🔥🔥🔥 Work Contentment In Nursing

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Work Contentment In Nursing

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Proper Patient Care - Communication Techniques

Concern regarding competency with quality and safety extends beyond nursing. The Lucian Leape Institute issued a report in that was highly critical of the lack of quality and safety content and experience in medical student and residency programs. Prevention and management of potential never events in ambulatory settings requires competencies in all six of the areas specified in QSEN. It is expected that providers, nurses, physicians, and other health care professionals will use best evidence-based practices in the provision of care and that they will track evidence-based processes and outcomes achieved.

Tracking is where informatics comes into play. The Accountable Care law provides funding for equipment to support the EHR, especially in primary care practice. It is the expectation that the EHR will enhance communication within the health care team and across settings and decrease errors and costs due to duplication of testing, lost test results, etc. The EHR is also key to tracking evidence-based processes of care and outcomes. In addition to falls and pressure ulcers discussed as potential never events in ambulatory care in our last ViewPoint issue, surgical or invasive procedure events and product or devise events in ambulatory care are also of concern.

The Joint Commission requires use of the Universal Protocol in all accredited hospitals, ambulatory care, and office-based surgical practices to prevent such events and there is evidence that can be employed in EBP protocols to prevent adverse surgical or device events. So where do ambulatory nurse leaders start? It is designed to assist in both nursing student and staff education, as well as education of the educator. You can search for teaching strategies by indicating which QSEN competency you want to work on, your learning setting, learner level, and strategy type such as simulation. These interactive modules were funded by a grant from the National Institutes of Health. Such a plan starts with developing an understanding among leadership and nurses and an appreciation of the issue of never events, methods to identify potential for them in ambulatory care settings, methods to develop or enhance understanding and comfort with development of EBP protocols suited to the ambulatory care setting, and knowledge and skills with use of documentation formats in EHR to track EBP processes and outcomes.

Such a project may seem overwhelming, but leaders need to look at one potential never event at a time. For example, look at historical data on falls or operating room errors so you can see where you should start. Begin with work on the event that has the highest incidence and the one that will have the greatest costs, both in poor patient outcomes as well as financial, should it occur and thus the greatest return on investments that will be made in EBP and the EHR. Much of the cost is related to education time for staff as well as development time needed for work on EBP protocols and EHR documentation formats. While there are financial incentives to EBP and the use of EHR, there is a greater incentive that ambulatory nurses will respond to — providing higher quality and safer care to their patients.

References Cronenwett, L. It is no surprise that educational costs and living expenses play a major role in determining which degree is pursued and the numbers of nurses who seek advanced degrees. To better understand the costs of nursing education, the committee asked the Robert Wood Johnson Foundation RWJF Nursing Research Network to estimate the various costs associated with pursuing nursing education, specifically at the advanced practice level, in comparison with those for a medical doctor MD or doctor of osteopathy DO.

An area of particular difficulty arose in assessing costs associated with obtaining an ADN degree. In most non—health care disciplines, the associates degree takes 2 years to complete. In nursing, however, surveys have found that it takes students 3 to 4 years to complete an ADN program because of the need to fulfill prerequisites necessary to prepare students for entry into degree programs and the lack of adequate faculty, which lead to long waiting lists for many programs and classes Orsolini-Hain, Box illustrates the challenges of this task by outlining the difficulty of comparing the cost of becoming a physician with the cost of becoming an APRN. In the end, the committee decided not to include detailed discussion of the costs of nursing education in this report.

Costs of Health Professional Education. Depending on the method used, the number of advanced practice registered nurses APRNs that can be trained for the cost of training 1 physician is between 3 and Assessing the costs of education is a multidimensional more The qualifications and level of education required for entry into the nursing profession have been widely debated by nurses, nursing organizations, academics, and a host of other stakeholders for more than 40 years NLN, The causal relationship between the academic degree obtained by RNs and patient outcomes is not conclusive in the research literature. However, several studies support a significant association between the educational level of RNs and outcomes for patients in the acute care setting, including mortality rates Aiken et al.

