Exploring the challenges and issues facing undergraduate nursing education in one Canadian province from an institutional theory perspective: a case study
Date
2021-04-30
Authors
Sheane, Vanessa
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Aim
The study aim was to explore the issues and challenges facing undergraduate nursing education in one Canadian province from an institutional theory perspective. The research questions were: What is the institutional field of nursing education? What are the issues and challenges facing nursing education? How is the institutional field of nursing education contributing to the issues and challenges? How are the issues and challenges contributing to the institutional complexity?
Background
Nursing education is essential for the health care of society, yet face various issues and challenges at the system level. Institutional theory has been used in higher education to better understand how higher education institutions are structured and operate. Institutional theory has not been used in nursing education. The issues facing nursing education have been examined from a critical or descriptive perspective, but a system-level perspective is missing. Institutional theory could fill this gap and examine the institution of nursing and how its structure, behaviours, and rules influence those issues and challenges.
Methods
An exploratory single-case study with embedded units design was used. Theoretical propositions from institutional theory informed the sample, recruitment, data collection, and data analysis. In 2019, representatives from organizations comprising the institutional field of nursing education and senior-level administrators were interviewed and relevant documents were collected and reviewed. The data were analyzed using deductive and inductive thematic analysis, building a case description, and visual analysis techniques.
Findings
The findings from sixty documents and seven interviews suggested the institutional field of nursing education is composed of postsecondary institutions, health service organizations, the regulatory body, the ministry for health, and the ministry for postsecondary education. The issues and challenges facing nursing education included demands on curricula, teaching and learning values versus practice, the relationship between education and practice, limiting financial supports, clarity of the RN role, and need for faculty. The institutional field of nursing education is complex and includes dominant organizations, such as the regulatory body and health service organization, and the non-dominant organization, postsecondary institutions.
Discussion / Conclusion
The use of institutional theory was beneficial to explore the issues and challenges facing undergraduate nursing education from a system-level perspective and captured the complexity within the system. The institutional field including the influences of structure, dominance, and complexity impact the issues and challenges facing nursing education. The institutional perspective of the issues and challenges diverges from previous examinations. In addition, the use of institutional theory in higher education offers strategies for advocacy in nursing education. Recommendations for nursing education practice, policy, and research include: (a) awareness of the organizations comprising the institutional field of nursing education, (b) including the nursing education accreditation body and the professional association within the interorganizational structures, (c) acknowledgement of the sources of dominance within the field, and (d) developing strategies for academic nurse leaders to navigate the complexity of nursing education. The most urgent consideration arising from this research is the dominant forces from
regulation and health service organizations and the subsequent non-existence of the professional voice of nursing for nursing education within the institutional field.
Description
Keywords
Nursing education, Institutional theory, Institutional complexity, Dominant organizations, Case study