CNC-AC 12-7-12 Nursing Summit Keynote Presentation

Report
Connecticut Consultation
Creativity and Connections:
Building the Framework for the
Future of Nursing Education and
Practice
The Nurse of the Future Competency
Model
Maureen Sroczynski, DNP, RN
Nursing Expert/Consultant
Center to Champion Nursing in America
Today’s Agenda
 The National Perspective
 Competency Development Process
 The Structure and Process and Outcomes to Date
 Lessons Learned along Journey
 Widening the Circle: Expanding the Work
Fragmentation
High costs
Primary care
shortage
Health care
disparities
Aging and sicker
population
Advancing Education
Transformation
Removing Barriers to
Practice and Care
Interprofessional Collaboration
Diversity
DATA
Nursing Leadership
Practice
Diversity
Data
Education
Collaboration
Leadership
8
Evidence
Some association between educational level and patient
outcomes
Twenty percent of BSN graduates get advanced degrees
Six percent of associate-degree graduates get advanced
degrees
Learning
Collaborative
Regional
Facilitated
Sharing
Nurse Experts
• Webinars and face to face meetings
• Listserv facilitated discussions
• Determine and share best practices
• Ongoing dialogue on Campaign for Action website
• State sharing; virtual and face to face
• Resource guides as result of work
• Web archives of all work accomplished
• Nursing expertise
• Coordination in region and nationally
• Communication
• Facilitation and collaboration
Source: Gajda, R. & Koliba, C. (2007). Evaluating the Imperative of Interorganizational Collaboration.
American Journal of Evaluation, (28)1,26-44
8
• Sharing knowledge and creativity
• Spreading innovation and information across states
• Contributing to ongoing dialogue on education
transformation
• Making connections and moving forward together to
achieve education transformation
Northeast Region (April 13 2011)
• North Carolina: Polly Johnson
• Massachusetts: Maureen Sroczynski
• New York: Maureen Wallace
National: NLN; Elaine Tagliareni, AACN;
Jane Kirschling, NCSBN; Nancy Spector
•
•
•
•
Western Region (June 29 2011)
• New Mexico: Jean Giddens
• California: Liz Close
• Washington: Gerianne Babbo and Sharon
Fought
• National: Fran Roberts, Private for Profit
Schools
Mid-western Region (July 7 2011)
Southeast Region (July 7 2011)
Indiana: Donna Boland
Michigan: Teresa Wehrwein
Ohio: Susan Taft
National: Linda Tieman, Workforce data
• Mississippi: Wanda Jones
• Florida: Mary Lou Brunell
• Texas: Sondra Flemming
• National: Deana L. Molinari, Rural Health
Southeast Region (Dec 8 & 9 2011)
•St Petersburg, Florida
•Nine state Action Coalitions participated
•Key CCNA staff attended
•Discussed; key partnership, promising
models, and key components of success
• Special focus on BSN at Community
Colleges
Midwest Region ( April 16 & 17 2012)
• Minneapolis, Minn.
• Thirteen state Action Coalitions
participated
•Key CCNA staff attended
•Discussed online education models and
proprietary school programs
•Special focus on accelerated models
Western Region (Feb 23 & 24 2012)
• Sacramento, California
•Ten state Action Coalitions participated
•Key CCNA staff attended
• Discussed four promising models
•Special focus on shared curricular
components
Northeast (May 10 & 11 2012)
•Princeton, New Jersey RWJF
•Two participants from each Action Coalition
in the Northeast invited
•Key CCNA staff will attend
•Continue the discussion
•Special focus on competency based
curriculum
• Community Colleges Grant RN to BSN Degree
• Accelerated Options: RN to MSN Programs
• State or Regional Shared Curriculum
• State or Regional Competency Based Programs
35
Partnerships of education and practice
BSN completed in no more that four academic years
Substantive curriculum transformation
Strong evaluation plans to provide data and analyze
strategies
• Intentional strategies to increase diversity of students and
graduates
•
•
•
•
• Associate degree in nursing (ADN) nurses with an RN
advance directly to BSN
• May be more affordable
• The American Association of Colleges of Nursing(AACN)
supports provided the Baccalaureate Essentials are utilized
and the program is accredited
• Especially beneficial for nurses who are place bound with
limited access to other options
• May require legislative changes
• Does not include a four year BSN
• Offers a shorter timeline to completion than traditional BSN
or MSN
• An accelerated model that values the practice experience
of AD nurses and meets BSN criteria
• Is seamless and university based
• Emphasizes practice components
• A major challenge of this model is meeting the needs of
students with varying clinical expertise
• Models meet AACN/CCNE Accreditation standards
• Educational collaboratives between universities and
community colleges to enable automatic and seamless
transition from an AD t0 BSN program
• All schools share curriculum, simulation facilities and
faculty
• Shared components include pre-requisites and graduation
requirements
• Requires formal articulation agreements and buy in from
legislative bodies and institutions
• Partners from different education programs develop a
shared understanding , common goals and education
framework
• Partners universally agree on the outcomes
• The scope of the curriculum reaches beyond core
competencies and across the entire profession focusing on
knowledge, attitudes and skills
• The curriculum is not standardized but aims to reach
standardized outcomes
• Partners from different education programs develop a
shared understanding , common goals and education
framework
• Partners universally agree on the outcomes
• The scope of the curriculum reaches beyond core
competencies and across the entire profession focusing on
knowledge, attitudes and skills
• The curriculum is not standardized but aims to reach
standardized outcomes
Competency Based Models





