Ling Chen, PhD, RN, a gastrointestinal department manager and accomplished researcher, and Hongmei Quan, MSN, RN, a clinician specializing in pelvic floor therapy, spent two months at Goldfarb in St. Louis. Their goal: gain insights from Goldfarb’s curriculum to bring the first family nurse practitioner program to China.
The roots of their visit go back to 2023, when Wenzhi Cai, PhD, RN, vice president of Shenzhen Hospital, recognized the need for FNPs in China, Dr. Chen told Becker’s. Dr. Cai reached out to Lihua Yu, DNP, RN, an assistant professor at Goldfarb, through Chris Lee, MD, PhD, an anesthesiologist at Washington University in St. Louis. Following discussions and Dr. Cai’s initial visit to Goldfarb in summer 2024, plans were finalized for the scholars’ visit.
From Dec. 1 to Feb. 5, Dr. Chen and Ms. Quan studied curriculum design, simulation training, community health, and advanced nursing roles and nursing leadership at Goldfarb.
Dr. Chen arrived in St. Louis aware of significant improvements in China’s health system in recent years, but said challenges remain, including an increased aging population.
Roughly 22% of the population (300 million people) is 60 or older, according to China’s National Bureau of Statistics. The World Health Organization projects that percentage to reach 28% (402 million people) by 2040.
In addition to an aging population, people in China face increased chronic health conditions and continue to have a widening gap between health demand and supply, said Dr. Chen, citing data from the Chinese Center for Disease Control and Prevention and the National Health Commission.
These healthcare challenges are compounded by the current state of nursing education and roles in China.
“In China, nursing education primarily prepares nurses to work in hospitals, focusing on specific diseases under physicians’ direction,” Dr. Chen said. “In practice, this means nurses simply follow the physician’s orders and do what the physician tells them to do with limited autonomy to make independent clinical decisions.”
She also noted challenges in China in terms of lack of an existing FNP program with standardized training, limited scope of practice, and an undefined insurance reimbursement system, in addition to nursing educator shortage, and difficulty in the FNP certification process.
“Without these structural reforms, NPs can’t fully integrate into the healthcare system,” Dr. Chen said.
These challenges spurred the scholars to gain insights from Goldfarb’s NP programs, simulation labs and clinical partnerships with Washington University and Barnes-Jewish Hospital.
During their visit, they learned about curriculum design, simulation training, community health, and advanced nursing roles and nursing leadership.
“We learned their FNP-DNP curriculum in more detail during our two-month visit, and we wanted to adapt them into our master-level FNP program based on our need,” Dr. Chen said. “We observed some courses, including both undergraduate BSN courses and graduate-level courses. [Goldfarb’s] integration of theory and clinical practice was inspiring.”
The scholars also attended simulation labs on nursing skills training such as IV insertion and Foley catheterization.
Dr. Chen said one experience that deeply moved her was joining Dr. Yu’s population health clinical group at the Gene Slay’s Boys & Girls Club Dutchtown Campus.
“The nursing students spent weeks designing programs like ‘Happy Hygiene Drive’ to teach the girls and boys in the club to learn appropriate hygiene techniques and develop good hygiene habits,” she said.
“The clinical group has gone above and beyond collecting hygiene items from Goldfarb campus and campuses across the Barnes-Jewish Hospital. This approach resonated. … In China, rural left-behind children — those whose parents had to leave their hometowns each year to seek an opportunity in urban cities to make money in order to raise their families — face similar challenges: poor nutrition, limited healthcare access and emotional neglect. Watching what Goldfarb’s students have been doing, we realized we need to move beyond top-down interventions. For example, training local nurses as community health advocates, or partnering with schools to create peer-led health clubs in rural communities are imperative.”
Additionally, Dr. Chen and Ms. Quan observed specialized nursing roles across departments and studied the residency and career ladder programs at Barnes-Jewish Hospital. They also discussed potential collaborations with Goldfarb, including joint degrees, faculty development and certification systems tailored to China.
The scholars have various goals in the next six to 12 months, such as finalizing an FNP curriculum specific to China. Dr. Chen said they also seek to explore partnerships with universities to develop a master’s-level FNP program, and work with health authorities to define FNP practice scopes and and certification standards.
Shenzhen Hospital of Southern Medical University hopes to recruit the first cohort of FNP students by late 2025.
“Dr. Cai wants to initiate this program in Shenzhen, hoping they can expand the nurses’ role and take on more of the pressure from the primary care doctor,” Dr. Yu said. “Hopefully, they can do some assessments, prescribe some medication and manage primary preventive care — part of primary care for the population. That’s what they hope to do.”
