TheEssentialsofBaccalaureateEducation

forProfessionalNursingPractice
October20,2008

TABLEOFCONTENTS

ExecutiveSummary 3

Background 5
NursingEducation 6
TheDisciplineofNursing 7
Assumptions 8
RolesfortheBaccalaureateGeneralistNurse 8
PreparationfortheBaccalaureateGeneralistNurse:
ComponentsoftheEssentials 10

TheEssentialsofBaccalaureateEducationforProfessionalNursingPractice
I. LiberalEducationforBaccalaureateGeneralistNursingPractice 10

II. BasicOrganizationalandSystemsLeadershipfor
QualityCareandPatientSafety 13

III. ScholarshipforEvidenceBasedPractice 15

IV. InformationManagementandApplicationofPatient
CareTechnology 17

V. HealthcarePolicy,Finance,andRegulatoryEnvironments 20

VI. InterprofessionalCommunicationandCollaborationfor
ImprovingPatientHealthOutcomes 22

VII. ClinicalPreventionandPopulationHealth 23

VIII. ProfessionalismandProfessionalValues 26

IX. BaccalaureateGeneralistNursingPractice 29

ExpectationsforClinicalExperienceswithintheBaccalaureateProgram 33

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Summary 35

Glossary 36

References 40

AppendixA:TaskForceontheRevisionoftheEssentialsofBaccalaureate
EducationforProfessionalNursingPractice 45

AppendixB:ConsensusProcessto RevisetheEssentialsofBaccalaureate 46
EducationforProfessionalNursingPractice

AppendixC:Participantswho AttendedStakeholderMeetings 47

AppendixD:SchoolsofNursingthatParticipatedintheRegionalMeetings 49

AppendixE:ProfessionalOrganizationsthatParticipatedintheRegionalMeetings 60

AppendixF: HealthcareSystemsthatParticipatedintheRegionalMeetings 61

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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.

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 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.

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 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

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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

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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,

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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.

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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.

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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.

18
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
 References

Allan,J.,Barwick,T.A.,Cashman,S.,Cawley,J.F.,Day,C.,Douglass,C.W.,Evans,
C.H.Garr,D.R.,Maeshiro,R.,McCarthy,R.L., Meyer,S. M.,Riegelman,R.,
Seifer,S .D.,Stanley,J.,Swenson,M.,Teitelbaum,H .S.,Timothe,P.,Werner,
K.E.,&Wood.,D.(2004).Clinicalpreventionandpopulationhealthcurriculum
frameworkforhealthprofessions. AmericanJournalofPreventiveMedicine,
27(5),471481.

Allan,J.D.,Stanley,J.,Crabtree, M.K.,Werner,K.E., & Swenson,M.(2005).Clinical

preventionandpopulationhealthcurriculumframework:Thenursing
perspective.JournalofProfessionalNursing,21(5),259267.

AmericanAcademyofNursingExpertPanelonCulturalCompetence(In press).
AmericanAcademyofNursingStandardsofCulturalCompetence.

AmericanAssociationofCollegesofNursing(1998). Theessentialsofbaccalaureate
educationforprofessionalnursingpractice. Washington,DC:Author.

AmericanAssociationofCollegesofNursing(2002)Hallmarksoftheprofessional
nursingpracticeenvironment. RetrievedAugust18,2008,from
http://www.aacn.nche.edu/Publications/positions/hallmarks.htm

AmericanAssociationofCollegesofNursing.(2006a).Theessentialsofdoctoral
educationforadvancednursingpractice. RetrievedAugust18,2008,from
www.nche.edu/DNP/pdf/Essentials.pdf

AmericanAssociationofCollegesofNursing.(2006b).Positionstatementonnursing
research. RetrievedAugust18,2008,from
http://www.aacn.nche.edu/Publications/pdf/NsgResearch.pdf

AmericanHospitalAssociation(2002).Inourhands:Howhospitalleaderscanbuilda
thrivingworkforce.Washington,DC:Author.

AmericanNursesAssociation.(2005)Codeofethicsfornurseswithinterpretive
statements.SilverSpring,MD:Author.

AmericanNursesAssociation(2007). Publichealthnursing:Scopeandstandardsof
practice.SilverSpring,MD:Author.

