The following description of the prelicensure programs is excerpted from a detailed discussion of the curriculum prepared for the School of Nursing Heritage Committee [One hundred years of curriculum for registered nurse preparation, 1909 – 2009]
The First Curriculum (1909 – 1918)
At a 1909 joint meeting in Minneapolis of the Society of Superintendents of Training Schools for Nurses and the Associated Alumnae of the United States and Canada, Dr. Richard Olding Beard announced that the University of Minnesota would establish the first program for collegiate education of nurses. So committed was he to the education of nurses, that he became known as the “nester of nurses.” In anticipation of a school, Bertha Erdmann was appointed to be superintendent of nurses for the school and still non-existent hospital.
The School of Nursing began as a unit of the Medical School. It was not until 1970 that the school became an independent unit. The first four students were admitted in 1909. They were required to be high school graduates, to undergo a physical examination and be rated on their personalities. At first the curriculum was like that of the more advanced three-year hospital programs such as Teachers College, Columbia University with several exceptions: association with a medical school, highly selective admission criteria, and the prestige of a university experiment (Gray, 1960, p. 21). Physician faculty delivered lectures on clinical topics and nurse faculty taught the psychomotor skills classes. The first clinical experience in 1910 offered nursing experience at the newly opened Elliot Hospital.
Louise Powell assumed leadership of the school following Ms. Erdmann’s departure due to ill health. As she became aware of more resources of the university she added student experiences in Invalid Occupation[1], dental clinics, sociology and psychology. A library of nursing literature was established in a corner of the medical library. Experience with tuberculosis patients was added with a two-month rotation at Glen Lake Sanatorium. In 1918 the first course in public health nursing was offered in cooperation with the Minnesota Public Health Association. By 1934 all students received six weeks of preparation in public health nursing. Then, in 1939, the course was no longer required for all students because of overcrowding of venues for practice experience.
Five-Year (18 Quarter) Curriculum (1919-1952)
Although the university had ruled in 1912 that graduates of the school should receive degrees. Ms. Powell was uncomfortable with this knowing that the school’s curriculum was more like that of traditional nursing programs than the curriculum for students in other University of Minnesota programs. By 1919 she and her advisers were ready to combine science and the liberal arts with the professional training of the school. Applicants were required to earn seventy-five university credits before entering the school. These credits earned in five quarters included studies in composition, English, zoology, psychology, chemistry, history, political science and economics (Gray, 1960, p.54). There followed ten quarters that included courses from the nursing curriculum.
Among the curricular innovations were those in the clinical teaching method implemented in 1932. Two nurses who would become faculty in the School of Nursing were among the faculty at the Army School of Nursing (Washington, D.C.). Beginning in 1927, these two nurses, Ruth Johnson and Myrtle Hodgkins, worked with students at the patients’ bedsides. Katharine Densford took the opportunity to initiate this clinical teaching method in 1932 when the Army school was forced to close. Ms Hodgkins (later Coe) worked with students at Minneapolis General Hospital (now Hennepin County Medical Center). Students met with their instructor for orientation on their first morning on the medical service. Policies, methods, precautions, and techniques were discussed. Subsequently students attended ward classes twice weekly. The sessions were sometimes used to discuss problems and answer questions.
Opening of the psychopathic unit in the university hospital in 1937, provided the opportunity to offer instruction in psychiatric nursing. The concept of total care rather than completing routine tasks was also introduced. Ms. Densford gradually managed to reduce the hours of assignment in clinical practice from 48 to 44 to 40 and later on to 30 in order to reinforce the need for students to have time to attend classes, do class assignments, and study.
The onset of WWII called for the 1942 emergency adjustments that included admission of an additional class of 3-year students and the design of a special course for college graduates enabling them to become nurses in 2.5 years. In the next year the Cadet Corps was established. At its peak, 1,000 students were enrolled and the first induction ceremony was conducted in 1944.
In 1943, support from federal sources permitted a twelve-week summer demonstration project in which groups of three or four students were sent to small town hospitals (population of 10,000 or less) for experience in rural nursing. They also travelled about with public health nurses. The experience confirmed the philosophy of family-centered care.
In the fall of 1946, the school decided to admit both three-year and five-year students, but from then on only candidates for the B.S. degree would be admitted. The three-year program was ended in 1947.
Four-year Program (1949-1965)
Among the changes that followed WWII was implementation of the four-year curriculum in September 1949. Rather than streamlining the five-year program, the new curriculum was designed to give students a broader grounding in general education and a focus on nursing as a social service. Following six quarters of pre-nursing instruction, the professional nursing portion of the program began. The basic program was shortened from eighteen to sixteen quarters. Specialized baccalaureate programs for registered nurses were established in nursing education and nursing administration.
The school had been admitting students twice yearly but that stopped with the last spring class admitted in 1959. After that there was only one admission per year in Fall.
In 1962 a thirteen-quarter program was initiated leading to a Bachelor of Science in Nursing (BSN) degree. By 1968 all undergraduates were admitted to a single baccalaureate program.
A new undergraduate curriculum was implemented in 1962, the vision of four faculty members. In the new program, physician orders were considered delegated medical functions while nursing care was a different thing. “The nursing care plan came out of the student interviewing, interacting with, having conversations with the patient in order to learn what the patient’s needs were, what the patient’s concerns might be, what the person might be anxious about, and would try to learn from the patient the coping skills that the patient had. They would then develop a plan of care that was aimed at facilitating the patient to use their own coping skills, to add some other support if they could, for a goal of comfort—the term that was being used in that curriculum. That could be translated into reduced anxiety, reduced fear, a sense of competence, and ability to deal with their health situation” (Sime, p. 11).
