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TheEssentialsofBaccalaureateEducation

forProfessionalNursingPractice
October20,2008

TABLEOFCONTENTS
ExecutiveSummary

Background
NursingEducation
TheDisciplineofNursing
Assumptions
RolesfortheBaccalaureateGeneralistNurse
PreparationfortheBaccalaureateGeneralistNurse:
ComponentsoftheEssentials

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TheEssentialsofBaccalaureateEducationforProfessionalNursingPractice
I. LiberalEducationforBaccalaureateGeneralistNursingPractice
II.

BasicOrganizationalandSystemsLeadershipfor
QualityCareandPatientSafety

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10

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III. ScholarshipforEvidenceBasedPractice

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IV. InformationManagementandApplicationofPatient
CareTechnology

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V.

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HealthcarePolicy,Finance,andRegulatoryEnvironments

VI. InterprofessionalCommunicationandCollaborationfor
ImprovingPatientHealthOutcomes

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VII. ClinicalPreventionandPopulationHealth

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VIII. ProfessionalismandProfessionalValues

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IX. BaccalaureateGeneralistNursingPractice

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ExpectationsforClinicalExperienceswithintheBaccalaureateProgram

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Summary

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Glossary

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References

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AppendixA:TaskForceontheRevisionoftheEssentialsofBaccalaureate
EducationforProfessionalNursingPractice

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AppendixB:ConsensusProcessto RevisetheEssentialsofBaccalaureate
EducationforProfessionalNursingPractice

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AppendixC:Participantswho AttendedStakeholderMeetings

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AppendixD:SchoolsofNursingthatParticipatedintheRegionalMeetings

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AppendixE:ProfessionalOrganizationsthatParticipatedintheRegionalMeetings

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AppendixF: HealthcareSystemsthatParticipatedintheRegionalMeetings

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ExecutiveSummary
TheEssentialsofBaccalaureateEducation
forProfessionalNursingPractice(2008)
ThisEssentialsdocumentservestotransformbaccalaureatenursingeducationbyproviding
thecurricularelementsandframeworkforbuildingthebaccalaureatenursingcurriculumfor
the21st century.TheseEssentialsaddressthekeystakeholdersrecommendationsand
landmarkdocumentssuchastheIOMsrecommendationsforthecoreknowledgerequiredof
allhealthcareprofessionals.Thisdocumentemphasizessuchconceptsaspatientcentered
care,interprofessionalteams,evidencebasedpractice,qualityimprovement,patientsafety,
informatics,clinicalreasoning/criticalthinking,geneticsandgenomics,culturalsensitivity,
professionalism,andpracticeacrossthelifespaninaneverchangingandcomplexhealthcare
environment
EssentialsIIXdelineatetheoutcomesexpectedofgraduatesofbaccalaureatenursing
programs.Achievementoftheseoutcomeswillenablegraduatestopracticewithincomplex
healthcaresystemsandassumetheroles:providerofcaredesigner/manager/coordinatorof
careandmemberofaprofession.EssentialIXdescribesgeneralistnursingpracticeatthe
completionofbaccalaureatenursingeducation.ThisEssentialincludespracticefocused
outcomesthatintegratetheknowledge,skills,andattitudesdelineatedinEssentialsI VIII.
ThetimeneededtoaccomplisheachEssentialwillvary,andeachEssentialdoesnotrequirea
separatecourseforachievementoftheoutcomes.
ThenineEssentialsare:
EssentialI: LiberalEducationforBaccalaureateGeneralistNursingPractice
o Asolidbaseinliberaleducationprovidesthecornerstoneforthepracticeand
educationofnurses.
EssentialII:BasicOrganizationalandSystemsLeadershipforQualityCareand
PatientSafety
o Knowledgeandskillsinleadership,qualityimprovement,andpatientsafetyare
necessarytoprovidehighqualityhealthcare.
EssentialIII:ScholarshipforEvidenceBasedPractice
o Professionalnursingpracticeisgroundedinthetranslationofcurrentevidence
intoonespractice.
EssentialIV:InformationManagementandApplicationofPatientCareTechnology
o Knowledgeandskillsininformationmanagementandpatientcaretechnologyare
criticalinthedeliveryofqualitypatientcare.
EssentialV:HealthCarePolicy,Finance,andRegulatoryEnvironments
o Healthcarepolicies,includingfinancialandregulatory,directlyandindirectly
influencethenatureandfunctioningofthehealthcaresystemandtherebyare
importantconsiderationsinprofessionalnursingpractice.
EssentialVI:InterprofessionalCommunicationandCollaborationforImproving
PatientHealthOutcomes
o Communicationandcollaborationamonghealthcareprofessionalsarecriticalto
deliveringhighqualityandsafepatientcare.

EssentialVII:ClinicalPreventionandPopulationHealth
o Healthpromotionanddiseasepreventionattheindividualandpopulationlevel
arenecessarytoimprovepopulationhealthandareimportantcomponentsof
baccalaureategeneralistnursingpractice.
EssentialVIII:ProfessionalismandProfessionalValues
o Professionalismandtheinherentvaluesofaltruism,autonomy,humandignity,
integrity,andsocialjusticearefundamentaltothedisciplineofnursing.
EssentialIX:BaccalaureateGeneralistNursingPractice
o Thebaccalaureategraduatenurseispreparedtopracticewithpatients,
includingindividuals,families,groups,communities,andpopulationsacross
thelifespanandacrossthecontinuumofhealthcareenvironments.
o Thebaccalaureategraduateunderstandsandrespectsthevariationsofcare,
theincreasedcomplexity,andtheincreaseduseofhealthcareresources
inherentincaringforpatients.

Learningopportunities,includingdirectclinicalexperiences,mustbesufficientin
breadthanddepthtoensurethebaccalaureategraduateattainsthesepracticefocused
outcomesandintegratesthedelineatedknowledgeandskillsintothegraduates
professionalnursingpractice. Clinicallearningisfocusedondevelopingandrefiningthe
knowledgeandskillsnecessarytomanagecareaspartofaninterprofessionalteam.
Simulationexperiencesaugmentclinicallearningandarecomplementarytodirectcare
opportunitiesessentialtoassumingtheroleoftheprofessionalnurse. A clinical
immersionexperienceprovidesopportunitiesforbuildingclinicalreasoning,
management,andevaluationskills.

Introduction

TheEssentialsofBaccalaureateEducationforProfessionalNursingPracticeprovides
theeducational frameworkforthepreparation ofprofessionalnurses.Thisdocument
describestheoutcomesexpectedofgraduatesofbaccalaureatenursingprograms.
TheEssentialsapplytoall prelicensureandRNcompletionprograms,whetherthe
degreeisbaccalaureateor graduateentry.Programcurriculaaredesignedtoprepare
studentstomeettheendofprogramoutcomesdelineatedundereach Essential.
Background
Thehealthcaredeliverysystemhaschangeddramatically sinceTheEssentialsof
BaccalaureateEducationforProfessionalNursingPracticewasendorsedbythe
AmericanAssociationofCollegesofNursing(AACN,1998).Buildingasafer
healthcaresystemhasbecomethefocusofallhealthprofessionsfollowingnumerous
reportsfromtheInstituteofMedicine(IOM,2000,2001,2004),AmericanHospital
Association(2002),RobertWoodJohnsonFoundation(Kimball&ONeill,2002),the
JointCommission(2002)andotherauthorities.Nursinghasbeenidentifiedashavingthe
potentialformakingthebiggestimpacton a transformationofhealthcaredeliverytoa
safer,higherquality,andmorecosteffectivesystem.Withtheincreasingawarenessof
theneedforchangeinthehealthcaresystem,theclinicalmicrosystems(small,functional
unitswherecareisprovidedwithinthelargersystem)havebecomeanimportantfocus
forimprovinghealthcareoutcomes(Nelson,Batalden,&Godfrey,2007).
Inadditiontotheconcernoverhealthcareoutcomes,theUnitedStatesandtheglobal
marketareexperiencinganursingshortagethatisexpectedtointensifyasthedemandfor
moreanddifferentnursingservicesgrows.Buerhaus,Staiger,andAuerbach (2008)
reportedthattheU.S. may experienceashortage ofmorethan500,000registerednurses
bytheyear2025.Despiteannualincreasesinenrollmentsinentrylevelbaccalaureate
nursingprogramssince2001(Fang,Htut,&Bednash,2008), theseincreasesarenot
sufficienttomeettheprojecteddemandfornurses.AccordingtoBuerhausetal.(2008),
enrollmentinnursingprogramswouldhavetoincreaseatleast40% annuallytoreplace
thenursesexpectedtoleavetheworkforcethroughretirementalone.Addressingtheneed
foranincreasednumberofbaccalaureatepreparednursesiscriticalbutnotsufficient.
Nursingmusteducatefutureprofessionalstodeliverpatientcenteredcareasmembersof
aninterprofessional team,emphasizingevidencebasedpractice,qualityimprovement
approaches,andinformatics(IOM,2003b).Nursingeducationandpracticemustwork
togethertobetteraligneducationwithpracticeenvironments(JointCommission,2002,
Kimball & ONeill,2002).
Theenvironmentsinwhichprofessionalnursespracticehavebecomemorediverseand
moreglobalinnature.Scientificadvances,particularlyintheareasofgeneticsand

genomics,havehadandwillcontinuetohaveagrowingandsignificantimpacton
prevention,diagnosis,andtreatmentofdiseases,illnesses,andconditions.Theincreased
prevalenceofchronicillnessisaresultofanincreasinglyolderadultpopulation,
environmentalthreats, lifestylesthatincreaseriskofdisease,andenhancedtechnological
andtherapeuticinterventionsthatprolonglife.Increasesinlongevityoflifehavemade
theolderadultthefastestgrowingsegmentofthepopulation.In2003,12%ofthe
populationwasolderthan 65yearsofage.By2030, thispopulationwillincreaseto20%,
withalargemajority olderthan 80yearsofage(He,Sengupta,Velkoff,&DeBarros,
2005).Those olderthan 65yearsof agehadalmostfourtimesthenumberof
hospitalizationdaysthanthoseyoungerthan65yearsof age(CentersforDisease
Control,2007)
Educationforthebaccalaureategeneralistmustincludecontentandexperiencesacross
thelifespan,includingtheveryyoungwhoareespeciallyvulnerable.Thepercentageof
thepopulationunder18yearsofageis24.6%(U.S.CensusBureau,2008).U.S. infant
mortalityin2006ranked38th intheworld(WorldHealth Organization,2008).
Preventioniscriticalinaddressingbothacuteandchronicconditionsacrossthelifespan.
Theroleofthenurseinpreventioncontinuestobeofutmostimportance.
Increasingglobalizationofhealthcareandthediversityofthisnationspopulation
mandatesanattentiontodiversityinordertoprovidesafe,highqualitycare.The
professionalnursepracticesinamulticulturalenvironmentandmustpossesstheskillsto
provideculturally appropriatecare.AccordingtotheU.S.CensusBureau(2008),the
nation'sminoritypopulationtotaled102millionor34%oftheU.S.populationin2006.
Withprojectionspointingtoevengreaterlevelsofdiversityinthecomingyears,
professionalnursesneedtodemonstrateasensitivitytoandunderstandingofavariety of
culturestoprovidehighqualitycareacrosssettings.Liberaleducation,includingthe
studyof asecondlanguage,facilitatesthedevelopmentofanappreciationfordiversity.
Strongforcesinfluencingtheroleofnursesinclude:
scientificadvances,particularlyintheareaofgeneticsandgenomics,
changingdemographicsofpatientpopulations,
newcaretechnologies,and
patientaccesstohealthcareinformation.
Theseforcescallfornewwaysofthinkingandprovidinghealth care.Nursingis
uniquely positionedtorespondtothesemajorforces,requiringanincreasedemphasison
designingandimplementingpatientcenteredcare, developingpartnershipswiththe
patient,andafocuson customerservice.

NursingEducation
Inresponsetocallsfortransformingthehealthcaresystemandhowhealthcare
professionalsareeducated,AACNhasmaintainedanongoingdialoguewithabroad
representationofstakeholdersinternalandexternaltonursing.Thedialoguehasfocused
ontheknowledge,skills,andattitudesneededbynursestopracticeeffectivelywithinthis

complexandchangingenvironment.Newinnovativemodelsofnursingeducationhave
emerged,andAACNhastakenaleadershiproleincraftingapreferredvisionfornursing
education.
In2004,theAACNBoardofDirectorsreaffirmeditspositionthatbaccalaureate
educationistheminimumlevelrequiredforentryintoprofessionalnursingpracticein
todayscomplexhealthcareenvironment.Baccalaureategeneralisteducation,asdefined
inthisdocument,isthefoundationuponwhichall graduatenursingeducationbuilds.
Thepreferredvisionfornursingeducationincludesgeneralist,advancedgeneralist,and
advancedspecialtynursingeducation.Generalistnurseeducationoccursataminimumin
baccalaureatedegreenursingprograms.Advancedgeneralisteducationoccursin
mastersdegreenursingprograms,includingtheClinicalNurseLeader(CNL),whichis
anadvancedgeneralistnursingrole.Advancedspecialtyeducationoccursatthedoctoral
levelin Doctorof NursingPractice(DNP)orresearchfocuseddegreeprograms(PhD,
DNS,orDNSc).Endofprogram outcomesforthebaccalaureate,masters,anddoctoral
nursingprogramsbuildoneachother.
TheDisciplineofNursing
Rolesforthebaccalaureategeneralistnursearederivedfromthedisciplineofnursing.
Therolesofthebaccalaureategeneralistinclude:
providerofcare,
designer/manager/coordinatorofcare,and
memberofaprofession.
Nursinggeneralistpracticeincludesbothdirectandindirectcareforpatients,which
includesindividuals,families,groups, communities,andpopulations.Nursingpracticeis
builtonnursingknowledge,theory,andresearch.Inaddition,nursingpracticederives
knowledgefromawidearrayofotherfieldsandprofessions,adaptingandapplyingthis
knowledgeasappropriatetoprofessional practice.
Intheseniorcollegeanduniversitysetting,everyacademicdisciplineisgroundedin
discreteinquirybasedapplicationsthataredistinctivetothatdiscipline.Scientific
advances,(particularlyintheareaofgeneticsandgenomics),changingdemographicsof
patientpopulations,newcaretechnologies,andpatientaccesstohealthcareinformation
callfornewwaysofthinkinganddoingintheprovisionofhealthcare.Theacademic
settingprovidesaforumforcontemplatingphysical,psychological,social,cultural,
behavioral,ethical,andspiritual problemswithinandacrossdisciplines.Facultyhavea
responsibilitytofacilitatethetranslationofknowledgefromaliberaleducationbaseinto
thepracticeofnursing.Nursingfacultyintroducenursingscienceandtheories,andguide
thestudentindevelopinganunderstandingofthedisciplineofnursingsdistinctive
perspective.
Baccalaureatepreparednursesprovidepatientcenteredcare thatidentifies,respects,and
addressespatients differences,values,preferences,andexpressedneeds(IOM,2003a).
Patientcenteredcarealsoinvolvesthecoordinationofcontinuouscare,listeningto,

communicatingwith,andeducatingpatientsandcaregiversregardinghealth,wellness,
anddiseasemanagementandprevention.Thegeneralistnurseprovidesthehumanlink
betweenthehealthcaresystemandthepatientbytranslatingtheplanofcaretothe
patient.Abroadbasedskillsetisrequiredtofillthishumaninterfacerole.Patient
centeredcarealsorequiresthedevelopmentofanursepatientpartnership.Patients,as
consumersofhealthcareservices,andasintegralmembersofthehealthcareteam,have
anincreasingroleandresponsibilityforthemutualplanningofcareandhealthcare
decisionmaking.
Thefundamentalaspectsofgeneralistnursingpracticeare:directcareofthesickinand
acrossallenvironments,healthpromotionandclinicalprevention,andpopulationbased
healthcare.Adefiningfeatureofprofessionalnursingpracticeisthefocusonhealth
promotionandriskreduction.Advancesinscienceandtechnologywillcontinueto
emerge,which willhelptopredictfuturehealthproblems.Nurseswilldesignand
implementmeasurestomodifyriskfactorsandpromotehealthylifestyles.Thesesame
advancesinscienceandtechnologyalsohaveallowedindividualstolivelongerandoften
withincreasingnumbersofchronicillnessesandconditions.Withanincreasingemphasis
oncostsavingsandcostbenefits,nurseswill play aleadingroleintheprovisionofcare.