American NursesAssociation(2008). Draftpositionstatement:Mandatory

implementationofanANArecognizednursingterminologysetinallprofessional
nursingeducationprograms. SilverSpring,Md:Author.

American NursesAssociationandHealthMinistriesAssociation(2005).Faith
communitynursing:scope&standardsofpractice.SilverSpring,MD:ANA

40
AmericanPublicHealthAssociation,PublicHealthNursingSection(1996).Definition
androleofpublichealthnursing.Washington,D.C:Author.

Associationof AmericanCollegesandUniversities(2004). Takingresponsibilityforthe

qualityofthebaccalaureatedegree.Washington,DC:Author.

AssociationofAmericanCollegesandUniversities(2007). Collegelearningforthe
newglobalcentury.Washington,DC:Author.

Barnsteiner,J.,Disch,J.M.,Hall,L.,Mayer,D.&Moore,S.M. (2007).Promoting
interprofessionaleducation.NursingOutlook,55(3),144150.

Buerhaus,P.,Staiger,D.O., &Auerbach,D.I.(2008). TheFutureoftheNursing

WorkforceintheUnitedStates:Data,TrendsandImplications.Boston:Jonesand
BartlettPublishers.

CarnegieFoundationfortheAdvancementofTeaching.(Inpress).PrcisofChapters
fromEducatingNurses:TeachingandLearningforaComplexPracticeofCare

CentersforDiseaseControlandPrevention(n.d.). Theguidetocommunitypreventive
services.CentersforDiseaseControlandPrevention.Accessat
http://www.thecommunityguide.org (AvailablefromDivisionofHealth
CommunicationandMarketing,NationalCenterforHealthMarketingCentersfor
DiseaseControlandPrevention,1600CliftonRoad,NE,MSE69,Atlanta,GA
30333).

CentersforDiseaseControlandPreventionandTheMerckCompanyFoundation(2007).
TheStateofAgingandHealthinAmerica.WhitehouseStation,NJ:TheMerck
CompanyFoundation

CenterforVulnerablePopulationResearch,UCLASchoolofNursing(2008). Whoare
vulnerablepopulations?RetrievedAugust18,2008,
http://www.nursing.ucla.edu/orgs/cvpr/whoarevulnerable.html

Cronenwett,L.,Sherwood,G.,BarnsteinerJ.,Disch,J.,Johnson,J.,Mitchell,P.,Taylor
Sullivan,D.,&Warren,J.(2007).Qualityandsafetyeducationfornurses.
NursingOutlook,55(3),122131.

Fang,D.,Htut,A.,&Bednash,G. (2008).20072008Enrollmentand Graduationsin

BaccalaureateandGraduateProgramsinNursing.Washington,DC:American
AssociationofCollegesofNursing.

Freeth,D.,Hammick,M.,Koppel,I.,&Reeves,S.(2002).Evaluatinginterprofessional
education:Twosystematicreviewsforhealthandsocialcare. BritishEducational
ResearchJournal,25(4),533543.

41
GallupPoll(2006).Honesty/ethicsinprofessions.RetrievedAugust18,2008,from
http://www.galluppoll.com/content/?ci=1654&pg=1

Hammer,D.(2003).CivilityandprofessionalisminB.Berger(ed.), PromotingCivility
in PharmacyEducation (pp.7191).Binghamton,NY:PharmaceuticalProducts
Press.

He,W.,Sengupta,M.,Velkoff,V.,& DeBarros,K.(2005). CurrentPopulation

Reports:65+intheUnitedStates.Washington,DC:U.S.CensusBureau,
GovernmentPrintingOffice.

Hermann,M.L.(2004).Linkingliberalandprofessionallearninginnursingeducation.
LiberalEducation,90(4):4247.

InstituteofMedicine.(2000). ToErrisHuman:BuildingaSaferHealthSystem.
Washington,DC:NationalAcademiesPress.

InstituteofMedicine.(2001).Crossingthequalitychasm.Washington,DC:National
AcademiesPress.

InstituteofMedicine(2003a).Thefutureofthepublicshealthinthetwentyfirstcentury.
Washington,DC:NationalAcademyPress.

