This blog is a follow-up to my previous blog, Call to Action NOW
My participation in a November 24, 2025 webinar presented by staff of the American Association of Colleges of Nursing (AACN) (WF25_11_24_OBBBA_Webinar Handout.pdf) brought to my attention a possible rationale for the United States (US) Department of Education proposal for a change in category for nursing and public health and a few other health professions from professional to higher education which will lead to a decrease in the annual and total amounts of funding for student/faculty loan programs. Based on the information provided by the AACN staff, my best guess is that the rationale is that for nursology, the first degree granting entry into practice is an undergraduate degree — diploma, associate, or baccalaureate — and that graduate degrees are considered advanced nursology rather than entry into practice.
Guided by sociopolitical knowing (White, 1995), which focuses on the politics and practices of nursology, why, we may ask, have the state Boards of Nursing and other nursology organizations designated an undergraduate degree as entry into practice when many other health professions require a graduate degree for entry into practice, including but not limited to Pharmacy (Pharm.D.), Dentistry (D.D.S. or D.M.D.), Veterinary Medicine (D.V.M.), Chiropractic (D.C. or D.C.M.), Law (L.L.B. or J.D.), Medicine (M.D.), Optometry (O.D.), Osteopathic Medicine (D.O.), Podiatry (D.P.M., D.P., or Pod.D.), and Theology (M.Div., or M.H.L.) (WF25_11_24_OBBBA_Webinar Handout.pdf), as well as Clinical Psychology (Psy.D or PhD) (see What Colleges of Nursing Need to Know about Federal Student Loan Limits Impacting Post-Baccalaureate Nursing Education) . Note that all of these professions require a doctoral degree for entry into practice.
Could it be that, as in 1970 on the advent of the First Earth Day, Walt Kelly (the artist) had Pogo (the comic character), say: “We have met the enemy and he [sic] is us.” Pogo’s statement is a slight adaptation of Commander Oliver Perry’s communication to General William Henry Harrison during the War of 1812, “We have met the enemy and they are ours.” (https://library.osu.edu/site/40stories/2020/01/05/we-have-met-the-enemy/).
Are we nursologists our own enemy by not designating the Doctor of Nursing Practice (DNP) or even the DSc or PhD as entry into nursology practice? Do we continue to insist that we must have undergraduate degrees regarded as entry into practice due to the apparent shortage of nursologists? If we base our practice and educational curricula on nursology conceptual models and theories and revive primary nursing and the attending nurse practice delivery models (Fawcett, 2021), would there really be a shortage of nursologists?
If we continue to agree that undergraduate degree is the most appropriate entry into practice degree, then our request to the US Department of Education should be that professional degree and higher education degree categories should have the same amount of funding for the student/faculty loan program, with emphasis on the higher amount now allotted to the professional degree. This is the what our Call to Action should be!
We certainly can and should continue to regard nursology as a profession regardless of highest degree-to do otherwise is an insult to all nursologists—those who develop our discipline-specific knowledge and those who use that knowledge to guide their practice, research, education, and administration.
Onward!
References
Fawcett, J. (2021). More thoughts about nursing practice delivery models. Nursing Science Quarterly, 34(4), 458-461. https://doi.org/10.1177/08943184211031584
White, J. (1995). Patterns of knowing: Review, critique, and update. Advances in Nursing Science, 17(4), 73-86. https://doi.org/10.1097/00012272-199506000-00007
Thanks Jacqui
for your thoughtful and valued comment. I can say that in Switzerland the practice and educational curricula are based (or were??) on nursing conceptual models and theories for many years. But with leading institutions leaning backward to the medical model (despite and mainly with higher educations) and to a profit oriented health care system (according to the US model) much of this was partially lost.
I strongly support that the base nursing models/theories along with reviving primary nursing and the attending nurse practice delivery models (Fawcett, 2021), would prevent the shortage of nursologists.
A new area can start if we jointly build on these grounds!
Maria Müller Staub (PhD, EdN, MNS, RN, FEANS)
Maria, Greetings and thank you very much for your comment. It always is of great concern when the emphasis on nursology knowledge is diminished in educational programs. One concern is what, exactly, is the medical model, as I have never seen any literature that includes a description of such a model. If the emphasis is on body systems, many nursology conceptual models include physiological phenomena, so the difference is that nursology conceptual models also include psychosocial and (sometimes) spiritual phenomena, so we are more comprehensive/holistic in our practice and what we teach and study. Although we, alas, do not have any relevant data, it is possible that nursology practice guided by a nursology conceptual model is less costly and more efficient than otherwise, so institutions (clinical agencies and educational institutions and the federal government) who are concerned with health care costs should keep that in mind and support research that will provide the needed evidence. Best regards, Jacqui
I agree with Dr. Fawcett’s opinion. I would like to add that the content of nursing education must include more than scientific, professional education. Philosophy, theology, logic, epistemology and the arts and humanities should be part of nursing education. The ability to disagree and dialogue respectfully without demonizing different views is key. For example I have read some nursing organizations are very pro choice in terms of life positions but I have not found any pro life statements from these organizations.