Assumptions
Thebaccalaureategeneralistgraduateispreparedto:
practicefromaholistic,caringframework
practicefromanevidencebase
promotesafe,quality patientcare
useclinical/criticalreasoningtoaddresssimpletocomplexsituations
assumeaccountabilityforonesownanddelegatednursingcare
practiceinavarietyofhealthcaresettings
careforpatientsacrossthehealthillnesscontinuum
careforpatientsacrossthelifespan
carefordiversepopulations
engageincareofselfinordertocareforothersand
engageincontinuousprofessionaldevelopment.

RolesfortheBaccalaureateGeneralistNurse
BaccalaureateGeneralistnursesareprovidersofdirectandindirectcare.Inthisrole,
nursesarepatientadvocatesandeducators.Historically,thenursingrolehasemphasized
partnershipswithpatientswhetherindividuals,families,groups,communities,or
populationsinordertofosterandsupportthepatientsactiveparticipationin
determininghealthcaredecisions.Patientadvocacyisahallmarkoftheprofessional
nursingroleandrequiresthatnursesdeliverhighqualitycare,evaluatecareoutcomes,
andprovideleadershipinimprovingcare.

Changingdemographicsandongoingadvancesinscienceandtechnologyarearealityof
healthcarepractice.Thegeneralistnurseprovidesevidencebasedcaretopatientswithin
thischangingenvironment.Thisclinicianusesresearchfindingsandotherevidencein
designingandimplementingcarethatismultidimensional,highquality,andcost
effective.Thegeneralistnursealsoispreparedfortheethicaldilemmasthatarisein
practiceandwillbeabletomakeandassistothersinmakingdecisionswithina
professionalethicalframework.Understandingadvancesinscienceandtechnologyand
theinfluencetheseadvanceshaveonhealthcareandindividualwellbeingisessential.
Understandingpatientsandthevaluestheybringtothehealthcarerelationshipisequally
important.
Thegeneralistnursepracticesfromaholistic,caringframework.Holisticnursingcareis
comprehensiveandfocuseson themind,body,andspirit,aswellasemotions.The
generalistnurserecognizestheimportantdistinctionbetweendiseaseandtheindividuals
illnessexperience.Assistingpatients tounderstandthisdistinctionisanimportantaspect
ofnursing.Inaddition,nursesrecognizethatdeterminingthehealthstatusofthepatient
withinthecontextofthepatientsvaluesisessentialinprovidingaframeworkfor
planning,implementing,andevaluatingoutcomesofcare.
Thegeneralistnurseprovidescareinandacrossallenvironments.Nursesfocuson
individual,family,community,andpopulationhealthcare,asthey monitorandmanage
aspectsof theenvironmenttofosterhealth.
Baccalaureategeneralistnursesaredesigners,coordinators,andmanagersofcare.The
generalistnurse,preparedatthebaccalaureatedegreelevel,willhavetheknowledgeand
authoritytodelegatetaskstootherhealthcarepersonnel,aswellastosuperviseand
evaluatethesepersonnel.Ashealthcareproviderswhofunctionautonomouslyand
interdependentlywithinthehealthcareteam,nursesareaccountablefortheirprofessional
practiceandimage,aswellasfor outcomesoftheirownanddelegatednursingcare.
Nursesaremembersofhealthcareteams,composedofprofessionalsandotherpersonnel
thatdelivertreatmentandservicesincomplex,evolvinghealthcaresystems.Nursesbring
auniqueblendofknowledge,judgment,skills,andcaringtothehealthcareteam.
Baccalaureategeneralistnursesaremembersoftheprofessionandinthisroleare
advocatesforthepatientandthe profession.Theuseofthetermprofessionalimplies
theformation ofaprofessionalidentityandaccountabilityforonesprofessionalimage.
Asprofessionals,nursesareknowledgeworkerswhouseawelldelineatedandbroad
knowledgebaseforpractice.Professionalnursingrequiresstrongcriticalreasoning,
clinicaljudgment,communication,andassessmentskills.Theprofessionalnursealso
requiresthedevelopmentanddemonstrationofanappropriatesetofvaluesandethical
frameworkforpractice.Asadvocatesforhighqualitycareforall patients,nursesare
knowledgeableandactiveinthepolicyprocessesdefininghealthcaredeliveryand
systemsofcare.Thegeneralistnursealsoiscommittedtolifelonglearning,including
careerplanning,whichincreasinglywillincludegraduatelevelstudy.

PreparationfortheBaccalaureateGeneralistNurseRoles:Componentsof The
Essentials
Thissection outlinesthenineEssentialsofBaccalaureateEducationforProfessional
NursingPractice.TheseEssentialsarethecurricularelementsthatprovidethe
frameworkforbaccalaureatenursingeducation.Each Essentialisoperationalizedthrough
theprogramscurriculum andisnotintendedtorepresentacourse.EssentialIXdescribes
baccalaureatenursingpracticeandintegratestheknowledge,skills,andattitudesfrom
EssentialsIVIII. Each Essentialincludesarationaleexplainingitsrelevanceforthe
educationoftheprofessionalnursetodayandin thefuture.Therationaleforeach
Essentialisfollowedby outcomesthatdelineatetheknowledge,skills,andattitudes
expectedofnewbaccalaureategeneralistgraduates.Theseoutcomesserveasaguideto
helpfacultyidentifyprogramandcourseobjectivesthatarespecificandmeasurable.
Next,samplecontentislistedtoaidfacultyinselectingmaterial suitedtoachievingthe
specificEssential.Thelistofcontentisnotinclusive,norisitintendedasrequired.A
vastselectionofcontentisavailableforeachEssential,andthespecificbaccalaureate
programscurriculumwillspecifythecontentasappropriatetotheirmission,community
served,andstudentpopulation.TheEssential outcomescanbeobtainedthrougha
varietyofcontentapproaches,andpotentialcontentcanandwillevolveovertimeasnew
knowledgedevelops.Thesamplecontentisofferedasaguidetoprogramsortofurther
elucidatethenatureoftheEssentialwithwhichthecontentislisted.

TheEssentialsofBaccalaureateEducationfor ProfessionalNursingPractice
EssentialI:LiberalEducationfor BaccalaureateGeneralistNursingPractice
Rationale
AsdefinedbytheAssociationofAmericanCollegesandUniversities(AAC&U),a
liberaleducationisonethatintentionallyfosters,acrossmultiplefieldsofstudy,wide
rangingknowledgeofscience,cultures,andsocietyhighlevelintellectualandpractical
skillsanactivecommitmenttopersonalandsocialresponsibilityandthedemonstrated
abilitytoapplylearningtocomplexproblemsandchallenges(AAC&U,2007,p.4). For
thepurposesofthisdocument,a liberaleducationincludesboththesciencesandthearts.
Thesciencesinclude:
physicalsciences(e.g.,physicsandchemistry),
lifesciences(e.g.,biologyandgenetics),
mathematicalsciences,and
socialsciences(e.g.,psychologyandsociology).
Theartsinclude:
finearts(e.g.,paintingandsculpture),
performingarts(e.g.,danceandmusic),and
humanities(e.g.,literatureand theology).

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Liberaleducationiscriticaltothegenerationofresponsiblecitizensinaglobalsociety.
Inaddition,liberaleducationisneededforthedevelopmentofintellectual andinnovative
capacitiesforcurrentandemergentgeneralistnursingpractice.Liberallyeducatednurses
workwithinahealthcareteamtoaddressissuesimportanttotheprofessionofnursing,
questiondominantassumptions,andsolvecomplexproblemsrelatedtoindividualsand
populationbasedhealthcare.Nursinggraduateswithaliberaleducationexercise
appropriateclinicaljudgment,understandthereasoningbehindpoliciesandstandards,
andacceptresponsibilityforcontinueddevelopmentofselfandthedisciplineofnursing.
Asolidbaseinliberaleducationprovidesthedistinguishingcornerstoneforthestudyand
practiceofprofessionalnursing.Studyingthehumanities,socialsciences,andnatural
sciencesexpandsthelearnerscapacitytoengageinsociallyvaluedworkandcivic
leadershipinsociety.Astrongfoundationinliberalartsincludesageneraleducation
curriculumthatprovidesbroadexposuretomultipledisciplinesandwaysofknowing.
Otherthanthenursingmajor,someaspectsof liberalartsstudywillbeprovidedas
discretepartsofthefulleducationalcurriculumhowevertherichanddiverse
perspectivesandknowledgeembeddedintheliberalartsandscienceswill beintegrated
throughoutthenursingcurriculum,astheseperspectivesareintegraltothefullspectrum
ofprofessionalnursingpractice(Hermann,2004).
Successfulintegrationofliberaleducationandnursingeducationprovidesgraduateswith
knowledgeofhumancultures,includingspiritualbeliefs,andthephysicalandnatural
worldssupportinganinclusiveapproach topractice.Thestudyofhistory,finearts,
literature, andlanguagesareimportantbuildingblocksfordevelopingcultural
competenceandclinicalreasoning.Furthermore,theintegrationofconceptsfrom
behavioral,biological,andnaturalsciencesthroughoutthenursingcurriculumpromotes
theunderstandingofselfandothersandcontributestosafe,qualitycare.Theintegration
ofconceptsfrom theartsandsciencesprovidesthefoundationforunderstandinghealth
aswellasdiseaseprocesses,andformsthebasisforclinicalreasoning.Asnotedbythe
CarnegieFoundationfortheAdvancementofTeaching,thesciencesareacriticalaspect
ofliberaleducationfornurses. Sciencesthathaveclinical relevanceareespecially
importanttotheprofessionofnursingtoensurethatgraduateshavetheabilitytokeep
pacewithchangesdrivenbyresearchandnewtechnologies(CarnegieFoundation,in
press).
Aliberaleducationfornursesformsthebasisforintellectualandpracticalabilitiesfor
nursingpracticeaswellasforengagementwiththelargercommunity,bothlocallyand
globally.Skillsofinquiry,analysis,criticalthinking,andcommunicationinavarietyof
modes,includingthewrittenandspokenword,preparebaccalaureategraduatesto
involveothersinthecommongoodthroughuseofinformationtechnologies,teamwork,
andinterprofessionalproblemsolving.Liberaleducation,includingthestudyof asecond
language,facilitatesthedevelopmentofanappreciationforculturalandethnicdiversity.
Strongemphasisonthedevelopmentofapersonalvaluessystemthatincludesthe
capacitytomakeandactuponethicaljudgmentsisahallmarkofliberaleducation.
Studentseducatedinaliberaleducationenvironmentareencouragedtopursue

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meaningfulpersonalandprofessionalgoalsaswellastocommittohonestyin
relationshipsandthesearchfortruth.Thedevelopmentofleadershipskillsand
acceptanceofresponsibilitytopromotesocialjusticeareexpectedoutcomesofaliberal
education.
Liberaleducation allowsthegraduate toformthevaluesandstandardsneededtoaddress
twentyfirstcenturychangesintechnology,demographics,andeconomics.Thesetrends
includeanagingpopulation,diversefamilyandcommunitystructures,andincreasing
globalinterdependence,aswellaseconomicandpoliticalchangesintheUnitedStates
healthcaresystem.Liberaleducationprovidesthebaccalaureategraduatewiththeability
tointegrateknowledge,skills,andvaluesfromtheartsandsciencestoprovide
humanistic,safequalitycaretoactasadvocatesforindividuals,families,groups,
communities,and/orpopulationsandtopromotesocialjustice.Liberallyeducated
graduatespracticefromafoundationofprofessionalvaluesandstandards.
Thebaccalaureateprogrampreparesthegraduateto:
1. Integratetheoriesandconceptsfromliberaleducationintonursingpractice.
2. Synthesizetheoriesandconceptsfromliberaleducation tobuildan understandingof
thehumanexperience.
3. Useskillsofinquiry,analysis,andinformationliteracy toaddresspracticeissues.
4. Usewritten,verbal,nonverbal,andemergingtechnologymethodstocommunicate
effectively.
5. Applyknowledgeofsocialandculturalfactors tothecareofdiversepopulations.
6. Engageinethicalreasoningandactionstoprovideleadershipin promotingadvocacy,
collaboration,andsocialjusticeasasociallyresponsiblecitizen.
7. Integrate theknowledgeandmethodsofavarietyofdisciplinestoinform decision
making.
8. Demonstratetolerancefortheambiguityandunpredictabilityof theworldandits
effectonthehealthcaresystem.
9. Valuetheidealof lifelonglearningtosupportexcellenceinnursingpractice.