InstituteofMedicine(2003b).Healthprofessionseducation:Abridgetoquality.
Washington,DC:NationalAcademiesPress.

InstituteofMedicine.(2004).Keepingpatientssafe:Transformingtheworkenvironment
ofnurses.Washington,DC:NationalAcademiesPress.

InternationalCouncilofNursing(2006).Internationalcodeofethicsfornurses.
RetrievedAugust18,2008,from http://www.icn.ch/icncode.pdf

InterprofessionalProfessionalismMeasurementGroup (2008).Interprofessional
professionalism:Whatsallthefuss?PresentedattheAmericanPhysical
TherapyMeetingonFebruary7,2008inNashville,Tenn.

JointCommissiononAccreditationofHealthcareOrganizations.(2002).Healthcareat
thecrossroads,Strategiesforaddressingtheevolvingnursingcrisis.Chicago:
Author.

Kimball,B.&ONeill,E.(2002). Healthcareshumancrisis:TheAmericannursing
shortage.Princeton,NJ:TheRobertWoodJohnsonFoundation.

McNeil,B.J.,Elfrink,V.,Beyea,S.C.,Pierce,S.T.,&Bickford,C.J.(2006).
"Computerliteracystudy:reportofqualitativefindings."JournalofProfessionalNursing
22(1):529.

42
McNeil,B.J.,Elfrink,V.L.,Bickford,C.J.,Pierce,S.T.,Beyea,S.C.,Averill,C.,&
Klappenbach,C.(2003). Nursinginformationtechnologyknowledge,skills,and
preparationofstudentnurses,nursingfaculty,andclinicians:AUSsurvey.Journalof
NursingEducation42(8):3419.

National Councilof StateBoardsof Nursing(2005). ClinicalinstructioninPrelicensure

NursingPrograms.RetrievedAugust18,2008,from
https://www.ncsbn.org/Final_Clinical_Instr_Pre_Nsg_programs.pdf

NationalQualityForum(2003).NQFendorsedTM nationalvoluntaryconsensus
standardsfornursingsensitivecare.RetrievedAugust18,2008,from
http://www.qualityforum.org/nursing/#endorsed

Nehring,W.M.,Ellis,W.E.,&Lashley,F.R.(2001).Humanpatientsimulatorsin
nursingeducation:Anoverview.SimulationandGaming,32,194204.

Nelson,E. A.,Batalden,P.B., & Godfrey,M.M.(2007).Qualitybydesign:Aclinical

microsystemsapproach.SanFranciso,CA:JosseyBass.

Pesut,J.(2001).Clinicaljudgment:foreground/background.JournalofProfessional
Nursing,17(5),215.

Puchalski,C.(2006).Spiritualassessmentinclinicalpractice. PsychiatricAnnals,36
(3),150.

QuadCouncilofPublicHealthNursingOrganizations.(2004).Publichealthnursing
competencies. PublicHealthNursing,21(5),443452.

Rindfleisch,T.(1997). Privacy,informationtechnologyandhealthcare.NewYork:
ACMPress

Rothschild,J.M.,Hurley,A.C.,Landrigan,C.P.,Cronin,J.W.,etal.(2006,).Recovering
frommedicalerrors: Thecriticalcarenursingsafetynet.JointCommission
JournalonQualityandPatientSafety, 32(2),6372.

Simmons,B.,Lanuza,D.,Fonteyn,M.,& Hicks,F.(2003).Clinicalreasoningin
experiencednurses. WesternJournalofNursingResearch,25,701719.

Tervalon,M.,& MurrayGarcia,J.(1998).Culturalhumilityversusculturalcompetence:
A criticaldistinctionindefiningphysiciantrainingoutcomesinmulticultural
education. JournalofHealthCareforthePoorandUnderserved,9(2),117.

U.S.CensusBureau(2008). Stateandcountyquickfacts. RetrievedAugust18,2008,

from http://quickfacts.census.gov.gov/qfd/states/00000.html

43
U.S.Departmentof HealthandHumanServices.(2000a,November).HealthyPeople
2010(2nded.).(Vols.12).Washington,DC:U.S.GovernmentPrintingOffice.

U.S.DepartmentofHealthandHumanServices(2000b). Plainlanguage:Apromising
strategyforclearlycommunicatinghealthinformationandimprovinghealth
literacy.RetrievedAugust18,2008,from
http://www.health.gov/communication/literacy/plainlanguage/PlainLanguage.htm

WorldHealthOrganization(2008).Corehealthindicators. RetrievedAugust18,2008,
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
JeanW.Lange,PhD,RN,CNL, faculty
representative
FairfieldUniversity
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
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 LindaOlsonKeller
JohnA.HartfordFoundation,Inc. AssociationofStateandTerritorial
ProgramOfficer DirectorsofNursing(ASTDN)
NewYork,NY ProjectDirector
Arlington,VA
LindaCronenwett
QualityandSafetyEducationforNurses DarrellKirch
(QSEN) AssociationofAmericanMedicalColleges
ChapelHill,NC (AAMC)
President
LisaDay Washington,DC
TheCarnegieFoundationforthe
AdvancementofTeaching EllenKurtzman
SanFrancisco,CA NationalQualityForum(NQF)
SeniorProgramDirector
JerryGaff Washington,DC
AssociationofAmericanColleges&
Universities(AAC&U) PamMalloy
SeniorFellow EndofLifeNursingEducationConsortium
Washington,DC (ELNEC)
ProjectDirector,AACN
JodyGandy Washington,DC
InterprofessionalProfessionalismGroup,
AmericanPhysicalTherapyAssociation JeanneMatthews
(APTA) QuadCouncilofPublicHealthNursing
Director,PhysicalTherapyEducation Organizations
Alexandria,VA Chairelect,APHAPublicHealthNursing
(PHN)SectionfortheQuadCouncil
PamHagan Washington,DC
AmericanNursesAssociation(ANA)
ChiefProgramsOfficer LeylaMcCurdy
SilverSpring,MD NationalEnvironmentalEducation&
TrainingFoundation(NEETF)
JanieE.Heath SeniorDirector
AmericanAssociationofCriticalCare Washington,DC
Nurses(AACN)
PastBoardMember DulaPacquiao
AlisoViejo,CA AACNCulturalAdvisoryGroup,
AssociateProfessorandDirectorSchoolof
JeanJenkins Nursing
AdvisoryGroupforGeneticsandGenomics UniversityofMedicine&DentistryofNJ
NationalInstitutesofHealth(NIH),National Newark,NJ
HumanGenomeResearchInstitute
(NHGRI)
SeniorClinicalAdvisor
Bethesda,MD

47
PatriciaRutherford ToddUhlmann
InstituteforHealthCareImprovement(IHI) NationalStudentNursesAssociation
VicePresident (NSNA)
Cambridge,MA President
Brooklyn,NY
DouglasScheckelhoff
AmericanSocietyofHealthSystem TenerVeneema
Pharmacists(ASHP) DisasterPreparednessExpert
Director,PharmacyPracticeSections AssociateProfessorofClinicalNursing
Bethesda,MD UniversityofRochester
Rochester,NY
NancySpector
NationalCouncilofStateBoardsofNursing MaryWakefield
(NCSBN) InstituteofMedicine(IOM)Chairof
DirectorofEducation QualityChasmSeries
Chicago,IL HealthCareServicesBoard,
AssociateDeanforRuralHealth,
MollySutphen UniversityofNorthDakota
TheCarnegieFoundationforthe Washington,DC
AdvancementofTeaching
ResearchScholar JuliaWatkins
Stanford,CA CouncilonSocialWorkEducation
ExecutiveDirector
Alexandria,VA

48
 APPENDIXD

SchoolsofNursingthatParticipatedintheRegionalMeetings(N=329)

AdelphiUniversity BaylorUniversity
GardenCity,NY Dallas,TX

ArizonaStateUniversity BeckerCollege
Phoenix,AZ Worcester, MA

ArkansasStateUniversity BemidjiStateUniversity
StateUniversity,AR Bemidji,MN

ArmstrongAtlanticStateUniversity BethuneCookmanUniversity
Savannah,GA DaytonaBeach,FL

