulated
by conference planners foreshadowed much of this
priority setting, articulating such foci as: inter-pro-
fessional education; research, evidence based
practice, and technology in health and education;
and service user involvement in the way we edu-
cate health care professionals. The enthusiasm
with which conference participants engaged in
sharing their stories, listening to the experience
of others, and reflecting upon their commonalities
and diversities fuelled a sense of excitement that
nurse educators have considerable power to shape
an exciting future.
Given the privilege of speaking in the confer-
ences opening session, I took the opportunity to
enter this dialogue by structuring my comments
around the dialectic between nursing knowledge
and nursing action, recognizing that this is the
intersection within which so much of our nursing
educational analysis resides. I took as my starting
points what I believe to be shared foundational
assumptions regarding our core business in nursing
education if our discipline is to continue to serve
its fundamental mandate of preserving and sup-
porting the health of populations. For me, these
are a knowledgeable nursing workforce and a via-
ble professional voice.
A knowledgeable nursing workforce
We who have taken up the mantle of nursing educa-
tion believe to our core that the health of a society
is shaped by the degree to which it can develop and
sustain a knowledgeable nursing workforce. How-
ever, what this meant historically and what it is
coming to mean are changing. We need to find ways
to shift this forward without leaving behind what is
precious. As various nurse scholars have recog-
nized, nursing has historically been caught at the
level of the patient (and we know total patient
care better than any other). In the current world,
we are going to have to find ways to preserve that
commitment without it becoming our limitation.
The paradox, as we have realised, is that if we
allow our collective gaze to remain entirely at
the level of that individual, we cannot make a dis-
S.E. Thorne
ciplinary contribution to the social policy issues
that ultimately have far more impact on that indi-
viduals overall likelihood of health and well-being
than our individual care can secure.
I believe that our success in building a knowl-
edgeable nursing workforce of the future will de-
pend on our coming to some agreement on a
balanced combination of what they will need to
know and also how they will need to know it. In
the following discussion, I propose a few of the
areas in which we could use some thoughtful
reflection and dialogue.
Pragmatics
In the future, the knowledge we bring to bear to
develop nursing practice will have to include a very
large dose of practicality. From all indications, it
seems clear that that which will be funded as our
global health care systems evolve is that which
can be economically justifiable. Nurses, being en-
trenched into a service ethic and committed to
care regardless of economic context have an inor-
dinately difficult time adjusting their sights to in-
clude that economic argument. And yet, because
we know that this is an essential ingredient in gen-
erating effective programs and services for the fu-
ture, we must learn how to include something of it
within our core curricula.
We will also need to create a generation of
nurses who can move beyond the intuitive know-
ing that their ministrations make a difference to-
ward grappling with the complexities of
measurable nurse-sensitive outcomes. In order
to do so, we will need to continue to take leader-
ship in methodological innovations to permit re-
search integration and synthesis, to combine
methods so that complex ideas can be considered
in context, and so that those who control the re-
sources can begin to understand the implications
of systems of nursing at the population level.
Toward this end, we will need to find ways to
move beyond some of our individual positioning
in the sense of what constitutes a right ap-
proach, and our convictions as to which theoretical
perspective ought to dominate. In order for nursing
do really do what it has always set out to do, to re-
tain a focus on the full spectrum of human experi-
ence in health and illness, we must find ways to
prepare the next generation of nurses to be as
competent and comfortable in the language of
pathophysiology and molecular biology as feel they
are in the discourse of spirituality and holism. Not
only will we have to educate the new generation
toward competence and confidence, but we will
Nursing education: Key issues for the 21st century
also have to ensure that it comes well prepared
with humility; each of these fields is enormous,
vast, and complex, and oversimplifying them would
ultimately disserve us in meeting those objectives.
We must not only remain credible to ourselves, but
to an increasingly sophisticated and critical audi-
ence of interprofessional team members, public
policy decision-makers, and health care consum-
ers. So that delicate balance between confidence
in what we do know and reverence for what we
do not and cannot know will have to be a hallmark
of that knowledgeable nursing workforce of the
future.
Evidence
One prominent aspect of disciplinary knowledge in
which we will need to steer a radical shift has to do
with what it means to make claims related to evi-
dence-based practice. The language of evidence
will increasingly shape policy and resource alloca-
tion, and so we need to be collectively conversant
with it and to have a strong cadre of our member-
ship who speak that language fluently. In particu-
lar, we need to move, quite quickly, beyond our
current conceptualization that we have done jus-
tice to this concept by teaching nurses to read a re-
search paper. That specific element is like the
well-known Sufi Parable of the Blind Born teach-
ing nurses to privilege a single angle of vision on a
particular problem, often without really knowing
that there are multiple angles that ought to be con-
sidered in order to understand the nature of the
phenomenon we are attempting to engage with.
