Curriculum changes in contemporary nursing education: Influences of public policy, professional associations, and nursing practice in three states from 1970 to 1995

Contemporary nursing curricula reflect the influences of public policy, nursing practice, and professional associations. This study explored curricula in the state universities of Hawaii, Oregon, and Colorado from 1970 to 1995. The Carnegie Foundation for the Advancement of Teaching's Missions of a College Curriculum and National League for Nursing's Perspective in Nursing: 1987-1989 provided a conceptual framework for comparative historical research on the three influences on these curricula as well as internal university mandates. This research is significant because of its focus on how health care policy influences the curricular reform of nursing education. Since universal insurance is an important contemporary question, this research examined school of nursing programs where state insurance existed in Hawaii and Oregon, while Colorado provided a contrasting example. The research used college catalogues, faculty minutes, state policy documents, and interviews to create a narrative describing curricula evolution of each nursing school. Using Yin's multiple case study approach, three distinctive periods thus emerged nationally: curriculum conflict (1970s), curriculum division (1980s), and curriculum revolution (1990s). Twenty-seven curricular changes were found, nine occurring at each university. Nursing deans through their leadership played prominent roles in these changes. Eleven changes came from public policies between 1982 and 1995. Of these external public policy curricular changes, state government caused six, while the federal government encouraged two. Three curricular changes were linked to health care reform. Professional associations and nursing practice also accounted for three curricular changes each. On the other hand, ten internal changes occurred through internal university decisions. This study demonstrated how various curricular influences coming from many different sources changed nursing education. Health care reform in two states has been an important influence on nursing curricula. As health care reform escalates, nurse educators need to proactively move towards community-based education and nurse practitioner programs.