AshlandUniversity BinghamtonUniversity
Ashland,OH Binghamton,NY

AuburnUniversity BiolaUniversity
Auburn,AL LaMirada,CA

AuburnUniversityatMontgomery BoiseStateUniversity
Montgomery,AL Boise,ID

AvilaUniversity BostonCollege
KansasCity,MO ChestnutHill,MA

AzusaPacificUniversity BradleyUniversity
Azusa,CA Peoria,IL

BakerUniversity BrenauUniversity
Topeka,KS Gainesville,GA

BallStateUniversity BrighamYoungUniversity
Muncie,IN Provo,UT

BaptistMemorialCollegeofHealth BryanLGHCollegeofHealthSciences
Sciences Lincoln,NE
Memphis,TN
CaliforniaBaptistUniversity
BarnesJewishCollegeofNursing Riverside,CA
St.Louis,MO
CaliforniaStateUniversityChannel
BarryUniversity Islands
MiamiShores,FL Camarillo,CA

49
CaliforniaStateUniversityBakersfield ChamberlainCollegeofNursing
Bakersfield,CA Columbus,OH

CaliforniaStateUniversityChico CharlestonSouthernUniversity
Chico,CA Charleston,SC

CaliforniaStateUniversityDominguez ClaytonStateUniversity
Hills Morro,GA
Carson,CA
ClemsonUniversity
CaliforniaStateUniversityEastBay Clemson,SC
Hayward,CA
CoeCollege
CaliforniaStateUniversityFullerton CedarRapids,IA
Fullerton,CA
ColbySawyerCollege
CaliforniaStateUniversityLongBeach NewLondon,NH
LongBeach,CA
CollegeofSaintCatherine
CaliforniaStateUniversityLosAngeles St.Paul,MN
LosAngeles,CA
CreightonUniversity
CaliforniaStateUniversitySan Omaha,,NE
Bernardino
SanBernardino,CA CumberlandUniversity
Lebanon,TN
CaliforniaStateUniversitySanMarcos
SanMarcos,CA CurryCollege
Milton,MA
CaliforniaStateUniversityStanislaus
Turlock,CA DrexelUniversity
Philadelphia,PA
CapitalUniversity
Columbus,OH DukeUniversity
Durham,NC
CarlowUniversity
Pittsburgh,PA DuquesneUniversity
Pittsburgh,PA
CarsonNewmanCollege
JeffersonCity,TN EastCarolinaUniversity
Greenville,NC
CedarCrestCollege
Allentown,PA EastTennesseeStateUniversity
JohnsonCity,TN
CentralConnecticutStateUniversity
NewBritain,CT

50
EasternIllinoisUniversity FloridaInternationalUniversity
Charleston,IL Miami,FL

EasternKentuckyUniversity FloridaSouthernCollege
Richmond,KY Lakeland,FL

EasternMennoniteUniversity FortHaysStateUniversity
Harrisonburg,VA Hays,KS

EasternMichiganUniversity FrancisMarionUniversity
Ypsilanti,MI Florence,SC

ElmhurstCollege GeorgeMasonUniversity
Elmhurst,IL Fairfax,VA

ElmsCollege GeorgetownUniversity
Chicopee,MA Washington,DC

EmmanuelCollege GeorgiaCollege&StateUniversity
Boston,MA Milledgeville,GA

EmoryUniversity GeorgiaSouthernUniversity
Atlanta,GA Statesboro,GA

ExcelsiorCollege GeorgiaStateUniversity
Albany,NY Atlanta,GA

FairfieldUniversity GonzagaUniversity
Fairfield,CT Spokane,WA

FairleighDickinsonUniversity GovernorsStateUniversity
Teaneck,NJ UniversityPark,IL