What the knowledgeable nursing workforce will de-
mand is a more collective capacity to understand
and collaborate with research integration and syn-
thesis processes in order to begin to work those dis-
tinctive perspectives into a more integrated whole.
And that kind of analysis will not be happening at
the front line of nursing or at the neophyte scholar
level, but more collectively within our specialty
groupings and substantive academic communities.
It will be work that we none of us can do inde-
pendently, and we must learn to do it as a
discipline.
Local context
Another shift needed in this new world is from the
orientation of knowing how-to-do and moving to-
ward the skills associated with how-to-ensure-it-
is-done. We know that there will be fewer nurses
focusing their everyday practice on high acuity
although it is of course important and getting even
617
more highly acute all the time. Instead, many
nurses will necessarily be shifting attention toward
the burden of chronic illness, whether we encoun-
ter it in hospitals, ambulatory clinics, or in commu-
nities. And this shift will not simply involve a new
orientation to skillsets, but also to undoing those
structures and processes we have put into place be-
cause the assumptions inherent in acuity (patient
passivity, professional expertise and so on) have
become part of the problem in chronic illness care.
We will also be increasingly learning to work with
unregulated care workers, coping with new pres-
sures such as the generic Health Care Worker
that has cropped up in some jurisdictions, and
working more effectively with the meaningful hu-
man social groupings that we historically related
to as if they were all nuclear families.
Global context
We are also fully aware that nursing education can
no longer afford to prepare practitioners for highly
specialized local settings to meet immediate work-
force needs. We all know that nurses will move
around, that settings will change even if they do
not, and so we must prepare for a global world
and a world of complexity. More importantly within
this context, we need to shift our attention from
training nurses who primarily think about local con-
ditions toward educating practitioners who have
the big picture thinking that allows them to
think globally. This new generation will have
to face the mobility of the world, and the intercon-
nectedness that entails. For example, no longer
will it be reasonable to consider certain diseases
to only exits there because there is now
here.
Beyond the practical reasons that this is
becoming an imperative, there are moral impera-
tives pointing us toward recognition that this is
the right thing to be doing. Taking up those
moral challenges, we want to shift our attention
from thinking of nurses as being good corporate
citizens to thinking of them as being exemplary
global citizens. We need to wrestle with such
challenges as how to nurture a service ethic with-
in a me first generation. We need to learn how
to prepare nurses who have a fully embedded
sense of the economic implications of health
and illness, of what causes ill health, of what
drives health service, and of what sustainable im-
pacts they can envision. And we need to create
strategies to guide nurses who will work effec-
tively within an increasing diversity of worldviews
and perspectives.
618
Diversity
We recognize that there are very few homogenous
societies in todays world and that a standard of
basic entry level practice competency in nursing is
to know how to work thoughtfully and as equitably
as possible with diversity. This includes people who
relate differently to what we offer, and people for
whom health and illness and our role in relation to
them are understood differently. This process has
caused us to reflect more seriously on the fact that
we as a discipline also hold a shared world view
that we represent a particular perspective on mat-
ters of illness and healing, and that we must recog-
nize and understand the implications of that
perspective. We need to be able to distinguish be-
tween the beliefs and values we hold by virtue of
our disciplinary allegiance and those facts and
truth claims we draw upon in order to justify what
we do and how we do it.
Complexity
In order to accomplish all of this, it seems evident
that we cannot any longer afford to accept uncrit-
ically held and superficial attachments to binary
dimensions like issues of right and wrong, good
and evil. The nurses of the future will have to be
able to simultaneously hold in their minds ideas
that are apparently contradictory the patient
as confronting death and at the same time hoping
for miracles, the seriously ill person who is manag-
ing well and also not coping at all, the patient as
autonomous being and the family as being the pri-
mary locus of that patients decision making. We
have for too long tolerated conceptualizations that
polarize possibilities compliance and non-com-
pliance, normalization and disability, health and
illness, hope and despair as by definition mutually
exclusive entities. In order to move forward in this
world, the nurses of the future have to be able to
recognize, but think beyond the conceptual cate-
gorizations with which we educate them. They will
have to understand that uncertainty and certainty
co-exist, that the patient who manages self-care
independently is also dependent, that the person
who is overwhelmed with fear is also grounded in
courage. They will learn to work with patients in
a sensitive and nuanced manner that respects and
reaches out to all of the contradictory parts of
their experience. This kind of thinking will force
us out of our standardized diagnostic approaches,
our simplistic conceptualization models, and into
new and more excitingly complex ways of organiz-
ing and shaping our understandings.