Other studies argue that clinical experience, qualifications before entering a nursing program e. One study found that the level of experience of nurses was more important than their education level in mitigating medication errors in hospitals Blegen et al. Another study performed within the Department of Veterans Affairs VA system found no significant association between the proportion of RNs with a baccalaureate degree and patient outcomes at the hospital level Sales et al. This debate aside, an all-BSN workforce at the entry level would provide a more uniform foundation for the reconceptualized roles for nurses and new models of care that are envisioned in Chapters 1 and 2.

Although a BSN education is not a panacea for all that is expected of nurses in the future, it does, relative to other educational pathways, introduce students to a wider range of competencies in such arenas as health policy and health care financing, leadership, quality improvement, and systems thinking. One study found that new BSN graduates reported significantly higher levels of preparation in evidence-based practice, research skills, and assessment of gaps in areas such as teamwork, collaboration, and practice Kovner et al.

Care within the hospital setting continues to grow more complex, and nurses must make critical decisions associated with care for sicker, frailer patients. Care in this setting depends on sophisticated, life-saving technology coupled with complex information management systems that require skills in analysis and synthesis. Care outside the hospital is becoming more complex as well. Nurses are being called upon to coordinate care among a variety of clinicians and community agencies; to help patients manage chronic illnesses, thereby preventing acute care episodes and disease progression; and to use a variety of technological tools to improve the quality and effectiveness of care.

A more educated nursing workforce would be better equipped to meet these demands. Shortages of nurses in these positions continue to be a barrier to advancing the profession and improving the delivery of care to patients. Some health care organizations in the United States are already leading the way by requiring more BSN-prepared nurses for entry-level positions. Depending on the type of hospital, the goal for the proportion of BSN-prepared nurses varies; for example, teaching hospitals aim for 90 percent, whereas community hospitals seek at least 50 percent Goode et al.

Absent a nursing shortage, then, nurses holding a baccalaureate degree are usually the preferred new-graduate hires in acute care settings Cronenwett, Likewise, in a recent survey of physician members of Sermo. Seventy percent of the physicians surveyed also either strongly or somewhat agreed that all nurses who provide care in a hospital should hold a BSN, although when asked about the characteristics they most value in nurses they work with, the physicians placed a significantly higher value on compassion, efficiency, and experience than on years of nursing education and caliber of nursing school RWJF, c.

In community and public health settings, the BSN has long been the preferred minimum requirement for nurses, given the competencies, knowledge of community-based interventions, and skills that are needed in these settings ACHNE, ; ASTDN, The U. Public Health Service has the same requirement for its Commissioned Officers. As Table shows, however, the average earnings of BSN-prepared nurses are not substantially higher than those of ADN- or diploma-prepared nurses.

Almost 15 years ago, the National Advisory Council on Nurse Education and Practice, which advises Congress and the secretary of Health and Human Services on areas relevant to nursing, called for the development of policy actions that would ensure a minimum of 66 percent of RNs who work as nurses would have a BSN or higher degree by Aiken et al. In sum, an increase in the percentage of nurses with a BSN is imperative as the scope of what the public needs from nurses grows, expectations surrounding quality heighten, and the settings where nurses are needed proliferate and become more complex.

The formal education associated with obtaining the BSN is desirable for a variety of reasons, including ensuring that the next generation of nurses will master more than basic knowledge of patient care, providing a stronger foundation for the expansion of nursing science, and imparting the tools nurses need to be effective change agents and to adapt to evolving models of care. Moreover, even as the breadth and depth of content increase within prelicensure curricula, the caring essence and human connectedness nurses bring to patient care must be preserved.

Nurses need to continue to provide holistic, patient-centered care that goes beyond physical health needs to recognize and respond to the social, mental, and spiritual needs of patients and their families. Other fundamental elements of nursing education, such as ethics and integrity, need to remain intact as well. Setting a goal of increasing the percentage to 80 percent by is, however, bold, achievable, and necessary to move the nursing workforce to an expanded set of competencies, especially in the domains of community and public health, leadership, systems improvement and change, research, and health policy. The committee believes achieving the goal of 80 percent of the nursing workforce having a BSN is possible in part because much of the educational capacity needed to meet this goal exists.

