The Essentials of Baccalaureate Education for Professional Nursing Practice
October 20, 2008
TABLE OF CONTENTS
Executive Summary 3
Background 5 Nursing Education 6 The Discipline of Nursing 7 Assumptions 8 Roles for the Baccalaureate Generalist Nurse 8 Preparation for the Baccalaureate Generalist Nurse: Components of the Essentials 10
The Essentials of Baccalaureate Education for Professional Nursing Practice I. Liberal Education for Baccalaureate Generalist Nursing Practice 10
II. Basic Organizational and Systems Leadership for Quality Care and Patient Safety 13
III. Scholarship for EvidenceBased Practice 15
IV. Information Management and Application of Patient Care Technology 17
V. Healthcare Policy, Finance, and Regulatory Environments 20
VI. Interprofessional Communication and Collaboration for Improving Patient Health Outcomes 22
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 33
Appendix A: Task Force on the Revision of the Essentials of Baccalaureate Education for Professional Nursing Practice 45
Appendix B: Consensus Process to Revise the Essentials of Baccalaureate 46 Education for Professional Nursing Practice
Appendix C: Participants who Attended Stakeholder Meetings 47
Appendix D: Schools of Nursing that Participated in the Regional Meetings 49
Appendix E: Professional Organizations that Participated in the Regional Meetings 60
Appendix F: Healthcare Systems that Participated in the Regional Meetings 61
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 patientcentered care, interprofessional teams, evidencebased practice, quality improvement, patient safety, informatics, clinical reasoning/critical thinking, genetics and genomics, cultural sensitivity, professionalism, and practice across the lifespan in an everchanging and complex healthcare environment
Essentials IIX 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 practicefocused 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.
• 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 baccalaureategraduate 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 practicefocused 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.
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 prelicensure and RN completion programs, whether the degree is baccalaureate or graduate entry. Program curricula are designed to prepare students to meet the endofprogram outcomes delineated under each Essential.
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 costeffective 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 entrylevel 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 baccalaureateprepared nurses is critical but not sufficient. Nursing must educate future professionals to deliver patientcentered care as members of an interprofessional team, emphasizing evidencebased 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
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 patientcentered care, developing partnerships with the patient, and a focus on customer service.
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
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 baccalaureatedegree 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 researchfocused degree programs (PhD, DNS, or DNSc). Endofprogram 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 inquirybased 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.
Baccalaureateprepared nurses provide patientcentered care that identifies, respects, and addresses patients’ differences, values, preferences, and expressed needs (IOM, 2003a). Patientcentered care also involves the coordination of continuous care, listening to,
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 broadbased skill set is required to fill this human interface role. Patient centered care also requires the development of a nursepatient 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 populationbased 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 costsavings and costbenefits, nurses will play a leading role in the provision of care.
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 healthillness 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.
Changing demographics and ongoing advances in science and technology are a reality of healthcare practice. The generalist nurse provides evidencebased care to patients within this changing environment. This clinician uses research findings and other evidence in designing and implementing care that is multidimensional, 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 wellbeing 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 of the environment to foster health.
Baccalaureate generalist nurses are designers, coordinators, and managers of care. The generalist nurse, prepared at the baccalaureatedegree level, will have the knowledge and authority to delegate tasks to other healthcare personnel, as well as to supervise and evaluate these personnel. As healthcare providers who function autonomously and interdependently within the healthcare team, nurses are accountable for their professional practice and image, as well as for outcomes of their own and delegated nursing care. Nurses are members of healthcare teams, composed of professionals and other personnel that deliver treatment and services in complex, evolving healthcare systems. Nurses bring a unique blend of knowledge, judgment, skills, and caring to the healthcare team.
Baccalaureate generalist nurses are members of the profession and in this role are advocates for the patient and the profession. The use of the term “professional” implies the formation of a professional identity and accountability for one’s professional image. As professionals, nurses are knowledge workers who use a welldelineated and broad knowledge base for practice. Professional nursing requires strong critical reasoning, clinical judgment, communication, and assessment skills. The professional nurse also requires the development and demonstration of an appropriate set of values and ethical framework for practice. As advocates for high quality care for all patients, nurses are knowledgeable and active in the policy processes defining healthcare delivery and systems of care. The generalist nurse also is committed to lifelong learning, including career planning, which increasingly will include graduate level study.
Preparation for the Baccalaureate Generalist Nurse Roles: Components of The Essentials
This section outlines the nine Essentials of Baccalaureate Education for Professional Nursing Practice. These Essentials are the curricular elements that provide the framework for baccalaureate nursing education. Each Essential is operationalized through the program’s curriculum and is not intended to represent a course. Essential IX describes baccalaureate nursing practice and integrates the knowledge, skills, and attitudes from Essentials IVIII. Each Essential includes a rationale explaining its relevance for the education of the professional nurse today and in the future. The rationale for each Essential is followed by outcomes that delineate the knowledge, skills, and attitudes expected of new baccalaureate generalist graduates. These outcomes serve as a guide to help faculty identify program and course objectives that are specific and measurable. Next, sample content is listed to aid faculty in selecting material suited to achieving the specific Essential. The list of content is not inclusive, nor is it intended as required. A vast selection of content is available for each Essential, and the specific baccalaureate program’s curriculum will specify the content as appropriate to their mission, community served, and student population. The Essential outcomes can be obtained through a variety of content approaches, and potential content can and will evolve over time as new knowledge develops. The sample content is offered as a guide to programs or to further elucidate the nature of the Essential with which the content is listed.
The Essentials of Baccalaureate Education for Professional Nursing Practice
Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice