The essentials of baccalaureate education for professional nursing practice PDF

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TheEssentialsofBaccalaureateEducation forProfessionalNursingPractice October20,2008

TABLEOFCONTENTS ExecutiveSummary

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Background NursingEducation TheDisciplineofNursing Assumptions RolesfortheBaccalaureateGeneralistNurse PreparationfortheBaccalaureateGeneralistNurse: ComponentsoftheEssentials

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TheEssentialsofBaccalaureateEducationforProfessionalNursingPractice I. LiberalEducationforBaccalaureateGeneralistNursingPractice II.

BasicOrganizationalandSystemsLeadershipfor QualityCareandPatientSafety

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III. ScholarshipforEvidenceBasedPractice

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IV. InformationManagementandApplicationofPatient CareTechnology

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V.

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HealthcarePolicy,Finance,andRegulatoryEnvironments

VI. InterprofessionalCommunicationandCollaborationfor ImprovingPatientHealthOutcomes

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VII. ClinicalPreventionandPopulationHealth

23

VIII. ProfessionalismandProfessionalValues

26

IX. BaccalaureateGeneralistNursingPractice

29

ExpectationsforClinicalExperienceswithintheBaccalaureateProgram

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Summary

35

Glossary

36

References

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AppendixA:TaskForceontheRevisionoftheEssentialsofBaccalaureate EducationforProfessionalNursingPractice

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AppendixB:ConsensusProcessto RevisetheEssentialsofBaccalaureate EducationforProfessionalNursingPractice

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AppendixC:Participantswho AttendedStakeholderMeetings

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AppendixD:SchoolsofNursingthatParticipatedintheRegionalMeetings

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AppendixE:ProfessionalOrganizationsthatParticipatedintheRegionalMeetings

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AppendixF: HealthcareSystemsthatParticipatedintheRegionalMeetings

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ExecutiveSummary TheEssentialsofBaccalaureateEducation forProfessionalNursingPractice(2008) ThisEssentialsdocumentservestotransformbaccalaureatenursingeducationbyproviding thecurricularelementsandframeworkforbuildingthebaccalaureatenursingcurriculumfor the21st century.TheseEssentialsaddressthekeystakeholders’recommendationsand landmarkdocumentssuchastheIOM’srecommendationsforthecoreknowledgerequiredof allhealthcareprofessionals.Thisdocumentemphasizessuchconceptsaspatientcentered care,interprofessionalteams,evidencebasedpractice,qualityimprovement,patientsafety, informatics,clinicalreasoning/criticalthinking,geneticsandgenomics,culturalsensitivity, professionalism,andpracticeacrossthelifespaninaneverchangingandcomplexhealthcare environment EssentialsIIXdelineatetheoutcomesexpectedofgraduatesofbaccalaureatenursing programs.Achievementoftheseoutcomeswillenablegraduatestopracticewithincomplex healthcaresystemsandassumetheroles:providerofcare;designer/manager/coordinatorof care;andmemberofaprofession.EssentialIXdescribesgeneralistnursingpracticeatthe completionofbaccalaureatenursingeducation.ThisEssentialincludespracticefocused outcomesthatintegratetheknowledge,skills,andattitudesdelineatedinEssentialsI –VIII. ThetimeneededtoaccomplisheachEssentialwillvary,andeachEssentialdoesnotrequirea separatecourseforachievementoftheoutcomes. ThenineEssentialsare: · EssentialI: LiberalEducationforBaccalaureateGeneralistNursingPractice o Asolidbaseinliberaleducationprovidesthecornerstoneforthepracticeand educationofnurses. · EssentialII:BasicOrganizationalandSystemsLeadershipforQualityCareand PatientSafety o Knowledgeandskillsinleadership,qualityimprovement,andpatientsafetyare necessarytoprovidehighqualityhealthcare. · EssentialIII:ScholarshipforEvidenceBasedPractice o Professionalnursingpracticeisgroundedinthetranslationofcurrentevidence intoone’spractice. · EssentialIV:InformationManagementandApplicationofPatientCareTechnology o Knowledgeandskillsininformationmanagementandpatientcaretechnologyare criticalinthedeliveryofqualitypatientcare. · EssentialV:HealthCarePolicy,Finance,andRegulatoryEnvironments o Healthcarepolicies,includingfinancialandregulatory,directlyandindirectly influencethenatureandfunctioningofthehealthcaresystemandtherebyare importantconsiderationsinprofessionalnursingpractice. · EssentialVI:InterprofessionalCommunicationandCollaborationforImproving PatientHealthOutcomes o Communicationandcollaborationamonghealthcareprofessionalsarecriticalto deliveringhighqualityandsafepatientcare.