SampleContent
selectedconceptsandwaysofknowingfrom thesciences
selectedconceptsandwaysofknowingfromthearts
principlesrelated toworkingwith peoplesfrom diversecultures

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conceptsrelatedtointellectual diversity,tolerance,andsocialjustice
conceptsrelatedtoglobalizationandmigrationofpopulations

EssentialII:BasicOrganizationalandSystemsLeadershipforQualityCareand
PatientSafety
Rationale
Organizationalandsystemsleadership,qualityimprovement,andsafetyarecritical to
promotinghighqualitypatientcare. Leadershipskillsareneededthatemphasizeethical
andcriticaldecisionmaking,initiatingandmaintainingeffectiveworkingrelationships,
usingmutuallyrespectful communicationandcollaborationwithininterprofessional
teams,carecoordination,delegation,anddevelopingconflictresolutionstrategies.Basic
nursingleadershipincludesanawarenessofcomplexsystems,andtheimpactofpower,
politics,policy,andregulatoryguidelinesonthesesystems.Tobeeffective,
baccalaureategraduatesmustbeabletopracticeatthemicrosystemlevel withinanever
changinghealthcaresystem.Thispracticerequirescreativityandeffectiveleadershipand
communicationskillstoworkproductivelywithininterprofessionalteamsinvarious
healthcaresettings.
Asamemberofahealthcareteam,baccalaureategraduateswill understandanduse
qualityimprovementconcepts,processes,andoutcomemeasures.Inaddition,graduates
will beabletoassistorinitiatebasicqualityandsafetyinvestigationsassistinthe
developmentofqualityimprovementactionplansandassistinmonitoringtheresultsof
theseactionplanswithintheclinicalmicrosystem,whichisembeddedwithinalarger
system ofcare.
Animportantcomponentofqualityissafety.Safetyinhealthcareisdefinedasthe
minimizationofriskofharmtopatientsandprovidersthroughbothsystemeffectiveness
andindividualperformance(Cronenwettetal.,2007).Researchhasdemonstratedthat
nursesmore thananyotherhealthcareprofessionalareabletorecognize,interrupt,
evaluate,andcorrecthealthcareerrors(Rothschildetal.,2006)Thebaccalaureate
graduateimplementssafetyprinciplesandworkswithothersontheinterprofessional
healthcareteamtocreatea safe,caringenvironmentforcaredelivery.
Baccalaureategraduateswill beskilledinworkingwithinorganizationalandcommunity
arenasandintheactualprovisionofcarebythemselvesand/orsupervisingcareprovided
byotherlicensedandnonlicensedassistivepersonnel.They willbeabletorecognize
safety andquality concernsandapplyevidencebasedknowledgefromthenursing
professionandotherclinicalsciencestotheirpractice.Baccalaureatenursinggraduates
aredistinguishedbytheirabilitiestoidentify,assess,andevaluatepracticeincare
deliverymodelsthatarebasedincontemporarynursingscienceandarefeasiblewithin
currentcultural,economic,organizational,andpoliticalperspectives.

13

Thebaccalaureateprogrampreparesthegraduateto:
1.Applyleadershipconcepts,skills,anddecisionmakingintheprovision ofhighquality
nursingcare,healthcareteamcoordination,andtheoversightandaccountability forcare
delivery inavarietyofsettings.
2.Demonstrateleadershipandcommunicationskillstoeffectivelyimplementpatient
safetyandqualityimprovementinitiativeswithinthecontextoftheinterprofessional
team.
3.Demonstrateanawarenessofcomplex organizational systems.
4.Demonstrateabasicunderstandingoforganizationalstructure,mission,vision,philosophy,
andvalues.
5. Participatein qualityandpatientsafety initiatives,recognizingthatthesearecomplexsystem
issues,whichinvolveindividuals,families,groups, communities,populations,andother
membersofthehealthcareteam.
6.Applyconceptsofqualityandsafetyusingstructure,process,andoutcomemeasuresto
identifyclinicalquestionsanddescribetheprocessofchangingcurrentpractice.
7.Promotefactorsthatcreateacultureofsafety andcaring.
8. Promoteachievementofsafeandqualityoutcomesofcarefordiversepopulations.
9. Applyqualityimprovementprocessestoeffectivelyimplementpatientsafetyinitiativesand
monitorperformancemeasures,includingnursesensitiveindicatorsinthemicrosystemof
care.
10.Useimprovementmethods,basedondatafromtheoutcomesofcareprocesses,todesignand
testchangestocontinuouslyimprovethequalityandsafetyofhealthcare.
11.Employprinciplesofqualityimprovement,healthcarepolicy,andcosteffectivenesstoassist
inthedevelopmentandinitiationofeffectiveplansforthemicrosystemand/orsystemwide
practiceimprovementsthatwillimprovethequalityofhealthcaredelivery.
12.Participatein thedevelopmentandimplementationof imaginativeandcreative
strategiestoenablesystemstochange.

SampleContent
leadership,includingtheory,behaviors,characteristics,contemporary
approaches,leadershipdevelopment,andstylesofleadership

14

leadershipskillsandstrategies(negotiating,collaborating,coordinating)
decisionmakingtopromotequality patientcareinavarietyofhealthcaresettings
changetheoryandcomplexityscience
communityorganizingmodels
socialchangetheories
creativeandimaginativestrategiesinproblemsolving
communication,includingelements,channels,levels,barriers,models,
organizationalcommunication,skill development,workplacecommunication,
conflictresolution,optimizingpatientcareoutcomes,andchainofcommand
principlesofinterpersonalinteractions/communication
healthcaresystems(structureandfinance)andorganizationalstructuresand
relationships(e.g.,betweenfinance,organizationalstructure, anddeliveryof
care,particularlyatthemicrosystemlevel,includingmission/vision/philosophy
andvalues)
reliabilityandreliabilitysciencesinhealthcare
operationsresearch,queuingtheory,andsystemsdesignsinhealthcare
teamworkskills,includingeffectiveteams/characteristics,applicationtopatient
careteams,teamprocess,conflictresolution,delegation,supervision,and
collaboration
microsystemsandtheirrelationshiptocomplexsystems,qualitycare,andpatient
safety
patientsafety principles,includingsafetystandards,organizationalsafety
processes,reportingprocesses,departmentalresponsibilities,ownership,national
initiatives,andfinancialimplications
quality improvement(QI), includinghistory,elements,ContinuousQuality
Improvement(CQI)models,concepts,principles,benchmarking,processes,
tools,departmentalownership,roles/responsibility,methodologies,regulatory
requirements,organizationalstructuresforQI,outcomes,monitoring,Quality
Assurance(QA)vs.QI,beginningresourceneedassessment,andresource
identification,acquisition,andevaluation
overviewof QIprocesstechniques,includingbenchmarks,basicstatistics,root
causeanalyses,andFailureModeEffectsAnalysis(FMEA)inthequality
improvementprocess
principlesofnursingcaredeliverymanagementandevaluation

EssentialIII:ScholarshipforEvidenceBasedPractice
Rationale
Professionalnursingpracticeisgroundedinthetranslation ofcurrentevidenceinto
practice.Scholarshipforthebaccalaureategraduateinvolvesidentificationofpractice
issues appraisal andintegration ofevidenceandevaluationofoutcomes.As
practitionersatthepointofcare,baccalaureatenursesareuniquelypositionedtomonitor
patientoutcomesandidentifypracticeissues.Evidencebasedpracticemodelsprovidea

15

systematicprocessfortheevaluationandapplicationofscientificevidencesurrounding
practiceissues(IOM,2003b).Disseminationisacriticalelementofscholarlypractice
baccalaureategraduatesarepreparedtoshareevidenceofbestpracticeswiththe
interprofessionalteam.
Baccalaureateeducationprovidesabasicunderstandingofhowevidenceisdeveloped,
includingtheresearchprocess,clinicaljudgment,interprofessionalperspectives,and
patientpreferenceasappliedtopractice.Thisbasicunderstandingservesasafoundation
formorecomplexapplicationsatthegraduatelevel(AACN,2006a).Baccalaureate
nursesintegratereliableevidencefrommultiplewaysofknowingtoinformpracticeand
makeclinicaljudgments.Incollaborationwithotherhealthcareteammembers,graduates
participateindocumentingandinterpretingevidenceforimprovingpatientoutcomes
(AACN,2006b).
Inallhealthcaresettings,ethicalandlegalpreceptsguideresearchconducttoprotectthe
rightsofpatientseligiblefor, orparticipatingin,investigations.Professionalnurses
safeguardpatientrights,includingthoseofthemostvulnerablepatients,insituations
whereanactualorpotentialconflictofinterest,misconduct,orthepotentialforharmare
identified.
Thebaccalaureateprogrampreparesthegraduateto:
1.Explaintheinterrelationshipsamongtheory,practice,andresearch.
2.Demonstrateanunderstandingofthebasicelementsoftheresearchprocessand
modelsforapplyingevidencetoclinical practice.
3.Advocatefortheprotectionofhumansubjectsintheconductofresearch.
4.Evaluate thecredibilityof sourcesof information,includingbutnotlimitedto
databasesandInternetresources.
5.Participatein theprocessofretrieval,appraisal,andsynthesisofevidencein
collaborationwithothermembersofthehealthcareteam toimprovepatientoutcomes.
6.Integrateevidence,clinicaljudgment,interprofessionalperspectives,andpatient
preferencesinplanning,implementing,andevaluatingoutcomesof care.
7.Collaborateinthecollection,documentation,anddisseminationof evidence.
8.Acquireanunderstandingoftheprocessforhownursingandrelatedhealthcarequality
andsafetymeasuresaredeveloped,validated,andendorsed.
9.Describemechanismstoresolveidentifiedpracticediscrepanciesbetweenidentified
standardsandpracticethatmayadverselyimpactpatientoutcomes.

16

SampleContent
principlesandmodelsofevidencebasedpractice
nursesensitivequalityindicators(National Quality Forum,2004),performance
measures
overviewof qualitativeandquantitativeresearchprocesses
methodsforlocatingandappraisinghealth andotherrelevantresearchliterature
andothersourcesofevidence
basicappliedstatistics
basicdesigns,correspondingquestions,analyticalmethodsrelatedtoresearch
questions,andlimitsonimplicationsoffindings(e.g.,causalvs.relational)
ethicalconductofresearchandscholarlywork
linkagesamongpractice,researchevidence,patientoutcomes,andcost
containment
forcesdrivingresearchagendas
locatingandevaluatingsourcesofevidence
electronicdatabasesearchstrategies(e.g., CINAHL,PubMed)
systematicapplicationofinformation
levelsofevidence:textbooks,casestudies,reviewsofliterature,research
critiques,controlledtrials,evidencebasedclinicalpracticeguidelines(
www.guideline.gov),metaanalyses,andsystematicreviews(e.g.,theCochrane
DatabaseofSystematicReviews)
differentiationofclinicalopinionfromresearchandevidencesummaries
scholarshipdisseminationmethods:oral/visual presentations,publications,
newsletters,etc.

EssentialIV:InformationManagementandApplicationofPatientCareTechnology
Rationale
Knowledgeandskillsininformationandpatientcaretechnologyarecriticalinpreparing
baccalaureatenursinggraduatestodeliverqualitypatientcareinavarietyofhealthcare
settings(IOM,2003a).Graduatesmusthavebasiccompetenceintechnicalskills,which
includestheuseofcomputers,aswellastheapplicationof patientcaretechnologiessuch
asmonitors,datagatheringdevices,andothertechnologicalsupports forpatientcare
interventions.Inaddition,baccalaureategraduatesmusthavecompetenceintheuseof
informationtechnologysystems,includingdecisionsupportsystems,togatherevidence
toguidepractice.Specificintroductory levelnursinginformaticscompetenciesinclude
theabilitytouseselectedapplicationsinacomfortableandknowledgeableway.
Computerandinformationliteracyarecrucialtothefutureofnursing.Improvementof
costeffectivenessandsafetydependonevidencebasedpractice,outcomesresearch,
interprofessional carecoordination,andelectronichealthrecords,allofwhichinvolve
informationmanagementandtechnology(McNeiletal.,2006).Therefore,graduatesof
17

baccalaureateprogramsmusthavecompetenceinusingbothpatientcaretechnologies
andinformationmanagementsystems.
Inaddition,baccalaureategraduatesethicallymanagedata,information,knowledge,and
technologytocommunicateeffectivelyprovidesafeandeffectivepatientcareanduse
researchandclinicalevidencetoinformpracticedecisions.Graduateswillbeawarethat
newtechnology often requiresnewworkflowpatternsandchangesinpracticeapproaches
topatientcarepriortoimplementation.
Theuseandunderstandingofstandardizedterminologiesarefoundationaltothe
developmentofeffectiveclinicalinformationsystems(CIS).Integrationof standardized
terminologiesintotheCISnotonlysupportsdaytodaynursingpracticebutalsothe
capacitytoenhanceinterprofessional communicationandautomaticallygenerate
standardizeddatatocontinuouslyevaluateandimprovepractice(American Nurses
Association,2008). Baccalaureategraduatesarepreparedtogatheranddocumentcare
datathatserveasafoundationfordecisionmakingforthehealthcareteam.
Courseworkandclinicalexperienceswillprovidethebaccalaureategraduatewith
knowledgeandskillstouseinformationmanagementandpatientcaretechnologiesto
deliversafeandeffectivecare.Graduateswillhaveexposuretoinformationsystemsthat
providedataaboutqualityimprovementandrequiredregulatoryreportingthrough
informationsystems.Courseworkandclinicalexperienceswillexposegraduatestoa
rangeoftechnologiesthatfacilitateclinicalcare,includingpatientmonitoringsystems,
medicationadministrationsystems,andothertechnologiestosupportpatientcare.
Integraltothesebasicskillsisanattitudeofopennesstoinnovationandcontinual
learning,asinformationsystemsandpatientcaretechnologiesareconstantlychanging.
Thebaccalaureateprogrampreparesthegraduateto:
1. Demonstrateskillsinusingpatientcaretechnologies,informationsystems,and
communicationdevicesthatsupportsafenursingpractice.
2. Usetelecommunicationtechnologiestoassistineffectivecommunicationinavariety
ofhealthcaresettings.
3. Applysafeguardsanddecisionmakingsupporttoolsembeddedinpatientcare
technologiesandinformationsystemstosupportasafepracticeenvironmentforboth
patientsandhealthcareworkers.
4. UnderstandtheuseofCISsystemstodocumentinterventionsrelatedtoachieving
nursesensitiveoutcomes.
5. Usestandardizedterminologyinacareenvironmentthatreflectsnursingsunique
contributiontopatientoutcomes.

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6. Evaluatedatafrom allrelevantsources,includingtechnology,toinformthedelivery
ofcare.
7. Recognizetheroleofinformationtechnologyinimprovingpatientcareoutcomesand
creatingasafecareenvironment.
8. Upholdethicalstandardsrelatedtodatasecurity,regulatoryrequirements,
confidentiality,andclientsrighttoprivacy.
9. Applypatientcaretechnologiesasappropriatetoaddresstheneedsofadiverse
patientpopulation.
10. Advocatefortheuseofnewpatientcaretechnologiesforsafe,qualitycare.
11. Recognizethatredesignof workflowandcareprocessesshouldprecede
implementationofcaretechnology tofacilitatenursingpractice.
12. Participateinevaluationofinformationsystemsinpracticesettingsthroughpolicy
andproceduredevelopment.
SampleContent
useofpatientcaretechnologies(e.g.,monitors,pumps,computerassisted
devices)
useoftechnologyandinformationsystemsforclinicaldecisionmaking
computerskillsthatmayincludebasicsoftware,spreadsheet,andhealthcare
databases
informationmanagementforpatientsafety
regulatoryrequirementsthroughelectronicdatamonitoringsystems
ethicalandlegalissuesrelatedtotheuseofinformationtechnology,including
copyright,privacy,andconfidentialityissues
retrievalinformationsystems,includingaccess,evaluationofdata,and
applicationofrelevantdatatopatientcare
onlineliteraturesearches
technologicalresourcesforevidencebasedpractice
webbasedlearningandonlineliteraturesearchesforselfandpatientuse
technologyandinformationsystemssafeguards(e.g., patientmonitoring,
equipment,patientidentificationsystems,drugalertsandIVsystems,and
barcoding)
interstatepracticeregulations(e.g.,licensure,telehealth)
technologyforvirtualcaredeliveryandmonitoring
principlesrelatedtonursingworkloadmeasurement/resourcesandinformation
systems
informationliteracy
electronichealthrecord/physicianorderentry

19

decisionsupporttools
roleofthenurseinformaticistinthecontextofhealthinformaticsandinformation
systems

EssentialV:HealthcarePolicy,Finance,andRegulatoryEnvironments
Rationale
Healthcarepolicies,includingfinancialandregulatory policies,directlyandindirectly
influencenursingpracticeaswellasthenatureandfunctioningofthehealthcaresystem.
Thesepoliciesshaperesponsestoorganizational,local,national,andglobalissuesof
equity,access,affordability,andsocialjusticeinhealthcare. Healthcarepoliciesalsoare
centraltoanydiscussionaboutqualityandsafetyinthepracticeenvironment.
Thebaccalaureateeducatedgraduatewillhaveasolidunderstandingofthebroader
contextofhealthcare,includinghowpatientcareservicesareorganizedandfinanced,
andhowreimbursementisstructured. Regulatoryagenciesdefineboundariesofnursing
practice,andgraduatesneedtounderstandthescopeandroleoftheseagencies.
Baccalaureategraduatesalsowill understandhowhealthcareissuesareidentified,how
healthcarepolicyisbothdevelopedandchanged,andhowthatprocesscanbeinfluenced
throughtheeffortsof nurses,andotherhealthcareprofessionals,aswellaslayand
special advocacygroups.
Healthcarepolicyshapesthenature,quality,andsafetyofthepracticeenvironmentand
allprofessionalnurseshavetheresponsibilitytoparticipateinthepoliticalprocessand
advocateforpatients,families,communities,thenursingprofession,andchangesinthe
healthcaresystemasneeded. Advocacy forvulnerablepopulationswith thegoal of
promotingsocialjusticeisrecognizedasmoralandethicalresponsibilitiesofthenurse.
Thebaccalaureateprogrampreparesthegraduateto:
1. Demonstratebasicknowledgeofhealthcarepolicy,finance,andregulatory
environments,includinglocal,state, national,andglobal healthcaretrends.
2. Describehowhealthcareisorganizedandfinanced,includingtheimplicationsof
businessprinciples,suchaspatientandsystem costfactors.
3. Comparethebenefitsandlimitationsofthemajorformsof reimbursementonthe
deliveryof healthcareservices.
4. Examinelegislativeandregulatoryprocessesrelevanttotheprovisionofhealth
care.

20

5. Describestate andnational statutes,rules,andregulationsthatauthorizeand


defineprofessionalnursingpractice.
6. Explore theimpactofsociocultural,economic,legal,andpoliticalfactors
influencinghealthcaredeliveryandpractice.
7. Examinetherolesandresponsibilitiesoftheregulatoryagenciesandtheireffect
on patientcarequality,workplacesafety,andthescopeofnursingandotherhealth
professionals practice.
8. Discusstheimplicationsofhealthcarepolicyonissuesofaccess,equity,
affordability,andsocialjusticeinhealthcaredelivery.
9. Useanethicalframeworktoevaluatetheimpactofsocialpoliciesonhealthcare,
especiallyforvulnerablepopulations.
10. Articulate,throughanursingperspective,issuesconcerninghealthcaredelivery
todecisionmakerswithinhealthcareorganizationsandotherpolicyarenas.
11. Participateasanursingprofessional inpoliticalprocessesandgrassroots
legislativeeffortstoinfluencehealthcarepolicy.
12. Advocateforconsumersandthenursingprofession.
SampleContent

policydevelopmentandthelegislativeprocess
policydevelopmentandtheregulatoryprocess
licensureandregulationofnursingpractice
socialpolicy/publicpolicy
policyanalysisandevaluation
healthcarefinancingandreimbursement
economicsofhealthcare
consumerism andadvocacy
politicalactivismandprofessionalorganizations
disparitiesinthehealthcaresystem
impactofsocial trendssuchasgeneticsandgenomics,childhoodobesity,and
agingonhealthpolicy
roleofnurseaspatientadvocate
ethicalandlegalissues
professionalorganizations roleinhealthcarepolicy,financeandregulatory
environments
scopeofpracticeandpolicyperspectivesofotherhealthprofessionals
negligence,malpractice,andriskmanagement
NursePracticeAct

21

EssentialVI:Interprofessional CommunicationandCollaborationforImproving
PatientHealthOutcomes
Rationale
Effectivecommunicationandcollaborationamonghealthprofessionalsisimperativeto
providingpatientcenteredcare.Allhealthprofessionsarechallengedtoeducatefuture
clinicianstodeliverpatientcenteredcareasmembersofaninterprofessionalteam,
emphasizingcommunication,evidencebasedpractice,qualityimprovementapproaches,
andinformatics(IOM,2003a).Interprofessionaleducationisdefinedasinteractive
educationalactivitiesinvolvingtwoormoreprofessionsthatfostercollaborationto
improvepatientcare(Freeth,Hammick,Koppel,& Reeves,2002). Teamworkamong
healthcareprofessionalsisassociatedwithdeliveringhighqualityandsafepatientcare
(Barnsteiner,Disch,Hall,Mayer,&Moore,2007).Collaborationisbasedonthe
complementaritiesofrolesandtheunderstandingof theserolesbythemembersofthe
healthcareteams.
Interprofessionaleducationenablesthebaccalaureategraduatetoentertheworkplace
withbaselinecompetenciesandconfidenceforinteractionsandwith communication
skillsthatwillimprovepractice,thusyieldingbetterpatientoutcomes. Interprofessional
educationcanoccurinavarietyofsettings. Anessentialcomponentforthe
establishmentofcollegialrelationshipsisrecognitionoftheuniquedisciplinespecific
practicespheres.Fundamentaltoeffectiveinterprofessionalandintraprofessional
collaborationisadefinitionofsharedgoalsclearroleexpectationsofmembersa
flexibledecisionmakingprocessandtheestablishmentofopencommunicationpatterns
andleadership.Thus,interprofessionaleducationoptimizesopportunitiesforthe
developmentofrespectandtrustforothermembersofthehealthcareteam.
Thebaccalaureateprogrampreparesthegraduateto:
1. Compare/contrasttherolesandperspectivesofthenursingprofessionwithother
careprofessionalsonthehealthcareteam (i.e.,scopeofdiscipline,educationand
licensurerequirements).
2. Useinterandintraprofessional communicationandcollaborativeskillstodeliver
evidencebased,patientcenteredcare.
3. Incorporateeffectivecommunicationtechniques,includingnegotiationand
conflictresolution toproducepositiveprofessionalworkingrelationships.
4. Contributetheuniquenursingperspectivetointerprofessionalteamstooptimize
patientoutcomes.
5. Demonstrateappropriateteambuildingandcollaborativestrategieswhenworking
withinterprofessionalteams.

22

6. Advocateforhighqualityandsafepatientcareasamemberofthe
interprofessionalteam.

SampleContent
interprofessional andintraprofessional communication,collaboration,and
socialization,withconsiderationofprinciplesrelatedtocommunicationwith
diversecultures
teamwork/conceptsofteambuilding/cooperativelearning
professionalroles,knowledgetranslation,roleboundaries,anddiverse
disciplinaryperspectives
relationshipbuilding
navigatingcomplexsystems,systemfacilitation
interdependenceandresourcesharingofhealthcareprofessions
individualaccountability/sharedaccountability
advocacy
ethicalcodesandcorevaluesofdifferenthealthcareprofessions
autonomy
safety
scopesofpractice
conflictmanagement,conflictresolutionstrategies,andnegotiation
groupdynamics
principlesofreferralprocessforspecializedservices
participatorydecisionmaking
caring

EssentialVII:ClinicalPreventionandPopulationHealth
Rationale
Healthpromotion,disease,andinjurypreventionacrossthelifespanareessential
elementsofbaccalaureatenursingpracticeattheindividualandpopulationlevels.These
conceptsarenecessarytoimprovepopulationhealth.Epidemiologicstudiesshowthat
lifestyle,environmental,andgeneticfactorsaremajordeterminantsof populationhealth
inareasofhealth,illness,disease,disability,andmortality (U.S.DepartmentofHealth
andHumanServices,2000a). Thus,acutecareanddiseasebasedepisodicinterventions
aloneareinadequateforimprovinghealth(Allanetal.,2004Allan,Stanley,Crabtree,
Werner,&Swenson,2005). Healthpromotionalongwithdiseaseandinjuryprevention
areimportantthroughoutthelifespanandincludeassistingindividuals,families,groups,
communities,andpopulationstoprepareforandminimizehealthconsequencesof
emergencies,includingmasscasualtydisasters.

23

Clinicalpreventionreferstoindividuallyfocusedinterventionssuchasimmunizations,
screenings,andcounselingaimedatpreventingescalationofdiseasesandconditions.
(Allan,Stanley,Crabtree,Werner,&Swenson,2005) Becausetheseinterventionsare
relevantacross thelifespan,nursesneedknowledgeaboutgrowthanddevelopmentas
wellasevidencebasedclinicalpreventionpractices.Nursescollaboratewithother
healthcareprofessionalsandpatientsforimprovinghealththroughclinicalprevention.
Inpopulationfocusednursing,theaggregate,community,orpopulationistheunitof
care.Emphasisisplacedonhealthpromotionanddiseaseprevention.Because
populationfocusedcareisfundamentaltonursingpractice,andbecauseabaccalaureate
degreeinnursingistherecommendedminimaleducationalcredentialforpopulation
focusedcare,baccalaureateprogramspreparegraduatesforpopulationhealthaswellas
clinicalprevention(AACN,1998AmericanPublicHealthAssociation,1996 Quad
CouncilofPublicHealthNursingOrganizations,2004). Populationfocusednursing
involvesidentifyingdeterminantsofhealth,prioritizingprimarypreventionwhen
possible,activelyidentifyingandreachingouttothosewhomightbenefitfromaservice,
andusingavailableresourcestoassurebestoverallimprovementinthehealthofthe
population(AmericanNursesAssociation,2007). Forinstance,populationfocused
interventionsinvolvereachinganappropriatelevelofherdimmunityinthecommunity
andensuringthatinformationaboutappropriatescreeningsreachtheentirepopulation,
notjustthosewhochoosetocometohealthcarefacilities.Collaborationwithother
healthcareprofessionalsandpopulationsisnecessarytopromoteconditionsandhealthy
behaviorsthatimprovepopulationhealth.
Thebaccalaureateprogrampreparesthegraduateto:
1. Assessprotectiveandpredictivefactors,includinggenetics,whichinfluencethe
healthofindividuals,families,groups,communities,andpopulations.
2. Conductahealthhistory,includingenvironmentalexposureandafamilyhistory
thatrecognizesgeneticrisks,toidentifycurrentandfuturehealthproblems.
3. Assesshealth/illnessbeliefs,values,attitudes,andpracticesof individuals,
families,groups, communities,andpopulations.
4. Usebehavioralchangetechniquestopromotehealthandmanageillness.
5. Useevidencebasedpracticestoguidehealthteaching,healthcounseling,
screening,outreach,diseaseandoutbreakinvestigation,referral,andfollowup
throughoutthelifespan.
6. Useinformationandcommunicationtechnologiesinpreventivecare.
7. Collaboratewithotherhealthcareprofessionalsandpatientstoprovidespiritually
andculturallyappropriatehealthpromotion anddiseaseandinjury prevention
interventions.

24

8. Assessthehealth,healthcare,andemergency preparednessneedsofadefined
population.
9. Useclinicaljudgmentanddecisionmakingskillsinappropriate,timelynursing
careduringdisaster,masscasualty,andotheremergencysituations.
10. Collaboratewithotherstodevelopaninterventionplanthattakesintoaccount
determinantsofhealth,availableresources,andtherangeofactivitiesthat
contribute tohealthandthepreventionofillness,injury,disability,andpremature
death.
11. Participatein clinicalpreventionandpopulationfocusedinterventionswith
attentiontoeffectiveness,efficiency,costeffectiveness,andequity.
12. Advocateforsocialjustice,includingacommitmenttothehealthofvulnerable
populationsandtheeliminationofhealthdisparities.
13. Useevaluationresultstoinfluencethedeliveryofcare,deploymentofresources,
andtoprovideinputintothedevelopmentofpoliciestopromotehealthand
preventdisease.

