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The cost and quality agenda comes to higher education.

IN MID-AUGUST, when most of us were taking that long last weekend before the busyness of the fall semester, the secretary of education's Commission on the Future of Higher Education released a new report, "A Test of Leadership: Charting the Future of U.S. Higher Education" (1). By many accounts, this report calls for a broad overhaul of the higher education system as we know it. Now, the cost reduction and quality enhancement efforts that have been implemented throughout the health care delivery system are at the door of nursing education. Some nursing programs may be protected from the proposed reforms based on their specialized focus. And in nursing education, we are in the enviable position of having great demand for our courses from potential applicants. However, we are not totally immune from the reforms that this report recommends. In fact, we will strengthen our programs if we pay attention to this report, as it holds many implications for nursing education. I recommend that we reflect on it and engage in dialogue within our nursing education programs, voicing our thoughts at policy levels locally and nationally (at college/university and state levels and to our elected officials and to the commission itself).

While some are concerned that this report was too watered down, with compromises made based on the strong opposition of colleges and universities, it represents, according to the Chronicle of Higher Education, an attempt to make higher education more affordable, more accountable, and more innovative (2). These are all worthy goals, but change could strike hard at nursing education. The way we do business is costly, and often we have not demonstrated the cost effectiveness of our teaching modalities.

The most vulnerable of those modalities is our traditional clinical teaching model, in which we have tried to maintain faculty-student ratios of 1:10. Even though the numbers of students per faculty member have increased in the past decade, this is still a costly model, one that is rarely used in other professional education programs. While preceptors are now more frequently used for clinical instruction, and at times are paid for their involvement, this practice is still not routine. And we lack data detailing the financial models and learning outcomes to compare the two methods of clinical teaching. It is time to apply a cost analysis model along with measurement of quality outcomes.

On the quality side of the proposed changes, we need to be more transparent in the data that we provide to prospective students and to the public. Of course, we are now in a seller's market--the demand for placements in schools of nursing has reached astounding numbers, and students are on waiting lists for years. Once they make it to the top of the list, it is not likely that they will comparison shop. Yet, reporting our outcomes will only strengthen our programs. Students have a right to know the percentage of the school's graduates who pass the NCLEX exam, as well as the success of its graduates in the marketplace. While it is most likely that all of our graduates will secure employment, it is important to know how competitive a school's graduates are for the best positions.

No one is quite sure what will happen with the recommendations of the commission's report. And, even if no sweeping changes are implemented, the language of cost and quality has been introduced into the discussions of our hallowed hallways. We in nursing education would be wise to get our house in order.


(1.) US Department of Education Commission on the Future of Higher Education. (2006).A test of leadership: Charting the future of U.S. higher education. [Online].Available:

(2.) Chronicle of Higher Education Live Discussion. (2006). The commission's report." Landmark or footnote? [Online].Available:

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Title Annotation:From the Editor
Author:Fitzpatrick, Joyce J.
Publication:Nursing Education Perspectives
Date:Nov 1, 2006
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