Nurse Education Today (2006) 26, 614–621

Nurse

intl.elsevierhealth.com/journals/nedt

EducationToday

Nursing education: Key issues for the 21stcentury q

Sally E. Thorne *

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

Accepted 19 July 2006

Summary In this paper, I reflect on what can be learned by engaging in futurethinking within our discipline, and what implications the results of that thinkingmay have for the development of nursing education. Recognizing the marvelousdiversity of perspective within our discipline with regard to what will and oughtto be our future mandate, it seems reasonable to search for some grounding in whatmight 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 weakjustification for failure to plan. Nurse educators hold a particular obligation toensure 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 ontomorrow, it is inordinately difficult to come to some agreement on how we can bestbridge that gap within our educational programs and strategies. Toward this end, Idraw on lessons that can be drawn from our professional history as a rich and vibrantcontext 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. 614–621 and Nurse Education in Practice Vol. 6, No. 6, pp. 306–313.

KEYWORDSNursing education;Trends;Nursing profession;History of nursing

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Introduction

The world of future thinking in nursing is a strangeone. Reading through the marvelous diversity of

260-6917/$ - see front matter �c 2006 Elsevier Ltd. All rights reser

q Initially presented as a keynote lecture at the Nursingducation Today/Nursing Education in Practice First Interna-ional Nursing Education Conference, May 14–16, Vancouver BC.* Tel.: +1 604 822 7748; fax: +1 604 822 7423.E-mail address: thorne@nursing.ubc.ca.

imaginal projections that are contained withinour futuristic literature, one gets the sense of sci-ence fiction run wild in the minds of our theoristsand 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 thatstretching our minds into improbable possibilitiesis something we must learn if we are to enter that

ved.

Nursing education: Key issues for the 21st century 615

future wisely. We intuitively understand that look-ing beyond what we can immediately grasp be-comes an imperative if we are to withstand theforces of change and cling on to what we in nursinghold most dear. And we recognize that whateverour trepidations, that future will still unfold withits own commanding trajectory.

We who carry the torch for nursing educationhold a particular responsibility for our part in thisfuture thinking. Our core business is the prepara-tion of the next generation of nurses so that theymight take their rightful place in a world order thatwe can only begin to comprehend. We craft knowl-edge frameworks, conceptualizations, and theoret-ical structures so that an infinite set of new ideaswill arise out of the mist and take shape in theworld of nursing practice. In this paper, I argue thatwhat guides us is not simply our capacity to projectthe details of that future but rather, more impor-tantly, to learn from our past. Drawing on ourphilosophical foundations, the values and idealsupon which this nursing profession is grounded,we find substance that can help us reflect uponwhat and who we are, and how we might carry thatontological 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 inour quest for ensuring that the core values inherentin 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 timefor reflection and reconsideration. With half ofthe millennium’s first decade now past, we recallwith humour how frightening it was when we madethat transition from 1999 to 2000, sure that all ofour computer-based society would fall apart withthe digital adjustment, and also worried that, hav-ing lived all our time in years beginning with thedigits one and nine, that we would not know howto feel this new millennium. Having now foundour way into it, we discover that in most aspectsit is not all that different from the decade thatwent before. We still struggle with the same healthcare reform issues, still worry about impendingnursing shortages, and still battle with the samefunding agencies to consider nursing educationalscholarship a viable form of research.

Coincident with this same millennium transition,we have seen considerable reflective reinventionwithin many of society’s institutions (Inayatullahand Gidley, 2000). National governments have beenrapidly cycling from left to right and back again,

corporate structures have been undergoing unprec-edented upheaval, and social institutions such asthe university are exploring new mechanisms forrelevance and accountability. Within our varioushealth care systems, there have been massive glo-bal shifts in professional autonomy, public engage-ment, and system redesign (Romanow, 2002). Withour colleagues across the full range of health disci-plines and social policy sectors, we have begun torealise that 10% of the world’s health problems re-ceive 90% of the world’s health resources and thatthis is no longer defensible (Global Forum for HealthResearch, 2004). Our tolerance for a have/have notworld is rapidly shifting as we realise the inherentand immediate global impact of economic inequi-ties on such shared problems as epidemics.