SampleContent

preventionandharmreduction
ecologicalmodelasframeworkforunderstandingdeterminantsofhealth
publichealthprinciples
fundamentalsofepidemiologyandbiostatistics(distribution,incidence,prevalence,
rates,riskfactors,healthstatusindicators,andcontrolofdiseaseinpopulations)
publichealthcorefunctions
systemstheory
ethical,legal,andeconomicprinciplesrelatedtoclinicalpreventionandpopulation
health
cultural,psychological,andspiritualimplicationsofclinicalpreventionand
populationhealth
environmentalhealthrisks
healthliteracy
healthbehaviorchangetheories
theoreticalfoundationsandprinciplesofindividualandpopulationfocused
educationandcounseling
geneticsandgenomics
nutrition
globalhealth
occupationalhealth,includingergonomics

25

evidencebasedclinicalpreventionpractices
complementaryandalternativetherapies
populationassessment
individualandpopulationfocusedinterventions(e.g.weightcontrol,nicotine
management,socialmarketing,policy development)
healthsurveillance
healthdisparitiesandvulnerablepopulations
screening
immunization
pharmaceuticalpreventivestrategies
communicatingandsharinghealthinformationwiththepublic
riskcommunication
emergency preparednessanddisasterresponseincludingselfprotection
usingtechnologyinpopulationfocusedcareandclinicalprevention
outcomemeasurement
pedigreefromathreegenerationfamilyhealthhistoryusingstandardizedsymbols
andterminology

EssentialVIII:ProfessionalismandProfessionalValues
Rationale
Professionalvaluesandtheirassociatedbehaviorsarefoundationaltothepracticeof
nursing.Inherentinprofessionalpracticeisanunderstandingofthehistorical,legal,and
contemporarycontextofnursingpractice.Professionalismisdefinedastheconsistent
demonstrationofcorevaluesevidencedbynursesworkingwithotherprofessionalsto
achieveoptimalhealthandwellnessoutcomesinpatients,families,andcommunitiesby
wiselyapplyingprinciplesofaltruism,excellence,caring,ethics,respect,
communication,andaccountability(InterprofessionalProfessionalismMeasurement
Group,2008). Professionalismalsoinvolvesaccountabilityforonesselfandnursing
practice,includingcontinuousprofessionalengagementandlifelonglearning.As
discussedintheAmericanNursesAssociationCodeofEthicsforNursing(2005,p.16),
Thenurseisresponsibleforindividualnursingpracticeanddeterminestheappropriate
delegationoftasksconsistentwiththenursesobligationtoprovideoptimumpatient
care.Also,inherentinaccountabilityisresponsibilityforindividualactionsand
behaviors,includingcivility.Inordertodemonstrateprofessionalism,civilitymustbe
present.Civilityisafundamental setofacceptedbehaviorsforasociety/cultureupon
whichprofessionalbehaviorsarebased(Hammer,2003).
Professionalnursinghasenjoyedalongtraditionofhighrespectfromthepublic(Gallup
Poll,2006).Aprimary reasonforthisrecognitionisthecaringandcompassionofthe
nurse.Caringisaconceptcentraltoprofessionalnursingpractice.Caringasrelatedto
thisEssentialencompassesthenursesempathyfor,connectionto, andbeingwiththe
patient,aswellastheabilitytotranslatetheseaffectivecharacteristicsinto
compassionate,sensitive,andpatientcenteredcare.Historically,nurseshaveprovided
26

careforpatientswithinacontextofprivilegedintimacyaspaceintowhichanurseis
allowedandinpartnershipwiththepatientcreatesaunique,healingrelationship.
Throughthisconnection,thenurseandpatientworktowardanunderstandingofawide
varietyofphysical,psychosocial,cultural,andspiritualneeds,healthillnessdecisions,
andlifechallenges.Professionalnursingrequiresabalancebetweenevidencebased
knowledge,skills,andattitudesandprofessionalconfidence,maturity,caring,and
compassion.Inthisglobalsociety,patientpopulationsareincreasinglydiverse.
Therefore,essentialtothecareofdiversepopulationsistheneedforevidencebased
knowledgeandsensitivitytovariablessuchasage,gender,culture,healthdisparities,
socioeconomicstatus,race,andspirituality.Baccalaureategraduatesare preparedtocare
foratriskpatients,includingtheveryyoungandthefrailelderly,andtoassistpatients
withdecisionmakingaboutendoflifeconcernswithinthecontextofthepatientsvalue
system.Inaddition,nursesarepreparedtoworkwithpatientsacrossthelifespanwho
requiregenetictechnologiesandtreatments.
Baccalaureateeducationincludesthedevelopmentofprofessionalvaluesandvaluebased
behavior.Understandingthevaluesthatpatientsandotherhealthprofessionalsbringto
the therapeuticrelationshipiscriticallyimportanttoprovidingqualitypatientcare.
Baccalaureategraduatesare preparedforthenumerousdilemmasthatwillarisein
practiceandareabletomakeandassistothersinmakingdecisionswithinaprofessional
ethicalframework.Ethicsisanintegralpartofnursingpracticeandhasalwaysinvolved
respectandadvocacyfortherightsandneedsofpatientsregardlessofsetting. Honesty
andactingethicallyaretwokeyelementsofprofessionalbehavior,which haveamajor
impactonpatientsafety.Ablamefreecultureofaccountability andan environmentof
safety areimportantforencouragingteammemberstoreporterrors.Suchanenvironment
enhancesthesafetyofallpatients.
Thefollowingprofessional valuesepitomizethecaring,professionalnurse.Nurses,
guidedbythesevalues,demonstrateethicalbehaviorinpatientcare.
Altruismisaconcernforthewelfareandwellbeingofothers.Inprofessionalpractice,
altruismisreflectedbythenursesconcern andadvocacy forthewelfareofpatients,
othernurses,andotherhealthcareproviders.
Autonomy istherighttoselfdetermination.Professionalpracticereflectsautonomy
whenthenurserespectspatientsrightstomakedecisionsabouttheirhealthcare.
HumanDignityisrespectfortheinherentworthanduniquenessofindividualsand
populations.Inprofessionalpractice,concernforhumandignityisreflectedwhenthe
nursevaluesandrespectsallpatientsandcolleagues.
Integrityisactinginaccordancewithanappropriatecodeofethicsandaccepted
standardsofpractice.Integrityisreflectedinprofessionalpracticewhenthenurseis
honestandprovidescarebasedonanethicalframeworkthatisacceptedwithinthe
profession.

27

SocialJusticeisactinginaccordancewithfairtreatmentregardlessofeconomicstatus,
race,ethnicity,age,citizenship,disability,orsexualorientation.
Thebaccalaureateprogrampreparesthegraduateto:
1. Demonstratetheprofessionalstandardsofmoral,ethical,andlegalconduct.
2. Assumeaccountabilityforpersonalandprofessionalbehaviors.
3. Promotetheimageofnursingbymodelingthevaluesandarticulatingthe
knowledge,skills,andattitudesofthenursingprofession.
4. Demonstrateprofessionalism,includingattentiontoappearance,demeanor,
respectforselfandothers,andattentiontoprofessional boundarieswithpatients
andfamiliesaswellasamongcaregivers.
5. Demonstrateanappreciationofthehistory of andcontemporaryissuesin nursing
andtheirimpactoncurrentnursingpractice.
6. Reflecton onesown beliefsandvaluesasthey relatetoprofessionalpractice.
7. Identifypersonal,professional,andenvironmentalrisksthatimpactpersonaland
professionalchoicesandbehaviors.
8. Communicatetothehealthcareteamonespersonalbiasondifficulthealthcare
decisionsthatimpactonesabilitytoprovidecare.
9. Recognizetheimpactofattitudes,values,andexpectationsonthecareofthevery
young,frail olderadults,andothervulnerablepopulations.
10. Protectpatientprivacyandconfidentialityofpatientrecordsandotherprivileged
communications.
11. Accessinterprofessional andintraprofessional resourcestoresolveethical and
otherpracticedilemmas.
12. Acttopreventunsafe,illegal,orunethicalcarepractices.
13. Articulatethevalueofpursuingpracticeexcellence,lifelonglearning,and
professionalengagementtofosterprofessionalgrowthanddevelopment.
14. Recognizetherelationshipbetweenpersonalhealth,selfrenewal,andtheability
todeliversustainedqualitycare.

28

SampleContent
NursePracticeActsandscopeof practice
professionalcodesofconductandprofessionalstandards(e.g.,ANA,Codeof
EthicsforNurseswithInterpretiveStatements,2005 International Councilof
Nursing,CodeofEthics forNurses,2006, andAACNsHallmarksofthe
ProfessionalNursingPracticeEnvironment,2002)
ethicalandlegalframeworksandsocialimplications
communication
interprofessionalteamsandteambuildingconcepts
cultural humility andspiritual awareness
healthdisparities
historyofnursing
contemporarynursingissues
problemsolvingmethodssuchasappreciativeinquiry
professionalaccountability
stereotypesandbiases,suchasgender,race,andagediscrimination
nurseself care/stressmanagementstrategies
humanrights
informedconsent
professionalidentity formation
privacy,confidentiality
moralagency
professionalimage
selfreflection,personalknowing,personalselfcareplan
professionalorganizations,particularlynursingandhealthcareorganizations

EssentialIX:BaccalaureateGeneralistNursingPractice
Rationale
EssentialIXdescribesgeneralistnursingpracticeatthecompletionofbaccalaureate
nursingeducation.ThisEssentialincludespracticefocusedoutcomesthatintegratethe
knowledge,skills,andattitudesdelineatedinEssentialsIVIIIintothenursingcareof
individuals,families,groups,communities,andpopulationsinavarietyofsettings.
Becauseprofessionalnursesarethehumanlinkbetweenthepatientandthecomplex
healthcareenvironment, theymustprovidecompassionatecareinformedbyascientific
baseofknowledge,includingcurrentevidencefromnursingresearch.EssentialIX
recognizesthattheintegrationofknowledgeandskillsiscriticaltopractice.Practice
occursacrossthelifespanandinthecontinuumofhealthcareenvironments.The
baccalaureategraduatedemonstratesclinicalreasoningwithinthecontextofpatient
centeredcaretoformthebasisfornursingpracticethatreflectsethicalvalues.

29

Knowledgeacquisitionrelatedtowellness,healthpromotion,illness,disease
managementandcareofthedyingiscoretonursingpractice.Inaddition,acquisitionof
communicationandpsychomotorskillsiscriticaltoprovidingnursingcare.Skill
developmentwillfocusonthemasteryofcorescientificprinciplesthatunderlieallskills,
thuspreparingthebaccalaureategraduatetoincorporatecurrentandfuturetechnical
skillsintoothernursingresponsibilitiesandapplyskillsindiversecontextsofhealthcare
delivery.Directcaremaybedeliveredinpersonorvirtuallyandthatcareisbasedona
sharedunderstandingwiththepatientandthehealthcareteam.Thisbaseofknowledge
andskillspreparesthegraduateforpracticeasamemberandleaderofthe
interprofessionalhealthcareteam.
Baccalaureateeducatednurseswillbepreparedtocareforpatientsacrossthelifespan,
from theveryyoungtotheolderadult.Specialattention willbepaidtochanging
demographics.Amongthesedemographicsaretheincreasedprevalenceofchronic
illnessesandcomorbiditiesamongallages,includingthoserelatedtomental disorders,
specificallydepression.However,thereisclearevidencethatthelargestgroupseeking
andreceivinghealthcareservicesistheolderadultpopulation.Thegraduatewill
understandandrespectthevariationsofcare,theincreasedcomplexity,andtheincreased
useofhealthcareresourcesinherentincaringforpatientswhoarevulnerableduetoage,
theveryyoungandveryold,aswellasdisabilitiesandchronicdisease.
Theincreasingdiversityofthisnationspopulationmandatesanattentiontodiversityin
ordertoprovidesafe,humanistichighqualitycare.Thisincludescultural,spiritual,
ethnic,gender,andsexual orientation diversity.Inaddition,theincreasingglobalization
ofhealthcarerequiresthatprofessionalnursesbepreparedtopracticeinamulticultural
environmentandpossesstheskillsneededtoprovideculturallycompetentcare.
Baccalaureategraduateswill haveknowledge,skills,andattitudesthatpreparethemfora
longtermcareerinachangingpracticeenvironment.Theincreasedprevalenceofchronic
illnessisaresultofanincreasinglyolderadultpopulation,environmentalthreats,
lifestylesthatincreaseriskofdisease,andenhancedtechnologicalandtherapeutic
interventionsthatprolonglife.Inadditiontoprimaryprevention,theprofessionalnurse
providessupportformanagementofchronicillness,healtheducation,andpatient
centeredcareinpartnershipwiththepatientandtheinterprofessionalteam.Patientsand
theirfamiliesoftenareknowledgeableabouthealthcaretherefore,thegraduatewillbe
abletocommunicatewiththeseconsumersandappreciatetheimportanceofthecare
partnership.
Graduatestranslate,integrate,andapplyknowledgethatleadstoimprovementsinpatient
outcomes.Knowledgeisincreasinglycomplexandevolvingrapidly.Forexample,
geneticsandgenomicsareareaswhereknowledgeisescalatingandthegraduatewill be
cognizantofcustomizedtherapiesdesignedtoimprovecareoutcomes.Therefore,
baccalaureategraduateswillbeexpectedtofocusoncontinuousselfevaluationand
lifelonglearning.

30

Thebaccalaureateprogrampreparesthegraduateto:
1. Conductcomprehensiveandfocusedphysical,behavioral,psychological,
spiritual,socioeconomic,andenvironmentalassessmentsofhealthandillness
parametersinpatients,usingdevelopmentallyandculturallyappropriate
approaches.
2. Recognizetherelationshipofgeneticsandgenomicstohealth,prevention,
screening,diagnostics,prognostics,selectionoftreatment,andmonitoringof
treatmenteffectiveness,usingaconstructedpedigreefromcollectedfamily
historyinformation aswellasstandardizedsymbolsandterminology.
3. Implementholistic,patientcenteredcarethatreflectsanunderstandingof human
growthanddevelopment,pathophysiology,pharmacology,medicalmanagement,
andnursingmanagementacrossthehealthillnesscontinuum,acrossthelifespan,
andinallhealthcaresettings.
4. Communicateeffectivelywith allmembersofthehealthcareteam,includingthe
patientandthepatientssupportnetwork.
5. Delivercompassionate,patientcentered,evidencebasedcarethatrespectspatient
andfamilypreferences.
6. Implementpatientandfamilycarearoundresolutionofendoflifeandpalliative
careissues,suchassymptommanagement,supportofrituals,andrespectfor
patientandfamilypreferences.
7. Provideappropriatepatientteachingthatreflectsdevelopmentalstage,age,
culture,spirituality,patientpreferences,andhealthliteracyconsiderationsto
fosterpatientengagementin theircare.
8. Implementevidencebasednursinginterventionsasappropriateformanagingthe
acuteandchroniccareofpatientsandpromotinghealth acrossthelifespan.
9. Monitorclientoutcomestoevaluatetheeffectivenessofpsychobiological
interventions.
10. Facilitatepatientcenteredtransitionsofcare,includingdischargeplanningand
ensuringthecaregiversknowledgeofcarerequirementstopromotesafecare.
11. Providenursingcarebasedonevidencethatcontributestosafeandhighquality
patientoutcomeswithinhealthcaremicrosystems.
12. Createasafecareenvironmentthatresultsinhighqualitypatientoutcomes.

31

13. Revisetheplanofcarebasedonanongoingevaluation ofpatientoutcomes.


14. Demonstrateclinicaljudgmentandaccountabilityforpatientoutcomeswhen
delegatingtoandsupervisingothermembersofthehealthcareteam.
15. Managecaretomaximizehealth,independence,andqualityoflifeforagroupof
individualsthatapproximatesabeginningpractitionersworkload
16. Demonstratetheapplicationofpsychomotorskillsfortheefficient,safe,and
compassionatedeliveryofpatientcare.
17. Developabeginningunderstandingofcomplementaryandalternativemodalities
andtheirroleinhealthcare.
18. Developanawarenessofpatientsaswellashealthcareprofessionalsspiritual
beliefsandvaluesandhowthosebeliefsandvaluesimpacthealthcare.
19. Managetheinteractionofmultiplefunctionalproblemsaffectingpatientsacross
thelifespan,includingcommongeriatricsyndromes.
20. Understandonesroleandparticipationin emergency preparednessanddisaster
responsewithanawarenessofenvironmentalfactorsandtheriskstheyposeto
selfandpatients.
21. Engageincaringandhealingtechniquesthatpromoteatherapeuticnursepatient
relationship.
22. Demonstratetolerancefortheambiguityandunpredictabilityoftheworldandits
effectonthehealthcaresystemasrelatedtonursingpractice.