FairmontStateUniversity GrandValleyStateUniversity
Fairmont,WV GrandRapids,MI

FelicianCollege GrandViewCollege
Lodi,NJ DesMoines,IA

FloridaA&MUniversity HopeCollege
Tallahassee,FL Holland,MI

FloridaAtlanticUniversity HunterCollegeofCUNY
BocaRaton,FL NewYork,NY

51
HuntingtonUniversity KennesawStateUniversity
Huntington,IN Kennesaw,GA

HussonCollege KeukaCollege
Bangor,ME KeukaPark,NY

IdahoStateUniversity LakeviewCollegeofNursing
Pocatello,ID Danville,IL

IllinoisWesleyanUniversity LamarUniversity
Bloomington,IL Beaumont,TX

IndianaUniversityBloomington LeMoyneCollege
Bloomington,IL Syracuse,NY

IndianaUniversityNorthwest LinfieldCollege
Gary,IN Portland,OR

IndianaUniversitySouthBend LomaLindaUniversity
SouthBend,IN LomaLinda,CA

IndianaUniversitySoutheast LouisianaCollege
NewAlbany,IN Pineville,LA

IndianaWesleyanUniversity LouisianaStateUniversityHealth
Marion,IN SciencesCtr
NewOrleans,LA
JacksonvilleStateUniversity
Jacksonville,AL LourdesCollege
Sylvania,OH
JacksonvilleUniversity
Jacksonville,FL LutherCollege
Decorah,IA
JamesMadisonUniversity
Harrisonburg,VA LycomingCollege
Williamsport,PA
JohnsHopkinsUniversity
Baltimore,MD LynchburgCollege
Lynchburg,VA
KaplanUniversity
Chicago,IL MaconStateCollege
Macon,GA
KeanUniversity
Union,NJ MadonnaUniversity
Livonia,MI

52
MartinMethodistCollege MinnesotaStateUniversityMankato
Pulaski,TN Mankato,MN

MaryvilleUniversitySaintLouis MississippiCollege
St.Louis,MO Clinton,MS

MassachusettsCollegeofPharmacyand MississippiUniversityforWomen
AlliedHealthSciences Columbus,MS
Boston,MA
MissouriWesternStateUniversity
McKendreeCollege St.Joseph,MO
Lebanon,IL
MontanaStateUniversityBozeman
McNeeseStateUniversity Bozeman,MT
LakeCharles,LA
MoravianCollege
MedcenterOneCollegeofNursing Bethlehem,PA
Bismarck,ND
MountCarmelCollegeofNursing
MedCentralCollegeofNursing Columbus,OH
Mansfield,OH
MountMercyCollege
MedicalCollegeofGeorgia CedarRapids,IA
Augusta,GA
MountSaintMary'sCollege
MedicalUniversityofSouthCarolina LosAngeles,Ca
Charleston,SC
MuskingumCollege
MercyCollege NewConcord,OH
DobbsFerry,NY
NationalUniversity
MetropolitanStateUniversity LaJolla,CA
St.Paul,MN
NeumannCollege
MGHInstituteofHealthProfessions Aston,PA
Boston,MA
NewJerseyCityUniversity
MichiganStateUniversity JerseyCity,NJ
EastLansing,MI
NewMexicoHighlandsUniversity
MilwaukeeSchoolofEngineering LasVegas,NM
Milwaukee,WI
NewYorkUniversity
MinnesotaIntercollegiateNursing NewYork,NY
Consortium
Northfield,MN

53
NichollsStateUniversity PointLomaNazareneUniversity
Thibodaux,LA SanDiego,CA

NorthParkUniversity PurdueUniversity
Chicago,IL WestLafayette,IN

NortheasternUniversity QueensUniversityofCharlotte
Boston,Mass. Charlotte,NC

NorthernArizonaUniversity ResearchCollegeofNursing
Flagstaff,AZ KansasCity.MO

NorthernIllinoisUniversity RegisCollege
DeKalb,IL Weston,MA

NorthwestUniversity RhodeIslandCollege
Kirkland,WA Providence,RI

NotreDameCollege RivierCollege
SouthEuclid,OH Nashua,NH

OaklandUniversity RobertMorrisUniversity
Rochester,MI MoonTownship,PA

OldDominionUniversity Rutgers,TheStateUniversityofNew
Norfolk,VA Jersey
Camden,NJ
OregonHealthandScienceUniversity
Portland,OR SacredHeartUniversity
Fairfield,CT
OtterbeinCollege
Westerville,OH SaginawValleyStateUniversity
UniversityCenter,MI
PaceUniversity
NewYork,NY SaintAmbroseUniversity
Davenport,IA
PattyHanksSheltonSchoolofNursing
Abilene,TX SaintAnselmCollege
Manchester,NH
PiedmontCollege
Demorest,GA SaintAnthonyCollegeofNursing
Rockford,IL
PlattCollege
Aurora,Co SaintFrancisMedicalCenterCollegeof
Nursing
Peoria,IL