There has also been a corresponding reflexivitywithin 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 ofand contribute to the evidence basis for academicmedicine; (2) develop strategy around reformedacademic medicine, and (3) stimulate a public de-bate on the future (International Working Party toPromote and Revitalise Academic Medicine,2004). Toward those ends, the project has gener-ated scenarios depicting what the world might looklike and how academic medicine might move for-ward toward leadership rather than reactivity(Clark, 2005). Among the observations arising fromanalysis of the common features of these scenariosare the suggestions that: academic medicine willhave 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 beincreasingly important, individuals will also haveto shine and to flourish; that teaching, researching,improving, leading and providing service will con-tinue to be important, but expecting individualsto be equally competent in them will be recognizedas increasingly impractical; that competitionamong academic institutions is likely to increase;and that academic institutions will need to becomeincreasingly businesslike and more adept at usingmedia (paraphrased from Clark, 2005).

In highlighting what our colleagues in academicmedicine consider the real imperatives, theseobser-vations reflect many of the issues about which aca-demic nursing should also be profoundly concerned.

616 S.E. Thorne

A time for dialogue

The occasion of the First International Conferenceon Nursing Education (NETNEP 2006), in which hun-dreds of passionately committed nurse educatorsgathered 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 withinour scholarly literature. The key issues articulatedby conference planners foreshadowed much of thispriority setting, articulating such foci as: inter-pro-fessional education; research, evidence basedpractice, and technology in health and education;and service user involvement in the way we edu-cate health care professionals. The enthusiasmwith which conference participants engaged insharing their stories, listening to the experienceof others, and reflecting upon their commonalitiesand diversities fuelled a sense of excitement thatnurse educators have considerable power to shapean exciting future.

Given the privilege of speaking in the confer-ence’s opening session, I took the opportunity toenter this dialogue by structuring my commentsaround the dialectic between nursing knowledgeand nursing action, recognizing that this is theintersection within which so much of our nursingeducational analysis resides. I took as my startingpoints what I believe to be shared foundationalassumptions regarding our core business in nursingeducation if our discipline is to continue to serveits fundamental mandate of preserving and sup-porting the health of populations. For me, theseare 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 societyis shaped by the degree to which it can develop andsustain a knowledgeable nursing workforce. How-ever, what this meant historically and what it iscoming to mean are changing. We need to find waysto shift this forward without leaving behind what isprecious. As various nurse scholars have recog-nized, nursing has historically been caught at thelevel of ‘‘the patient’’ (and we know total patientcare better than any other). In the current world,we are going to have to find ways to preserve thatcommitment without it becoming our limitation.The paradox, as we have realised, is that if weallow our collective gaze to remain entirely atthe level of that individual, we cannot make a dis-

ciplinary contribution to the social policy issuesthat ultimately have far more impact on that indi-vidual’s overall likelihood of health and well-beingthan 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 abalanced combination of what they will need toknow and also how they will need to know it. Inthe following discussion, I propose a few of theareas in which we could use some thoughtfulreflection and dialogue.

Pragmatics

In the future, the knowledge we bring to bear todevelop nursing practice will have to include a verylarge dose of practicality. From all indications, itseems clear that that which will be funded as ourglobal health care systems evolve is that whichcan be economically justifiable. Nurses, being en-trenched into a service ethic and committed tocare regardless of economic context have an inor-dinately difficult time adjusting their sights to in-clude that economic argument. And yet, becausewe 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 itwithin our core curricula.

We will also need to create a generation ofnurses who can move beyond the intuitive ‘‘know-ing’’ that their ministrations make a difference to-ward grappling with the complexities ofmeasurable ‘‘nurse-sensitive outcomes’’. In orderto do so, we will need to continue to take leader-ship in methodological innovations to permit re-search integration and synthesis, to combinemethods so that complex ideas can be consideredin context, and so that those who control the re-sources can begin to understand the implicationsof systems of nursing at the population level.