SampleContent
theoriesofhumangrowthanddevelopment
principlesofbasicnursingcare(e.g., skin,mobility,painmanagement,immediate
patientcareenvironment,etc.)
patientandfamilycenteredcare
managementofacuteandchronicphysicalandpsychosocialconditionsacrossthe
lifespan
integrationof pathophysiologyintocare
careacrossthelifespanfocusingonchangingdemographicswithanemphasison
careofolderadultsandtheveryyoung.
palliativeandendoflifecare
commongeriatricsyndromes
geneticsandgenomics

32

nutrition
emergencypreparednessanddisasterresponse
bioterrorism
infectioncontrolissues,suchasdrugresistantorganismsandmanagement
caringandhealingtechniques
psychobiologicalinterventions
milieutherapy
depressionscreening
healthpromotion
patientadvocacy
disparities
complementaryandalternativetherapies
spiritual care
therapeuticcommunication
culturallydiversecare
evidencebasedpractice
pharmacology/pharmacogenetics
nursingcaremanagement
prioritizationofpatientcareneeds
principlesofdelegatingandmonitoringcare
leadership
informationmanagementsystems
integratingtechnologyintopractice
resourcemanagement
teaching/learningprinciples

ExpectationsforClinicalExperienceswithintheBaccalaureateProgram
Baccalaureateprogramsproviderichandvariedopportunitiesforpracticeexperiences
designedtoassistgraduates toachievetheBaccalaureateEssentialsuponcompletionof
theirprogram.Clinical experiencesareessentialforbaccalaureatenursingprogramsto
preparestudentstocareforavarietyofpatientsacrossthelifespanandacrossthe
continuumofcare.Inadditionclinicalexperiencesassistthegraduateto:
developproficiencyinperformingpsychomotorskills
applyprofessionalcommunicationstrategiestoclientandinterprofessional
interactions and
acquireaprofessionalidentity.
Clinicallearningisfocusedondevelopingandrefiningtheknowledgeandskills
necessarytomanagecareaspartofaninterprofessionalteam.Theoreticallearning
becomesrealityasstudentsarecoachedtomakeconnectionsbetweenthestandardcase
orsituationthatispresentedintheclassroom or laboratorysettingandtheconstantly
shiftingrealityofactualpatientcare. Clinicaleducatorsforbaccalaureateprogramsare
wellinformedaboutthespecificlearningthatistakingplaceintheclassroomand
33

laboratorysettingandfindclinical education opportunitiestoreinforceandapplythat


learning. Programsprovideclinicalplacementsacrosstherangeofpracticesettingsand
acrossthecontinuumofcarethataresafe,supportive,andconduciveforgroupsof
studentstopracticeandlearn professionalroles.Clinicalpracticeopportunitiesexpose
studentstopracticeissuessuchastechnologicalinnovations,acceleratedcaretransitions,
an unpredictablefastpacedenvironment,andcomplex systemissues,whichareall
importantin preparingthestudentsforpracticefollowinggraduation.Inaddition,clinical
practiceopportunitiesprovidestudentswithexperiencesandnursingrolemodelsthat
preparethemforpracticeincomplex,changinghealthcareenvironments.
Simulationexperiencesaugmentclinicallearningandarecomplementarytodirectcare
opportunitiesessentialtoassumingtheroleoftheprofessionalnurse.Laboratoryand
simulationexperiencesprovideaneffective,safeenvironmentforlearningandapplying
thecognitiveandperformanceskillsneededforpractice.Realitybased,simulatedpatient
careexperiencesincreaseselfconfidenceincommunicationandpsychomotorskills,and
professionalroledevelopment.Beginningresearchsupportstheuseofsimulationin
nursingeducation.Nehring,Ellis,andLashley(2001)describetheuseofhumanpatient
simulatorsinnursingeducationasanexcellenttooltomeasurecompetencyinthe
applicationofknowledgeandtechnicalskills.Debriefing,orfeedbacktothestudents,is
asessentialforsimulationasitisforinstructionintheclinicalsetting(National Council
of StateBoardsof Nursing,2005). Simulationisavaluableelementofclinical
preparation.However,patientcareexperienceswithactualpatientsformthemost
importantcomponentofclinical education.Overtime,asevidenceemergesregardingthe
useofsimulationasasubstituteforactualpatientexperience,thebalancebetweenactual
andsimulatedpatientcaremay change.
Directpatientcareclinical experiencesprovidevaluableopportunitiesforstudent
learningnotfoundinotherexperiences.Earlylearningexperiences,includingproviding
careforalimitednumberofpatients,allowstudentstoexplorethechallengingworldof
clinicalpractice.Asstudentsbecomemoreexperienced,increasinglycomplex clinical
learningopportunitiesareselectedtoprovideasufficientbreadthanddepthof learningto
developthecompetencenecessaryforentrylevel practicewith diversepatientsacrossthe
lifespaninvarioustypesofsettings.Through animmersionexperience,studentshave
theopportunitytodevelopincreasingautonomyandassumeanassignmentthatmore
closelyapproximatesarealisticworkloadofanovicenurseinthatenvironment.
A clinicalimmersionexperienceprovidesopportunitiesforbuildingclinicalreasoning,
management,andevaluationskills.Theseopportunitiesincreasethestudentsself
confidence,professionalimage,andsenseof belongingthatfacilitatethetransitionto
competentandconfidentpractice.Immersionexperiencesallowstudentstointegrate
previouslearningandmorefully developtherolesofthebaccalaureategeneralistnurse:
providerof care
evaluateclientchangesandprogressovertime
developabeginningproficiencyandefficiencyindeliveringsafecare
designer/manager/coordinatorof care
managecaretransitions

34

beanactiveparticipantontheinterprofessionalteam
identifysystemissues
developworkingskillsindelegation,prioritization,andoversightofcare
memberofaprofession
evaluateonesownpractice
assumeresponsibilityforsupportingtheprofession
Animmersionexperienceprovidesfaculty opportunitiesto observestudentperformance
overtimeandmoreeffectively evaluatethestudentsprofessional development.
Graduatesof alltypesof baccalaureateprogramsneedsufficientdidactic,laboratory,and
clinicalexperiencestoattaintheendofprogramoutcomesoftheseEssentials. The
nursingprogramdeterminesandassessesclinicalsitestoensuretheclinical experiences
forstudentsprovide:
patientsfromdiversebackgrounds,cultures,andofdifferinggender,religious,and
spiritual practices
thecontinuumofcare,includingpopulationfocusedcare
allagegroups,includingtheveryyoungandthefrail elderlyand
comprehensivelearningopportunitiestopromoteintegrationofbaccalaureate
learningoutcomesthatpreparethegraduateforprofessionalnursingpractice.

Summary
TheEssentialsforBaccalaureateEducationforProfessionalNursingPracticeservesto
transform baccalaureatenursingeducationandareadramaticrevisionofthe1998
version.Further,theseEssentialsmeettheIOMsrecommendationsforcoreknowledge
neededforallhealthcareprofessionals(IOM,2003b).Duetotheeverchangingand
complexhealthcareenvironment, thisdocumentemphasizessuchconceptsaspatient
centeredcare,interprofessionalteams,evidencebasedpractice,qualityimprovement,
patientsafety,informatics,clinicalreasoning/criticalthinking,geneticsandgenomics,
culturalsensitivity,professionalism,practiceacrossthelifespan,andendoflifecare.
EssentialsIIXdelineatetheoutcomesexpectedforbaccalaureatenursingprogram
graduates.Achievementoftheseoutcomeswillenablethebaccalaureateprepared
generalistnursetopracticewithincomplexhealthcaresystemsandassumetheroles:
providerof care
evaluateclientchangesandprogressovertime
developabeginningproficiencyandefficiencyindeliveringsafecare
designer/manager/coordinator of care
managecaretransitions
beanactiveparticipantontheinterprofessionalteam
identifysystemissues
developworkingskillsindelegation,prioritization,andoversightofcare
memberofaprofession
evaluateonesownpractice
assumeresponsibilityforsupportingtheprofession

35

EssentialIXdescribesgeneralistnursingpracticeatthecompletionofbaccalaureate
nursingeducation.ThisEssentialincludespracticefocusedoutcomesthatintegratethe
knowledge,skills,andattitudesdelineatedinEssentialsIVIII. Thetimeneededto
accomplish eachEssentialwillvary,andeachEssentialdoesnotrequireaseparatecourse
forachievementoftheoutcomes. Learningopportunities,includingclinicalexperiences,
mustbesufficientinbreadthanddepthtoensurethegraduateattainsthesepractice
focusedoutcomesandintegratesthisknowledgeandtheseskillsintoonesprofessional
nursingpractice.
Baccalaureategraduatestranslate,integrate,andapplyknowledgethatleadsto
improvementsinpatientoutcomes.Knowledgeisincreasinglycomplexandevolving
rapidly.Therefore,baccalaureategraduatesareexpectedtofocusoncontinuousself
evaluationandlifelonglearning.

Glossary
CriticalThinking: Allorpartoftheprocessofquestioning,analysis,synthesis,
interpretation,inference,inductiveanddeductivereasoning,intuition,application,and
creativity(AACN,1998).Criticalthinkingunderliesindependentandinterdependent
decisionmaking.
ClinicalJudgment:Theoutcomesofcriticalthinkinginnursingpractice.Clinical
judgmentsbeginwithanendinmind.Judgmentsareaboutevidence,meaningand
outcomesachieved(Pesut,2001).
ClinicalReasoning:Theprocessusedtoassimilateinformation,analyzedata,andmake
decisionsregardingpatientcare (Simmons,Lanuza,Fonteyn,&Hicks,2003).
ClinicalPrevention:Individuallyfocusedinterventionssuchasimmunizations,
screenings,andcounseling,aimedatpreventingescalationofdiseasesandconditions.
Cultural Humility:Incorporatesalifelongcommitmenttoselfevaluationandself
critique,toredressingthepowerimbalancesinthepatientcliniciandynamic,andto
developingmutuallybeneficialandadvocacypartnershipswithcommunitiesonbehalfof
individualsanddefinedpopulations.Culturalhumilityisproposedasamoresuitablegoal
thanculturalcompetenceinhealthcareeducation (Tervalon& MurrayGarcia,1998).
CulturalSensitivity:Culturalsensitivityisexperiencedwhenneutrallanguage,both
verbalandnotverbal,isusedinawaythatreflectssensitivityandappreciationforthe
diversityofanother.Cultural sensitivitymaybeconveyedthroughwords,phrases,and
categorizationsthatareintentionallyavoided,especiallywhenreferringtoanyindividual
whomaybeinterpretedasimpoliteoroffensive(AmericanAcademyofNursingExpert
PanelonCulturalCompetence,2007).

36

DecisionSupportSystem (Clinical):Interactivecomputerprogramsdesignedtoassist
clinicianswithdecisionmakingtasks. Clinical decisionsupportsystemslinkhealth
observationswithhealthknowledgetoinfluencechoicesbycliniciansforimproved
healthcare.
Diversity: Therangeofhumanvariation,includingage,race,gender,disability,
ethnicity,nationality,religiousandspiritual beliefs,sexualorientation,politicalbeliefs,
economicstatus,nativelanguage,andgeographicalbackground.
EvidencebasedPractice:Carethatintegratesthebestresearchwithclinicalexpertise
andpatientvaluesforoptimumcare(IOM,2003b).
HealthDeterminants:Complexinterrelationshipsoffactors,suchasthesocialand
economicenvironment,thephysical environment,individualcharacteristics,and
behaviorsthatinfluencehealth.
HealthLiteracy: Thedegreetowhichindividualshavethecapacitytoobtain,process,
andunderstandbasichealthinformationandservicesneededtomakeappropriatehealth
decisions(U.S.DepartmentofHealthandHumanServices,2000b)
HealthcareTeam:Thepatientplusallofthehealthcareprofessionalswhocareforthe
patient.Thepatientisanintegralmemberofthehealthcareteam.
HerdImmunity:Immunityofasufficientproportionofthepopulationtoreducethe
probabilityofinfectionofsusceptiblemembersofthatpopulation.
ImmersionExperience: Clinicalexperienceswithasubstantivenumberofhoursina
consistentclinicalsettingoveraconcentratedperiodoftime.
InformationTechnology:Thestudy,design,developmentimplementation,support, or
managementofcomputerbasedinformationsystems,particularlysoftwareapplications
andcomputerhardware.
IntegrativeStrategiesfor Learning:Coherentorganizationofeducationalpracticesthat
integrategeneraleducationconceptsthroughoutthemajor,throughthewidespreaduseof
powerful,active,andcollaborativeinstructionalmethods(AssociationofAmerican
CollegesandUniversities,2004) .
Interprofessional:Workingacrosshealthcareprofessionstocooperate,collaborate,
communicate,andintegratecareinteamstoensurethatcareiscontinuousandreliable.
Theteamconsistsofthepatient,thenurse,andotherhealthcareprovidersasappropriate
(IOM,2003b).
Intraprofessional: Workingwithhealthcareteammemberswithintheprofessionto
ensurethatcareiscontinuousandreliable.