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· EssentialVII:ClinicalPreventionandPopulationHealth o Healthpromotionanddiseasepreventionattheindividualandpopulationlevel arenecessarytoimprovepopulationhealthandareimportantcomponentsof baccalaureategeneralistnursingpractice. · EssentialVIII:ProfessionalismandProfessionalValues o Professionalismandtheinherentvaluesofaltruism,autonomy,humandignity, integrity,andsocialjusticearefundamentaltothedisciplineofnursing. · EssentialIX:BaccalaureateGeneralistNursingPractice o Thebaccalaureategraduatenurseispreparedtopracticewithpatients, includingindividuals,families,groups,communities,andpopulationsacross thelifespanandacrossthecontinuumofhealthcareenvironments. o Thebaccalaureategraduateunderstandsandrespectsthevariationsofcare, theincreasedcomplexity,andtheincreaseduseofhealthcareresources inherentincaringforpatients.

Learningopportunities,includingdirectclinicalexperiences,mustbesufficientin breadthanddepthtoensurethebaccalaureategraduateattainsthesepracticefocused outcomesandintegratesthedelineatedknowledgeandskillsintothegraduate’s professionalnursingpractice. Clinicallearningisfocusedondevelopingandrefiningthe knowledgeandskillsnecessarytomanagecareaspartofaninterprofessionalteam. Simulationexperiencesaugmentclinicallearningandarecomplementarytodirectcare opportunitiesessentialtoassumingtheroleoftheprofessionalnurse. A clinical immersionexperienceprovidesopportunitiesforbuildingclinicalreasoning, management,andevaluationskills.

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Introduction

TheEssentialsofBaccalaureateEducationforProfessionalNursingPracticeprovides theeducational frameworkforthepreparation ofprofessionalnurses.Thisdocument describestheoutcomesexpectedofgraduatesofbaccalaureatenursingprograms. TheEssentialsapplytoall prelicensureandRNcompletionprograms,whetherthe degreeisbaccalaureateor graduateentry.Programcurriculaaredesignedtoprepare studentstomeettheendofprogramoutcomesdelineatedundereach Essential. Background Thehealthcaredeliverysystemhaschangeddramatically sinceTheEssentialsof BaccalaureateEducationforProfessionalNursingPracticewasendorsedbythe AmericanAssociationofCollegesofNursing(AACN,1998).Buildingasafer healthcaresystemhasbecomethefocusofallhealthprofessionsfollowingnumerous reportsfromtheInstituteofMedicine(IOM,2000,2001,2004),AmericanHospital Association(2002),RobertWoodJohnsonFoundation(Kimball&O’Neill,2002),the JointCommission(2002)andotherauthorities.Nursinghasbeenidentifiedashavingthe potentialformakingthebiggestimpacton a transformationofhealthcaredeliverytoa safer,higherquality,andmorecosteffectivesystem.Withtheincreasingawarenessof theneedforchangeinthehealthcaresystem,theclinicalmicrosystems(small,functional unitswherecareisprovidedwithinthelargersystem)havebecomeanimportantfocus forimprovinghealthcareoutcomes(Nelson,Batalden,&Godfrey,2007). Inadditiontotheconcernoverhealthcareoutcomes,theUnitedStatesandtheglobal marketareexperiencinganursingshortagethatisexpectedtointensifyasthedemandfor moreanddifferentnursingservicesgrows.Buerhaus,Staiger,andAuerbach (2008) reportedthattheU.S. may experienceashortage ofmorethan500,000registerednurses bytheyear2025.Despiteannualincreasesinenrollmentsinentrylevelbaccalaureate nursingprogramssince2001(Fang,Htut,&Bednash,2008), theseincreasesarenot sufficienttomeettheprojecteddemandfornurses.AccordingtoBuerhausetal.(2008), enrollmentinnursingprogramswouldhavetoincreaseatleast40% annuallytoreplace thenursesexpectedtoleavetheworkforcethroughretirementalone.Addressingtheneed foranincreasednumberofbaccalaureatepreparednursesiscriticalbutnotsufficient. Nursingmusteducatefutureprofessionalstodeliverpatientcenteredcareasmembersof aninterprofessional team,emphasizingevidencebasedpractice,qualityimprovement approaches,andinformatics(IOM,2003b).Nursingeducationandpracticemustwork togethertobetteraligneducationwithpracticeenvironments(JointCommission,2002, Kimball & O’Neill,2002;). Theenvironmentsinwhichprofessionalnursespracticehavebecomemorediverseand moreglobalinnature.Scientificadvances,particularlyintheareasofgeneticsand

