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