The combination of these options and others yet to be developed will be needed to meet the 80 percent goal—no one strategy will provide a universal solution. Technologies, such as the use of simulation and distance learning through online courses, will have to play a key role as well. Above all, what is needed to achieve this goal is the will of nurses to return to higher education, support from nursing employers and others to help fund nursing education, the elevation of educational standards, an education system that recognizes the experience and previous learning of returning students, and regional collaboratives of schools of nursing and employers to share financial and human resources.

While there are challenges associated with shortages of nurse faculty and clinical education sites discussed below , these challenges are less problematic for licensed RNs pursuing a BSN than for prelicensure students, who require more intense oversight and monitoring by faculty. Additionally, most of what ADN-prepared nurses need to move on to a baccalaureate degree can be taught in a classroom or online, with additional tailored clinical experience. Online education creates flexibility and provides an additional skill set to students who will use technology into the future to retrieve and manage information. Over the course of its deliberations and during the forum on education held in Houston, the committee learned about several pathways that are available to achieve the goal of 80 percent of the nursing workforce having a BSN additional innovations discussed at the forum on education can be found in the forum summary on the CD-ROM in the back of this report.

Many hospitals also have joint arrangements with local universities and colleges to offer onsite classes. Hospitals generally provide stipends to employees as an incentive to continue their education. Online education programs make courses available to all students regardless of where they live. For prospective nursing students, there are traditional 4-year BSN programs at a university, but there are also community colleges now offering 4-year baccalaureate degrees in some states see the next section. Educational collaboratives between universities and community colleges, such as the Oregon Consortium for Nursing Education described in Box , allow for automatic and seamless transition from an ADN to a BSN program, with all schools sharing curriculum, simulation facilities, and faculty.

As described below, this type of model is goes beyond the conventional articulation agreement between community colleges and universities. These programs are offering new models and alternatives for delivering curriculum and reaching RNs and prospective students, although each of these schools should be evaluated for its ability to meet nursing accreditation standards, including the provision of clinical experiences required to advance the profession. The ADN-to-MSN program, in particular, is establishing a significant pathway to advanced practice and faculty positions, especially at the community college level. Financial support to help build capacity for these programs will be important, including funding for grants and scholarships for nurses wishing to pursue these pathways.

By the same token, the committee believes that diploma programs should be phased out over the next 10 years and should consolidate their resources with those of community college or preferably university programs offering the baccalaureate degree. Additionally, there are federal resources currently being used to support diploma schools that could better be used to expand baccalaureate and higher education programs. The committee anticipates that it will take a few years to build the educational capacity needed to achieve the goal of 80 percent of the nursing workforce being BSN-prepared by , but also emphasizes that existing BSN completion programs have capacity that is far from exhausted.

Regional networks of schools working together, along with health care organizations, may best facilitate reaching this goal. Moreover, the committee believes this clearly defined goal will stimulate stakeholders to take action. Community colleges play a key role in attracting students to the nursing education pipeline. Community colleges have an important role to play in ensuring that more BSN-prepared nurses are available in all regions of the United States and that nursing education at the associate level is high quality and affordable and prepares ADN nurses to move on to higher levels of education. This suggests that state and community investments in nursing education e. Community colleges are the predominant educational institutions in rural and medically underserved areas.

Therefore, they must either join educational collaboratives or develop innovative and easily accessible programs that seamlessly connect students to schools offering the BSN and higher degrees, or they must develop their own BSN programs if feasible within state laws and regulations. Community colleges must foster a culture that promotes and values academic progression and should encourage their students to continue their education through strategies that include making them aware of the full range of educational pathways and opportunities available to them e.

Box describes a community college in Florida where nursing students can take advantage of lower costs and online classes to receive a BSN degree. The College of Nursing at St. Although the committee believes the capacity needed to ensure a nursing workforce that is 80 percent BSN-prepared by can be attained using the approaches outlined above, getting there will not be easy. Nursing schools across the United States collectively turn away tens of thousands of qualified applicants each year because of a lack of capacity Kovner and Djukic, —a situation that makes filling projected needs for more and different types of nurses difficult.

