Q&A with Dr. Patricia Benner, Faculty Development Officer, NovEx: Novice to Expert Clinical Learning speaks with Dr. Patricia Benner, Director of the Carnegie Foundation's National Nursing Education Research Project, on the future of nursing education, and why reforms in nursing education are so necessary.

Q: What is the Carnegie Foundation's Study of Nursing Education?

It was the first national nursing education study in 40 years. It was nested in a study of professional education. The Carnegie Foundation wanted to take a look at what was going on in professional education in terms of ethics and civic professionalism. They were very interested in studying the process of professional education.

Q: The study led to the publication of "Educating Nurses: A Call for Radical Transformation." What does a nurse need to know about this work?

One of the strong recommendations that we made is for new nurses to have at least one year of residency after they graduate. Nurses have a huge amount of responsibility from the time that they graduate and enter the workforce. We found a large practice vs. education gap. Education wasn't really keeping up with both the science and the complexity of practice. One of the difficulties students have is confronting how much risk is involved in their practice and the narrow margin for error. New nurses would get a lot out of practice residencies in which they could further develop learning how to think like a nurse, in addition to developing in depth knowledge about particular patient specialties.

Q: What is the best way to prepare for the career?

In nursing schools, we really need to integrate knowledge acquisition and knowledge use. You have to engage in critical learning. Seek out excellent nurses who are developing their own clinical imagination and ways to solve the myriad issues involved in practice. Nurses are the most generally prepared of health care workers. They have a huge range of knowledge and responsibilities for their practice.

Q: What is the best entry point for a new nurse?

In California, it takes a minimum of three years to get an associate degree in nursing. You can get a baccalaureate in nursing in four years. It can even take up to five years to get the ADN because of the overcrowding in community colleges. If I were going to enter an ADN program, I would enter one with an articulation agreement like the one at the Oregon Consortium. Students can complete their ADN degree and then go on to their baccalaureate degree. The Oregon Program is seamless. It doesn't waste your time or money. We are now developing such programs in California and other states.

Q: In your work from "Novice to Expert," five levels of nursing experience were identified. What role does continuing education in addition to experience play in advancing from one level to the next?

When we use the word "experienced," we mean someone who is really actively learning from their practice experience. It's a dynamic model. It's not just about time. It's how good a learner someone is and how engaged he or she is in the process of learning in practice. Some nurses never advance to the expert level. Continuing education, especially if it's related to a clinical area in which someone is working, is very effective in helping a nurse advance in his or her skill acquisition.

Q: How does nursing education need to change?

We really have to improve the teaching and upgrade the sciences in basic nurse education. We have a problem - classroom and clinical instruction are drifting too far apart. We need to integrate classroom and clinical learning much better. Clinical coaching in practice settings and simulations should correspond to knowledge gained in the classroom. The emphasis on simulation is going to be very useful in developing clinical imagination so that students can be more flexible and astute in their use of knowledge in practice.

Q: How do you think the nursing shortage and the reforms in health care are going to impact careers?

Right now there is a sense that it's very hard to get a job because of the economy. It's not a bad time for nurses to be enhancing their education. We're going to need more and more nurses with advanced practice degrees to meet the new health care requirements. Most Labor Force experts think that within five years, there's going to be an incredible shortage of nurses again because of the age of the nursing workforce. Once the economy improves, a lot of nurses will retire. There is also going to be a huge demand for advanced practice nurses with their master's degrees in the newly reformed health care system.

Q: How necessary are bridge programs like the RN to BSN?

I think nurses need to continually progress and move to that higher degree. ADN graduates would be very smart to go for a bridge program that moves them to an MSN degree. That's a much more economical and useful degree for them because it gives them the ability to practice at a new level. I would recommend that over the baccalaureate degree for the ADN graduate.

Q: Why is a radical transformation in nursing education so crucial for nurses right now?

There has been a growing awareness of the level of the incredible contribution of nurses to health care. Nurses at all levels fill a niche in our health care delivery that is desperately needed. You have dedicated practitioners helping people manage chronic illnesses and helping them stay out of the hospital with better preventative services. The acute care setting really would not function well without advanced practice nurses working with their level of specialty, knowledge development and patient population management. The nurse is the patient's last line of defense. They're present 24/7. The level of judgment and responsibility needed by nurses is really very high.

Q: Why should someone join the nursing profession now?

I think it's just one of the best careers. It's a very rich field with a huge range of practice possibilities and settings. I've had a really wonderful career. Even though I've shifted what I've been doing, there's always been continuity and the chance to get in-depth knowledge of the field. Nurses deliver a very high quality of service without an exorbitant price.

Q: What should nurses graduating in the next few years expect?

We really need to demand a good work environment. That's so important for a new nurse and all nurses. The more we demand it; the more improvement we'll get, and the better health care we'll deliver.

Q: Any other recommendations for aspiring nurses?

There aren't many professions in which you can have so much impact on people's lives in such crucial and vulnerable times. I think nursing is very intellectually challenging and demanding and very interpersonally challenging as well.