37

Microsystem:Thestructuralunitresponsiblefordeliveringcaretospecificpatient
populationsorthefrontlineplaceswherepatients,families,andcareteamsmeet(Nelson,
Batalden,Godfrey,2007).
Moral Agency: A personscapacityformakingethicaljudgments.Mostphilosophers
suggestthatonlyrationalbeings,peoplewhocanreasonandformselfinterested
judgments,arecapableofbeingmoralagents.
Multidimensional Care:Relatingtoorhavingseveraldimensionsitspeakstothe
fullnessofthepatientclinicianexperience,butalso topeopleslivesingeneral.
Spiritualityisoneofthosemanydimensions.
NurseSensitiveIndicators:Measuresofprocessesandoutcomesandstructural
proxiesfortheseprocessesandoutcomes(e.g., skillmix,nursestaffinghours)thatare
affected,provided,andinfluencedbynursingpersonnel,butforwhichnursingisnot
exclusivelyresponsible(National Quality Forum,2003).
Outcome:Broadperformanceindicator,relatedtotheknowledge,skills,andattitudes,
neededbyabaccalaureategraduate.
Patient: Therecipientofnursingcareorservices.Thistermwasselectedforconsistency
andinrecognitionandsupportofthehistoricallyestablishedtraditionofthenursepatient
relationship.Patientsmaybeindividuals,families,groups,communities,orpopulations.
Further,patientsmayfunctioninindependent,interdependent,ordependentroles,and
mayseekorreceivenursinginterventionsrelatedtodiseaseprevention,healthpromotion,
orhealthmaintenance,aswellasillnessandendoflifecare.Dependingonthecontext
orsetting,patientsmay,attimes,moreappropriatelybetermedclients,consumers,or
customersofnursingservices(AACN,1998,p.2).
PatientcenteredCare:Includesactionstoidentify,respectandcareaboutpatients
differences,values,preferences,andexpressedneedsrelievepainandsuffering
coordinatecontinuouscarelistento,clearlyinform,communicatewith,andeducate
patientssharedecisionmakingandmanagementandcontinuouslyadvocatedisease
prevention,wellness,andpromotionofhealthylifestyles,includingafocusonpopulation
health(IOM,2003b).
PopulationHealthInterventions:Actionsintendedtoimprovethehealthofacollection
ofindividualshavingpersonalorenvironmentalcharacteristicsincommon.Population
healthinterventionsarebasedonpopulationfocusedassessments.
ProfessionalNurse:Anindividualpreparedwithaminimumofabaccalaureatein
nursingbutisalsoinclusiveofonewhoentersprofessionalpracticewithamasters
degreeinnursingoranursingdoctorate(AACN,1998).
Simulation:Anactivity thatmimicstherealityofaclinicalenvironmentandisdesigned
todemonstrateprocedures,decisionmaking,andcriticalthinkingthroughtechniques

38

suchasroleplayingandtheuseofdevices(e.g.,interactivevideos,mannequins)
(National Councilof StateBoardsof Nursing,2005).
SpiritualCare:Interventions,individualorcommunal,thatfacilitatetheabilityto
experiencetheintegrationofthebody,mind,andspirittoachievewholeness,health,and
asenseofconnectiontoself,others,andahigherpower (AmericanNursesAssociation
andHealthMinistriesAssociation,2005,p.38).
Spirituality:Speakstowhatgivesultimatemeaningandpurposetooneslife.Itisthat
partofpeoplethatseekshealingandreconciliationwithselforothers(Puchalski,2006).
VulnerablePopulations:Referstosocialgroupswithincreasedrelativerisk(i.e.,
exposuretoriskfactors)orsusceptibilitytohealthrelatedproblems.Thevulnerabilityis
evidencedinhighercomparativemortalityrates,lowerlifeexpectancy,reducedaccessto
care,anddiminishedqualityoflife(CenterforVulnerablePopulationsResearch,UCLA
SchoolofNursing,2008).

39

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http://www.galluppoll.com/content/?ci=1654&pg=1
Hammer,D.(2003).CivilityandprofessionalisminB.Berger(ed.), PromotingCivility
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from http://www.who.int/whosis/database/core/core_select_process.cfm

44

APPENDIXA
TaskForceontheRevisionof TheEssentialsofBaccalaureate
EducationforProfessionalNursing
PatriciaMartin,PhD,RNchair
Dean,WrightStateUniversity
CollegeofNursingandHealth
Carol A.Ashton,PhD,RN
AssociateDean andDirector,
IdahoStateUniversity
SchoolofNursing
DerrylBlock,PhD,MPH,RN
Chair,UniversityofWisconsinGreen
Bay
ProfessionalPrograminNursing
DaisyCruzRichman,PhD,RN
Dean,SUNYDownstateMedicalCenter
CollegeofNursing
TeriMurray,PhD,RN
Dean,SaintLouisUniversity
SchoolofNursing
LindaNiedringhaus,PhD,RN,faculty
representative
ElmhurstCollege
DeickeCenterforNursingEducation
Donald"Chip"Bailey,PhD,RN, faculty
representative
DukeUniversity
SchoolofNursing

RoxanneA.Moutafis,MS,RN,BC,
facultyrepresentative
TheUniversityofArizona
CollegeofNursing
JudithSands,EdD,RN, faculty
representative
UniversityofVirginia
SchoolofNursing
KarenDrenkard,PhD,RN,NEABC,
practicerepresentative
ChiefNurseExecutive,
INOVAHealthSystems
PollyBednash,PhD,RN,FAAN,staff
liaison
ExecutiveDirector
KathyMcGuinn,MSN,RN,CPHQ, staff
liaison
DirectorofSpecialProjects
JoanStanley,PhD,RN,FAAN,staff
liaison
SeniorDirectorofEducationPolicy
HoracioOliveira,staffliaison
EducationPolicyandSpecialProjects
Assistant

JeanW.Lange,PhD,RN,CNL, faculty
representative
FairfieldUniversity
SchoolofNursing

45

APPENDIXB
ConsensusProcesstoRevisetheEssentialsof
BaccalaureateEducationforProfessionalNursingPractice
In2006,theAACNBoardofDirectorsestablishedataskforceandchargedthisgroupto
reviseandupdatethe1998Essentialsdocument.Thistaskforcewascomprisedof
individualsrepresentinganarrayofexpertsinbaccalaureatenursingeducation,including
deansandfacultyrepresentatives.Additionally,achiefnurseexecutiverepresentedthe
practicesettingonthecommittee(seeAppendixA).Thetaskforcebegantheirworkby
reviewingtheliteratureandconsideringthechangesoccurringinhealthcare,higher
education,andhealthprofessionseducation.InFebruary2007,thetaskforceconveneda
groupof20stakeholdersrepresentingleadersfromhighereducation,professional
nursing,andinterprofessionaleducationinJune2007,threeadditionalstakeholdersmet
withthetaskforce(seeAppendixC).Theseleaderswereaskedtoidentify,fromtheir
ownperspectives,theanticipatedroleoftheprofessionalnurseinthefuturehealthcare
systemandthecriticalcompetenciesneededtofunctioninthisrole.Thesewideranging
andlivelydiscussionsservedasthebasisforthedevelopmentofadraftdocumentthat
wasthensharedwithnursingprofessionalsontheAACNWebsiteinAugust2007,prior
tothebeginningofthenextphaseoftherevisionprocess.
ThenextphaseconsistedofaseriesoffiveregionalmeetingsfromSeptember2007to
April2008.Thepurposeofthesemeetingswastogatherfeedbackandtobuildconsensus
abouttheEssentialsdraftdocument.Participants,includingnurseeducators,clinicians,
administrators,andresearchersrepresentingarangeofnursingprograms,specialties,and
organizations,discussed,debated,andmaderecommendationsregardingthedraft
document.Over700individuals,representingall50statesandtheDistrictofColumbia,
participatedintheconsensusbuildingprocess.Inaddition,329schoolsofnursing,11
professionalorganizations,and13healthcaredeliverysystemswererepresented(see
AppendicesD,E, & F).Toensureabroadbaseofnursinginput,thetaskforcesoughtthe
participationofawiderangeofnursingorganizationsandmanyoftheseorganizations
suchastheAmericanAcademyofNursing,SigmaThetaTau,andAmerican
OrganizationofNurseExecutivessentwrittenfeedbacktothetaskforce.Nursing
administratorsandclinicianswerespecificallyaskedtoparticipatetoensurethatthe
recommendationsfornursingeducationwouldaddressfuturehealthcarepractice.
Participantsintheregionalmeetingswereaskedtofocusontherationalesupportingeach
Essentialandalistofendofprogramoutcomes.Inaddition,theparticipantsprovided
inputintothedevelopmentof supportingdocumentsincludingalistofintegrative
learningstrategies,qualityindicators,andclinicallearningenvironments.Theprocess
wasiterativeandfollowingeachoftheregionalmeetings,anupdateddocumentwas
postedontheAACNWebsiteforreviewandcomment.AACNmemberschoolsandthe
nursingcommunityatlargewereabletoprovideongoingfeedback.
OnJuly19,2008,theAACNBoardunanimouslyapprovedtherevisedEssentialsof
BaccalaureateNursingEducation.

46

AppendixC
ParticipantswhoattendedStakeholderMeetings(N=23)
AmyBerman
JohnA.HartfordFoundation,Inc.
ProgramOfficer
NewYork,NY
LindaCronenwett
QualityandSafetyEducationforNurses
(QSEN)
ChapelHill,NC
LisaDay

TheCarnegieFoundationforthe
AdvancementofTeaching
SanFrancisco,CA
JerryGaff
AssociationofAmericanColleges&
Universities(AAC&U)
SeniorFellow
Washington,DC
JodyGandy
InterprofessionalProfessionalismGroup,
AmericanPhysicalTherapyAssociation
(APTA)
Director,PhysicalTherapyEducation
Alexandria,VA
PamHagan
AmericanNursesAssociation(ANA)
ChiefProgramsOfficer
SilverSpring,MD
JanieE.Heath
AmericanAssociationofCriticalCare
Nurses(AACN)
PastBoardMember
AlisoViejo,CA
JeanJenkins
AdvisoryGroupforGeneticsandGenomics
NationalInstitutesofHealth(NIH),National
HumanGenomeResearchInstitute
(NHGRI)
SeniorClinicalAdvisor
Bethesda,MD

LindaOlsonKeller
AssociationofStateandTerritorial
DirectorsofNursing(ASTDN)
ProjectDirector
Arlington,VA
DarrellKirch
AssociationofAmericanMedicalColleges
(AAMC)
President
Washington,DC
EllenKurtzman
NationalQualityForum(NQF)
SeniorProgramDirector
Washington,DC
PamMalloy
EndofLifeNursingEducationConsortium
(ELNEC)
ProjectDirector,AACN
Washington,DC
JeanneMatthews
QuadCouncilofPublicHealthNursing
Organizations
Chairelect,APHAPublicHealthNursing
(PHN)SectionfortheQuadCouncil
Washington,DC
LeylaMcCurdy
NationalEnvironmentalEducation&
TrainingFoundation(NEETF)
SeniorDirector
Washington,DC
DulaPacquiao
AACNCulturalAdvisoryGroup,
AssociateProfessorandDirectorSchoolof
Nursing
UniversityofMedicine&DentistryofNJ
Newark,NJ

47

PatriciaRutherford
InstituteforHealthCareImprovement(IHI)
VicePresident
Cambridge,MA
DouglasScheckelhoff
AmericanSocietyofHealthSystem
Pharmacists(ASHP)
Director,PharmacyPracticeSections
Bethesda,MD
NancySpector
NationalCouncilofStateBoardsofNursing
(NCSBN)
DirectorofEducation
Chicago,IL
MollySutphen

TheCarnegieFoundationforthe
AdvancementofTeaching
ResearchScholar
Stanford,CA

ToddUhlmann
NationalStudentNursesAssociation
(NSNA)
President
Brooklyn,NY
TenerVeneema
DisasterPreparednessExpert
AssociateProfessorofClinicalNursing
UniversityofRochester
Rochester,NY
MaryWakefield
InstituteofMedicine(IOM)Chairof
QualityChasmSeries
HealthCareServicesBoard,
AssociateDeanforRuralHealth,
UniversityofNorthDakota
Washington,DC
JuliaWatkins
CouncilonSocialWorkEducation
ExecutiveDirector

Alexandria,VA

48

APPENDIXD
SchoolsofNursingthatParticipatedintheRegionalMeetings(N=329)
AdelphiUniversity
GardenCity,NY

BaylorUniversity
Dallas,TX

ArizonaStateUniversity
Phoenix,AZ

BeckerCollege
Worcester, MA

ArkansasStateUniversity
StateUniversity,AR

BemidjiStateUniversity
Bemidji,MN

ArmstrongAtlanticStateUniversity
Savannah,GA

BethuneCookmanUniversity
DaytonaBeach,FL

AshlandUniversity
Ashland,OH

BinghamtonUniversity
Binghamton,NY

AuburnUniversity
Auburn,AL

BiolaUniversity
LaMirada,CA

AuburnUniversityatMontgomery
Montgomery,AL

BoiseStateUniversity
Boise,ID

AvilaUniversity
KansasCity,MO

BostonCollege
ChestnutHill,MA

AzusaPacificUniversity
Azusa,CA

BradleyUniversity
Peoria,IL

BakerUniversity
Topeka,KS

BrenauUniversity
Gainesville,GA

BallStateUniversity
Muncie,IN

BrighamYoungUniversity
Provo,UT

BaptistMemorialCollegeofHealth
Sciences
Memphis,TN

BryanLGHCollegeofHealthSciences
Lincoln,NE

BarnesJewishCollegeofNursing
St.Louis,MO
BarryUniversity
MiamiShores,FL

CaliforniaBaptistUniversity
Riverside,CA
CaliforniaStateUniversityChannel
Islands
Camarillo,CA

49

CaliforniaStateUniversityBakersfield
Bakersfield,CA

ChamberlainCollegeofNursing
Columbus,OH

CaliforniaStateUniversityChico
Chico,CA

CharlestonSouthernUniversity
Charleston,SC

CaliforniaStateUniversityDominguez
Hills
Carson,CA

ClaytonStateUniversity
Morro,GA

CaliforniaStateUniversityEastBay
Hayward,CA
CaliforniaStateUniversityFullerton
Fullerton,CA
CaliforniaStateUniversityLongBeach
LongBeach,CA
CaliforniaStateUniversityLosAngeles
LosAngeles,CA
CaliforniaStateUniversitySan
Bernardino
SanBernardino,CA
CaliforniaStateUniversitySanMarcos
SanMarcos,CA
CaliforniaStateUniversityStanislaus
Turlock,CA
CapitalUniversity
Columbus,OH
CarlowUniversity
Pittsburgh,PA
CarsonNewmanCollege
JeffersonCity,TN
CedarCrestCollege
Allentown,PA

ClemsonUniversity
Clemson,SC
CoeCollege
CedarRapids,IA
ColbySawyerCollege
NewLondon,NH
CollegeofSaintCatherine
St.Paul,MN
CreightonUniversity
Omaha,,NE
CumberlandUniversity
Lebanon,TN
CurryCollege
Milton,MA
DrexelUniversity
Philadelphia,PA
DukeUniversity
Durham,NC
DuquesneUniversity
Pittsburgh,PA
EastCarolinaUniversity
Greenville,NC
EastTennesseeStateUniversity
JohnsonCity,TN

CentralConnecticutStateUniversity
NewBritain,CT

50

EasternIllinoisUniversity
Charleston,IL

FloridaInternationalUniversity
Miami,FL

EasternKentuckyUniversity
Richmond,KY

FloridaSouthernCollege
Lakeland,FL

EasternMennoniteUniversity
Harrisonburg,VA

FortHaysStateUniversity
Hays,KS

EasternMichiganUniversity
Ypsilanti,MI

FrancisMarionUniversity
Florence,SC

ElmhurstCollege
Elmhurst,IL

GeorgeMasonUniversity
Fairfax,VA

ElmsCollege
Chicopee,MA

GeorgetownUniversity
Washington,DC

EmmanuelCollege
Boston,MA

GeorgiaCollege&StateUniversity
Milledgeville,GA

EmoryUniversity
Atlanta,GA

GeorgiaSouthernUniversity
Statesboro,GA

ExcelsiorCollege
Albany,NY

GeorgiaStateUniversity
Atlanta,GA

FairfieldUniversity
Fairfield,CT

GonzagaUniversity
Spokane,WA

FairleighDickinsonUniversity
Teaneck,NJ

GovernorsStateUniversity
UniversityPark,IL

FairmontStateUniversity
Fairmont,WV

GrandValleyStateUniversity
GrandRapids,MI

FelicianCollege
Lodi,NJ

GrandViewCollege
DesMoines,IA

FloridaA&MUniversity
Tallahassee,FL

HopeCollege
Holland,MI

FloridaAtlanticUniversity
BocaRaton,FL

HunterCollegeofCUNY
NewYork,NY

51

HuntingtonUniversity
Huntington,IN

KennesawStateUniversity
Kennesaw,GA

HussonCollege
Bangor,ME

KeukaCollege
KeukaPark,NY

IdahoStateUniversity
Pocatello,ID

LakeviewCollegeofNursing
Danville,IL

IllinoisWesleyanUniversity
Bloomington,IL

LamarUniversity
Beaumont,TX

IndianaUniversityBloomington
Bloomington,IL

LeMoyneCollege
Syracuse,NY

IndianaUniversityNorthwest
Gary,IN

LinfieldCollege
Portland,OR

IndianaUniversitySouthBend
SouthBend,IN

LomaLindaUniversity
LomaLinda,CA

IndianaUniversitySoutheast
NewAlbany,IN

LouisianaCollege
Pineville,LA

IndianaWesleyanUniversity
Marion,IN

LouisianaStateUniversityHealth
SciencesCtr
NewOrleans,LA

JacksonvilleStateUniversity
Jacksonville,AL
JacksonvilleUniversity
Jacksonville,FL
JamesMadisonUniversity
Harrisonburg,VA
JohnsHopkinsUniversity
Baltimore,MD
KaplanUniversity
Chicago,IL
KeanUniversity
Union,NJ