This final root cause—inadequate workforce planning—affects all levels of nursing education and is the subject of Chapter 6. There are not enough nursing faculty to teach the current number of nursing students, let alone the number of qualified applicants who wish to pursue nursing. The same forces that are leading to deficits in the numbers and competencies of bedside nurses affect the capacity of nursing faculty as well Allan and Aldebron, According to a survey by the NLN, 84 percent of U.

Age is also a contributing factor to faculty shortages. Nursing faculty tend to be older than clinical nurses because they must meet requirements for an advanced degree in order to teach. Figure shows that the average age of nurses who work as faculty as their principal nursing position—the position in which a nurse spends the majority of his or her working hours 6 —is 50 to By contrast, the median age of the total RN workforce is More than 19 percent of RNs whose principal position is faculty are aged 60 or older, while only 8. Nurses who work as faculty as their secondary position tend to be younger; among nurses under age 50, more work as faculty as their secondary than as their principal position HRSA, b.

Moreover, the average retirement age for nursing faculty is Given the landscape of the health care system and the fragmented nursing education system, the current pipeline cannot easily replenish this loss, let alone meet the potential demand for more educators. In addition to the innovative strategies of the Veterans Affairs Nursing Academy VANA and Gulf Coast Health Services Steering Committee for responding to faculty shortages discussed later in this chapter , a potential opportunity to relieve faculty shortages could involve the creation of programs that would allow MSN, DNP, and PhD students to teach as nursing faculty interns, with mentoring by full-time faculty.

Box presents a nurse profile of one assistant professor and her experience moving into an academic career. Age distribution of nurses who work as faculty. Nurse Profile: Jennifer Wenzel. Figure gives an overview of the highest educational degree obtained by women and men who hold the RN license. It includes RNs who are working as nurses and those who have retired, have changed professions, or are no longer working. According to an analysis by Aiken and colleagues , nurses whose initial degree is the ADN are just as likely as BSN-prepared nurses to seek another degree. A separate analysis of North Carolina nurses led to a similar conclusion Bevill et al.

Table shows the length of time it takes those nurses who do move on to higher levels of education to progress from completing initial nursing education to completing the highest nursing degree achieved. Distribution of the registered nurse population by highest nursing or nursing-related educational preparation, — NOTES: The totals in each bar may not equal the estimated numbers for RNs in each survey year because of incomplete information more Salary disparities Another factor that contributes to the current nursing faculty shortage is salary disparities between nurses working in education and those working in clinical service Gilliss, Projections of future faculty demand To establish a better understanding of future needs, the committee asked the RWJF Nursing Research Network to proj ect faculty demand for the next 15 years.

This projection is based on historical nurse faculty retirement rates and on graduation trends in research-focused nursing PhD programs. Additionally, the faculty supply may be affected positively by growing numbers of graduates with a DNP degree discussed later in this chapter who, as noted above, may be eligible for faculty positions in some academic institutions. As nursing education has moved out of hospital-based programs and into mainstream colleges and universities, integrating opportunities for clinical experience into coursework has become more difficult Cronenwett, Nursing leaders continue to confront challenges associated with the separation of the academic and practice worlds in ensuring that nursing students develop the competencies required to enter the workforce and function effectively in health care settings Cronenwett and Redman, ; Fagin, While efforts are being made to expand placements in the community and more care is being delivered in community settings, the bulk of clinical education for students still occurs in acute care settings.

The required number of clinical hours varies widely from one program to another, and most state boards of nursing do not specify a minimum number of clinical hours in prelicensure programs NCSBN, It is likely, moreover, that many of the clinical hours fail to result in productive learning. Students spend much of their clinical time performing routine care tasks repeatedly, which may not contribute significantly to increased learning. Faculty report spending most of their time supervising students in hands-on procedures, leaving little time focused on fostering the development of clinical reasoning skills McNelis and Ironside, Some advances in clinical education have been made through strong academic—service partnerships.

