Carole Kenner, DNS, RNC, FAAN has over 20 years of neonatal/perinatal/pediatric nursing experience.  She has taught in undergraduate and graduate nursing education for much of that time.  In this article, Dr. Kenner explains the crisis in nursing today and postulates how knowledge management could arm graduates with new tools for clinical excellence. 

Dr. Kenner is the Director for the Center of International Affairs at the University of Cincinnati College of Nursing and President of her own consulting company "Consultants with Confidence".   She received her BSN from the University of Cincinnati, her masters and doctorate degrees in nursing from Indiana University.  She is a fellow in the American Academy of Nursing and has received numerous honors for teaching, research, and leadership excellence as well as publishing awards for her nursing textbooks.  

Knowledge Management and Nursing Education
Carole Kenner, DNS, RNC, FAAN 

Nursing is facing one of its most severe crises.  There is a shortage of specialized nurses especially in acute care settings.  The nursing workforce’s age is contributing to this problem.  The average age of a practicing nurse is 46 years while the nursing faculty’s average is 52 years.  That means that shortly many nurses will be retiring at the same time enrollments in most undergraduate and graduate programs are at an all time low.  As a profession, nursing is not attracting the best and the brightest.  Educational institutions need to answer the question why and look to new strategies to meet consumer needs.  This article suggests that knowledge management as an educational philosophy might be one such strategy.  Yet there are many barriers that maintain the status quo.  These will be explored below.   

Nursing Education
The media attention to headlines of “Nurses Killing Patients” grabs attention but does little to make a prospective student eager to jump into a new nursing career.  While as such articles indicate there are many systems problems within the healthcare industry, nurses are just one faction caught in the healthcare bureaucracy.  Today’s nurse must be able to critically think, and handle a lot of information from many sources at the same time.  There are the doctor’s orders, patient requests, family needs, new admissions, sudden changes in one patient’s condition, oversight of unlicensed personnel assisting in patient care, and phone calls from various other departments within the hospital. 

In addition, most units are working short staff, have patients who are very acutely ill, and are forced to work 10-12 hour shifts.  There is no question nursing is hard work but it always has been.   In the past educational institutions were still able to attract students.  Men and women who wanted to help others.  The desire is still there; so what is the problem? 

Part of the problem is the lack of reality-oriented education that most prospective students feel they will receive.  Until recently few faculty maintained a clinical practice and often taught from a theoretical rather than practical model.  While theoretical underpinnings are needed for a professional career, this content must be balanced with real world information.  Faculty are not to blame for this problem as clinical practice has not been rewarded as part of the reappointment, promotion, and tenure criteria at many institutions.  Faculty were under the gun to publish or perish, research or die, but nowhere did it stress clinical competence.  The tides are changing, but slowly.  Some faculty are now being hired for just their clinical expertise and not the theoretical knowledge.  They are complementing those faculty who are heavily committed to theory and research.  But the reality is that the faculty rewards systems are still based on healthy competition.  To this end, the sharing of information is not always viewed as positive.  To receive a positive review and tenure, one must prove they can teach effectively, publish regularly, and write grants to support research on a regular basis.  The only way faculty can succeed is to manage knowledge efficiently and effectively.

Student Needs
Students are finding themselves in clinical situations where they have to think fast, make a decision, and process the myriad of diagnostic test results, medications, past treatment responses, and now, genetic conditions found in a family history.  They do not have time to go look up information at a library.  Information turns over about every three to five years in medicine so traditional resources are not very useful.  The student needs immediate access to fresh information to problem-solve in the clinical agency or in the classroom simulated lab.  They need to effectively manage knowledge.

Knowledge Management
Knowledge management seemingly holds the key to both the faculty and student’s dilemma.  It provides a method to categorize faculty expertise and use it to meet student needs.  It places value on the tacit knowledge that individuals hold within an institution. Knowledge management is the organizational activity of creating an environment that transforms knowledge into assets and information into knowledge (Kenner & Fernadez, in press).  Knowledge management makes use of information technologies to free up the collective wisdom of individuals within an organization (Davenport, & Prusak, 1998; Drucker, 1998; Kenner & Fernadez, in press).  The value shifts from quantity to quality of work and of education.  Knowledge management means that information that comes into a system must be translated to useable information.  It is concerned with creating, processing, and disseminating information (Duffy, 2000; Newman, 1991).  It must be available to people at all levels including the student.  Sharing of information also takes the emphasis off tasks and puts it on concepts such as strategic knowledge management (Ellis & Tissen, 1999) and intellectual capital (Schloetzer, 2000).  

If an educational institution gains the reputation of arming their graduates with the tools to meet the new clinical challenges, they will attract students.  This organizational strategy of knowledge management also translates into a marketing tool for the programs of study.  This transformation is not going to occur quickly or easily but if faculty are to be successful in the future, they must embrace a new way of doing business.  To attract younger faculty there must be some hope of achieving success or the institution will lose them to other more flexible organizations.   

It almost appears an oxymoron that institutions of higher learning are the very ones who have difficulty in achieving use of computer high technology.  They are supposed to be on the cutting edge yet seem to be light years behind industry in effective utilization of information.  Faculty and students regularly point out this flaw.  Commitment to a knowledge-based organization can change this.  It is up to the “educators” to become the change agent to transform flabby, unbending institutions into dynamic, ever-changing ones that are in tune with the future.

References
            (1998). Working knowledge: How organizations manage what they know.  Boston: Harvard Business School Press.
            Drucker, P.  (1998).  The coming of the new organization.  (pp.1-19).  Harvard Business Review on knowledge management.  Boston:  Harvard Business Review.
            Duffy, J.  (2000)  Knowledge management:  To be or not to be?  Information Management Journal, 34(1), 66-67.
            Ellis, J., & Tissen, R.  (1999).  Doing business in the knowledge based economy:  Strategic challenges for competition and growth.  Amsterdam:  Pearson Eduacation/Addison Wesley Longman.
            Kenner, C, & Fernadez, J.H. Knowledge Management and Advanced Practice Education
Neonatal and Infant Nursing Reviews.  In press.
            Newman, B.  (1991).  An open discussion of knowledge management. [On-Line].  Available:  http://www.3-cities.com/~bonewman/what_is.htm
            Shloetzer, J.  (2000).  Managing the intangible-knowledge.  http://www.eknowledgecenter.com/articles/1009/1009.htm