Not just skill based models or experience based
competencies
A number of different types
Common agreement on competencies and how to
integrate into curriculum
Some leveled and some not
Common goals
 Common outcomes
 Seamless progression
Agreement on
Competencies
Diploma, ADN,
BSN Nursing
Programs &
Practice Partners
Evaluation and
Updating of
Competencies
Implementation
of Seamless
Progression
Curriculum
Models
Gap
Analysis
Process of
Curricula
Designing
New Models
by
Addressing
the Gaps
20
The IOM Vision
2003
Health Professions Education

All health professionals should be
educated to deliver patient centered care
as members of an interdisciplinary team,
emphasizing evidence-based practice,
quality improvement approaches and
informatics.
As the storm began to gather in 2005, the
Massachusetts began to prepare for the future
MASSACHUSETTS DEPARTMENT OF HIGHER EDUCATION
The Nursing Initiative

Goals
 To rapidly increase the number of skilled nurses
 To increase nursing faculty
 To design a nursing education system to meet future
demands

Objectives
 Expand education and practice partnerships
 Build regional and statewide models
 Address quality issues
MASSACHUSETTS DEPARTMENT
OF HIGHER EDUCATION
Creativity and Connections
BUILDING THE FRAMEWORK FOR THE FUTURE OF
NURSING EDUCATION AND PRACTICE
Nurse of the Future Project
2006-2012
Volunteer Efforts
MACN
BSN
MA
Center for
Nursing
BORN
Home
Care
Alliance
Senior
Care
Association
DHE/
MONE
co-chairs
MARILN
Staff
Nurse
ADN
LPN
Program
Dean
Faculty
CCNE
Our Way of Being Together
Practices of Circle

Listen with attention
 Speak with intention
 Contribute to the well-being of the group
 Everyone should feel listened to, respected and
valued
Our Guide through the Storm
To envision the future , we must look to the past,
validate the present and move to the future
Florence Nightingale
Creativity and Connections Agenda

Day One: Understanding Best Practices
– National Council of State Boards
–
New Graduates Survey
– The Oregon Model
–
Collaborative Education Model
– AONE
–
Future Care Delivery Model
– DHMC
–
Simulation to Increase Competence
and Confidence
Day Two: Brainstorming Solutions
Creativity and Connections
Meeting Outcomes
Agreement on Priorities
 Creating a seamless progression through all levels of
nursing education
 Developing sufficient consensus on competencies to serve
as framework for educational curriculum
 Developing a statewide nurse internship/preceptor program
 Establishing a formal coalition to foster ongoing partnership
between nursing education and practice
Our Structure: Where we began
Nurse of the Future Project
DHE
Competency
Development
Group
MONE
Academic Practice Integration
Committee
Transition into Practice
Curriculum for the Future
Assumptions for the Model
Our Five Shared Beliefs

