Essential Content in RN-BSN Programs Melanie McEwen RN, PhD, Mary Joe White RN, PhD, Bridgette R. Pullis RN, PhD, Susan Krawtz RN, MSN PII: DOI: Reference:
S8755-7223(13)00166-X doi: 10.1016/j.profnurs.2013.10.003 YJPNU 795
To appear in:
Journal of Professional Nursing
Received date:
29 November 2012
Please cite this article as: McEwen, M., White, M.J., Pullis, B.R. & RN, MSN, S.K., Essential Content in RN-BSN Programs, Journal of Professional Nursing (2013), doi: 10.1016/j.profnurs.2013.10.003
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
RI P
T
Essential Content in RN-BSN Programs
MA
NU
SC
Essential Content in RN-BSN Programs
ED
Melanie McEwen, RN, PhD; Mary Joe White, RN, PhD;
PT
Bridgette R. Pullis, RN, PhD & Susan Krawtz, RN, MSN
AC
CE
The University of Texas Health Science Center at Houston School of Nursing
Correspondence concerning this article should be addressed to Melanie McEwen, Department of Nursing Systems, The University of Texas Health Science Center at Houston School of Nursing, 6901 Bertner, #730, Houston, Texas 77030. Email: [email protected]
1
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
T
Abstract
RI P
Currently, there are more than 600 RN-BSN programs in the U.S., and the number of students enrolled in them is growing quickly. This growth is at least partially in response to the
SC
Institute of Medicine‟s recent recommendation that 80% of RNs be BSN prepared by 2020.
NU
Proliferation of RN-BSN programs suggests a need to examine them more critically, as very little information is available in the nursing literature or through accrediting bodies regarding
MA
what courses and content they should include.
This study was conducted to determine what directors of RN-BSN educational programs
ED
report as being “essential” content. The findings can be used as a guide for developing new
PT
programs or revising existing programs. They may also be used as a starting place for nursing educators to dialogue on what content and competencies are truly “essential” for BSN prepared
AC
CE
nurses and where education should be focused in RN-BSN programs.
2
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
Introduction The recent recommendation from the Institute of Medicine (IOM, 2010) that 80% of
RI P
T
Registered Nurses (RNs) be baccalaureate (BSN) prepared by 2020 has shifted considerable attention in nursing education from simply increasing the number of RNs in the workforce, to
SC
increasing the number of BSN-educated RNs. The “80 by 2020” goal has also lead to recognition of the need to expand the ability of RN-BSN (“bridge” or “completion”) programs to
NU
enroll more students, thereby allowing practicing RNs, as well as future graduates from
MA
Associate Degree (ADN) and diploma programs, an opportunity to achieve their BSN. Currently, there are more than 600 RN-BSN programs in the U.S. and the number is
ED
growing. Until recently, these programs have received minimal attention in the nursing literature or from accrediting organizations. One challenge faced by faculty responsible for RN-BSN
PT
education is identifying or anticipating what content and experiences are missing or deficient in
CE
the basic pre-licensure program and designing a curriculum to address these deficiencies.
AC
Traditionally, ADN and diploma nursing programs are understood to prepare “technical” nurses, whereas BSN programs prepare “professional” nurses. Typically, RN-BSN completion programs require a set of nursing courses designed to expand upon or enhance what was learned in the initial nursing program by providing content and experiences that prepare the RN for work in highly complex environments and community settings, as well as preparing them for graduate education. This study presents vital information gleaned from a national survey to gather information on the courses, concepts and content areas, which have been identified by RN-BSN program directors as essential in equipping RNs to become “professional” nurses.
3
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
Literature Review Surprisingly little information was identified in the recent nursing literature specific to
RI P
T
RN-BSN programs or describing perceived differences between the educational preparation and anticipated competencies among ADN/diploma graduates and BSN graduates. Similarly, while
SC
there is some information on the updates to curricular content of BSN programs in general, there is almost no information found specifically related to what content and competencies should be
NU
included in RN-BSN programs. A review of the sparse findings is presented here.
MA
In her work discussing current and future needs in nursing education, Stokowski (2011) listed examples of competencies or “higher level skills” that should be included in nursing
ED
education. She noted that certain nursing competencies are a “foundation for decision-making skills under a variety of clinical situations across all care settings” (p. 4). Some competencies
PT
mentioned in this work (i.e. clinical judgment, teaching, critical reasoning, relationship-centered
CE
care, cultural sensitivity, and practice across the lifespan) are critical to nursing practice regardless of the level of educational attainment (i.e. BSN, ADN, diploma). Many of the
AC
identified “expanded competencies” (p. 6), however, may be more readily expected among BSNeducated RNs, and therefore should be part of RN-BSN programs. These expanded competencies include: evidence-based practice, leadership, assisting individuals and families in self-care practices for promotion of health and management of chronic illness, delegation and supervision of caregivers, genetics and genomics, and professionalism. Stokowski supported the notion of the BSN as being necessary for RNs‟ expanding practice into such areas as community and public health, leadership, systems improvement and change, research, and health policy, as well as to prepare nurses for graduate education.
4
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
In their literature review discussing curriculum reform for BSN education in general (i.e. not specific to RN-BSN programs), Forbes and Hickey (2009) explained that attention is
T
currently moving away from heavily content-driven curricula. They discussed trends for
RI P
updating BSN curricula focusing on: addition of safety and quality concepts/content and processes (i.e. QSEN); redesigning conceptual frameworks to focus on AACN Essentials;
SC
enhancing attention to community-based care; and increasing emphasis on “core” concepts (e.g.
NU
nursing knowledge, nursing skills, nursing values, and nursing experience). They also discussed the necessity of limiting some content while expanding other areas (e.g. genetics, informatics,
MA
population health).