Toward this end, we will need to find ways tomove beyond some of our individual ‘‘positioning’’in the sense of what constitutes a ‘‘right’’ ap-proach, and our convictions as to which theoreticalperspective ought to dominate. In order for nursingdo 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 toprepare the next generation of nurses to be ascompetent and comfortable in the language ofpathophysiology and molecular biology as feel theyare in the discourse of spirituality and holism. Notonly will we have to educate the new generationtoward competence and confidence, but we will

Nursing education: Key issues for the 21st century 617

also have to ensure that it comes well preparedwith humility; each of these fields is enormous,vast, and complex, and oversimplifying them wouldultimately disserve us in meeting those objectives.We must not only remain credible to ourselves, butto an increasingly sophisticated and critical audi-ence of interprofessional team members, publicpolicy decision-makers, and health care consum-ers. So that delicate balance between confidencein what we do know and reverence for what wedo not and cannot know will have to be a hallmarkof that knowledgeable nursing workforce of thefuture.

Evidence

One prominent aspect of disciplinary knowledge inwhich we will need to steer a radical shift has to dowith what it means to make claims related to evi-dence-based practice. The language of evidencewill increasingly shape policy and resource alloca-tion, and so we need to be collectively conversantwith 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 ourcurrent conceptualization that we have done jus-tice to this concept by teaching nurses to read a re-search paper. That specific element is like thewell-known Sufi Parable of the Blind Born – teach-ing nurses to privilege a single angle of vision on aparticular problem, often without really knowingthat there are multiple angles that ought to be con-sidered in order to understand the nature of thephenomenon we are attempting to engage with.What the knowledgeable nursing workforce will de-mand is a more collective capacity to understandand 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 atthe front line of nursing or at the neophyte scholarlevel, but more collectively within our specialtygroupings 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 adiscipline.

Local context

Another shift needed in this new world is from theorientation 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 nursesfocusing their everyday practice on high acuity –although it is of course important and getting even

more highly acute all the time. Instead, manynurses will necessarily be shifting attention towardthe 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 neworientation to skillsets, but also to undoing thosestructures and processes we have put into place be-cause the assumptions inherent in acuity (patientpassivity, professional expertise and so on) havebecome part of the problem in chronic illness care.We will also be increasingly learning to work withunregulated care workers, coping with new pres-sures such as the generic ‘‘Health Care Worker’’that has cropped up in some jurisdictions, andworking more effectively with the meaningful hu-man social groupings that we historically relatedto as if they were all ‘‘nuclear families’’.

Global context

We are also fully aware that nursing education canno longer afford to prepare practitioners for highlyspecialized local settings to meet immediate work-force needs. We all know that nurses will movearound, that settings will change even if they donot, and so we must prepare for a global worldand a world of complexity. More importantly withinthis context, we need to shift our attention fromtraining nurses who primarily think about local con-ditions toward educating practitioners who havethe ‘‘big picture thinking’’ that allows them to‘‘think globally’’. This new generation will haveto face the mobility of the world, and the intercon-nectedness that entails. For example, no longerwill it be reasonable to consider certain diseasesto only exits ‘‘there’’ because ‘‘there is nowhere’’.

Beyond the practical reasons that this isbecoming an imperative, there are moral impera-tives pointing us toward recognition that this isthe ‘‘right’’ thing to be doing. Taking up thosemoral challenges, we want to shift our attentionfrom thinking of nurses as being good corporatecitizens to thinking of them as being exemplary‘‘global citizens’’. We need to wrestle with suchchallenges as how to nurture a service ethic with-in a ‘‘me first’’ generation. We need to learn howto prepare nurses who have a fully embeddedsense of the economic implications of healthand illness, of what causes ill health, of whatdrives health service, and of what sustainable im-pacts they can envision. And we need to createstrategies to guide nurses who will work effec-tively within an increasing diversity of worldviewsand perspectives.