54
 SouthernIllinoisUniversity
SaintJohnFisherCollege Edwardsville
Rochester,NY Edwardsville,IL

SaintJoseph'sCollegeofMaine SouthernNazareneUniversity
Standish,ME Bethany,OK

SaintLouisUniversity SouthernUtahUniversity
SaintLouis,MO CedarCity,UT

SaintLuke'sCollegeofNursing StonyBrookUniversity
KansasCity,MO StonyBrook,NY

SaintXavierUniversity SUNYDownstateMedicalCenter
Chicago,IL Brooklyn,NY

SamfordUniversity SUNYInstituteofTechnologyat
Birmingham,AL Utica/Rome
Utica,NY
SamuelMerrittCollege
Oakland,CA SUNYPlattsburgh
Plattsburgh,NY
SanDiegoStateUniversity
SanDiego,CA SUNYUpstateMedicalUniversity
Syracuse,NY
SanFranciscoStateUniversity
SanFrancisco,CA TempleUniversity
Philadelphia,PA
SeattlePacificUniversity
Seattle,WA TennesseeTechnologicalUniversity
Cookeville,TN
SeattleUniversity
Seattle,WA TennesseeWesleyanCollege
Knoxville,TN
ShenandoahUniversity
Winchester,VA TexasA&MHealthScienceCenter
CollegeStation,TX
SimmonsCollege
Boston,MA TexasA&MUniversityCorpusChristi
CorpusChristi,TX
SouthDakotaStateUniversity
Brookings,SD TexasChristianUniversity
FortWorth,TX
SoutheastMissouriStateUniversity
CapeGirardeau,MO TexasTechUniversityHealthSciences
Center

55
Lubbock,TX UniversityofAlabamaatBirmingham
Birmingham,AL
TexasWoman'sUniversity
Denton,TX UniversityofAlabamainHuntsville
Huntsville,AL

TheCatholicUniversityofAmerica UniversityofAlaskaAnchorage
Washington,DC Anchorage,AK

TheCollegeofSt.Scholastica UniversityofArizona
Duluth,MN Tuscon,AZ

TheOhioStateUniversity UniversityofArkansasforMedical
Columbus,OH Sciences
LittleRock,AR
TheSageColleges
Troy,NY UniversityofArkansasFayetteville
Fayetteville,AR
TheUniversityofAlabama
Tuscaloosa,AL UniversityofCaliforniaDavis
Davis,CA
TheUniversityofAlabamainHuntsville
Huntsville,AL UniversityofCaliforniaLosAngeles
LosAngeles,CA
TheUniversityofLouisianaatLafayette
Lafayette,LA UniversityofCentralArkansas
Conway,AR
TheUniversityofLouisianaatMonroe
Monroe,LA UniversityofCincinnati
Cincinnati,OH
TheUniversityofNorthCarolina
ChapelHill UniversityofColoradoatColorado
ChapelHill,NC Springs
ColoradoSprings,CO
ThomasJeffersonUniversity
Philadelphia,PA UniversityofColoradoDenver
Aurora,CO
TouroUniversity
Henderson,NV UniversityofConnecticut
Storrs,CT
TuskegeeUniversity
Tuskegee,AL UniversityofDelaware
Newark,DE
UniversityatBuffalo
Buffalo,NY UniversityofDetroitMercy
Detroit,MI

56
 UniversityofMississippiMedical
UniversityofFlorida Center
Gainesville,FL Jackson,MS
UniversityofHawaiiatManoa
Honolulu,HI UniversityofMissouriColumbia
Columbia,MO
UniversityofIllinoisatChicago UniversityofMissouriKansasCity
Chicago,IL KansasCity,MO