Education and Practice partnerships are key to
developing an effective model.
– Nursing education and practice setting should facilitate individuals to
move more effectively move through the educational system.
– An integrated practice/education competency model will positively
impact patient safety and improve patient care.
– Nursing practice should be differentiated according to the registered
nurse’s educational preparation and the level of practice and further
defined by the role of the nurse and the work setting
– Practice environments that support and enhance professional
competence are essential.
Assumptions for the Model
Our Five Shared Beliefs

It is imperative that leaders in nursing education
and practice develop collaborative curriculum
models to facilitate the achievement of a minimum
of a baccalaureate degree in nursing (BSN) by all
nurses.
– Advancing the education of all nurses is increasingly being
recognized as essential to the future of nursing practice.
– Evidence has demonstrated that nurses with higher education
levels have a positive impact on patient care.
Assumptions for the Model
Our Five Shared Beliefs

There is a need to develop a more effective educational
system that is capable of incorporating the shifting
demographics in order to prepare the nursing workforce to
respond to current and future health care needs and
population health issues.
– The competencies are designed to be applicable across all care
settings and to encompass all patient populations across the
lifespan.
– In this global society, essential to the care of diverse populations is
the need for evidence-based knowledge and sensitivity to variables
such as age, gender, culture, health disparities, socioeconomic
status, race, and spirituality.
Assumptions for the Model
Our Five Shared Beliefs

The nurse of the future will be proficient at a core
set of competencies.
– There is a differentiation in competencies among practicing nurses
at various levels.
– Competence is developed over a continuum and can be measured

Nurse educators in both education and practice
settings will need to use a different set of
knowledge and teaching strategies to effectively
integrate the Nurse of the Future competencies
into curriculum.
The Process
Began with Questions

What are the models that are out there for
competencies?
 What competencies are currently being used
in Massachusetts?
 What do we need to develop a common
framework for the future in Massachusetts?
The IOM Vision
2003

All health professionals should be
educated to deliver patient centered care
as members of an interdisciplinary team,
emphasizing evidence-based practice,
quality improvement approaches and
informatics.
Innovation Process
New
Approaches to
Curriculum
Act
Study
Pilot Models
Plan
Creativity and
Connection
Process
Do
Competencies
Gap Analysis
Faculty
Feedback
RWJ/IHI
Massachusetts
•Patient Demographics
•Education and Practice
Competencies
•NCLEX Test Questions
NOF
Competency Committee
Sub group
Drafts
Joint Meetings
All Day Retreats
Sub group
Re- Drafts
Draft Document
for review
2007
Statewide
Summits
DHE
Website
Feedback
OCNE
AACN
CCNE
NLNAC
IOM
ACGME
QSEN
AONE
ANA
Adapt and
Spread
Regional Meetings
Local Meetings
MONE
MACN
MARILN
Schools
&
Practice Site
Meetings
An Innovation
Process
Final
Document
2010
Gap Analysis
Pilot Models
Competency Committee
Review and feedback
redraft
Final Competency Document 2010
Available at www.mass.edu/nursing
Available @ www.mass.edu/ nursing
Ten Core Nursing Competencies
In 2010 publication

Nursing Knowledge as foundation

Communication

Quality improvement

Safety

Evidence-based practice

Patient centered care

Leadership

Teamwork and Collaboration

Professionalism

Informatics

Systems Based Practice
Quality Improvement
The Nurse of the Future will use data to monitor outcomes and care processes, and use
improvement methods to design and test changes to continuously improve the quality
and safety of healthcare.
Knowledge
Attitudes/behaviors
Skills
Describes the nursing
context for improving
care
Recognizes that quality
improvement is an
important part of being a
nurse.
Actively seeks information about quality improvement from
relevant institutional, regulatory and local/national sources.
Understands that the
nurse and care
delivered is part of a
broader health care
system.
Recognizes that
interdependent
relationships and a
professional work process
are important to quality
improvement.
Participates in the use of quality improvement tools (such
as flow charts, cause & effect diagrams) to make processes
of care interdependent and explicit
Explains the
importance of variation
and measurement in
providing quality
nursing care.
Appreciates how
unwanted variation affects
care and how
standardization can
support quality patient
care.
Participates in the use of quality measures (such as control
and run charts) to assess performance and identify gaps
between local and best practices.
Describes approaches
for changing
processes of care in
which the learner is
involved.
Recognizes the value of
what individuals and
teams can do to improve
care.
Participates in the use of measures to evaluate the effect of
changes in the delivery of care.
Nurse of the Future
Core Nursing Competencies

These competencies are the expectations for all
professional nurses of the future.