S.E. Thorne
If these requirements for a truly knowledge-
able nursing workforce of the future are any indi-
cation, there are obvious and considerable
implications for nursing education. As a hospital-
trained RN who only reluctantly returned to
school to earn a degree (never knowing how far
that path would lead!), I have had the luxury of
seeing a significant shift in how we do business
in nursing education, and am therefore confident
we can do it again. For example, I believe that
we need the capacity to shift what we currently
do from both a curricular and a pedagogical per-
spective and extend beyond our motherhood
claims about such phenomena as holism which
is individualism in context and to figure out
how better to work and teach across the individ-
ual, family, community and societal continuum.
We need to know how to think bio-psycho-social
to population-based and back again, and do to
that in a dynamic and rapid-cycling intellectual
process, not on separate days and in separate
times. From my perspective, this capacity is and
will be the unique contribution of nursing, and
we need to ensure that it is effectively learned
in the foundational stages if we are to survive
as a profession into this challenging future.
Remember, across the planet, as we become
more educated and more expensive, we also be-
come more expendable unless we know how to
translate our inner conviction that nursing mat-
ters into an objective, defensible, business case
that clearly documents the value that a knowl-
edgeable nursing workforce brings to a healthy
society. So this knowing will have to move be-
yond subjectivities and individual patient care to
include a much different kind of justification
and evidence. In short, we need to move from
belief to defensible convictions, from assumptions
to objectively verifiable claims. And it is these
which will make that future nursing workforce
genuinely knowledgeable.
A viable professional voice
The second major issue that I think defines what we
all believe we are aiming for is a viable professional
voice. In this changing context, if nursing is to
remain professionally viable, we need not only to
prepare a new generation of nurses with a changing
body of knowledge and knowing, but also to pro-
vide them with the structural scaffolding within
which this knowledge and knowing can be enacted.
The following are what I would consider the foun-
dations of that scaffolding.
Nursing education: Key issues for the 21st century
Workplace organization
Globally, the workplace of nursing is shifting and
under predictable strain. We cannot any longer
do nursing in the older ways. This is not that un-
like the challenge facing our common ancestor,
Florence Nightingale, in formalizing the training re-
quired for nursing practice, or the later revolution
in turning the bulk of nursing from homes into hos-
pitals. One can only imagine the challenge of shift-
ing from untrained to trained, from one-to-one
convalescent care to a more orderly and organized
way of delivering nursing service to larger groups of
patients. Now it seems that we need to be working
within and across settings, with populations not
units, and ensuring that we keep our sights on what
the contribution of nursing is and ought to be with-
in that changing interprofessional context. Defend-
ing the old ways would not work, and reacting after
the fact to the changes that others decide on our
behalf is notoriously unsatisfying.
Leadership and power
We also need to train up a new generation not
to consider their professional leaders as having
joined the dark side but in fact as being the best
allies they can hope for at the level of system wide
decision-making. Large scale resource allocation
and policy revision will always seem set against
individual patient care. There is no policy change
in the world for which a good nurse cannot imagine
someone being negatively affected. However, we
need a new generation of nurses capable of avoid-
ing getting caught up in the passivity and victim
mentality characterized by the assumption that
bad decisions will always be made and nurses have
no power to influence them. Nursing is a large and
powerful professional occupational group, and has
tremendous power; however, we need to learn col-
lectively how to use that power as a social force
to work more closely together as an influence to-
ward social change, to find the places at which
we can speak with one voice, and to support each
other from our different angles of vision in so
doing.
Complexity and vision
This changing context will also require an increas-
ing number of nurses prepared at the masters
and doctoral levels. We need this because we need
individuals within our midst who are prepared to
deconstruct the ideological claims that are some-
times made on our behalf and to help nurses see
619
alternative ways of understanding the world. We
need to move beyond collectively indulging in some
of what can characteristically seem like disciplin-
ary knee-jerk reactions and to discover ways of
being within the world that will enhance our public
and political credibility and capacity.
We also need to learn collectively to grapple
with the really hard questions that will influence
how we do nursing in the future and could poten-
tially influence the way the public learns to think
about health and health care priorities. For exam-
ple, can we find ways to challenge the uncritically
held assumptions that our societies hold about
right action, and to surface the uncomfortable
truths that reveal our collective values? Why is it,
for example, that the appropriateness is rarely
challenged of rescuing conjoint twins from a small
village in Africa, bringing the family to North Amer-
ica for a year or more until the surgical correction
is complete, and then sending them all back into an
uncertain environment? Does that appease our col-
lective sense that we privileged folk in the West
have helped the less fortunate of the world? Or
should nursing be capable of balancing that kind
of act with a vociferous demand for the realloca-
tion of those resources so that antiretroviral and
anti-malarial medications might be provided for
an entire region? You can see by the example that
I have chosen here a difficult example I know
that I firmly believe this tension between individual
and population will characterize the moral leader-
ship that nursing of the future is capable of
enacting.
Interdisciplinarity
Clearly, we also must prepare nurses for an
increasingly complex and inherently interdisciplin-
ary health care team, one that will extend beyond
the medical and allied health professionals that we
are only now beginning to acknowledge in our nurs-
ing curricula, to include kinds of professional and
non-professional groups that we have not conven-
tionally considered as health care workers. These
will include unregulated workers, generic task-
oriented providers, and also members of those
public sectors who have not traditionally been con-
sidered part of health, such as education, public
works, the legal system, and housing.
Collectivity
And in this world of complexity, diversity, and
interdisciplinarity, we must also figure out how to
prepare nurses capable of retaining that capacity
620
for a common vision that we all hold dear. We work
in such different ways, with such different kinds of
problems. And yet, as those of us who are privi-
leged to be in the classroom with diverse groups
of specialized nurses who come together for the
purpose of graduate education appreciate, there
is a fundamental and powerful core connection be-
tween us all that has a lot to do with where we
came from and how we got there. That shared
understanding of the body, of the body in the hu-
man context, of the experience, of the nursepa-
tient relationship, of the infinite capacity for
human variation, and of the translation from the
general to the particular these cannot be lost
as we shape our nursing workforce into the future
or we may risk losing the power of that collective
vision of what it means to be a nurse. And that col-
lective vision no matter how tricky it is and has
always been to define it is the essence of what
we are.
As we move forward toward ensuring this viable
professional voice, we will grapple with a number
of tough questions. How can we educate nurses to-
ward the capacity for a common vision? How can
we help them balance surface self-advocacy with
coming together toward future thinking and creat-
ing a leading a force for service to society? How can
we help them sustain the passion for nursing within
workplace contexts that are likely to be increasingly
challenging? We all know that our governments are
facing shortages, and that employers want job
ready graduates. So how can we look beyond sim-
ply getting them ready for this context and ensure
that we are providing them with what it will take to
stick with it and to thrive in this kind of practice
world, and then ultimately to be its next change
agents? How can we prepare nurses who retain
their core essence despite an increasing diversity
of practice contexts, settings, and foci nurses
who will continue to recognize one another as
nurses? And how can we reformulate our theories
and conceptualizations so that they are better sui-
ted to the social, economic and political realities
of the world in which this future nursing will occur?
It seems to me that we need to work collabora-
tively between the nursing education and service
leadership community to advance the contributions
of the discipline to the fundamental challenge of
health system reform. And because of this, the
skillset that is needed to be a really effective nurse
educator will also shift so that we are all equally
comfortable in drawing knowledge from books
and bedsides, and we all know how to work effec-
tively within the academy and the health authority.
After all, that is what our historic leaders under-
stood that linkage between hospital administra-
S.E. Thorne
tion and the running of nursing schools, that
integration of the passion of apprenticeship and
mentorship, of creating workplace environments
in which the wisdom of the seasoned practitioner
could interact with the idealism of the neophyte.
Aligning knowledge and action in nursing
education
Fundamentally, then, it seems apparent that our
ideas and our action vision will have to inform
one another in a new form of nursing educational
praxis. While it may not be a major stretch to teach
about a model of praxis, we know that by far the
best approach is to learn to model it. In order to
move toward this capacity, we need to discover
what the nursing professorate must learn to shift
its knowledge and rapidly engage with the newer
ideas. It seems evident that we cannot simply wait
for a generation to change; rather, we will have to
develop a scholarship around how to support new
ideas, strategies and ways of thinking within nurs-
ing education itself. Conferences such as the Inter-
national Nursing Education Conference (NETNEP)
held in Vancouver in 2006 are an excellent begin-
ning. We know that excitement about nursing
knowledge is infectious, and it seems that we ought
to try to capitalize on what we know about how
infectious processes spread most rapidly to really
catalyze significant change; we can ensure that
we spread our enthusiasm with high doses, friendly
vectors, and multiple exposures.
