The Future of Nursing
Education: A Collaborative
Perspective
Christine A. Tanner, RN, PhD
Oregon Health & Science
University
School of Nursing
Calls for Reform
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Reexamination of curricular
structures & processes (The
Curriculum Revolution)
Preparing a new kind of nurse
The Curriculum Revolution
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New pedagogies
Preparing tomorrows leaders
Multicultural diversity
Caring Curriculum
Demands for a New Kind of Nurse
Fueled by changes in the nursing
practice environment:
Increasing complexity and acuity
Decreased length of stay
Shift of care to home & community
Exponential growth of knowledge
Explosion of technologies
Identification of the “Quality Chasm”
Demands for a New Kind of Nurse
Fueled by changes in demographics:
Aging population with increased
prevalence of chronic illness
Families increasingly engaged in care
giving with little or no nursing
support
Increased attention to healthpromotion
Central Competencies
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Critical thinking
Critical thinking =
Thinking Like a Nurse?
A Short History of
Nursing Process
Clinical Problem Solving
Clinical Decision Making
Diagnostic Reasoning
Critical Thinking
in other words . . .
Thinking Like a Nurse
Two decades of Research on CT
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Critical thinking and clinical thinking
(i.e., decision making, clinical
judgment) are different constructs.
No relationship between education &
critical thinking.
No relationship between critical
thinking and patient outcomes
Central Competencies
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Clinical Judgment:
• Case based
• Contextually bound
• Interpretive reasoning
Central Competencies
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Clinical Judgment requires deep
background knowledge for:
• Noticing
• Considering plausible interpretations
• Collecting reasonable evidence
• Choosing the best course of action
Central Competencies
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Clinical Judgment is always within
• the context of a particular patient
• A deep understanding the patient’s
experience, values and preferences
• Ethical standards of the discipline
Central Competencies

Understanding clinical judgment in
this way
• Renews interest in case-based
approaches to instruction
• Demand new approaches to clinical
education
• Provides guidance to use of simulation
in nursing education
Central Competencies:
Quality-Safety Initiative
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Patient-centered care
Team-work and collaboration
Evidence-based practice
Quality improvement
Informatics
Preparing More Nurses
Preparing More Nurses
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In the face of a profound faculty
shortage
Preparing More Nurses
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In the face of a profound faculty
shortage
Limitation in the number, type and
quality of sites for clinical education.
Current practices in clinical
education
A very short history of clinical
education
Challenges in Clinical Education
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Traditional clinical learning driven by
placement opportunities and challenges
Insufficient number of “placements” using
total patient care model
High acuity, greater risk with neophyte
students
Staff nurse burden for supervision of
students in rapidly changing situations
Learning is dependent on…
• Available patient population
• Facility’s schedule availability
• Availability of faculty with required expertise
Summary: Driving Forces for
Reform

Demands for Reform in Nursing
Education 1985-2005
• Study of Curricular processes
• Evidence of poorly prepared graduates
even for acute care
• Quality-safety
Summary: Driving Forces for
Reform
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Demands for Reform in Nursing
Education 1985-2005
Need for a “new” nurse
Changes in the practice environment
Emerging health care needs
Practice in environment of severe
shortage
Summary: Driving Forces for
Reform
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Demands for Reform in Nursing
Education 1985-2005
Need for a “new” nurse
Other pressures:
Content explosion
Advances in the science of learning
Outdated model of Clinical education
Part II: The Oregon Consortium for
Nursing Education
OCNE
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A collaboration among 8 community
colleges and 5 campuses of OHSU to:
• Deliver a standard competency based
curriculum with an AAS exit and
completion of Baccalaureate in nursing on
“home” campus
• Increase the number of nurses prepared
with baccalaureate degree
• Transform nursing education to more
closely align with emerging health care
needs
A very short history of OCNE
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2000: Study of nursing shortage in Oregon
2001: Strategic plan developed by Oregon Nursing leaders
2002: Education plan unveiled and political turmoil ensued
2003: Launched OCNE with Project Director
2004: Began curriculum development & Phase I of Faculty
Development
2005: Curriculum change approved by OSBN, NLNAC &
CCNE
2006: Phase I Clinical Education Project launched
2006: First class of 255 students admitted on 6 campuses
to nursing courses
2007: Phase II Faculty Development
2008: Preceptor Development
2009: First Baccalaureate class graduates
OCNE as a response to these
challenges
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Committed to collaboration across
programs enabling the best use of scarce
resources
Standard, competency based curriculum
focused on preparing the “new” nurse.
Teaching approaches that rest on the
science of learning
Faculty development as an integral part of
curriculum development
Reform of clinical education
Guiding Principles in Curriculum
Design
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Responsive to demands for reform
• NCSBN – 2001 – lack of preparation of
grads
• JCAHO (2002) – continental divide
between education and practice
• IOM reports
Guiding Principles in Curriculum
Design
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Responsive to demands for reform
Emerging health care needs
• Aging population
• Increasing acuity
• Increasing prevalence of chronic
illnesses
• Demands placed on caregiving families
with inadequate nursing care support
Guiding Principles in Curriculum
Design
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Responsive to demands for reform
Emerging health care needs
Graduates would be practicing in an
environment of chronic, severe RN
shortages
More efficient & effective with dwindling
supply of nursing faculty
Competencies of the “new” nurse would
require at least 4 years, but there would
need to be AD exit
Overview of the Curriculum
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First year: Prerequisites
Second year & first two quarters of the
third year:
• Required non-nursing courses
• Standard nursing courses on all campuses
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Third quarter of the third year:
• Complete Precepted Scope of Practice
Practicum, graduate with AAS and be eligible
to sit for NCLEX OR
• Continue directly into 400 level nursing
courses for 4 remaining quarters, complete 15
credits of upper division arts & science, and
graduate with BS
Transformation of the Nursing
Curriculum:Some Features
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Courses organized around foci of
care:
• Health Promotion
• Chronic Illness Management
• Acute Care
• End-of-Life Care
Transformation of the Nursing
Curriculum: Some Features
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Last 4 clinical nursing courses toward
Bachelors degree, students may
select a population for focus in:
• Public health and population-based
care
• Leadership and outcomes
management
• Clinical immersion or integrative
practicum for twenty weeks
Transformation of the Nursing
Curriculum: Some Features
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Redefines nursing fundamentals to:
• Clinical Judgment
• Evidence-based Practice
• Patient-centered care
• Leadership
Transformation of the Nursing
Curriculum: ApplyingThe New Pedagogy
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Draws on tremendous advances in
the science of learning from a variety
of disciplines (cognitive science,
psychology, higher education)
The New Pedagogy
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Emphasizes deep understanding of
the discipline’s most central concepts
--• Purposeful REDUCTION in content
• Selection of content based on:
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Prevalence of condition
Useful to teach integration across
competencies
• (e.g. ethical comportment, clinical judgment,
evidence-based practice, health systems issues &
leadership,
The New Pedagogy
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Emphasizes deep understanding of
the discipline’s most central concepts
Active learning through case-based
instruction, integration among
theory, clinical and simulation.
The New Pedagogy
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Emphasizes deep understanding of
the discipline’s most central concepts
Active learning through case-based
instruction, integration among
theory, clinical and simulation.
Authentic performance assessment &
promotion of self-directed learning
Process for Consensus Building
during Curriculum Development
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Institutional representatives
Leadership model
Faculty development combined with
curriculum development
Frequent Review & Counsel by
groups with expertise & vested
interests:
• Faculty on each of the 12 campuses
• Specialty task forces
Challenges in Clinical Education





