Qui Bono? Nursing Education in the Context of Nursing's Agenda for Health Care Reform

Article excerpt

The nursing community's proactive position on how, where and by whom health care should be delivered will ultimately depend for its success on similar changes in the educational sector. Nursing's proposal for a consumer-driven, communitybased system of primary health care providers has called into question long-held beliefs about how, where, and by whom nurses should be educated. In addition to the structural changes proposed in the prevailing delivery system, Nursing's Agenda for Health Care Reform calls upon providers?in both community and institutional settings?to radically redefine their clinical practice, loyalties, political allies and power nexus. No less will be expected of nursing education and nurse educators.

The nature of the demand for nurses will change significantly from what has been the case until now as Nursing's Agenda for Health Care Reform is successfully advanced at the national and local levels. The Agenda proposes changes in structures, practice patterns, financing and the relationships among professionals and between professionals and patients. These changes include an increased emphasis on promotion and prevention services and decreased dependence on technology and medical interventions. The medical monopoly that characterizes the status quo will be disassembled as private and public financing provides direct reimbursement for a range of alternative providers, including nurses; services will be more accessible, delivered in such settings as schools and worksites, community clinics and nursing centers.

If we are to meet this new kind of demand, the supply of nurses will need to differ from the current profile in both numbers and kind. Nurse educators are, therefore, about to undertake the task of designing and/or modifying programs and curricula in order to assure that we can deliver on the promises made within the reforms proposed. At this moment, the questions for nurse educators include where and how to begin.

Before the reform movement in either health care delivery or nursing education is further advanced, however, additional analysis is needed as to both systems' social construction (i.e, how, and by whom, they are developed) and social function (i.e., what purposes they serve in society.) This paper argues that: (a) Stevens' question exposes the social construction of health care but not its social function; (b) Nursing's Agenda for Health Care Reform implicitly questions the social function but not the social construction of the delivery System; and (c) while both the social construction and social function of nursing education have been questioned by the "Curriculum Revolution," considerable theoretical work remains to be done relative to higher education in general.

WHICH QUESTIONS EXPOSE WHICH RELATIONSHIPS?

Health care and education are but two of society's mediating systems. Mediating systems are those through which society's values and a culture's mores are transmitted, reproduced and extended. They include both discrete entities such as the legal and penal systems, and the more amorphous ones such as the arts.

In the view of most (but admittedly not all) social analysts, such systems play several roles in addition to their specific functions of, in this case, delivering health care services and preparing individuals for particular professional responsibilities. Within such an understanding, mediating systems are socially constructed to reflect, reinforce, reproduce and extend a society's prevailing ideology. In addition, precisely because they are social constructs, such systems also reflect, reproduce and extend the relationships among any society's constituent parts.

In posing the question: "Who Gets Care," Stevens begins her analysis from an especially illuminating position that advances the socio-political understanding necessary for health care reform to take place. By identifying those denied access?the poor and working class, women and children, individuals from traditionally underrepresented racial and ethnic communities, gays and lesbians? …