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genomics,havehadandwillcontinuetohaveagrowingandsignificantimpacton prevention,diagnosis,andtreatmentofdiseases,illnesses,andconditions.Theincreased prevalenceofchronicillnessisaresultofanincreasinglyolderadultpopulation, environmentalthreats, lifestylesthatincreaseriskofdisease,andenhancedtechnological andtherapeuticinterventionsthatprolonglife.Increasesinlongevityoflifehavemade theolderadultthefastestgrowingsegmentofthepopulation.In2003,12%ofthe populationwasolderthan 65yearsofage.By2030, thispopulationwillincreaseto20%, withalargemajority olderthan 80yearsofage(He,Sengupta,Velkoff,&DeBarros, 2005).Those olderthan 65yearsof agehadalmostfourtimesthenumberof hospitalizationdaysthanthoseyoungerthan65yearsof age(CentersforDisease Control,2007) Educationforthebaccalaureategeneralistmustincludecontentandexperiencesacross thelifespan,includingtheveryyoungwhoareespeciallyvulnerable.Thepercentageof thepopulationunder18yearsofageis24.6%(U.S.CensusBureau,2008).U.S. infant mortalityin2006ranked38th intheworld(WorldHealth Organization,2008). Preventioniscriticalinaddressingbothacuteandchronicconditionsacrossthelifespan. Theroleofthenurseinpreventioncontinuestobeofutmostimportance. Increasingglobalizationofhealthcareandthediversityofthisnation’spopulation mandatesanattentiontodiversityinordertoprovidesafe,highqualitycare.The professionalnursepracticesinamulticulturalenvironmentandmustpossesstheskillsto provideculturally appropriatecare.AccordingtotheU.S.CensusBureau(2008),the nation'sminoritypopulationtotaled102millionor34%oftheU.S.populationin2006. Withprojectionspointingtoevengreaterlevelsofdiversityinthecomingyears, professionalnursesneedtodemonstrateasensitivitytoandunderstandingofavariety of culturestoprovidehighqualitycareacrosssettings.Liberaleducation,includingthe studyof asecondlanguage,facilitatesthedevelopmentofanappreciationfordiversity. Strongforcesinfluencingtheroleofnursesinclude: · scientificadvances,particularlyintheareaofgeneticsandgenomics, · changingdemographicsofpatientpopulations, · newcaretechnologies,and · patientaccesstohealthcareinformation. Theseforcescallfornewwaysofthinkingandprovidinghealth care.Nursingis uniquely positionedtorespondtothesemajorforces,requiringanincreasedemphasison designingandimplementingpatientcenteredcare, developingpartnershipswiththe patient,andafocuson customerservice.

NursingEducation Inresponsetocallsfortransformingthehealthcaresystemandhowhealthcare professionalsareeducated,AACNhasmaintainedanongoingdialoguewithabroad representationofstakeholdersinternalandexternaltonursing.Thedialoguehasfocused ontheknowledge,skills,andattitudesneededbynursestopracticeeffectivelywithinthis

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complexandchangingenvironment.Newinnovativemodelsofnursingeducationhave emerged,andAACNhastakenaleadershiproleincraftingapreferredvisionfornursing education. In2004,theAACNBoardofDirectorsreaffirmeditspositionthatbaccalaureate educationistheminimumlevelrequiredforentryintoprofessionalnursingpracticein today’scomplexhealthcareenvironment.Baccalaureategeneralisteducation,asdefined inthisdocument,isthefoundationuponwhichall graduatenursingeducationbuilds. Thepreferredvisionfornursingeducationincludesgeneralist,advancedgeneralist,and advancedspecialtynursingeducation.Generalistnurseeducationoccursataminimumin baccalaureatedegreenursingprograms.Advancedgeneralisteducationoccursin master’sdegreenursingprograms,includingtheClinicalNurseLeader(CNL®),whichis anadvancedgeneralistnursingrole.Advancedspecialtyeducationoccursatthedoctoral levelin Doctorof NursingPractice(DNP)orresearchfocuseddegreeprograms(PhD, DNS,orDNSc).Endofprogram outcomesforthebaccalaureate,master’s,anddoctoral nursingprogramsbuildoneachother. TheDisciplineofNursing Rolesforthebaccalaureategeneralistnursearederivedfromthedisciplineofnursing. Therolesofthebaccalaureategeneralistinclude: · providerofcare, · designer/manager/coordinatorofcare,and · memberofaprofession. Nursinggeneralistpracticeincludesbothdirectandindirectcareforpatients,which includesindividuals,families,groups, communities,andpopulations.Nursingpracticeis builtonnursingknowledge,theory,andresearch.Inaddition,nursingpracticederives knowledgefromawidearrayofotherfieldsandprofessions,adaptingandapplyingthis knowledgeasappropriatetoprofessional practice. Intheseniorcollegeanduniversitysetting,everyacademicdisciplineisgroundedin discreteinquirybasedapplicationsthataredistinctivetothatdiscipline.Scientific advances,(particularlyintheareaofgeneticsandgenomics),changingdemographicsof patientpopulations,newcaretechnologies,andpatientaccesstohealthcareinformation callfornewwaysofthinkinganddoingintheprovisionofhealthcare.Theacademic settingprovidesaforumforcontemplatingphysical,psychological,social,cultural, behavioral,ethical,andspiritual problemswithinandacrossdisciplines.Facultyhavea responsibilitytofacilitatethetranslationofknowledgefromaliberaleducationbaseinto thepracticeofnursing.Nursingfacultyintroducenursingscienceandtheories,andguide thestudentindevelopinganunderstandingofthedisciplineofnursing’sdistinctive perspective. Baccalaureatepreparednursesprovidepatientcenteredcare thatidentifies,respects,and addressespatients’ differences,values,preferences,andexpressedneeds(IOM,2003a). Patientcenteredcarealsoinvolvesthecoordinationofcontinuouscare,listeningto,

