It's Time to Build a Better Healthcare Workforce by Innovating Nursing Education
The healthcare system is transforming on multiple fronts, and academic programs must adapt to ensure that nurses are equipped to meet the demands of modern patient care. But according to a well-known healthcare executive and educator, traditional approaches to preparing nurses — which often revolve around more memorization than application — aren’t keeping pace with complexities in healthcare delivery.
Dan Weberg, PhD, MHI, BSN, RN, executive director of nursing workforce development and innovation at Kaiser Permanente, advocates a shift in educational strategies. Weberg has been publishing and speaking about healthcare innovation for more than 15 years and is well-versed in the challenges and opportunities in nursing education. He is the coauthor of Leadership for Evidence-Based Innovation in Nursing and Health Professions, a Jones and Bartlett text whose 3rd edition will be published in September 2024. The book provides new perspectives on healthcare education, practice and leadership.
The video below captures highlights of our recent conversation with Weberg. Continue reading for additional detail on his thoughts about building a better healthcare workforce.
Transitioning from Memorization to Information Mastery
Weberg argues that the intricacies of patient care, particularly in intensive care settings, have reached a level of complexity that renders memorization ineffective in establishing adequate knowledge.
“You can memorize anatomy, and that makes sense. But the complexity of an ICU patient today is so advanced that you can't memorize all the different pathways, all the different decisions, all the different drugs, all the different interventions,” he said. “It's impossible.”
He recommends a pivot toward teaching methods that emphasize the mastery of real-time information.
“We have to teach nurses how to access reliable, safe, vetted information, either through evidence-based practice or through an AI search tool — and to incorporate that into real-time information,” Weberg said. “Because they can no longer memorize all this stuff. I think that's a fundamental shift for us as educators. Nursing school needs to be set up to access information, not memorize it.”
He provided the example of having students compare their clinical decisions with insights from faculty and AI. This can provide a well-rounded view of patient care scenarios that helps students identify their knowledge gaps, Weberg said.
Cultivating Clinical Judgment
The ability to make sound clinical decisions is a critical skill for nurses, and it is being evaluated more pointedly on the Next Generation NCLEX (NGN), which was implemented in April 2023. To develop nurses who are prepared for practice, however, Weberg believes that nursing education must address clinical judgment even more directly. His opinion stems from his dual roles as nursing faculty and a hiring manager.
“NCLEX pass scores mean zero to me as a hiring manager, because that's the lowest part of our profession,” he said. “When I hire 97% pass rate graduates, I still have to put them through a year-long training in order to get them to be independent and safe. Something is broken on the education side …
“From a hiring manager standpoint, what I would like to see is that even if a program had a 10% NCLEX pass rate, those graduates could hit the ground running safely in 2 months versus 12,” he continued. “That's the outcome I want to see.”
Weberg said he has been working to establish the understanding that NCLEX pass rate represents table stakes — the minimum rather than the desired.
“What’s more important is how safe and effective a graduate is — whether they have the critical thinking and skill set that are necessary so that we can actually onboard them into the workforce in a reasonable time,” he said.
Incorporating AI to Broaden Perspectives
Artificial intelligence has the potential to improve nursing education by offering an additional layer of analysis and feedback, Weberg said.
“One of my burning platforms is nowhere in nursing education,” he said. “We should be teaching how to take machine-generated insights and turn them into clinical decision making. I think that goes back to how do we access real-time information.”
As an example, Weberg said faculty could engage students in a comprehensive review and discussion about a care plan and seek additional analysis from an AI resource. Receiving feedback from fellow students, faculty, and an appropriately informed artificial intelligence resource could help students better understand the nuances of the decision-making process.
“This would produce three different perspectives on that care plan,” he said. “Now you can have a debrief with those students to compare the three. What's missing here? What did we not see? What did we see? What did this source see that we missed? What could we not even know if we didn't use this tool or that expert?”
By implementing an AI-informed approach, students would have a more accurate understanding of their knowledge, Weberg said.
“If they understand where their gaps in knowledge are, they understand where they might be able to find the answers to those things,” he explained. “And now they have a more formed clinical reasoning, rather than just a red mark on the care plan that ‘this isn't right,’ or ‘you used the wrong nursing diagnosis.’
“You really need to have a conversation to get to the point where the decision that they were making deviated from what the normal response would be,” he continued. “You get to there and figure out what the data point was that made that deviation. Then start uncovering how you can avoid doing that again.”
Moving Beyond Checklists to True Competence
The American Association of Colleges of Nursing (AACN) developed The Essentials: Core Competencies for Professional Nursing Education to guide nursing programs in developing the competencies necessary to work in today’s healthcare systems.
Weberg supports the move toward competency-based education but cautions against a simplistic checklist approach. He said true competency involves a deep understanding of the reasons behind each nursing task, and urges educators to focus on developing a comprehensive skill set in their students, rather than just ticking off tasks.
“We have to really be careful that we don't go down the checklist route and that we actually go to a competence route,” Weberg said. “It's not just doing the task. … Nursing is understanding all the complexities that go into every decision.”
Innovation as a Core Component of Nursing Practice
Weberg's vision for the future of nursing education includes an emphasis on innovation as a core feature. As a longtime voice on the need for greater innovation in healthcare, he proposed that AACN identify innovation as one of the Essentials. AACN did not adopt his proposal, so he continues to advocate for innovation as a core tenet of nursing education practice.
A commitment to innovation is crucial for nurses to be trained to provide the best possible care in a rapidly changing healthcare environment. And technology is one component of that. “It is a professional obligation for us to assess and incorporate valid reliable technology into our practice,” he said.
Nursing education requires a more dynamic and responsive approach to teaching and learning, Weberg said. “By embracing methods that prioritize information mastery, advanced clinical decision-making, and the integration of technology, nursing education can produce a workforce that is not only competent, but also innovative and adaptable.”