ED
Directly addressing the IOM‟s “80% by 2020” recommendation, Tanner (2010) presented several strategies to change nursing education. One suggestion was to improve articulation
PT
between ADN and BSN programs. She described how faculty in community colleges and
CE
university programs can and should work together to develop curricula responsive to emerging health care needs, while addressing nursing‟s updated competencies. Discussing curriculum
AC
innovation, she specifically mentioned the enhancement of content in geriatric care/gerontology, providing care in community-based settings, and population-based care. She also focused considerable attention on how to address the problem of the “content-laden curriculum.” Describing the differentiation in outcomes and competencies among the three program levels, the NLN (2010) explained that baccalaureate nursing education provides students with the foundational knowledge and skills commensurate with diploma and ADN programs preparing RNs. Additionally, the NLN explained that “baccalaureate nursing education includes learning experiences related to community and population-focused care, leadership and management, and research” (p. 39). The competencies outlined for BSN nurses build upon those defined for other 5
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
pre-licensure programs, and expressly includes care to families and communities, identification of research questions and critique of published research, using evidence to propose solutions to
T
clinical practice problems, focus on health promotion, and “a willingness to provide leadership in
RI P
improving care”(p. 39).
SC
The Texas Board of Nursing (TX-BON, 2011) also explicitly described the differences in competencies and knowledge between ADN/diploma and BSN-prepared RNs. The Texas BON‟s
NU
“Differentiated Essential Competencies” (DECs) provide detailed guidelines as to what content
MA
and concepts should be included in RN-BSN programs to ensure that BSN-prepared RNs will function at the professional level. The DECs are both broad and specific, and describe how
ED
graduates from BSN programs are expected to demonstrate the competencies (knowledge, clinical judgments, and behaviors) of the preceding levels of education (ADN/diploma), but with
PT
greater depth and breadth of application and synthesis. Finally, the DECs instruct BSN
CE
educators to focus on the addition of “populations” and “communities” and the promotion of
AC
“practice of Professional nursing through leadership activities and advocacy” (p. 4). In the only source that specifically discussed courses commonly found in RN-BSN curricula, Wros, Wheeler, and Jones (2011) observed that “bridge” programs prepare nurses for expanded professional roles. They maintained that content must be designed to assist students in developing higher levels of critical thinking skills and broadening their scope of practice, in addition to understanding the social, cultural, economic, and geopolitical context of health care. Wros and colleagues explained that RN-BSN curricula generally focus on topics such as enhancing professional communication, theoretical perspectives for practice, community and population-based nursing care, and leadership. They concluded that in RN-BSN programs,
6
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
clinical practica should be completed in community-based settings with attention to evidencebased perspectives, and should include nursing leadership projects and activities.
RI P
T
One significant observation in reviewing the literature is the absence of guidelines and recommendations from the nursing education accreditation entities explicitly addressing RN-
SC
BSN programs. While the accreditation materials from the National League for Nursing‟s Accrediting Commission (NLNAC, 2008, 2012) and the Commission on Collegiate Nursing
NU
Education (AACN, 2008) are instructive in providing general guidelines on content and
MA
competencies, they are geared toward general BSN curricula and programs. Indeed, nothing was identified in the accreditation materials from either organization specifically addressing RN-BSN
ED
program requirements or curricula.
PT
Purpose
The purpose of this study was to explore what directors of RN-BSN educational
CE
programs currently identify as being “essential” courses and content in their curriculum. The
AC
findings are important to the future of nursing, considering the rapid growth of RN-BSN programs and the anticipated increase in the number of students enrolled in them that will be necessary to meet the IOM recommendations. Methodology This report is a secondary analysis of a nationwide survey of RN-BSN program directors. The questionnaire used for the study was developed by a team of faculty responsible for the RNBSN program at a large, medical center-based, nursing program. The survey form incorporated questions from discussions with students, colleagues, and administration as well as from information found in the literature. Survey questions were grouped into four general categories: 7
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
1) basic background information (e.g. program size, number of credit hours, admission criteria); 2) curricular and instructional information (e.g. courses, clinical requirements, instructional
T
formats used); 3) evaluation methods; and 4) content or topics were covered in the different
RI P
courses. Most questions were „forced choice‟, with an option for the respondent to provide comments. The information related to specific content of the courses (e.g. research,
SC
leadership/management, community/public health nursing) were evaluated using a Likert-type
NU
format. The survey tool was forwarded to several faculty to determined content validity; revisions were made based on their input. The survey was then formatted for online delivery and
MA
circulated to six faculty to assess readability and evaluate the time needed to complete the survey.
ED
To obtain the sample, the directories of the RN-to-BSN programs accredited by the
PT
AACN/CCNE (2011) and the NLNAC (2011) were compared and duplicates removed. The result was a list containing 614 programs. The program director or a contact person from each
CE
program was sent an e-mailed letter explaining the purpose of the survey and inviting
AC
participation. Those agreeing to participate were instructed to open a link to the instructordesigned survey employing “Zoomerang” software. The survey was determined to be “exempt” from Institutional Review and completion of the survey was accepted as consent to participate in the study. The initial report (McEwen, White, Pullis & Krawtz, 2012) discussed findings related to: program characteristics, instructional format, general curricula, clinical requirements, and evaluation.
Presented here is information related to the courses and content areas that RN-BSN
program directors deemed to be “essential,” and thereby necessary to include in the curriculum.
8
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
Results Of the 614 RN-to-BSN program directors asked to participate in the survey, 210 finished
RI P
T
it, for a completion rate of 34.2%. The geographic location of the responding programs was very diverse, representing all regions of the U.S. More than half of the respondents were from
SC
public universities and 40% were from private programs. The remainder were located in medical centers, community colleges and “other” (e.g. online only programs). Most of the programs
NU
were relatively small (less than 50 students enrolled and fewer than 25 graduates per year),
MA
although about 20% had more than 125 students enrolled and 13% reported graduating more than 75 students per year.
ED
Findings Related to Discrete Courses. When queried about specific courses required in their programs, four courses were required by a considerable majority. The most commonly
PT
reported discrete courses and percentage of programs that require them were: leadership and
CE
management (92%); community/public health (90%); research (89%); and health assessment
AC
(79%). Other commonly required courses were statistics (55%) and pathophysiology (45%). Notably, several respondents explained that statistics is a pre-requisite, while others said the same of pathophysiology. The survey invited comments for each of section and these open comments gave insight into other course commonly reported as being “required.” For example, several participants noted that students are must take an “issues” course and/or a “transitions” or “bridge” course. An “ethics” course was specifically listed as a requirement by four respondents. Elective courses are common among RN-BSN Programs. In some programs, courses such as health assessment, pathophysiology and pharmacology were designated to be electives rather than required courses.
9
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
Courses also mentioned as being offered as electives were: “women‟s health,” “patient education,” “critical care,” “health promotion,” “transcultural nursing,” and “gerontology.”
RI P
T
Findings Related to Essential Content for Key Courses. To gather more detailed information on what was considered to be key or essential content for each of the traditional
SC
content areas (i.e. community/public health, leadership/management, research), and professional issues and legal/ethical content, respondents were given a list of content areas specifically related
NU
to each course and asked to rate these content areas on a Likert scale. The responses were scaled
MA
as: “Not Critical,” Somewhat Important,” “Important,” Very Important,” and “Essential.” Presented in this section are findings regarding the content respondents reported as being most
ED
important for each course. Topics or content that were not included in the original researcherdeveloped survey, but added by respondents in the “comments” sections, are also discussed.
PT
Leadership and Management Content. Essential content findings related to
CE
leadership/management are shown in Table 1. Comments regarding additional course content
AC
areas in leadership and management not listed in the narrative section but mentioned by multiple respondents included attention to: health care policy, magnet hospital designation, conflict resolution, lateral violence/civility, informatics, advocacy, professional organizations, change theories/change, cultural competence/diversity, professionalism, and risk management. “Facilitating effective change” and topics associated with management of interpersonal conflict (e.g. “conflict management” and “dealing with horizontal violence”) were mentioned most often in the open comments section for this content area. Community and Public Health Nursing Content. As explained previously, 90% of the programs reported having a discreet course in “community health nursing.” This percentage is
10
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
likely higher as four respondents commented that they required a course in “public health nursing,” suggesting a difference of semantics.
RI P
T
Table 2 lists the “essential” to “not critical” findings for content related to community/public health nursing. Comments for the community/public health content area were
SC
relatively few. Additional content areas mentioned by multiple respondents as “essential” were: health care policy, health care finance and reform, cultural competence, vulnerable populations, Mentioned at least once were: home health, domestic violence,
NU
and gerontology.
One respondent
MA
communicable disease, care of those with disabilities, and end-of-life care.
noted that RN- BSN students in their program take separate courses in disaster and emergency
ED
nursing and health promotion.
Nursing Research Content. Table 3 presents the findings related to weighting
PT
components of the course on nursing research. Written comments related to essential research
CE
content and added multiple times by respondents were: critique of research evidence/critique of
AC
research reports and application of research into practice. Other content areas mentioned at least once in the comments section were: the difference between evidence-based practice and research, collaboration with the research team, ethical issues in research, implementation of evidence-based practice, and sampling (specifically, how sampling should relate to race/ethnicity). Professionalism and Legal/Ethical Content. Findings regarding content related to professionalism and legal/ethical issues are shown in Table 4. Comments for this section included the addition of content covering “communication” and “cultural competence” (each mentioned by several respondents). Also listed at least once were: patient advocacy,
11
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
socialization, professional development, group process, decision making, credibility, standards of care, participation in professional nursing organizations, civility, and writing.
RI P
T
“Other” Nursing Content. “Other” content areas, some specific and some very general in scope, were presented and the respondents were asked to rate each in the same manner as the
SC
previous sections. Table 5 contains findings from this section. Comments indicated that in several cases, much of the material of interest was either covered elsewhere in the survey (e.g.
NU
safety, culture, geriatrics) or perhaps should have been addressed in the initial nursing program
MA
(e.g. problem solving, infection control, nursing theories), therefore, although it is essential, it is not covered in the respondent‟s RN-BSN program.
ED
Content Needing Additional or Less Emphasis. The final questions were open ended and specially addressed areas that may need more emphasis in RN-BSN programs, as well as those
PT
content areas that should receive less emphasis. Table 6 shows the content areas that were most Repeatedly mentioned were: informatics,
CE
commonly noted as needing increased emphasis.
AC
gerontology/geriatrics/care of elders, and genetics/genomics. Issues related to health policy, health economics and health reform were also commonly listed. Content areas mentioned less frequently were: evidence-based practice, end-of-life care, health promotion, community/public health nursing, nursing during disasters, the nurse as educator, vulnerable populations, and alternative therapies/holism. One of the problems often cited with adding courses/content is the need to then deemphasize or eliminate other content. When asked what content in the program could be removed or given less attention, there were quite a few comments. Among them were: “moving health assessment from a required course to an elective”; “dropping health assessment”; “making
12
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
statistics a pre-requisite”; “reducing 6 hours of research to 3,” and reducing content on nursing theories and health policy. Reducing clinical time was mentioned by several respondents.
RI P
T
Discussion
There appears to be considerable consensus on the basic or core courses/content (i.e.
SC
leadership/management, community/public health, nursing research/evidence-based practice, and
NU
professionalism/legal and ethical issues) that should comprise much of RN-BSN education. These findings were consistent with the literature (Stokowski, 2011; TX-BON, 2011; Wros,
MA
et.al., 2011). Likewise, overall there appears to be considerable agreement on essential content areas that should be included in RN-BSN programs. Reported here are some brief observations
ED
for each content area.
PT
Leadership and Management Content. Inclusion of content, concepts and experiences in leadership and management are clearly “essential” according to RN-BSN program directors.
CE
Findings related to this course (or perhaps courses), show that communication/collaboration and
AC
coordination of care, along with quality care, and principles and models of leadership are considered to be critical for RN-BSN programs. Interestingly, although management-related topics, such as practice models, budgeting and electronic health records were considered to be very important by a majority, they were seen as relatively less “essential”. Community/Public Health Nursing Content. The findings related to community/public health nursing present a very clear picture as to what is expected for RN-BSN students. Conceptualization of “population health” and application of the nursing process to populations and communities (i.e. community assessment, population interventions, diversity/ disparities), along with health promotion, were almost universally considered “essential.” Traditional 13
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
public health topics such as environmental health, global health, screening and epidemiology were also mentioned frequently by respondents as being key content.
RI P
T
Several respondents noted that “cultural care” and/or “vulnerability” were essential content in community/public health. These concepts were presumed by the researchers to be
SC
implicitly included in the option of “health disparities/diversity” in the survey. Arguably, “culture” per se, should have been more explicit, as that is a very critical part of
NU
community/public health nursing.