An example of such partnerships in community settings is nurse-managed health centers discussed in Chapter 3 , which serve a dual role as safety net practices and clinical education sites. Another, commonly used model is having skilled and experienced practitioners in the field oversee student clinical experiences. According to a recent integrative review, using these skilled practitioners, called preceptors, in a clinical setting is at least as effective as traditional approaches while conserving scarce faculty resources Udlis, A variety of other clinical partnerships have been designed to increase capacity in the face of nursing faculty shortages Baxter, ; DeLunas and Rooda, ; Kowalski et al.

In addition to academic—service partnerships and preceptor models, the use of high-fidelity simulation offers a potential solution to the problem of limited opportunities for clinical experience, with early studies suggesting the effectiveness of this approach Harder, To establish uniform guidelines for educators, accreditation requirements should be evaluated and revised to allow simulation to fulfill the requirement for a standard number of clinical hours.

The use of simulation in relationship to the promotion of interprofessional education is discussed below. Increased attention is being focused on the dedicated education unit DEU as a viable alternative for expanding clinical education capacity Moscato et al. In this model, health care units are dedicated to the instruction of students from one program. Staff nurses who want to serve as clinical instructors are prepared to do so, and faculty expertise is used to support their development and comfort in this role.

Since then, the University of Portland has helped at least a dozen other U. Early results suggest the DEU can dramatically increase capacity and have a positive effect on satisfaction among students and nursing staff. DEUs offer benefits for the nursing schools, the hospitals, the faculty, and the students. Because the hospital employs the clinical instructors, the nursing school can increase its enrollment without increasing costs. The hospital benefits by training students it can hire after their graduation and licensure.

Students benefit by having consistent clinical instructors each day, something not guaranteed under the traditional preceptorship model. As the case study in Box shows, the benefits of DEUs extend beyond the academic environment to the practice setting as well. A look at the way nursing students are educated at the prelicensure level 11 shows that most schools are not providing enough nurses with the required competencies in such areas as geriatrics and culturally relevant care to meet the changing health needs of the U. The majority of nursing schools still educate students primarily for acute care rather than community settings, including public health and long-term care.

Most curricula are organized around traditional medical specialties e. The intricacies of care coordination are not adequately addressed in most prelicensure programs. Nursing students may gain exposure to leading health care disciplines and know something about basic health policy and available health and social service programs, such as Medicaid.

Nursing curricula need to be reexamined and updated. They need to be adaptive enough to undergo continuous evaluation and improvement based on new evidence and a changing science base, changes and advances in technology, and changes in the needs of patients and the health care system. Many nursing schools have dealt with the rapid growth of health research and knowledge by adding layers of content that require more instruction Ironside, For example, new competencies have been promulgated to address quality and patient safety goals Cronenwett et al. Greater emphasis on prevention, wellness, and improved health outcomes has led to new competency requirements as well Allan et al. These models, many of which could be focused in alternative settings such as schools and workplaces, will create new student placement options that will need to be tested for scalability and compared for effectiveness with more traditional care settings.

See also the discussion of competencies later in the chapter. The explosion of knowledge and decision-science technology also is changing the way health professionals access, process, and use information. No longer is rote memorization an option. There simply are not enough hours in the day or years in an undergraduate program to continue compressing all available information into the curriculum. New approaches must be developed for evaluating curricula and presenting fundamental concepts that can be applied in many different situations rather than requiring students to memorize different lists of facts and information for each situation. Just as curricula must be assessed and rethought, so, too, must teaching—learning strategies.

Most nurse faculty initially learned to be nurses through highly structured curricula that were laden with content NLN Board of Governors, , and too few have received advanced formal preparation in curriculum development, instructional design, or performance assessment. Faculty, tending to teach as they were taught, focus on covering content Benner et al. They also see curriculum-related requirements as a barrier to the creation of learning environments that are both engaging and student-centered Schaefer and Zygmont, ; Tanner, Even absent passage of the ACA, the need for APRNs, nurse faculty, and nurse researchers would have increased dramatically under any scenario Cronenwett, Not only must schools of nursing build their capacity to prepare more students at the graduate level, but they must do so in a way that fosters a unified, competency-based approach with the highest possible standards.