UniversityofIowa UniversityofMissouriSaintLouis
IowaCity,IA St.Louis,MO

UniversityofKansas UniversityofNevadaLasVegas
KansasCity,KS LasVegas,NV

UniversityofLouisianaatMonroe UniversityofNevadaReno
Monroe,LA Reno,NV

UniversityofLouisville UniversityofNewHampshire
Louisville,KY Durham,NH

UniversityofMary UniversityofNewMexico
Bismark,ND Albuquerque,NM

UniversityofMaryland UniversityofNorthCarolinaat
Baltimore,MD Greensboro
Greensboro,NC
UniversityofMassachusettsAmherst
Amherst,MA UniversityofNorthCarolinaCharlotte
Charlotte,NC
UniversityofMassachusettsLowell
Lowell,MA UniversityofNorthDakota
GrandForks,ND
UniversityofMedicine&Dentistryof
NewJersey UniversityofNorthFlorida
Newark,NJ Jacksonville,FL

UniversityofMemphis UniversityofNorthernColorado
Memphis,TN Greeley,CO

UniversityofMichigan UniversityofOklahoma
AnnArbor,MI OklahomaCity,OK

UniversityofMinnesota UniversityofPennsylvania
Minneapolis,MN Philadelphia,PA

57
UniversityofPhoenix Knoxville,TN
Phoenix,AZ
UniversityofTennesseeHealthScience
UniversityofPittsburgh Center
Pittsburgh,PA Memphis,TN

UniversityofPortland UniversityofTennesseeChattanooga
Portland,OR Chattanooga,TN

UniversityofRhodeIsland
Kingston,RI
UniversityofSaintFrancisIndiana
FortWayne,IN
UniversityofSaintMary
Leavenworth,KS
UniversityofSanDiego
SanDiego,CA
UniversityofSanFrancisco
SanFrancisco,CA
UniversityofSouthAlabama
Mobile,AL
UniversityofSouthCarolina
Columbia,SC
UniversityofSouthCarolinaAiken SaltLakeCity,UT
Aiken,SC
UniversityofSouth CarolinaUpstate
Spartanburg,SC
UniversityofSouthernMaine
Portland,ME
UniversityofSouthernMississippi
Hattiesburg,MS
UniversityofSt.FrancisIllinois EauClaire,WI
Joliet,IL
UniversityofTennesseeKnoxville GreenBay,WI
UniversityofTexasHealthScience
Center Houston
Houston,TX
UniversityofTexasHealthScience
CenterSanAntonio
SanAntonio,TX
UniversityofTexasElPaso
ElPaso,TX
UniversityofTexasTyler
Tyler,TX
UniversityoftheIncarnateWord
SanAntonio,TX
UniversityofToledo
Toledo,OH
UniversityofUtah
UniversityofVermont
Burlington,VT
UniversityofVirginia
Charlottesville,VA
University ofWestGeorgia
Carrollton,GA
UniversityofWisconsinEauClaire
UniversityofWisconsinGreenBay

58
 WestChester,PA

UniversityofWisconsinMilwaukee WestTexasA&MUniversity
Milwaukee,WI Canyon,TX

UniversityofWisconsinOshkosh WestVirginiaUniversity
Oshkosh,WI Morgantown,WV

UniversityofWyoming WesternCarolinaUniversity
Laramie,WY Cullowhee,NC

UpperIowaUniversity WesternKentuckyUniversity
Fayette,IA BowlingGreen,KY

UrsulineCollege WesternMichiganUniversity
PepperPike,OH Kalamazoo,MI

UticaCollege WichitaStateUniversity
Utica,NY Wichita,KS

ValdostaStateUniversity WidenerUniversity
Valdosta,GA Chester,PA

ValparaisoUniversity WilkesUniversity
Valparaiso,IN WilkesBarre,PA

VanguardUniversityofSouthern WilliamCareyUniversity
California Hattiesburg,MS
CostaMesa,CA
WilliamJewellCollege
VillaJulieCollege Liberty,MO
Stevenson,MD
WilliamPatersonUniversity
WagnerCollege Wayne,NJ
StatenIsland,NY
WilmingtonUniversity
WashburnUniversity NewCastle,DE
Topeka,KS
WinstonSalemStateUniversity
WashingtonStateUniversity WinstonSalem,NC
Spokane,WA
WisconsinLutheranCollege
WaynesburgUniversity Milwaukee,WI
Waynesburg,PA
WrightStateUniversity
WestChesterUniversity 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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Washington, DC 20036

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