LourdesCollege
Sylvania,OH
LutherCollege
Decorah,IA
LycomingCollege
Williamsport,PA
LynchburgCollege
Lynchburg,VA
MaconStateCollege
Macon,GA
MadonnaUniversity
Livonia,MI

52

MartinMethodistCollege
Pulaski,TN

MinnesotaStateUniversityMankato
Mankato,MN

MaryvilleUniversitySaintLouis
St.Louis,MO

MississippiCollege
Clinton,MS

MassachusettsCollegeofPharmacyand
AlliedHealthSciences
Boston,MA

MississippiUniversityforWomen
Columbus,MS

McKendreeCollege
Lebanon,IL
McNeeseStateUniversity
LakeCharles,LA
MedcenterOneCollegeofNursing
Bismarck,ND
MedCentralCollegeofNursing
Mansfield,OH
MedicalCollegeofGeorgia
Augusta,GA
MedicalUniversityofSouthCarolina
Charleston,SC
MercyCollege
DobbsFerry,NY
MetropolitanStateUniversity
St.Paul,MN
MGHInstituteofHealthProfessions
Boston,MA
MichiganStateUniversity
EastLansing,MI
MilwaukeeSchoolofEngineering
Milwaukee,WI
MinnesotaIntercollegiateNursing
Consortium
Northfield,MN

MissouriWesternStateUniversity
St.Joseph,MO
MontanaStateUniversityBozeman
Bozeman,MT
MoravianCollege
Bethlehem,PA
MountCarmelCollegeofNursing
Columbus,OH
MountMercyCollege
CedarRapids,IA
MountSaintMary'sCollege
LosAngeles,Ca
MuskingumCollege
NewConcord,OH
NationalUniversity
LaJolla,CA
NeumannCollege
Aston,PA
NewJerseyCityUniversity
JerseyCity,NJ
NewMexicoHighlandsUniversity
LasVegas,NM
NewYorkUniversity
NewYork,NY

53

NichollsStateUniversity
Thibodaux,LA

PointLomaNazareneUniversity
SanDiego,CA

NorthParkUniversity
Chicago,IL

PurdueUniversity
WestLafayette,IN

NortheasternUniversity
Boston,Mass.

QueensUniversityofCharlotte
Charlotte,NC

NorthernArizonaUniversity
Flagstaff,AZ

ResearchCollegeofNursing
KansasCity.MO

NorthernIllinoisUniversity
DeKalb,IL

RegisCollege
Weston,MA

NorthwestUniversity
Kirkland,WA

RhodeIslandCollege
Providence,RI

NotreDameCollege
SouthEuclid,OH

RivierCollege
Nashua,NH

OaklandUniversity
Rochester,MI

RobertMorrisUniversity
MoonTownship,PA

OldDominionUniversity
Norfolk,VA

Rutgers,TheStateUniversityofNew
Jersey
Camden,NJ

OregonHealthandScienceUniversity
Portland,OR
OtterbeinCollege
Westerville,OH
PaceUniversity
NewYork,NY
PattyHanksSheltonSchoolofNursing
Abilene,TX
PiedmontCollege
Demorest,GA
PlattCollege
Aurora,Co

SacredHeartUniversity
Fairfield,CT
SaginawValleyStateUniversity
UniversityCenter,MI
SaintAmbroseUniversity
Davenport,IA
SaintAnselmCollege
Manchester,NH
SaintAnthonyCollegeofNursing
Rockford,IL
SaintFrancisMedicalCenterCollegeof
Nursing
Peoria,IL

54

SaintJohnFisherCollege
Rochester,NY

SouthernIllinoisUniversity
Edwardsville
Edwardsville,IL

SaintJoseph'sCollegeofMaine
Standish,ME

SouthernNazareneUniversity
Bethany,OK

SaintLouisUniversity
SaintLouis,MO

SouthernUtahUniversity
CedarCity,UT

SaintLuke'sCollegeofNursing
KansasCity,MO

StonyBrookUniversity
StonyBrook,NY

SaintXavierUniversity
Chicago,IL

SUNYDownstateMedicalCenter
Brooklyn,NY

SamfordUniversity
Birmingham,AL

SUNYInstituteofTechnologyat
Utica/Rome
Utica,NY

SamuelMerrittCollege
Oakland,CA
SanDiegoStateUniversity
SanDiego,CA
SanFranciscoStateUniversity
SanFrancisco,CA
SeattlePacificUniversity
Seattle,WA
SeattleUniversity
Seattle,WA
ShenandoahUniversity
Winchester,VA
SimmonsCollege
Boston,MA
SouthDakotaStateUniversity
Brookings,SD
SoutheastMissouriStateUniversity
CapeGirardeau,MO

SUNYPlattsburgh
Plattsburgh,NY
SUNYUpstateMedicalUniversity
Syracuse,NY
TempleUniversity
Philadelphia,PA
TennesseeTechnologicalUniversity
Cookeville,TN
TennesseeWesleyanCollege
Knoxville,TN
TexasA&MHealthScienceCenter
CollegeStation,TX
TexasA&MUniversityCorpusChristi
CorpusChristi,TX
TexasChristianUniversity
FortWorth,TX
TexasTechUniversityHealthSciences
Center

55

Lubbock,TX
TexasWoman'sUniversity
Denton,TX

UniversityofAlabamaatBirmingham
Birmingham,AL
UniversityofAlabamainHuntsville
Huntsville,AL

TheCatholicUniversityofAmerica
Washington,DC

UniversityofAlaskaAnchorage
Anchorage,AK

TheCollegeofSt.Scholastica
Duluth,MN

UniversityofArizona
Tuscon,AZ

TheOhioStateUniversity
Columbus,OH

UniversityofArkansasforMedical
Sciences
LittleRock,AR

TheSageColleges
Troy,NY
TheUniversityofAlabama
Tuscaloosa,AL
TheUniversityofAlabamainHuntsville
Huntsville,AL
TheUniversityofLouisianaatLafayette
Lafayette,LA
TheUniversityofLouisianaatMonroe
Monroe,LA
TheUniversityofNorthCarolina
ChapelHill
ChapelHill,NC
ThomasJeffersonUniversity
Philadelphia,PA
TouroUniversity
Henderson,NV
TuskegeeUniversity
Tuskegee,AL
UniversityatBuffalo
Buffalo,NY

UniversityofArkansasFayetteville
Fayetteville,AR
UniversityofCaliforniaDavis
Davis,CA
UniversityofCaliforniaLosAngeles
LosAngeles,CA
UniversityofCentralArkansas
Conway,AR
UniversityofCincinnati
Cincinnati,OH
UniversityofColoradoatColorado
Springs
ColoradoSprings,CO
UniversityofColoradoDenver
Aurora,CO
UniversityofConnecticut
Storrs,CT
UniversityofDelaware
Newark,DE
UniversityofDetroitMercy
Detroit,MI

56

UniversityofFlorida
Gainesville,FL
UniversityofHawaiiatManoa
Honolulu,HI

UniversityofMississippiMedical
Center
Jackson,MS

UniversityofIllinoisatChicago
Chicago,IL

UniversityofMissouriColumbia
Columbia,MO
UniversityofMissouriKansasCity
KansasCity,MO

UniversityofIowa
IowaCity,IA

UniversityofMissouriSaintLouis
St.Louis,MO

UniversityofKansas
KansasCity,KS

UniversityofNevadaLasVegas
LasVegas,NV

UniversityofLouisianaatMonroe
Monroe,LA

UniversityofNevadaReno
Reno,NV

UniversityofLouisville
Louisville,KY

UniversityofNewHampshire
Durham,NH

UniversityofMary
Bismark,ND

UniversityofNewMexico
Albuquerque,NM

UniversityofMaryland
Baltimore,MD

UniversityofNorthCarolinaat
Greensboro
Greensboro,NC

UniversityofMassachusettsAmherst
Amherst,MA
UniversityofMassachusettsLowell
Lowell,MA

UniversityofNorthCarolinaCharlotte
Charlotte,NC
UniversityofNorthDakota
GrandForks,ND

UniversityofMedicine&Dentistryof
NewJersey
Newark,NJ

UniversityofNorthFlorida
Jacksonville,FL

UniversityofMemphis
Memphis,TN

UniversityofNorthernColorado
Greeley,CO

UniversityofMichigan
AnnArbor,MI

UniversityofOklahoma
OklahomaCity,OK

UniversityofMinnesota
Minneapolis,MN

UniversityofPennsylvania
Philadelphia,PA

57

UniversityofPhoenix
Phoenix,AZ

Knoxville,TN

UniversityofPittsburgh
Pittsburgh,PA

UniversityofTennesseeHealthScience
Center
Memphis,TN

UniversityofPortland
Portland,OR

UniversityofTennesseeChattanooga
Chattanooga,TN

UniversityofRhodeIsland
Kingston,RI

UniversityofTexasHealthScience
Center Houston
Houston,TX

UniversityofSaintFrancisIndiana
FortWayne,IN
UniversityofSaintMary
Leavenworth,KS
UniversityofSanDiego
SanDiego,CA
UniversityofSanFrancisco
SanFrancisco,CA
UniversityofSouthAlabama
Mobile,AL
UniversityofSouthCarolina
Columbia,SC
UniversityofSouthCarolinaAiken
Aiken,SC
UniversityofSouth CarolinaUpstate
Spartanburg,SC
UniversityofSouthernMaine
Portland,ME
UniversityofSouthernMississippi
Hattiesburg,MS
UniversityofSt.FrancisIllinois
Joliet,IL
UniversityofTennesseeKnoxville

UniversityofTexasHealthScience
CenterSanAntonio
SanAntonio,TX
UniversityofTexasElPaso
ElPaso,TX
UniversityofTexasTyler
Tyler,TX
UniversityoftheIncarnateWord
SanAntonio,TX
UniversityofToledo
Toledo,OH
UniversityofUtah
SaltLakeCity,UT
UniversityofVermont
Burlington,VT
UniversityofVirginia
Charlottesville,VA
University ofWestGeorgia
Carrollton,GA
UniversityofWisconsinEauClaire
EauClaire,WI
UniversityofWisconsinGreenBay
GreenBay,WI

58

WestChester,PA
UniversityofWisconsinMilwaukee
Milwaukee,WI

WestTexasA&MUniversity
Canyon,TX

UniversityofWisconsinOshkosh
Oshkosh,WI

WestVirginiaUniversity
Morgantown,WV

UniversityofWyoming
Laramie,WY

WesternCarolinaUniversity
Cullowhee,NC

UpperIowaUniversity
Fayette,IA

WesternKentuckyUniversity
BowlingGreen,KY

UrsulineCollege
PepperPike,OH

WesternMichiganUniversity
Kalamazoo,MI

UticaCollege
Utica,NY

WichitaStateUniversity
Wichita,KS

ValdostaStateUniversity
Valdosta,GA

WidenerUniversity
Chester,PA

ValparaisoUniversity
Valparaiso,IN

WilkesUniversity
WilkesBarre,PA

VanguardUniversityofSouthern
California
CostaMesa,CA

WilliamCareyUniversity
Hattiesburg,MS

VillaJulieCollege
Stevenson,MD
WagnerCollege
StatenIsland,NY
WashburnUniversity
Topeka,KS
WashingtonStateUniversity
Spokane,WA
WaynesburgUniversity
Waynesburg,PA
WestChesterUniversity

WilliamJewellCollege
Liberty,MO
WilliamPatersonUniversity
Wayne,NJ
WilmingtonUniversity
NewCastle,DE
WinstonSalemStateUniversity
WinstonSalem,NC
WisconsinLutheranCollege
Milwaukee,WI
WrightStateUniversity
Dayton,OH

59

XavierUniversity
Cincinnati,OH

YorkCollegeofPennsylvania
York,PA

YaleUniversity
NewHaven,CT

APPENDIXE
ProfessionalOrganizationsthatParticipatedintheRegionalMeetings(N=11)
AmericanHolisticNursesAssociation
Flagstaff,Arizona
AmericanNursesAssociation
SilverSpring,MD
AssociationofCommunityHealthNursingEducators
WheatRidge,CO
AssociationofPerioperativeRegisteredNurses
Denver,CO
AssociationofRehabilitationNurses
Glenview,IL
CommissiononGraduatesofForeignNursingSchoolsInternational
Philadelphia,PA
InternationalSocietyofNursesinGenetics
Pittsburgh,PA
KentuckyBoardofNursing
Louisville,KY
MinnesotaBoardofNursing
Minneapolis,MN
NationalCouncilofStateBoardsofNursing
Chicago,IL
NationalLeagueforNursing
NewYork,NY
OncologyNursingSociety
Pittsburgh,PA

60

SocietyofPediatricNurses
Pensacola,FL
APPENDIXF
HealthcareSystemsthatParticipatedintheRegionalMeetings(N=13)
AdvocateChristMedicalCenter
OakLawn,IL
BaptistMemorialHealthCareCorporation
Memphis,TN
BaptistMemorialHealthCareCorporationDeSoto
Southaven,MS
BonSecoursHamptonRoadsHealthSystem
Norfolk,VA
Children'sHealthcareofAtlanta
Atlanta,GA
DartmouthHitchcockMedicalCenter
Lebanon,NH
HospitalCorporationofAmerica
Nashville,TN
INOVAHealthSystems
FallsChurch,VA
Ovations/Evercare
Minnetonka,MN
SoutheastHealthDistrict
Waycross,GA
St.Mary'sHospital
Passaic,NJ
UPMCSt.Margaret's
Pittsburgh,PA
MiriamHospital
Providence,RI

61

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