MA
Nursing Research Content. In regard to content on nursing research, clearly there is a focus on “evidence-based practice.” Indeed, several respondents shared that the name of their
ED
course is now “evidence-based practice” (or some variation) rather than “nursing research.” In these courses – which are at the undergraduate level – there seems to be less attention given to
PT
teaching research methods and more attention being directed toward application of research.
CE
Comments provided by several respondents noted areas (i.e. critique of research evidence,
AC
critique of research reports and application of research into practice) that should have been included as part of the original survey, as they are important content in nursing research courses. Professionalism and Legal/Ethical Content. Very notably, “professional accountability” was one of the highest percentages (96%) of the all of the content areas rated as being either “essential” or “very important.” Not surprisingly, legal/ethical issues, scope of practice, and “contemporary issues” were also mentioned by many as being essential or very important. More tellingly, however, was that “professional image” was seen by most as being a key content area, with nearly as many rating it as very important as scope of practice and legal/ethical issues. This
14
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
suggests considerable agreement, or perhaps concern, that “professional image” is not sufficiently addressed in ADN/diploma programs.
RI P
T
“Other” Nursing Content. Somewhat surprisingly, problem solving/critical thinking rated as one of the most essential of all of the content areas presented, indicating that RN-BSN
SC
program directors believe those skills are not sufficiently addressed in the initial ADN/diploma program. That “safety” was also in important content area, on the other hand, is not surprising.
NU
While safety concepts are vital in all aspects of nursing and should be a critical component of
MA
ADN and diploma programs, they are truly “essential” components of leadership, management and professional practice, and therefore a key component of RN-BSN programs.
ED
Of all of the content questions, the “Other” section provided the most information as to what is not necessary to include in RN-BSN programs. Considered to be only “somewhat
PT
important” or “not critical” in RN-BSN programs were: high acuity, illness/disease management,
CE
infection control, and care transitions. These content areas are evidently presumed to have been covered in the RN‟s initial licensure program. Interestingly, the responses for four topical areas
AC
– theories, spiritual care, genetics/genomics, and complementary and alternative care were somewhat “mixed” (i.e. some thought it essential; others indicated “not critical”). This might indicate that while these topics may be viewed as important, they may not be “essential” enough to be included in the RN-BSN program, or it is unclear as to whether they were covered in the student‟s initial licensure program.
Genetics/genomics, in particular, is an area that has been
stressed by accrediting bodies, but may or may not have been added as yet into the programs of study.
15
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
Content Needing Additional Emphasis. There appears to be considerable attention to the notion of increasing “informatics” content in RN-BSN programs. What to include and where to
T
place it needs to be examined. For example: Should “informatics” be incorporated in the
RI P
leadership/management course in discussions on electronic health records? Should informatics be part of community/public health nursing during discussions on the use of electronic sources
SC
for gathering population health data? Should informatics be part of nursing research while
NU
discussing how to conduct computerized literature searches? Or all of the above? Enhancing content on geriatrics and genetics/genomics is a widely-recognized need, and follows suggested
MA
curricular changes mentioned earlier and which are seen as integral to BSN education (AACN
ED
2008; Forbes & Hickey 2009; Stowoski, 2011; Tanner, 2010). Summary
PT
The call to dramatically increase the percentage of BSN-prepared RNs has focused
CE
attention on the need to increase the number of RN-BSN programs and the capacity of existing
AC
programs to graduate greater numbers of students. Inherent in this is the need to examine the basic content, concepts, and experiences that are essential to transitioning the ADN/diploma RN into a “professional” nurse. The findings from this survey indicate that there is considerable consensus on the foundational courses to be used as the framework for RN-BSN programs. Further, there is also considerable agreement on basic content areas that need to be addressed within these courses (or elsewhere in the program). The results of this study can be used as a guide for developing new programs or revising existing programs. It can also be used as a starting place for nursing education leaders to dialogue on what content and competencies are indeed “essential” for BSN prepared nurses and where to focus education for RN-BSN programs.
16
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
Limitations Although there was excellent representation from all geographic areas and from many
RI P
T
different types of programs, one limitation of the study was potential bias relating to willingness to complete the survey. Also, specific to the findings reported here, participants were asked to
SC
respond to a researcher-developed list of content areas for each course. In an effort to keep the survey at a reasonable length, content area options for each course were limited. As a result,
NU
several key topics were likely missed in each content area, as was noted several times in the
MA
discussion. Conclusion
ED
It is paramount that nursing educators who teach in RN-BSN programs identify courses,
PT
concepts, and content areas that are needed by this cohort of students to complete their education at the baccalaureate level. From here, more attention needs to be given to delineating
CE
competencies and educational experiences (e.g. clinical) needed y BSN-prepared RNs, and
AC
therefore critical to include in RN-BSN programs. The findings are important to the future of nursing, considering the rapid growth of RN-BSN programs and the anticipated increase in the number of RN-BSN completion students necessary to meet the IOM recommendations. Future work, perhaps in a nation-wide forum or dialogue needs to be considered in order to better streamline and more explicitly focus guidelines and recommendations for RN-BSN programs.
17
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
References American Association of Colleges of Nursing (AACN). (2008). Essentials of Baccalaureate
T
Education for Professional Nursing Practice. http://www.aacn.nche.edu/education-
RI P
resources/BaccEssentials08.pdf
American Association of Colleges of Nursing (AACN). (2011). Schools offering RN to
SC
baccalaureate programs. Retrieved September 25, 2012, from
NU
http://www.aacn.nche.edu/research-data/RNBSN.pdf
MA
Forbes, M.O. & Hickey, M.T. (2009). Curriculum reform in baccalaureate nursing education: Review of the literature. International Journal of Nursing Education Scholarship, 6(1),
ED
1-16.
PT
Institute of Medicine (IOM). (2010). The future of nursing: Leading change, advancing health.
CE
Washington, DC: The National Academies Press.
AC
McEwen, M., White, M.J., Pullis, B., & Krawtz, S. (2012). National survey of RN-to-BSN programs. Journal of Nursing Education, 51(7), 373-380. National League for Nursing (NLN). (2010). Outcomes and competencies for graduates of practical/vocational, diploma, associate degree, baccalaureate, master’s, practice doctorate and research doctoral programs in nursing. New York, NY: NLN.