618 S.E. Thorne

Diversity

We recognize that there are very few homogenoussocieties in today’s world – and that a standard ofbasic entry level practice competency in nursing isto know how to work thoughtfully and as equitablyas possible with diversity. This includes people whorelate differently to what we offer, and people forwhom health and illness and our role in relation tothem are understood differently. This process hascaused us to reflect more seriously on the fact thatwe 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 thatperspective. We need to be able to distinguish be-tween the beliefs and values we hold by virtue ofour disciplinary allegiance and those facts andtruth claims we draw upon in order to justify whatwe do and how we do it.

Complexity

In order to accomplish all of this, it seems evidentthat we cannot any longer afford to accept uncrit-ically held and superficial attachments to binarydimensions like issues of right and wrong, goodand evil. The nurses of the future will have to beable to simultaneously hold in their minds ideasthat are apparently contradictory – the patientas confronting death and at the same time hopingfor miracles, the seriously ill person who is manag-ing well and also not coping at all, the patient asautonomous being and the family as being the pri-mary locus of that patient’s decision making. Wehave for too long tolerated conceptualizations thatpolarize possibilities – compliance and non-com-pliance, normalization and disability, health andillness, hope and despair as by definition mutuallyexclusive entities. In order to move forward in thisworld, the nurses of the future have to be able torecognize, but think beyond the conceptual cate-gorizations with which we educate them. They willhave to understand that uncertainty and certaintyco-exist, that the patient who manages self-careindependently is also dependent, that the personwho is overwhelmed with fear is also grounded incourage. They will learn to work with patients ina sensitive and nuanced manner that respects andreaches out to all of the contradictory parts oftheir experience. This kind of thinking will forceus out of our standardized diagnostic approaches,our simplistic conceptualization models, and intonew and more excitingly complex ways of organiz-ing and shaping our understandings.

If these requirements for a truly knowledge-able nursing workforce of the future are any indi-cation, there are obvious and considerableimplications for nursing education. As a hospital-trained RN who only reluctantly returned toschool to earn a degree (never knowing how farthat path would lead!), I have had the luxury ofseeing a significant shift in how we do businessin nursing education, and am therefore confidentwe can do it again. For example, I believe thatwe need the capacity to shift what we currentlydo from both a curricular and a pedagogical per-spective and extend beyond our ‘motherhood’claims about such phenomena as holism – whichis individualism in context – and to figure outhow better to work and teach across the individ-ual, family, community and societal continuum.We need to know how to think bio-psycho-socialto population-based and back again, and do tothat in a dynamic and rapid-cycling intellectualprocess, not on separate days and in separatetimes. From my perspective, this capacity is andwill be the unique contribution of nursing, andwe need to ensure that it is effectively learnedin the foundational stages if we are to surviveas a profession into this challenging future.Remember, across the planet, as we becomemore educated and more expensive, we also be-come more expendable unless we know how totranslate our inner conviction that nursing mat-ters into an objective, defensible, business casethat clearly documents the value that a knowl-edgeable nursing workforce brings to a healthysociety. So this ‘‘knowing’’ will have to move be-yond subjectivities and individual patient care toinclude a much different kind of justificationand evidence. In short, we need to move frombelief to defensible convictions, from assumptionsto objectively verifiable claims. And it is thesewhich will make that future nursing workforcegenuinely knowledgeable.

A viable professional voice

The second major issue that I think defines what weall believe we are aiming for is a viable professional‘‘voice’’. In this changing context, if nursing is toremain professionally viable, we need not only toprepare a new generation of nurses with a changingbody of knowledge and knowing, but also to pro-vide them with the structural scaffolding withinwhich 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 619

Workplace organization

Globally, the workplace of nursing is shifting andunder 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 revolutionin 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-oneconvalescent care to a more orderly and organizedway of delivering nursing service to larger groups ofpatients. Now it seems that we need to be workingwithin and across settings, with populations notunits, and ensuring that we keep our sights on whatthe contribution of nursing is and ought to be with-in that changing interprofessional context. Defend-ing the old ways would not work, and reacting afterthe fact to the changes that others decide on ourbehalf is notoriously unsatisfying.