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communicatingwith,andeducatingpatientsandcaregiversregardinghealth,wellness, anddiseasemanagementandprevention.Thegeneralistnurseprovidesthehumanlink betweenthehealthcaresystemandthepatientbytranslatingtheplanofcaretothe patient.Abroadbasedskillsetisrequiredtofillthishumaninterfacerole.Patient centeredcarealsorequiresthedevelopmentofanursepatientpartnership.Patients,as consumersofhealthcareservices,andasintegralmembersofthehealthcareteam,have anincreasingroleandresponsibilityforthemutualplanningofcareandhealthcare decisionmaking. Thefundamentalaspectsofgeneralistnursingpracticeare:directcareofthesickinand acrossallenvironments,healthpromotionandclinicalprevention,andpopulationbased healthcare.Adefiningfeatureofprofessionalnursingpracticeisthefocusonhealth promotionandriskreduction.Advancesinscienceandtechnologywillcontinueto emerge,which willhelptopredictfuturehealthproblems.Nurseswilldesignand implementmeasurestomodifyriskfactorsandpromotehealthylifestyles.Thesesame advancesinscienceandtechnologyalsohaveallowedindividualstolivelongerandoften withincreasingnumbersofchronicillnessesandconditions.Withanincreasingemphasis oncostsavingsandcostbenefits,nurseswill play aleadingroleintheprovisionofcare.

Assumptions Thebaccalaureategeneralistgraduateispreparedto: · practicefromaholistic,caringframework; · practicefromanevidencebase; · promotesafe,quality patientcare; · useclinical/criticalreasoningtoaddresssimpletocomplexsituations; · assumeaccountabilityforone’sownanddelegatednursingcare; · practiceinavarietyofhealthcaresettings; · careforpatientsacrossthehealthillnesscontinuum; · careforpatientsacrossthelifespan; · carefordiversepopulations; · engageincareofselfinordertocareforothers;and · engageincontinuousprofessionaldevelopment. RolesfortheBaccalaureateGeneralistNurse BaccalaureateGeneralistnursesareprovidersofdirectandindirectcare.Inthisrole, nursesarepatientadvocatesandeducators.Historically,thenursingrolehasemphasized partnershipswithpatients–whetherindividuals,families,groups,communities,or populations–inordertofosterandsupportthepatient’sactiveparticipationin determininghealthcaredecisions.Patientadvocacyisahallmarkoftheprofessional nursingroleandrequiresthatnursesdeliverhighqualitycare,evaluatecareoutcomes, andprovideleadershipinimprovingcare.

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Changingdemographicsandongoingadvancesinscienceandtechnologyarearealityof healthcarepractice.Thegeneralistnurseprovidesevidencebasedcaretopatientswithin thischangingenvironment.Thisclinicianusesresearchfindingsandotherevidencein designingandimplementingcarethatismultidimensional,highquality,andcost effective.Thegeneralistnursealsoispreparedfortheethicaldilemmasthatarisein practiceandwillbeabletomakeandassistothersinmakingdecisionswithina professionalethicalframework.Understandingadvancesinscienceandtechnologyand theinfluencetheseadvanceshaveonhealthcareandindividualwellbeingisessential. Understandingpatientsandthevaluestheybringtothehealthcarerelationshipisequally important. Thegeneralistnursepracticesfromaholistic,caringframework.Holisticnursingcareis comprehensiveandfocuseson themind,body,andspirit,aswellasemotions.The generalistnurserecognizestheimportantdistinctionbetweendiseaseandtheindividual’s illnessexperience.Assistingpatients tounderstandthisdistinctionisanimportantaspect ofnursing.Inaddition,nursesrecognizethatdeterminingthehealthstatusofthepatient withinthecontextofthepatient’svaluesisessentialinprovidingaframeworkfor planning,implementing,andevaluatingoutcomesofcare. Thegeneralistnurseprovidescareinandacrossallenvironments.Nursesfocuson individual,family,community,andpopulationhealthcare,asthey monitorandmanage aspectso...