Nursing Leadership, 26(2) June 2013: 25-28.doi:10.12927/cjnl.2013.23451

Perspectives In Nursing Policy and Innovation

Leaders Hold an Invitational Think Tank on Undergraduate Nursing Education

Kathleen MacMillan and Mary Ellen Gurnham

In response to the Canadian Nurses Association National Expert Commission's Call to Action (NEC 2012), a focused meeting of nurse leaders was convened at (NEC) Dalhousie University in early November 2012. Hosted by the School of Nursing in collaboration with CNA, the purpose of the Think Tank was to initiate dialogue on how to respond to the report's recommendation regarding reform of Canadian nursing education and to consider potential preliminary actions. The overarching goal of the meeting was to serve as a catalyzing force, identifying ideas about how best to move from the NEC's report to a design for action. To quote Florence Nightingale, "Reports are not self-executive,"1 and we were keen to support the NEC's work by initiating a much-needed dialogue.

In preparing for the Think Tank, invitees representing education, service and policy were offered a reading list that included a number of recent reports touching on reform of nursing entry-to-practice education to inform the discussion. These included Benner and colleagues' (2009) work for the Carnegie Foundation for the Advancement of Teaching, the Willis Commission report (Willis 2012), initiated by the Royal College of Nursing in the United Kingdom and recent papers from the Oxford ILC group on Fundamentals of Care (Kitson et al. 2010). In addition, three scholarly papers were presented at the meeting by selected participants, and Barbara Mildon, president of CNA, presented an overview of the NEC's Call to Action. The scholarly papers included "Future-Proofing Nursing Education" (Tom Keighly); "Implications of the Fundamentals of Care for Nursing Education" (Sarah Kagan); and "Closing the Quality and Safety Gap by Optimizing Learning in Undergraduate Curricula across Canada" (Lianne Jeffs).

The meeting took place over two full days and included ample opportunity for discussion and debate. All discourse was audio-recorded, transcribed and then thematically analyzed. A full document of the proceedings, including pre-reading reference list, scholarly papers, meeting agenda, participant list, emerging themes and key messages, is available in digital format on the Dalhousie School of Nursing website (MacMillan 2013).

Themes Identified During the Think Tank

It is important to note that while there have been myriad organizational and provincial reviews of curricula and other aspects of education over the years, no comprehensive, pan-Canadian review of nursing education has been undertaken in this country since Helen Mussallem's (1965) report to the Royal Commission on Health Services. Significant changes to nursing education ultimately were made as a result of that report. The Think Tank participants believe the time has come again to act decisively to shape the future of nursing education.

Analysis of the dialogue at the Think Tank revealed three prominent themes, summarized below.

1. There is a need for change

To equip the next generation of nurses to function in new ways in a transformed and increasingly complex health system, Think Tank participants agreed unanimously that nursing education must also be transformed. Fundamental to planning the change will be a definition developed and shared among the service and education sectors about the roles and expectations of nurses in that new system. As the participants noted, transformation must take into account fundamentals of care as well as "curriculum and pedagogy … generalist and specialist education … interprofessional education and practice; and … safety and quality" (MacMillan 2013: 11).

2. Nursing is a career for life

Participants in the Think Tank returned repeatedly to discuss the need for undergraduate education to launch a lifelong career and plant the seeds to instill a strong professional nursing identity. In his paper for the proceedings, Keighley speaks of the role of nursing education in "future-proofing" nurse graduates.

3. Bridges, links and partnerships are the "new normal"

Successful transformation of practice and education now depends absolutely on rich and vibrant networks and partnerships among all the sectors where nurses are educated and practise. The participants particularly envision new relationships among education and service, with new views of the roles, benefits and accountabilities of both.

Potential Next Steps and Areas for Action

Advancing this agenda in a timely way would benefit from three immediate actions:

  1. Engage champions for change, including leadership of CNA and the Canadian Association of Schools of Nursing (CASN), with "an alliance of partners including regulators, unions, administrators and students, engaged in a fresh, highly consultative and collaborative approach …" (MacMillan 2013: 12).
  2. Commission an inventory of innovations in nursing education curriculum and pedagogy and vibrant partnerships that support success in education and excellent practice.
  3. Commission a national review of Canadian nursing education, building on reports such as that of the National Expert Commission, and taking into account the themes and priorities identified during the Think Tank.


The Think Tank proceedings document was reviewed and critiqued by three esteemed nurse leaders – two in education (Dr. Alison Kitson, University of Melbourne and Anne Marie Rafferty, King's College, London) and one from the service delivery sector, who had also been president of CNA during the activities of the National Expert Commission and preparation of its Call to Action (Judith Shamian, president, International Council of Nurses). Their commentaries open the proceedings document.

The Think Tank is one example of nurse leaders taking up the challenge of the Call to Action. It is important to consider the role that each of us may play in ensuring that the good work of the NEC does not gather dust on a shelf but becomes a platform for much-needed change in our healthcare system. The work of responding to the NEC is for all nurses, and cannot be solely the burden of CNA. We urge all nurse leaders to read the proceedings and become involved in the transformation ahead. How we educate Canada's nurses to meet the demands of a changing context of practice is a vital piece of the work that we must all do if we commit ourselves to being part of the change that we want to see.

About the Author

Kathleen MacMillan, Director, School of Nursing, Dalhousie University, Halifax, NS

Mary Ellen Gurnham, Chief Nursing Officer and Executive Director of Learning, Capital District Health Authority, Halifax, NS


Benner, P., M. Sutphen, V. Leonard and L. Day. 2009. Educating Nurses: A Call for Radical Transformation. Hoboken, NJ: Jossey-Bass/Wiley.

Kitson, A., T. Conroy, Y. Wengstrom, J. Profetto-McGrath and S. Robertson-Malt. 2010. "Defining the Fundamentals of Care." International Journal of Nursing Practice, 16(4): 423-34. doi: 10.1111/j.1440-172X.2010.01861.x

MacMillan, K., ed. 2013. Responding to the National Expert Commission's Call to Action: Proceedings of a Think Tank on the Future of Undergraduate Nursing Education in Canada. Halifax: Dalhousie University School of Nursing. Retrieved April 10, 2013. <>.

Mussallem, H.K. 1965. Nursing Education in Canada. Submission to the Royal Commission on Health Services. Ottawa: Queen's Printer.

National Expert Commission (NEC). 2012. A Nursing Call to Action: The Health of Our Nation, the Future of Our Health System. Ottawa: Canadian Nurses Association. Retrieved May 10, 2013. <>.

Willis, P. 2012. Quality with Compassion: The Future of Nursing Education. Report of the Willis Commission on Nursing Education, 2012. London: Royal College of Nursing. Retrieved May 10, 2013. <>.


1 First used in a letter from Nightingale to Sir John McNeill, July 9, 1863: "No one knows better than yourself that a report is not self-executive."



Linda Roulston wrote:

Posted 2013/08/10 at 11:35 AM EDT

Glad to see that Kathleen MacMillan remains very much engaged in Nursing Education!


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