Therefore, building the science of nursing education research, or how best to teach students, is an important emphasis for the field of nursing education. For APRNs, graduate education should ensure that they can contribute to primary care and help respond to shortages, especially for those populations who are most underserved. For nurse researchers, a focus on fundamental improvements in the delivery of nursing care to improve patient safety and quality is key. A PhD in nursing is a research-oriented degree designed to educate nurses in a wide range of scientific areas that may include clinical science, social science, policy, and education. Traditionally, PhD-educated nurses teach in university settings and conduct research to expand knowledge and improve care, although they can also work in clinical settings and assume leadership and administrative roles in health care systems and academic settings.

The DNP is the complement to other practice doctorates, such as the MD, PharmD, doctorate of physical therapy, and others that require highly rigorous clinical training. Nurses with DNPs are clinical scholars who have the capacity to translate research, shape systems of care, potentiate individual care into care needed to serve populations, and ask the clinical questions that influence organizational-level research to improve performance using informatics and quality improvement models. The DNP is a relatively new degree that offers nurses an opportunity to become practice scholars in such areas as clinical practice, leadership, quality improvement, and health policy. Schools of nursing have been developing DNP programs since , but only in the last 5 years have the numbers of graduates approached a substantial level Raines, Between and the number of programs offering the degree increased by nearly 40 percent, as is shown in Figure At this point, more evidence is needed to examine the impact DNP nurses will have on patient outcomes, costs, quality of care, and access in clinical settings.

It is also difficult to discern how DNP nurses could affect the provision of nursing education and whether they will play a significant role in easing faculty shortages. While the DNP provides a promising opportunity to advance the nursing profession, and some nursing organizations are promoting this degree as the next step for APRNs, the committee cannot comment directly on the potential role of DNP nurses because of the current lack of evidence on outcomes. Growth trends in different nursing programs. Although 13 percent of nurses hold a graduate degree, fewer than 1 percent 28, nurses have a doctoral degree in nursing or a nursing-related field, the qualification needed to conduct independent research HRSA, b.

In fact, only students graduated with a PhD in nursing in , a number that has remained constant for the past decade AACN, a. As noted, key roles for PhD nurses include teaching future generations of nurses and conducting research that becomes the basis for improvements in nursing practice. As the need for nursing education and research and for nurses to engage with interprofessional research teams has grown, the numbers of nurses with a PhD in nursing or a related field have not kept pace see Figure for trends in the various nursing programs. The main reasons for this lag are 1 an inadequate pool of nurses with advanced nursing degrees to draw upon, 2 faculty salaries and benefits that are not comparable to those of nurses with advanced nursing degrees working in clinical settings, and 3 a culture that promotes obtaining clinical experience prior to continuing graduate education.

To gain certification in one of these advanced practice areas, nurses must take specialized courses in addition to a basic core curriculum. Nurses who receive certification, including those serving in all advanced practice roles, provide added assurance to the public that they have acquired the specialized professional development, training, and competencies required to provide safe, quality care for specific patient populations. Certification is time-limited, and maintenance of certification requires ongoing acquisition of both knowledge and experience in practice. These requirements must be fulfilled within the 5 years preceding submission of the renewal application ANCC, b.

CRNAs are recertified every 2 years and must be substantially engaged in the practice of nurse anesthesia during those years, in addition to completing continuing education credits NBCRNA, As the health care system grows in complexity, expectations are that APRNs will have competence in expanding areas such as technology, genetics, quality improvement, and geriatrics. Coursework and clinical experience requirements are increasing to keep pace with these changes. As discussed above, DNP programs allow nurses to hone their expertise in roles related to nurse executive practice, health policy, informatics, and other practice specialties. Graduate-level education produces nurses who can assume roles in advanced practice, leadership, teaching, and research.

For the latter role, a doctoral degree is required, yet as noted above, fewer than 1 percent of nurses have achieved this level of education. This number is insufficient to meet the crucial need for research in two key areas: nursing education and nursing science. At no time in recent history has there been a greater need for research on nursing education. As health care reform progresses, basic and advanced nursing practices are being defined by the new competencies alluded to above and discussed in the next section, yet virtually no evidence exists to support the teaching approaches used in nursing education.