National League for Nursing Accrediting Commission (NLNAC). (2008). NLNAC
Accreditation Manual: Includes the 2008 Standards and Criteria. http://www.nlnac.org/manuals/NLNACManual2008.pdf 18
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
National League for Nursing Accrediting Commission (NLN-AC) (2011). NLNAC accredited nursing programs. Retrieved from: http://www.nlnac.org/Forms/directory_search.htm
RI P
T
National League for Nursing Accrediting Commission (NLNAC). (2012). NLNAC Standards and Criteria – Baccalaureate.
SC
http://www.nlnac.org/manuals/SC2008_BACCALAUREATE.pdf
NU
Stokowski, LA. (2011). Overhauling nursing education. Medscape Nurses News. Accessed
MA
August 22, 2012 from: http://www.medscape.com/viewarticle/736236 Tanner, C.A. (2010). Transforming prelicensure nursing education: Preparing the new nurse to
ED
meet emerging health care needs. Nursing Education Perspectives, 31(6), 347-353.
PT
Texas Board of Nursing (TX-BON) (2011). Differentiated Essential Competencies of Graduates
CE
of Texas Nursing Programs http://www.bon.texas.gov/about/pdfs/delc-2010.pdf Wros, P., Wheeler, P., & Jones, M. (2011). Curriculum planning for baccalaureate nursing
AC
programs. In S.B. Keating (ed). Curriculum development and evaluation in nursing (2nd ed., pp 209-240). New York, NY: Springer Publishing Co.
19
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs Table 1 – RN-BSN Programs Key Content in Leadership/Management Percent reporting
Percent reporting
content as:
content as
content as
“Essential” or
“Important”
“Somewhat
T
Percent reporting
RI P
Content area
SC
“Very Important”
91
“Not Critical” 7
2
89
10
1
89
10
1
82
14
4
74
21
5
72
22
6
71
26
3
71
25
4
69
26
5
67
25
8
Electronic health records
61
28
11
Budgeting
55
34
11
NU
Communication/collaboration/socialization
Important” or
Quality care/quality improvement
MA
Leadership theories/concepts/models/skills Coordination of care/ delegation/
ED
supervision/performance appraisal Health care systems
PT
Patient satisfaction
Health care reform
CE
Organizational theories and models
Practice models
AC
Health care financing and reimbursement
20
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs Table 2 – RN-BSN Programs Key Content in Community/Public Health Nursing Percent reporting
Percent reporting
content as:
content as
content as
“Essential” or
“important”
“Somewhat
95
Important” or “Not Critical”
5
0
94
6
0
93
6
1
92
5
3
88
11
1
88
11
1
85
14
1
80
18
2
76
20
4
72
21
7
Emergency preparedness/disaster response
71
25
4
Bioterrorism
62
28
10
49
40
11
NU
Population health
SC
“Very Important”
T
Percent reporting
RI P
Content area
Population/community assessment
MA
Health disparities/diversity Health promotion/risk reduction
Population-focused interventions
PT
Environmental health
ED
Public Health Core Functions
CE
Global health Screening
AC
Epidemiology and biostatistics
Occupational health
21
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs Table 3 – RN-BSN Programs Key Content in Nursing Research Percent reporting
Percent reporting
content as:
content as
content as
“Essential” or “Very
“important”
“Somewhat
Levels of evidence
Electronic data based search strategies
Basic applied statistics
PT
Forces driving research agendas
ED
Research process/methods/designs
AC
CE
Scholarship dissemination methods
22
“Not Critical” 0
90
10
0
89
10
1
88
10
2
86
13
1
68
27
5
63
31
6
63
31
6
MA
Protection of human subjects
Important” or
2
NU
98
SC
Important”
Evidence-based practice
T
Percent reporting
RI P
Content area
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs Table 4 – RN-BSN Programs Key Content Related to Professionalism and Legal/ethical Issues Percent reporting
Percent reporting
content as:
content as
content as
“Essential” or
“important”
“Somewhat
T
Percent reporting
RI P
Content area
SC
“Very Important”
96
Legal and ethical issues
MA
Scope of practice/Nurse Practice Acts Professional image
ED
Contemporary nursing issues Policy development
PT
Self care
AC
History of nursing
CE
Political activism
23
“Not Critical” 4
0
93
7
0
90
9
1
88
10
2
87
11
2
71
26
3
67
24
9
64
31
5
44
40
26
NU
Professional accountability
Important” or
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs Table 5 – RN-BSN Programs - “Other” Key Content Percent reporting
Percent reporting
content as:
content as
content as
“Essential” or
“important”
“Somewhat
95
Important” or “Not Critical” 5
0
NU
Problem solving/critical thinking
SC
“Very Important”
T
Percent reporting
RI P
Content area
92
6
2
86
13
2
83
11
5
77
20
2
73
18
9
73
19
7
69
20
12
Illness/disease management
65
17
18
Care transition (e.g. discharge planning)
65
23
13
63
24
12
Genetics/genomics
55
31
14
Complementary & alternative therapies
53
35
11
Infection control
50
24
16
Nursing theories
47
33
10
Borrowed/shared theories
47
40
13
High acuity/critical care
46
29
14
Safety (patient, organizational safety)
MA
Culture/cross cultural care Patient education/health literacy
ED
Information systems Geriatrics/care of elders
PT
Web-based learning
Spiritual care
AC
CE
End of life care/palliative care
24
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs Table 6 – RN-BSN Programs – Key Content Areas Needing Enhancement Content area
Number of Respondents Noting
RI P
T
Emphasis should increase Informatics Geriatrics
SC
Genetics/genomics
NU
Health policy/health economics/health care reform QSEN/quality/safety
MA
Ethics Global health
ED
Writing
15 14 12 7 4 3 3 3
AC
CE
PT
Professional expectations/accountability
21
25
S8755-7223(13)00166-X doi: 10.1016/j.profnurs.2013.10.003 YJPNU 795
To appear in:
Journal of Professional Nursing
Received date:
29 November 2012
Please cite this article as: McEwen, M., White, M.J., Pullis, B.R. & RN, MSN, S.K., Essential Content in RN-BSN Programs, Journal of Professional Nursing (2013), doi: 10.1016/j.profnurs.2013.10.003
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
RI P
T
Essential Content in RN-BSN Programs
MA
NU
SC
Essential Content in RN-BSN Programs
ED
Melanie McEwen, RN, PhD; Mary Joe White, RN, PhD;
PT
Bridgette R. Pullis, RN, PhD & Susan Krawtz, RN, MSN
AC
CE
The University of Texas Health Science Center at Houston School of Nursing
Correspondence concerning this article should be addressed to Melanie McEwen, Department of Nursing Systems, The University of Texas Health Science Center at Houston School of Nursing, 6901 Bertner, #730, Houston, Texas 77030. Email: [email protected]
1
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
T
Abstract
RI P
Currently, there are more than 600 RN-BSN programs in the U.S., and the number of students enrolled in them is growing quickly. This growth is at least partially in response to the
SC
Institute of Medicine‟s recent recommendation that 80% of RNs be BSN prepared by 2020.