Diana, Thank you for your comment. Although I doubt that all baccalaureate nursing programs include philosophy (including logic and epistemology), and especially theology, most if not all do include courses in the arts and humanities. Perhaps philosophy is included in non-clinical nursology courses. At least some PhD nursing programs include a philosophy of nursing science course. Best regards, Jacqiu
En.
Thank you all for sharing these thought-provoking reflections.
I believe there is a long list of reasons why nursing must break with current paradigms that, stemming from naturalism, have led to neoliberalism. Starting with a radical shift away from the biomedical paradigm. Nursing is a human science, not a natural science. Nursing is the most beautiful of the fine arts, they say. I would add: “It is the most humane of the human sciences.” With an ontology rooted in the humanities, nursing can have greater epistemic authority.
Es.
Gracias a todos por compartir estas reflexiones que invitan a la reflexión.
Creo que hay una larga lista de razones por las que la enfermería debe romper con los paradigmas actuales que, derivados del naturalismo, han conducido al neoliberalismo. Empezando por un cambio radical del paradigma biomédico. La enfermería es una ciencia humana, no una ciencia natural. La enfermería es la más bella de las bellas artes, dicen. Yo añadiría: «Es la más humana de las ciencias humanas». Con una ontología arraigada en las humanidades, la enfermería puede tener mayor autoridad epistémica.
Ramiro, Thank you very much for your comments. I agree that nursology is a human science, which sets us apart from many other sciences. We have already identified several fundamental patterns of knowing that give direction and guidance for how we think and what we do as the result of our thinking–empirical, aesthetic, ethical, personal, sociopolitical emancipatory, and spiritual, (see https://nursology.net/patterns-of-knowing-in-nursing/) all from a Eurocentric White privilege perspective, so we most likely will identify other patterns of knowing and/or other descriptions/meanings of these patterns of knowing as nursology knowledge becomes much more decolonized. Best regards, Jacqui
Thank you to Peggy Chinn for sharing the link to a document from the US Department of Education (DOE) about the proposal to recategorize nursing (and public health, etc.) from professional to higher education, with the result of a substantially lower amount of funding for the higher education category. The link is: http://www.ed.gov/about/news/press-release/myth-vs-fact-definition-of-professional-degrees
The so-called “facts” in the DOE document are, in my opinion, outrageous and are directed only toward funding, which the DOE admits with this statement: “The definition of a “professional degree” is an internal definition used by the Department to distinguish among programs that qualify for higher loan limits, not a value judgement about the importance of programs. It has no bearing on whether a program is professional in nature or not.”
The MD, etc. programs have the most expensive tuition and any attempt to lower the tuition for nursing and public health graduate programs are the DOE’s fantasy. If the goal is to reduce costs, the DOE should be pressuring universities that offer MD etc. programs to reduce their tuition. It is insulting to base at least part of the rationale on earning potential.
Universities will not lower tuition for any graduate program just because the students MIGHT have total funding from the DOE student/faculty loan program. Indeed, the DOE presents no data about the number of nursing students who seek funding from the loan program.
If the DOE “fact” that their “data indicates [sic] that 95% of nursing students borrow below the annual loan limit and therefore are not affected by the new caps” is accurate, then why reclassify nursing as higher education rather than professional? This so-called “fact” defies logic. Similarly, if the DOE ”fact” that “80% of the nursing workforce does not have a graduate degree,” is accurate (note that no systematic data are given for the 80%) then the cost to the DOE for the student/faculty loan program would be negligible if the professional classification were retrained.
I encourage all nursology.net readers to read The Quiet Demotion; the link is https://drkechiiheduruanderson.substack.com/p/the-quiet-demotion?utm_source=substack&utm_medium=email&utm_campaign=email-restack-comment&r=5gq1ud&triedRedirect=true
The author presents a much more comprehensive analysis of the Department of Education proposal to reclassify nursing (and a few other professions) as higher education than anything I have written about this issue.
Noteworthy is that the proposal is about much more than the amounts allocated to those fields classified as professional and those classified as higher education. I very much appreciate the author’s perspective and even more appreciate the actions that we should take in response.
Also noteworthy is that the author did not address the entry into practice issue, which I highlight in this blog.