The Knowledge, Attitude and Skills (KAS)
grids are the minimal expectations for initial
nursing practice following completion of a prelicensure professional nursing educational
program.
Core Competency Comparisons
IOM
ACGME
QSEN
NOF
Apply Quality
Improvement
Practice based
Learning
& Improvement
Systems Based
Practice
Quality
Improvement
Safety
Quality Improvement
Safety
Systems based practice
Provide
PatientCentered Care
Patient Care
Interpersonal &
Communication
Skills
Patient
Centered
Care
Patient Centered Care
Communication
Leadership
Work in
InterDisciplinary
Teams
Professionalism
Employ
EvidencedBased
Practice
Medical Knowledge
Utilize
Informatics
Teamwork
and
Collaboration
Teamwork and Collaboration
Professionalism
Evidence
based
practice
Evidence based practice
Informatics
Informatics
NOF COMPETENCIES
NLN ASSOCIATE DEGREE COMPETENCIES
(2000)
Nursing Knowledge
Content is found across all competencies
Patient Centered Care
Clinical decision making
Caring Interventions
Assessment
Professionalism
Professional behaviors
Caring Interventions
Managing care
Communication
Communication
Teaching and learning
System Based Practice
Teamwork/Collaboration
Collaboration
Evidence Based Practice
Clinical decision making
Quality Improvement
Clinical decision making
Safety
Clinical decision making
Caring interventions
Informatics
NOF COMPETENCIES
Leadership
NLN ASSOCIATE DEGREE
COMPETENCIES (2000)
Managing care
Collaboration
Professional behaviors
Nurse of the Future (NOF)
AACN. (2008). Essentials of Baccalaureate
Education for Professional Nursing Practice
(adopted by AACN 10/28/08)
Quality Improvement
Quality improvement
Continuous quality improvement
Safety
Safety
Leadership
Basic organizational systems leadership
Patient-centered Care
Patient-centered care
Communication
Communication, including elements, levels,
barriers, models
Interprofessional communication and
collaboration
Systems-based practice
Baccalaureate generalist nursing practice
Basic organizational systems leadership
Health care policy, finance and regulatory
environments
Teamwork and Collaboration
Team building and collaborative strategies
Interprofessional collaboration
Nurse of the Future (NOF)
AACN. (2008). Essentials of Baccalaureate
Education for Professional Nursing Practice
(adopted by AACN 10/28/08)
Professionalism
Professionalism and professional values
Evidence-based practice
Scholarship for evidence-based practice
Nursing Knowledge
Liberal education
Discipline of nursing
Informatics
Information literacy
Information management and patient care
technology
NOF
Bologna
Communication
Nursing Function
Promotion of Health
Information and Education
Caring
Planning –Coordination and Management
Functions
Systems-based practice
Nursing Function
1.1 Promotion of Health
Planning –Coordination and Management
Functions
Teamwork and Collaboration
Nursing Function
1.2 Information and Education
Collaborative Functions
Research
4Planning –Coordination and Management
Functions
Professionalism
Collaborative Functions
Research
Planning –Coordination and Management
NOF
Bologna
Quality Improvement
Research and Development
Planning –Coordination and Management Functions
Safety
Planning –Coordination and Management Functions
Patient–centered care
Nursing Function
1.1 Promotion of Health
1.2 Information and education
1.3 Caring for Patient
Leadership
Collaborative Functions
Planning –Coordination and Management Functions
NOF
COPA 1999
Quality
Improvement
Accountability and responsibility; performance appraisals
and QI (5d)
Safety
Assessment and Intervention Skills
oSafety and protection (1a)
Leadership
Leadership (6)
Management Skills
Teaching Skills (7)
Patient Centered Human Caring and Relationship Skills
Care
oClient advocacy (4c)
Communication
Communication Skills (2)
Systems Based
Practice
Teamwork and
Collaboration
Human Caring and Relationship Skills
oCultural respect, cooperative interpersonal
relationships (4b)
oCollaboration; assertiveness, risk taking (6a)
Knowledge Integration Skills
oNursing healthcare and related disciplines (8a)
NOF
COPA 1999
Professional Accountability, role behaviors, appearance (6d)
Professionalism
Evidence Based Planning, anticipating, supporting with evidence (6c)
Practice
Nursing
Knowledge
Knowledge Integration Skills (8)
Teaching Skills
Health Promotion; health restorations (7a)
Human Caring and Relationship Skills
Morality, ethics, legality (4a)
Informatics
Computing skills (3c)
Testing the Model
Gap Analysis
Definition
Technique for determining the steps to be taken in moving
from a current state to a desired future state.
It begins with (1) listing of characteristic factors (such as
attributes, competencies, performance levels) of the
present situation (“what is”), (2) cross-lists factors
required to achieve the future objectives (“what could
be”), and then (3) highlights the ‘gaps' that exist and
need to be 'filled.' Also called need-gap analysis, needs
analysis, and needs assessment.
Source
Business Dictionary Online
Gap Analysis Process