Traditional clinical learning driven by
placement opportunities and challenges
Insufficient number of “placements” using
total patient care model
High acuity, greater risk with neophyte
students
Staff nurse burden for supervision of
students in rapidly changing situations
Learning is dependent on…
• Available patient population
• Facility’s schedule availability
• Availability of faculty with required expertise
Desired Features of New Clinical
Education Model
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Relationship-centered care keeping
the patient and family at the center
Science of learning and findings of
the Carnegie study
• (i.e. integration across apprenticeships,
retain prep, coaching and debriefing and
other best practices)
Desired Features of New Clinical
Education Model
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Relies on Clinical learning activities that:
• Are designed to support attainment of
Competencies
• Include, but not dominated by “Total Patient
Care”
• Developmentally appropriate for level of
student
• Vary faculty–student ratios & nursing staff
roles by level of student, acuity of patient,
nature of learning activity
• Culminate in one or more Immersion
experiences.
Types of Clinical Learning
Experiences
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Focused direct care experiences
• Patient-centered care
• Therapeutic relationship
• Individualized care
Types of Clinical Learning
Experiences
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Focused direct care experiences
Concept-based experiences: focus
on learning concepts (e.g.
oxygenation) through seeing many
patients who exemplify the concept
Types of Clinical Learning
Experiences
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Focused direct care experiences
Concept-based experiences
Case-based experiences: focused on
learning clinical judgment through
working through clinical problems
presented in text-based through fully
simulated scenarios.
Types of Clinical Learning
Experiences
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Focused direct care experiences
Concept-based experiences
Case-based experiences
Skill-based experiences: focused on
learning basic skills through
repetitive practice, includes
psychomotor skills, such as
interviewing.
Types of Clinical Learning
Experiences
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Focused direct care experiences
Concept-based experiences
Case-based experiences
Skill-based experiences
Integrative experiences: opportunity
to integrate prior learning and linking
learning activities to RN role in
clinical agency.
Types of Clinical Learning
Experiences: Differentiated by:
Type of learning and appropriate
pedagogy
Degree of accountability for patient
care
Transformation of Clinical
Education
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Phase I & II: consensus building on need
for change
Phase III: 8 pilot projects, evaluating
innovative clinical learning activities that
when combined may lead to a new
model
Phase IV: development of and
consensus building on new model
Phase V: statewide demonstration of
new model through 3 years of OCNE
nursing curriculum
6 Major Components of
Consortium Development
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Developmental Processes &
Infrastructure
Faculty Development
Simulation Capacity
Curriculum Development
Clinical Education Capacity
Comprehensive evaluation
A relationship-centered change
process
Driven by our passions with . . .
 Commitment to health of Oregonians
 Strong Leadership & persistence
 One leap of faith after another
An African Proverb:
To go quickly, go alone.
To go far, go together.
For more information
Visit us at www.ocne.org