The paucity of evidence in nursing education and pedagogy calls for additional research and funding to ascertain the efficiency and effectiveness of approaches to nursing education, advancing evidence-based teaching and interprofessional knowledge. Chapter 7 outlines specific research priorities that could shape improvements to nursing education. The expansion of knowledge about the science of nursing is key to providing better patient care, improving health, and evaluating outcomes. Nurse scientists are a critical link in the discovery and translation of knowledge that can be generated by nurses and other health scientists. To carry out this crucial work, a sustainable supply of and support for nurse scientists will be necessary IOM, The research conducted by nurse scientists has led to many fundamental improvements in the provision of care.

Advances have been realized, for example, in the prevention of pressure ulcers; the reduction of high blood pressure among African American males; and the models described elsewhere in this report for providing transitional care after hospital discharge and for promoting health and well-being among young, disadvantaged mothers and their newborns. Evaluating these and other factors will be essential to achieving the transformation of the nursing profession that this report argues is essential to a transformed health care system. Competencies that are well known to the nursing profession, such as care management and coordination, patient education, public health intervention, and transitional care, are likely to dominate in a reformed health care system.

A review of medical school education found that evidence in favor of competency-based education is limited but growing Carraccio et al. Nursing schools also have embraced the notion of competency-based education, as noted earlier in the chapter in the case study on the Oregon Consortium for Nursing Education Box In addition, Western Governors University uses competency-based education exclusively, allowing nursing students to move through their program of study at their own pace.

Mastery of the competency is achieved to the satisfaction of the faculty without the normal time-bound semester structure IOM, The value of competency-based education in nursing is that it can be strongly linked to clinically based performance expectations. Numerous sets of core competencies for nursing education are available from a variety of sources. It has proven difficult to establish a single set of competencies that cover all clinical situations, across all settings, for all levels of students.

The competencies in these reports focus on aspects of professional behavior e. While students appear to gradu ate with ample factual knowledge of these types of core competencies, however, they often appear to have little sense of how the competencies can be applied or integrated into real-world practice situations Benner et al. Imparting emerging competencies, such as quality improvement and systems thinking, is also key to developing a more highly educated workforce.

Doing so will require performing a thorough evaluation and redesign of educational content, not just adding content to existing curricula. An exploration of the educational changes required to teach all the emerging competencies required to meet the needs of diverse patient populations is beyond the scope of this report. Defining an agreed-upon set of core competencies across health professions could lead to better communication and coordination among disciplines see the discussion of the Interprofessional Education Collaborative below for an example of one such effort. Additionally, the committee supports the development of a unified set of core competencies across the nursing profession and believes it would help provide direction for standards across nursing education.

Defining these core competencies must be a collaborative effort among nurse educators, professional organizations, and health care organizations and providers. This effort should be ongoing and should inform regular updates of nursing curricula to ensure that graduates at all levels are prepared to meet the current and future health needs of the population. Changes in the way competencies are assessed are also needed.

Steps are already being taken to establish competency-based assessments in medical education. The NCSBN has considered various challenges related to competency assessment and is considering approaches to ensure that RNs can demonstrate competence in the full range of areas that are required for the practice of nursing. A competency-based approach to education strives to make the competencies for a particular course explicit to students and requires them to demonstrate mastery of those competencies Harden, Performance-based assessment then shows whether students have both a theoretical grasp of what they have learned and the ability to apply that knowledge in a real-world or realistically simulated situation.

The transition-to-practice or nurse residency programs discussed in Chapter 3 could offer an extended opportunity to reinforce and test core competencies in real-world settings that are both safe and monitored. Many professions, such as nursing, that depend heavily on knowledge are becoming increasingly technical and complex The Lewin Group, No individual can know all there is to know about providing safe and effective care, which is why nurses must be integral members of teams that include other health professionals. Nor can a single initial degree provide a nurse with all she or he will need to know over an entire career.

Creating an expectation and culture of lifelong learning for nurses is therefore essential. Nurses, physicians, and other health professionals have long depended on continuing education programs to maintain and develop new competencies over the course of their careers. Likewise, the NCSBN has found that there is no clear link between continuing education requirements and continued competency. Therefore, building the capacity for lifelong learning—which encompasses both continuing competence and advanced degrees—requires ingenuity on the part of employers, businesses, schools, community and government leaders, and philanthropies.