Leadership and power

We also need to ‘‘train up’’ a new generation notto consider their professional leaders as havingjoined the ‘‘dark side’’ but in fact as being the bestallies they can hope for at the level of system widedecision-making. Large scale resource allocationand policy revision will always seem set againstindividual patient care. There is no policy changein the world for which a good nurse cannot imaginesomeone being negatively affected. However, weneed a new generation of nurses capable of avoid-ing getting caught up in the passivity and victimmentality characterized by the assumption thatbad decisions will always be made and nurses haveno power to influence them. Nursing is a large andpowerful professional occupational group, and hastremendous 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 whichwe can speak with one voice, and to support eachother from our different angles of vision in sodoing.

Complexity and vision

This changing context will also require an increas-ing number of nurses prepared at the master’sand doctoral levels. We need this because we needindividuals within our midst who are prepared todeconstruct the ideological claims that are some-times made on our behalf and to help nurses see

alternative ways of understanding the world. Weneed to move beyond collectively indulging in someof what can characteristically seem like disciplin-ary knee-jerk reactions and to discover ways ofbeing within the world that will enhance our publicand political credibility and capacity.

We also need to learn collectively to grapplewith the really hard questions that will influencehow we do nursing in the future and could poten-tially influence the way the public learns to thinkabout health and health care priorities. For exam-ple, can we find ways to challenge the uncriticallyheld assumptions that our societies hold aboutright action, and to surface the uncomfortabletruths that reveal our collective values? Why is it,for example, that the appropriateness is rarelychallenged of rescuing conjoint twins from a smallvillage in Africa, bringing the family to North Amer-ica for a year or more until the surgical correctionis complete, and then sending them all back into anuncertain environment? Does that appease our col-lective sense that we privileged folk in the Westhave helped the less fortunate of the world? Orshould nursing be capable of balancing that kindof act with a vociferous demand for the realloca-tion of those resources so that antiretroviral andanti-malarial medications might be provided foran entire region? You can see by the example thatI have chosen here – a difficult example I know –that I firmly believe this tension between individualand population will characterize the moral leader-ship that nursing of the future is capable ofenacting.

Interdisciplinarity

Clearly, we also must prepare nurses for anincreasingly complex and inherently interdisciplin-ary health care team, one that will extend beyondthe medical and allied health professionals that weare only now beginning to acknowledge in our nurs-ing curricula, to include kinds of professional andnon-professional groups that we have not conven-tionally considered as health care workers. Thesewill include unregulated workers, generic ‘‘task-oriented’’ providers, and also members of thosepublic sectors who have not traditionally been con-sidered part of ‘‘health’’, such as education, publicworks, the legal system, and housing.

Collectivity

And in this world of complexity, diversity, andinterdisciplinarity, we must also figure out how toprepare nurses capable of retaining that capacity

620 S.E. Thorne

for a common vision that we all hold dear. We workin such different ways, with such different kinds ofproblems. And yet, as those of us who are privi-leged to be in the classroom with diverse groupsof specialized nurses who come together for thepurpose of graduate education appreciate, thereis a fundamental and powerful core connection be-tween us all that has a lot to do with where wecame from and how we got there. That sharedunderstanding of the body, of the body in the hu-man context, of the experience, of the nurse–pa-tient relationship, of the infinite capacity forhuman variation, and of the translation from thegeneral to the particular – these cannot be lostas we shape our nursing workforce into the futureor we may risk losing the power of that collectivevision of what it means to be a nurse. And that col-lective vision – no matter how tricky it is and hasalways been to define it – is the essence of whatwe are.