NU
Proliferation of RN-BSN programs suggests a need to examine them more critically, as very little information is available in the nursing literature or through accrediting bodies regarding
MA
what courses and content they should include.
This study was conducted to determine what directors of RN-BSN educational programs
ED
report as being “essential” content. The findings can be used as a guide for developing new
PT
programs or revising existing programs. They may also be used as a starting place for nursing educators to dialogue on what content and competencies are truly “essential” for BSN prepared
AC
CE
nurses and where education should be focused in RN-BSN programs.
2
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
Introduction The recent recommendation from the Institute of Medicine (IOM, 2010) that 80% of
RI P
T
Registered Nurses (RNs) be baccalaureate (BSN) prepared by 2020 has shifted considerable attention in nursing education from simply increasing the number of RNs in the workforce, to
SC
increasing the number of BSN-educated RNs. The “80 by 2020” goal has also lead to recognition of the need to expand the ability of RN-BSN (“bridge” or “completion”) programs to
NU
enroll more students, thereby allowing practicing RNs, as well as future graduates from
MA
Associate Degree (ADN) and diploma programs, an opportunity to achieve their BSN. Currently, there are more than 600 RN-BSN programs in the U.S. and the number is
ED
growing. Until recently, these programs have received minimal attention in the nursing literature or from accrediting organizations. One challenge faced by faculty responsible for RN-BSN
PT
education is identifying or anticipating what content and experiences are missing or deficient in
CE
the basic pre-licensure program and designing a curriculum to address these deficiencies.
AC
Traditionally, ADN and diploma nursing programs are understood to prepare “technical” nurses, whereas BSN programs prepare “professional” nurses. Typically, RN-BSN completion programs require a set of nursing courses designed to expand upon or enhance what was learned in the initial nursing program by providing content and experiences that prepare the RN for work in highly complex environments and community settings, as well as preparing them for graduate education. This study presents vital information gleaned from a national survey to gather information on the courses, concepts and content areas, which have been identified by RN-BSN program directors as essential in equipping RNs to become “professional” nurses.
3
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
Literature Review Surprisingly little information was identified in the recent nursing literature specific to
RI P
T
RN-BSN programs or describing perceived differences between the educational preparation and anticipated competencies among ADN/diploma graduates and BSN graduates. Similarly, while
SC
there is some information on the updates to curricular content of BSN programs in general, there is almost no information found specifically related to what content and competencies should be
NU
included in RN-BSN programs. A review of the sparse findings is presented here.
MA
In her work discussing current and future needs in nursing education, Stokowski (2011) listed examples of competencies or “higher level skills” that should be included in nursing
ED
education. She noted that certain nursing competencies are a “foundation for decision-making skills under a variety of clinical situations across all care settings” (p. 4). Some competencies
PT
mentioned in this work (i.e. clinical judgment, teaching, critical reasoning, relationship-centered
CE
care, cultural sensitivity, and practice across the lifespan) are critical to nursing practice regardless of the level of educational attainment (i.e. BSN, ADN, diploma). Many of the
AC
identified “expanded competencies” (p. 6), however, may be more readily expected among BSNeducated RNs, and therefore should be part of RN-BSN programs. These expanded competencies include: evidence-based practice, leadership, assisting individuals and families in self-care practices for promotion of health and management of chronic illness, delegation and supervision of caregivers, genetics and genomics, and professionalism. Stokowski supported the notion of the BSN as being necessary for RNs‟ expanding practice into such areas as community and public health, leadership, systems improvement and change, research, and health policy, as well as to prepare nurses for graduate education.
4
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
In their literature review discussing curriculum reform for BSN education in general (i.e. not specific to RN-BSN programs), Forbes and Hickey (2009) explained that attention is
T
currently moving away from heavily content-driven curricula. They discussed trends for
RI P
updating BSN curricula focusing on: addition of safety and quality concepts/content and processes (i.e. QSEN); redesigning conceptual frameworks to focus on AACN Essentials;
SC
enhancing attention to community-based care; and increasing emphasis on “core” concepts (e.g.
NU
nursing knowledge, nursing skills, nursing values, and nursing experience). They also discussed the necessity of limiting some content while expanding other areas (e.g. genetics, informatics,
MA
population health).
ED
Directly addressing the IOM‟s “80% by 2020” recommendation, Tanner (2010) presented several strategies to change nursing education. One suggestion was to improve articulation
PT
between ADN and BSN programs. She described how faculty in community colleges and
CE
university programs can and should work together to develop curricula responsive to emerging health care needs, while addressing nursing‟s updated competencies. Discussing curriculum
AC
innovation, she specifically mentioned the enhancement of content in geriatric care/gerontology, providing care in community-based settings, and population-based care. She also focused considerable attention on how to address the problem of the “content-laden curriculum.” Describing the differentiation in outcomes and competencies among the three program levels, the NLN (2010) explained that baccalaureate nursing education provides students with the foundational knowledge and skills commensurate with diploma and ADN programs preparing RNs. Additionally, the NLN explained that “baccalaureate nursing education includes learning experiences related to community and population-focused care, leadership and management, and research” (p. 39). The competencies outlined for BSN nurses build upon those defined for other 5
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
pre-licensure programs, and expressly includes care to families and communities, identification of research questions and critique of published research, using evidence to propose solutions to
T
clinical practice problems, focus on health promotion, and “a willingness to provide leadership in
RI P
improving care”(p. 39).