The case study in Box describes a program that extends the careers of nurses by training them to transition from the acute care to the community setting. The importance of interprofessional collaboration and education has been recognized since the s Alberto and Herth, What is new is the introduction of simulation and web-based learning—solutions that can be used to can break down traditional barriers to learning together, such as the conflicting schedules of medical and APRN students or their lack of joint clinical learning opportunities. Simulation technology offers a safe environment in which to learn and make mistakes , while web-based learning makes schedule conflicts more manageable and content more repeatable.

If all nursing and medical students are educated in aspects of interprofessional collaboration, such as knowledge of professional roles and responsibilities, effective communication, conflict resolution, and shared decision making, and are exposed to working with other health professional students through simulation and web-based training, they may be more likely to engage in collaboration in future work settings. England, Canada, and the United States have made strides to improve interprofessional education by bringing students together from academic health science universities and medical centers e.

It is expected that graduates of programs with interprofessional education will be ready to work effectively in patient-centered teams where miscommunication and undermining behaviors are minimized or eliminated, resulting in safer, more effective care and greater clinician and patient satisfaction. Interprofessional education is thought to foster collaboration in implementing policies and improving services, prepare students to solve problems that exceed the capacity of any one profession, improve future job satisfaction, create a more flexible workforce, modify negative attitudes and perceptions, and remedy failures of trust and communication Barr, These organizations are committed to fulfilling the social contract that every nursing, pharmacy, dental, public health, and medical graduate is proficient in the core competencies required for interprofessional, team-based care, including preventive, acute, chronic, and catastrophic care.

The collaborative is also committed to facilitating the identification, development, and deployment of the resources essential to achieving this vision. As a first step, the collaborative is developing a shared and mutually endorsed set of core competencies that will frame the education of the six represented health professions. Efforts have been made to evaluate the effectiveness of interprofessional education in improving outcomes, including increased student satisfaction, modified negative stereotypes of other disciplines, increased collaborative behavior, and improved patient outcomes. However, the effect of interprofessional education is not easily verified since control group designs are expensive, reliable measures are few, and time lapses can be long between interprofessional education and the behavior of graduates.

Barr and colleagues reviewed evaluations of interprofessional education in published reports and found support for three outcomes: interprofessional education creates positive interaction among students and faculty; encourages collaboration between professions; and results in improvements in aspects of patient care, such as more targeted health promotion advice, higher immunization rates, and reduced blood pressure for patients with chronic heart disease.

Reeves and colleagues reviewed six later studies of varying designs. Four of the studies found that interprofessional education improved aspects of how clinicians worked together, while the remaining two found that it had no effect Reeves et al. Although empirical evidence is mixed, widespread theoretical agreement and anecdotal evidence suggest that students who demonstrate teamwork skills in the simulation laboratory or in a clinical education environment with patients will apply those skills beyond the confines of their academic programs. Chapter 3 highlighted a variety of challenges facing the nursing profession in meeting the changing needs of patients and the health care system.

What It Is The word Paul uses for contentment literally means to be sufficient. Contentment is the attitude or mindset that who I am, what I have, and where God has placed me right now is sufficient to biblically fulfill the roles and responsibilities God has given to me. Let me explain. As a young boy, I loved watching the television show MacGyver. The show follows secret agent Angus MacGyver who faced a slew of situations that looked hopeless.

MacGyver could break out of prison or jumpstart a car using things like a pair of scissors and toothpaste. It was as if he knew that what he had around him was sufficient. This is contentment. Contentment is recognizing that even though it may not look like it, we have everything we need to biblically succeed. Contentment is making the most of what we have in front of us today. So how do we get it? How We Get It Learn the lesson; one of the most encouraging things about contentment is that it first must be learned. Paul says twice verses 11 and 12 that he had to learn to be content. Why is that encouraging? It comes when we embrace what God is teaching us through any and every situation.

The U. Self-Improvement Goals, they will play important roles in future Work Contentment In Nursing on nursing competency. Other duties typically include:.

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