Despite rumors circulating that many students of this new curriculum had failed the licensing examination, a report from the Minnesota Board of Nursing showed that passing rates declined but only slightly. From 1962-1966, the rates continued to be well within the acceptable range, but given the previous almost perfect record, the decline was cause for concern.
The National League for Nursing conducted its periodic review of the school in 1965 and raised serious questions about the curriculum. Director Fritz was asked to resign in 1968. In a letter to alumni, she stated that there were disagreements among the faculty about the amount of clinical experience. She also noted that a large group of faculty resignations had made it necessary to limit admission to 80. A five-year systematic curriculum evaluation project began in 1971 using federal funds.
During the early sixties, registered (licensed) nurses seeking a baccalaureate degree were able to enroll in the four-year baccalaureate program. These students were required to complete the same curriculum as other non-licensed nursing students.
Continuing Changes (1970- 1990s)
A five-year systematic curriculum evaluation project began in 1971 using federal funds. In the 1970s there was a shift in the framework for the curriculum so that it included a guiding, unifying conceptual framework based on adaptation. Half of the curriculum was in the liberal arts. The second half was evenly divided between course work and practicums in the community and hospital-settings. In the sophomore year the emphasis was on basic ideas and interpersonal skills while the junior year was focused on adaptation as an individual and how the nurse relates to a person’s adaption as an individual. The senior year was focused on adaptation as a member of a group and the adaptation of groups within health cohorts (Anonymous, 1972).
During the 1994-95 academic year, a “staggering” number (19) of new courses were evaluated by the Curriculum Coordinating Committee and its Coursework Subcommittee in anticipation to the conversion to the semester system. The work included revised procedures for the review of the level of content and freedom from duplication. Among the developments were concerns expressed about the definition and use of critical thinking and cultural diversity that were being used in reviewing courses. The revamping of the curriculum took account of the trends in health care with greater emphasis on community- based care, increased acuity of hospital and nursing home patients, growing emphasis on health promotion and disease prevention as well as other contemporary changes. These developments affected the availability of traditional practicum sites and led to development of new experiences.
An accelerated program for RNs seeking baccalaureate degrees in nursing began in 1973 in response to the profession’s movement toward baccalaureate preparation and needs for more nurses prepared for teaching. A proposal for an RN/BSN/Master’s Program was created in 1989. By the late nineties questions began to emerge about whether the RN/BSN/MS option continued to be a core function of the school. An analysis of the current status of the option in the school was completed in relation to the demand for and availability of such education in Minnesota. It showed that there were a large number of programs similar to the one offered in the School of Nursing, but that an accelerated entry-level program for individuals with baccalaureate degrees in other fields was an area of demand that was not currently met in Minnesota.
The New Century 2000-2009
In 2000 the baccalaureate program was an upper division major with a guiding framework that emphasized caring in the human health experience. The knowledge base was focused on the discipline (nursing knowledge), profession (multiple kinds of knowledge), interdisciplinary health sciences (knowledge common to health care professions), and related knowledge (Self Study Report, 2000). As noted in the description of the curriculum in the 1990s, the curriculum was configured to fit into the semester plan for the university. A revision in 2003 produced a change from an upper division curriculum to a three-year curriculum beginning in the sophomore year.
In response to requests from the University’s office of admissions, the school began the Freshman Nursing Guarantee Program in 2003 to accommodate applicants who listed the Nursing Premajor as their intended major. By the 2014-15 enrollment the number of admissions grew from eight in its first year to over eighty students eleven years later. Applicants who indicated an interest in nursing were automatically invited for the program and were given the opportunity to accept or decline the offer. The plan was that in the near future all undergraduates on the Twin Cities campus would be admitted via the Freshman Guarantee mechanism. Under the program, students spend their first year in the College of Liberal Arts and the remaining three years in the School of Nursing if they maintain a GPA of at least 3.0 in both freshman semesters. Failing that they may petition for consideration with the school’s Scholastic Standing Committee for admission along with other applicants. Recent analysis shows that only ten percent of those admitted change their minds about continuing in nursing.[2]
The Honors Program, launched in 1987, provided students with high ability and interest in alternative, self-selected opportunities an enriched experience. They enrolled in Honors sections of nursing theory and research courses, and completed an honors thesis and honors experiences consistent with their personal goals. From 1987 through 2007, the Honors Program was entirely a School of Nursing program.
Requirements and opportunities evolved along with curriculum changes described above.
In 2008, after several years of planning, the University of Minnesota started the University Honors Program (UHP) to coordinate honor programming across the entire University of Minnesota, Twin Cities. School of Nursing faculty still taught the honors courses offered by the School of Nursing and each student worked with a School of Nursing honors advisor (a faculty member) and a UHP advisor (a member of the UHP group of staff advisors). The first director of UHP was a professor of physics and the second was a professor of music theory. Each major in the university has a faculty representative to UHP.
References
Anonymous (1972, February). Changing to meet modern needs. Alumni News in Remembering Things Past: An Heritage of Excellence. B.H. Canedy, Ed., University of Minnesota.
Gray, J. (1960). Education for Nursing. Minneapolis: University of Minnesota Press.
Sime, A.M. (2010, April 15). Oral History Interview with A. Marilyn Sime by Dominique A. Tobbell, University of Minnesota, Academic Health Center, Oral History Project, 6.
University of Minnesota, School of Nursing. (2000, March ). Commission on Collegiate Nursing Education Self-Study Report.