SC
The Texas Board of Nursing (TX-BON, 2011) also explicitly described the differences in competencies and knowledge between ADN/diploma and BSN-prepared RNs. The Texas BON‟s
NU
“Differentiated Essential Competencies” (DECs) provide detailed guidelines as to what content
MA
and concepts should be included in RN-BSN programs to ensure that BSN-prepared RNs will function at the professional level. The DECs are both broad and specific, and describe how
ED
graduates from BSN programs are expected to demonstrate the competencies (knowledge, clinical judgments, and behaviors) of the preceding levels of education (ADN/diploma), but with
PT
greater depth and breadth of application and synthesis. Finally, the DECs instruct BSN
CE
educators to focus on the addition of “populations” and “communities” and the promotion of
AC
“practice of Professional nursing through leadership activities and advocacy” (p. 4). In the only source that specifically discussed courses commonly found in RN-BSN curricula, Wros, Wheeler, and Jones (2011) observed that “bridge” programs prepare nurses for expanded professional roles. They maintained that content must be designed to assist students in developing higher levels of critical thinking skills and broadening their scope of practice, in addition to understanding the social, cultural, economic, and geopolitical context of health care. Wros and colleagues explained that RN-BSN curricula generally focus on topics such as enhancing professional communication, theoretical perspectives for practice, community and population-based nursing care, and leadership. They concluded that in RN-BSN programs,
6
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
clinical practica should be completed in community-based settings with attention to evidencebased perspectives, and should include nursing leadership projects and activities.
RI P
T
One significant observation in reviewing the literature is the absence of guidelines and recommendations from the nursing education accreditation entities explicitly addressing RN-
SC
BSN programs. While the accreditation materials from the National League for Nursing‟s Accrediting Commission (NLNAC, 2008, 2012) and the Commission on Collegiate Nursing
NU
Education (AACN, 2008) are instructive in providing general guidelines on content and
MA
competencies, they are geared toward general BSN curricula and programs. Indeed, nothing was identified in the accreditation materials from either organization specifically addressing RN-BSN
ED
program requirements or curricula.
PT
Purpose
The purpose of this study was to explore what directors of RN-BSN educational
CE
programs currently identify as being “essential” courses and content in their curriculum. The
AC
findings are important to the future of nursing, considering the rapid growth of RN-BSN programs and the anticipated increase in the number of students enrolled in them that will be necessary to meet the IOM recommendations. Methodology This report is a secondary analysis of a nationwide survey of RN-BSN program directors. The questionnaire used for the study was developed by a team of faculty responsible for the RNBSN program at a large, medical center-based, nursing program. The survey form incorporated questions from discussions with students, colleagues, and administration as well as from information found in the literature. Survey questions were grouped into four general categories: 7
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
1) basic background information (e.g. program size, number of credit hours, admission criteria); 2) curricular and instructional information (e.g. courses, clinical requirements, instructional
T
formats used); 3) evaluation methods; and 4) content or topics were covered in the different
RI P
courses. Most questions were „forced choice‟, with an option for the respondent to provide comments. The information related to specific content of the courses (e.g. research,
SC
leadership/management, community/public health nursing) were evaluated using a Likert-type
NU
format. The survey tool was forwarded to several faculty to determined content validity; revisions were made based on their input. The survey was then formatted for online delivery and
MA
circulated to six faculty to assess readability and evaluate the time needed to complete the survey.
ED
To obtain the sample, the directories of the RN-to-BSN programs accredited by the
PT
AACN/CCNE (2011) and the NLNAC (2011) were compared and duplicates removed. The result was a list containing 614 programs. The program director or a contact person from each
CE
program was sent an e-mailed letter explaining the purpose of the survey and inviting
AC
participation. Those agreeing to participate were instructed to open a link to the instructordesigned survey employing “Zoomerang” software. The survey was determined to be “exempt” from Institutional Review and completion of the survey was accepted as consent to participate in the study. The initial report (McEwen, White, Pullis & Krawtz, 2012) discussed findings related to: program characteristics, instructional format, general curricula, clinical requirements, and evaluation.
Presented here is information related to the courses and content areas that RN-BSN
program directors deemed to be “essential,” and thereby necessary to include in the curriculum.
8
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
Results Of the 614 RN-to-BSN program directors asked to participate in the survey, 210 finished
RI P
T
it, for a completion rate of 34.2%. The geographic location of the responding programs was very diverse, representing all regions of the U.S. More than half of the respondents were from
SC
public universities and 40% were from private programs. The remainder were located in medical centers, community colleges and “other” (e.g. online only programs). Most of the programs
NU
were relatively small (less than 50 students enrolled and fewer than 25 graduates per year),
MA
although about 20% had more than 125 students enrolled and 13% reported graduating more than 75 students per year.
ED
Findings Related to Discrete Courses. When queried about specific courses required in their programs, four courses were required by a considerable majority. The most commonly
PT
reported discrete courses and percentage of programs that require them were: leadership and
CE
management (92%); community/public health (90%); research (89%); and health assessment
AC
(79%). Other commonly required courses were statistics (55%) and pathophysiology (45%). Notably, several respondents explained that statistics is a pre-requisite, while others said the same of pathophysiology. The survey invited comments for each of section and these open comments gave insight into other course commonly reported as being “required.” For example, several participants noted that students are must take an “issues” course and/or a “transitions” or “bridge” course. An “ethics” course was specifically listed as a requirement by four respondents. Elective courses are common among RN-BSN Programs. In some programs, courses such as health assessment, pathophysiology and pharmacology were designated to be electives rather than required courses.
9
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
Courses also mentioned as being offered as electives were: “women‟s health,” “patient education,” “critical care,” “health promotion,” “transcultural nursing,” and “gerontology.”
RI P
T
Findings Related to Essential Content for Key Courses. To gather more detailed information on what was considered to be key or essential content for each of the traditional
SC
content areas (i.e. community/public health, leadership/management, research), and professional issues and legal/ethical content, respondents were given a list of content areas specifically related
NU
to each course and asked to rate these content areas on a Likert scale. The responses were scaled
MA
as: “Not Critical,” Somewhat Important,” “Important,” Very Important,” and “Essential.” Presented in this section are findings regarding the content respondents reported as being most
ED
important for each course. Topics or content that were not included in the original researcherdeveloped survey, but added by respondents in the “comments” sections, are also discussed.