As we move forward toward ensuring this viableprofessional voice, we will grapple with a numberof tough questions. How can we educate nurses to-ward the capacity for a common vision? How canwe help them balance surface self-advocacy withcoming together toward future thinking and creat-ing a leading a force for service to society? How canwe help them sustain the passion for nursing withinworkplace contexts that are likely to be increasinglychallenging? We all know that our governments arefacing shortages, and that employers want ‘‘jobready’’ graduates. So how can we look beyond sim-ply getting them ready for this context and ensurethat we are providing them with what it will take tostick with it and to thrive in this kind of practiceworld, and then ultimately to be its next changeagents? How can we prepare nurses who retaintheir core essence despite an increasing diversityof practice contexts, settings, and foci – nurseswho will continue to recognize one another ‘‘asnurses’’? And how can we reformulate our theoriesand conceptualizations so that they are better sui-ted to the social, economic and political realitiesof 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 serviceleadership community to advance the contributionsof the discipline to the fundamental challenge ofhealth system reform. And because of this, theskillset that is needed to be a really effective nurseeducator will also shift so that we are all equallycomfortable in drawing knowledge from booksand 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-

tion and the running of nursing schools, thatintegration of the passion of apprenticeship andmentorship, of creating workplace environmentsin which the wisdom of the seasoned practitionercould interact with the idealism of the neophyte.

Aligning knowledge and action in nursingeducation

Fundamentally, then, it seems apparent that ourideas and our action vision will have to informone another in a new form of nursing educationalpraxis. While it may not be a major stretch to teachabout a model of praxis, we know that by far thebest approach is to learn to model it. In order tomove toward this capacity, we need to discoverwhat the nursing professorate must learn to shiftits knowledge and rapidly engage with the newerideas. It seems evident that we cannot simply waitfor a generation to change; rather, we will have todevelop a scholarship around how to support newideas, 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 nursingknowledge is infectious, and it seems that we oughtto try to capitalize on what we know about howinfectious processes spread most rapidly to reallycatalyze significant change; we can ensure thatwe spread our enthusiasm with high doses, friendlyvectors, and multiple exposures.

While the complexity of nursing necessitatesthat none of us can do it all and that we must diver-sify our foci, it also seems that we cannot afford anursing education community in which a significantnumber of us do only teaching, and not practice,professional service or research. Rather, a hall-mark of continuing competence within teachingshould include a sustained relevance within a rangeof these activities. Thus we must increasingly findcreative ways to blend various combinations ofthose dimensions – so that our students are ex-posed to excellent practitioners, that the knowl-edge development we ascribe to does not onlyget translated into practice but also taken up ineducation. I believe that we need to work aggres-sively toward a culture of engagement, and a broadbase of what we consider scholarship that includeseducational scholarship in all of its diversity (Boy-er, 1990; Riley et al., 2002; Storch and Gamroth,2002). Nurse educators are not simply nurses whohave mastered practice sufficiently to overseethe learning of neophyte practitioners, or thosewho have taken a graduate degree within the disci-

Nursing education: Key issues for the 21st century 621

pline, but rather they are professional experts witha substantive body of knowledge related to thecomplexities inherent in creating learning con-texts, guiding intellectual journeys, and igniting apassion for what this profession embodies in its es-sence. We therefore have an obligation to attendseriously to the scholarship of teaching within allof its diversity, to ensure that it has equivalentstature with clinical research as a disciplinary andacademic priority for nursing.

Concluding thoughts

In a brief commentary such as this, a deep andthoughtful analysis of any of these complex issuesis impossible. What I have instead intended is a tan-talizing overview of the wide scope of angles fromwhich I think we must collectively approach this21st century, and some hints of strategies towardwhich we might marshal our collective imagina-tion. In so doing, I attempt to set the stage forthe truly creative, innovative, and impassionededucational scholarship that nurse educators sharewhen 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 RevitalizeAcademic Nursing’’ would make excellent sense aswe navigate the way forward over the comingyears. And so I encourage my colleagues in nursingeducation to take up that challenge. From my per-spective, there is no greater profession in theworld than nursing, and no greater privilege thanto be involved in nurturing the next generation ofnurses. As we embark on this 21st century, we havesuch a marvelous base of history, of tradition, andof knowledge upon which to build, and we can en-ter the new complexities fully grounded with anunderstanding of why we are here and what our

part must be in shaping this future. We are notleaving the past; we are merely bringing it withus into this exciting new world.

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