While the complexity of nursing necessitates
that none of us can do it all and that we must diver-
sify our foci, it also seems that we cannot afford a
nursing education community in which a significant
number of us do only teaching, and not practice,
professional service or research. Rather, a hall-
mark of continuing competence within teaching
should include a sustained relevance within a range
of these activities. Thus we must increasingly find
creative ways to blend various combinations of
those dimensions so that our students are ex-
posed to excellent practitioners, that the knowl-
edge development we ascribe to does not only
get translated into practice but also taken up in
education. I believe that we need to work aggres-
sively toward a culture of engagement, and a broad
base of what we consider scholarship that includes
educational scholarship in all of its diversity (Boy-
er, 1990; Riley et al., 2002; Storch and Gamroth,
2002). Nurse educators are not simply nurses who
have mastered practice sufficiently to oversee
the learning of neophyte practitioners, or those
who have taken a graduate degree within the disci-
Nursing education: Key issues for the 21st century
pline, but rather they are professional experts with
a substantive body of knowledge related to the
complexities inherent in creating learning con-
texts, guiding intellectual journeys, and igniting a
passion for what this profession embodies in its es-
sence. We therefore have an obligation to attend
seriously to the scholarship of teaching within all
of its diversity, to ensure that it has equivalent
stature with clinical research as a disciplinary and
academic priority for nursing.
Concluding thoughts
In a brief commentary such as this, a deep and
thoughtful analysis of any of these complex issues
is impossible. What I have instead intended is a tan-
talizing overview of the wide scope of angles from
which I think we must collectively approach this
21st century, and some hints of strategies toward
which we might marshal our collective imagina-
tion. In so doing, I attempt to set the stage for
the truly creative, innovative, and impassioned
educational scholarship that nurse educators share
when they do find the occasion to gather together.
It is in these conversations that the deep analysis,
the insightful innovation, and the genuine leader-
ship emerge.
As has emerged in academic medicine, I do be-
lieve that an International Campaign to Revitalize
Academic Nursing would make excellent sense as
we navigate the way forward over the coming
years. And so I encourage my colleagues in nursing
education to take up that challenge. From my per-
spective, there is no greater profession in the
world than nursing, and no greater privilege than
to be involved in nurturing the next generation of
nurses. As we embark on this 21st century, we have
such a marvelous base of history, of tradition, and
of knowledge upon which to build, and we can en-
ter the new complexities fully grounded with an
understanding of why we are here and what our
621
part must be in shaping this future. We are not
leaving the past; we are merely bringing it with
us into this exciting new world.
References
Boyer, E.L., 1990. Scholarship Revisited: Priorities of the
Professoriate. The Carnegie Foundation for the Advancement
of Teaching, Princeton, NJ.
Bunkers, S.S., 2000. Nurse scholar of the 21st century. Nursing
Science Quarterly 113, 116123.
Clark, J., 2005. Five futures for academic medicine: the ICRAM
scenarios. British Medical Journal 331, 101104.
Global Forum for Health Research, 2004. 10/90 Report on health
research, 20032004. Available from: <http://www.global-
forumhealth.org/Site/002_What%20we%20do/005_Publica-
tions/001_10%2090%20reports.php>.
Huch, M.H., 1995. Nursing and the next millennium. Nursing
Science Quarterly 8 (1), 3844.
Inayatullah, S., Gidley, J., 2000. The University in Transforma-
tion: Global Perspectives on the Futures of the University.
Bergin & Garvey, Westport CT.
International Working Party to Promote and Revitalise Academic
Medicine, 2004. ICRAM (the International Campaign to
Revitalise Academic Medicine): agenda setting. British Med-
ical Journal 329, 787789. Available from: <http://bmj.bmj-
journals.com/cgi/content/full/329/7469/787>.
Parse, R.R., 1991. Nursing knowledge for the 21st century: an
international commitment. Nursing Science Quarterly 5 (1),
812.
Riley, J.M., Beal, J., Levi, P., McCausland, M.P., 2002.
Revisioning nursing scholarship. Journal of Nursing Scholar-
ship 34 (4), 383389.
Romanow, R.J., 2002. Building on values: the future of health
care in Canada Final report of the Commission on the
Future of Health Care in Canada. Canadian Government,
Ottawa. Available from: <http://www.cbc.ca/healthcare/
final_report.pdf>.
Spitzer, A., 1998. Nursing in the health care system of the
postmodern world: crossroads, paradoxes and complexity.
Journal of Advanced Nursing 28, 164171.
Storch, J., Gamroth, L., 2002. Scholarship revisited: a collab-
orative nursing education programs journey. Journal of
Nursing Education 41 (12), 524530.
Tugwell, P., 2004. Editorial: Campaign to revitalise academic
medicine kicks off. British Medical Journal 328, 597. Avail-
able from: <http://bmj.bmjjournals.com/cgi/content/full/
328/7440/597>.