Assesses curriculum
Involves practice and education partners
Measures opportunities for students to be
exposed to the competencies within curriculum
Opportunity for practice to examine and align
orientation programs
Quantitative process that requires evidence
The Nurse of the Future Nursing Core Competencies©
Curriculum Redesign Process
Outcome Focused, Individualized by Programs
Agreement on
Competencies
Implementation of
Seamless
Progression
Curriculum Models
Designing
New Models
by
Addressing
the Gaps
ADN, BSN
Nursing
Programs &
Practice
Partners
Gap
Analysis
Process of
Curricula
Massachusetts Nursing Education Redesign
Three Phases
•
Phase One:
•
•
•
Analyze curriculum against Nurse of Future
competencies in partnerships with practice
partners
Funded three partnerships
Phase Two:
• Gap Analysis results to develop plans for new
curriculum seamless progression curriculum models
• Funded four partnerships of ADN and BSN
nursing programs and their practice partners
Phase Three:
Pilot Model Implementation





Formal implementation of the curriculum plan
Define course components content, outlines, course
placements and outcomes reflecting the NOF
competencies.
Describe inter-program educational collaboration and
seamless transition between educational segments
Describe alternative strategies to increase capacity
integrated in new design.
Define how faculty & practice partners will be involved in
curricula change process and how resources will be
utilized and shared.
Collaborative Curriculum Model
ADN to BSN
Springfield Technical Community College
University of Massachusetts, Amherst
Baystate Health
Appendix B
The Outcome: Pilot Model
STCC Associate Degree in Nursing – UMass Amherst RN-BS Online Nursing Degree
1 + 2 + 1 program
Program of Study
STCC: Pre-Associate Degree
FALL:
PSYC 100 Gen Psych (3) (SB)
CHEM 101 Survey Chem (4) (PS)
CHEM 101 Survey Chem Lab
General Education course (3) *
General Education course (3) *
Elective course (3) **
16
STCC: Associate Degree – Year One
FALL:
NURS 102 Nursing 1 (8)
NURS 104 Nursing Seminar (1)
PSYC 400 Normal/Abnormal (3) #
ENGL 100 English Comp 1 (3) (CW)
BIOL 132 Anatomy & Physiology 1
(4) (BS) #
BIOL 132 Anatomy & Physiology 1
Lab
19
STCC: Associate Degree – Year Two
FALL:
NURS 302 Nursing 3 (9)
BIOL 121 Microbiology (4) (BS) #
BIOL 121 Microbiology Lab
SOCL 100 Sociology (3) (SBU)
UMASS: RN-BS Online Degree
FALL:
N397A Writing in Nursing (3)
N312 Cultural Diversity in Health
and Illness (3)
N XXX Community Health Nursing
Theory and Intervention
(Gerontology focus) (4)
16
10
WINTER:
N 290 Introduction to Healthcare
Informatics (3)
3
SPRING:
BIOL 142 Nutrition (3) (BS) #
STAT 142 Statistics (3) (R1/R2) #
Elective course (3) **
Elective course (3) **
Elective course (3) **
SPRING:
NURS 202 Nursing 2 (9)
BIOL 232 Anatomy & Physiology 2
(4) (BS) #
BIOL 232 Anatomy & Physiology 2
Lab
PSYC 325 Lifespan (3) (SB)
NURS XXX Pharmacology (3)
SPRING:
NURS 402 Nursing 4 (9)
NURS 404 Nursing Seminar (1)
ENGL 200 English Comp 2 (3) (AL)
Elective course (3) **
SPRING:
N420 Intro to Research in Nursing
(3)
N438 Professional Role (3)
N XXX Family Nursing Across the
Lifespan (includes genetics,
assessment) 4)
10
15
31
Key:
19
38
Total STCC credits – 70
16
NCLEX Licensure
SUMMER
DEU / Immersion experience (3)
N315 Health & Physical
Assessment (3)
NXXX Elders Theory Prep Course
(1)
7
39
Total UMASS credits – 61
23
Total credits – 13
The First Massachusetts Model

