Time for Disruptive Innovation in Nursing Education? Survey Results of Selected Western US Nursing Programs

Sunday, 22 July 2018: 11:15 AM

Carolyn Montoya, PhD
Marie L. Lobo, PhD, RN, FAAN
Blake Boursaw, MS, BMS
Jeffery Dubinski-Neessen, MS
College of Nursing, University of New Mexico, Albuquerque, NM, USA


A recent study by Fang and Kesten (2017) projected that one third of the nursing faculty active in 2015 in the United States will retire between 2016 and 2025. Among the general challenges to addressing the global shortage of nursing faculty noted by Nardi and Gyurko (2013) are aging faculty, poor salaries, lack of funding, faculty dissatisfaction with the role, and a decreasing number of full time equivalent faculty positions. These authors recommend designing new education models that fit global health care needs, pooling resources, sharing databases to project faculty needs, and collaboration between nursing schools and businesses. Other authors discuss the need for nursing to utilize disruptive innovations as solutions to the challenges facing nursing education (Grady, 2014; Pilcher, 2014; Huston, et al., 2017; Thompson, 2016a, 2016b; White, Pillay, & Huang, 2016). In order to understand nursing education challenges in the Western United States, a survey was conducted to assess perception of academic nursing leadership in these states related to: (a) current and future challenges facing nursing education; (b) implementation of innovative strategies in response to one of the identified challenges; and (c) identification of at least one potentially disruptive innovation that would possibly impact nursing education in the next 30 years. While this study is limited to selected states in the United States, the results speak to general findings in the literature and highlight a gap related to considering disruptive innovation as a strategy for solving challenges in nursing.


All members of the research team participated in the development of the survey tool which was then reviewed by and pilot tested with five senior leaders in academic nursing. Survey feedback was reviewed and incorporated into the survey during an iterative process over a three month period in 2017. The survey contained five core, open-ended questions regarding current challenges in nursing education at their institution as well as future challenges. Participants were also asked to describe at least one innovative strategy that they had implemented in response to a challenge and to describe at least one potentially disruptive innovation that they thought would impact nursing education in the next 30 years. The sampling frame for this survey consisted of 116 nursing programs at American Association of Colleges of Nursing member schools in the 13 states served by the Western Institute of Nursing. Contact information was located for a nursing leader with primary responsibility for the academic mission for 100 of these 116 programs. This survey and the methodology was approved as an exempt study by the institutional Human Research Protections Office. The REDCap platform was used to e-mail a survey to these 100 academic leaders, generating 42 responses in late fall 2017.


The majority of responses came from public institutions, about half of responses came from minority-serving institutions, and nearly half of responses came from institutions with more than 500 nursing students enrolled. A majority (14 of 20) minority serving institutions were Hispanic-serving, having undergraduate enrollment at least 25% Hispanic and less than 25% any other minority group. A majority (29 of 42) of institutions offered some type of graduate degree program in nursing and a majority of these institutions (23 of 29) offered nurse practitioner programs as specialty graduate programs. Aside from the ADN, the PhD was the least common degree program offered at responding institutions.


This survey was consistent with the literature in terms of identifying faculty shortage as one of the primary challenges facing nursing education. While no single innovation emerged as a major theme to address the faculty shortage, sharing faculty with other nursing programs and utilizing qualified faculty from other disciplines to teach nursing courses such as pathophysiology and research were identified. Many of the items listed as innovative strategies to address nursing education challenges, such as increased simulation, the development of private-public partnerships, the use of out-patient clinics to provide interprofessional student experiences, and offering programs in a hybrid format, have been in place for several years at many institutions. Disruptive innovation, as described by Christensen, Raynor and McDonald (2015), is a process which typically involves the development of a new, simpler product that is more convenient and more affordable and targets specific customers who are new to the market or are entirely shut out of a particular market. Often such innovators establish a foothold for their product, improve their product, and then gradually increase their share of customers until they edge out other competitors. While health care has experienced some disruptive innovations, such as quick-care clinics, nursing education has not been at the forefront of disruptive innovation. White, Pillay, and Huang (2015) recommend that innovation competencies should be part of all nursing programs. True innovation will mean a major shift in attitudes as most individuals resist change; academia is not particularly nimble at making changes; and there is strong aversion to the possibility of failure (Giddens, 2015). Given the pace at which our health care systems are changing, nursing education needs to embrace disruptive innovation in order to ensure that the health care system will have an adequate supply of nurses and that these nurses will be prepared to care for the changing health care needs of our diverse populations