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This publication discusses issues around nursing education in the USA, in particular the very contentious debate about the most appropriate educational requirements to become a nurse. The growing shortage of nurses in the USA adds urgency to the debate. Integral to the debate are skill and quality of care with much of the controversy surrounding questions of how best to identify the requisite skills and knowledge for competent nurse practice, particularly the difficulty of identifying, defining, teaching and quantifying such skills as critical thinking, professional judgement and ability to function in a highly complex work environment. Nurse educators and policy makers are seeking a way to ensure that registered nurses (RNs) have both the technical and cognitive skills to meet the demands of the profession while simultaneously trying to enhance the prestige of nursing and stem the growing nursing shortage.