Gap Analysis of both Community college and University
curricula
 All community college prerequisites aligned with University
•
•
•
•


Total STCC credits – 70
Total UMASS credits – 61
Total credits – 131
Generic BSN UMass credits- 120
NCLEX pass meets University residency requirements
Cost Difference
 Traditional 4 year UMA BS program Seamless AD-BS Curriculum Savings
$52,608
$27,432
$25,176
The Nurse of the Future
Lessons Learned
An iterative process of innovation
 Divergence and convergence are part of the process
 Circle methodology allows everyone to feel heard and
valued
 Volunteer time sustains and at time complicates the
process
 Move forward with the “Coalition of the Willing”

The Massachusetts Model
Creativity and Connection:
Building a Framework for the Future of
Nursing Education and Practice
DHE
Competency
Development
Group
Nursing
Core
Competencies
MONE
Academic Practice Integration
Committee
Transition into Practice
Curriculum and Practice Models for the Future
Widening the Circle
Massachusetts, New Hampshire and Rhode Island
Working Together
Robert Wood Johnson Partners Investing in Nursing ‘s
Future (PIN) Grant
Creativity and Connections:
Creating a Regional Nursing Education
Framework

Tufts Health Plan Foundation is Foundation leader
• Faculty Scholarships - $250,000 to be used as
match
•
Secured additional $106,000 in funding
•
Each state is at a different stage of the
journey but we all have the same goal.
Regional Model
Tufts Health Plan
Foundation (THPF)
Matching Funds
$250,000
Regional
Coordinating
Council
Massachusetts Hosp.
Education & Research
Association (MHREA)
Fiscal Agent
RI
Coordinating
Committee
NH
Coordinating
Committee
MA Nursing Initiative
Statewide Advisory
Committee
Faculty
Scholarships
Centralized Clinical
Placements
Nurse of the Future
Competency
Development
Different Approaches with Common Goal and Framework


New Hampshire
• 4 partnerships worked on models
• Two models seamless progression models
created
Rhode Island
• All five nursing programs working on the gap
analysis, curriculum redesign and curriculum
implementation
• One bridge course for the all nurses in state to
progress to BSN level
Learning From the Redesign Process

There is a need for a common language between education
and practice.

Similar gaps in curriculum across states in both ADN and
BSN programs
• System Based practice
• Informatics
• Quality Improvement
• Evidenced based practice
• Communication
• Leadership

Practice needs to be involved early in the education process

There is tremendous energy in collaboration and the
dialogue that occurs between education and practice in the
process
Education and Practice Transformation
The 3 “C” Process
Communication
Collaboration
Common
Understanding
A New Perspective
• We are all focused on the same goal: Increasing the supply
of BSN and doctorally prepared nurses
• Each state is moving at its own pace
• CCNA wants to provide support as states continue
progress toward education transformation
“This is a marathon, not a sprint”
Don’t be left behind!
What would Florence Say
“Nursing is an unending process of learning.”
“For us who nurse, our nursing is a thing which, unless we
are making progress every year, every month, every week,
take my word for it, we are going back." .
Real change does not come from decree, pressure,
permission or persuasion.
Real change comes from people who are passionately
and personally committed to a decision or direction
that they helped to shape.
Margaret Wheatley
How Can We Assist You to Meet Your
Goals

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