PT
Leadership and Management Content. Essential content findings related to
CE
leadership/management are shown in Table 1. Comments regarding additional course content
AC
areas in leadership and management not listed in the narrative section but mentioned by multiple respondents included attention to: health care policy, magnet hospital designation, conflict resolution, lateral violence/civility, informatics, advocacy, professional organizations, change theories/change, cultural competence/diversity, professionalism, and risk management. “Facilitating effective change” and topics associated with management of interpersonal conflict (e.g. “conflict management” and “dealing with horizontal violence”) were mentioned most often in the open comments section for this content area. Community and Public Health Nursing Content. As explained previously, 90% of the programs reported having a discreet course in “community health nursing.” This percentage is
10
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
likely higher as four respondents commented that they required a course in “public health nursing,” suggesting a difference of semantics.
RI P
T
Table 2 lists the “essential” to “not critical” findings for content related to community/public health nursing. Comments for the community/public health content area were
SC
relatively few. Additional content areas mentioned by multiple respondents as “essential” were: health care policy, health care finance and reform, cultural competence, vulnerable populations, Mentioned at least once were: home health, domestic violence,
NU
and gerontology.
One respondent
MA
communicable disease, care of those with disabilities, and end-of-life care.
noted that RN- BSN students in their program take separate courses in disaster and emergency
ED
nursing and health promotion.
Nursing Research Content. Table 3 presents the findings related to weighting
PT
components of the course on nursing research. Written comments related to essential research
CE
content and added multiple times by respondents were: critique of research evidence/critique of
AC
research reports and application of research into practice. Other content areas mentioned at least once in the comments section were: the difference between evidence-based practice and research, collaboration with the research team, ethical issues in research, implementation of evidence-based practice, and sampling (specifically, how sampling should relate to race/ethnicity). Professionalism and Legal/Ethical Content. Findings regarding content related to professionalism and legal/ethical issues are shown in Table 4. Comments for this section included the addition of content covering “communication” and “cultural competence” (each mentioned by several respondents). Also listed at least once were: patient advocacy,
11
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
socialization, professional development, group process, decision making, credibility, standards of care, participation in professional nursing organizations, civility, and writing.
RI P
T
“Other” Nursing Content. “Other” content areas, some specific and some very general in scope, were presented and the respondents were asked to rate each in the same manner as the
SC
previous sections. Table 5 contains findings from this section. Comments indicated that in several cases, much of the material of interest was either covered elsewhere in the survey (e.g.
NU
safety, culture, geriatrics) or perhaps should have been addressed in the initial nursing program
MA
(e.g. problem solving, infection control, nursing theories), therefore, although it is essential, it is not covered in the respondent‟s RN-BSN program.
ED
Content Needing Additional or Less Emphasis. The final questions were open ended and specially addressed areas that may need more emphasis in RN-BSN programs, as well as those
PT
content areas that should receive less emphasis. Table 6 shows the content areas that were most Repeatedly mentioned were: informatics,
CE
commonly noted as needing increased emphasis.
AC
gerontology/geriatrics/care of elders, and genetics/genomics. Issues related to health policy, health economics and health reform were also commonly listed. Content areas mentioned less frequently were: evidence-based practice, end-of-life care, health promotion, community/public health nursing, nursing during disasters, the nurse as educator, vulnerable populations, and alternative therapies/holism. One of the problems often cited with adding courses/content is the need to then deemphasize or eliminate other content. When asked what content in the program could be removed or given less attention, there were quite a few comments. Among them were: “moving health assessment from a required course to an elective”; “dropping health assessment”; “making
12
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
statistics a pre-requisite”; “reducing 6 hours of research to 3,” and reducing content on nursing theories and health policy. Reducing clinical time was mentioned by several respondents.
RI P
T
Discussion
There appears to be considerable consensus on the basic or core courses/content (i.e.
SC
leadership/management, community/public health, nursing research/evidence-based practice, and
NU
professionalism/legal and ethical issues) that should comprise much of RN-BSN education. These findings were consistent with the literature (Stokowski, 2011; TX-BON, 2011; Wros,
MA
et.al., 2011). Likewise, overall there appears to be considerable agreement on essential content areas that should be included in RN-BSN programs. Reported here are some brief observations
ED
for each content area.
PT
Leadership and Management Content. Inclusion of content, concepts and experiences in leadership and management are clearly “essential” according to RN-BSN program directors.
CE
Findings related to this course (or perhaps courses), show that communication/collaboration and
AC
coordination of care, along with quality care, and principles and models of leadership are considered to be critical for RN-BSN programs. Interestingly, although management-related topics, such as practice models, budgeting and electronic health records were considered to be very important by a majority, they were seen as relatively less “essential”. Community/Public Health Nursing Content. The findings related to community/public health nursing present a very clear picture as to what is expected for RN-BSN students. Conceptualization of “population health” and application of the nursing process to populations and communities (i.e. community assessment, population interventions, diversity/ disparities), along with health promotion, were almost universally considered “essential.” Traditional 13
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
public health topics such as environmental health, global health, screening and epidemiology were also mentioned frequently by respondents as being key content.
RI P
T
Several respondents noted that “cultural care” and/or “vulnerability” were essential content in community/public health. These concepts were presumed by the researchers to be
SC
implicitly included in the option of “health disparities/diversity” in the survey. Arguably, “culture” per se, should have been more explicit, as that is a very critical part of
NU
community/public health nursing.
MA
Nursing Research Content. In regard to content on nursing research, clearly there is a focus on “evidence-based practice.” Indeed, several respondents shared that the name of their
ED
course is now “evidence-based practice” (or some variation) rather than “nursing research.” In these courses – which are at the undergraduate level – there seems to be less attention given to
PT
teaching research methods and more attention being directed toward application of research.
CE
Comments provided by several respondents noted areas (i.e. critique of research evidence,
AC
critique of research reports and application of research into practice) that should have been included as part of the original survey, as they are important content in nursing research courses. Professionalism and Legal/Ethical Content. Very notably, “professional accountability” was one of the highest percentages (96%) of the all of the content areas rated as being either “essential” or “very important.” Not surprisingly, legal/ethical issues, scope of practice, and “contemporary issues” were also mentioned by many as being essential or very important. More tellingly, however, was that “professional image” was seen by most as being a key content area, with nearly as many rating it as very important as scope of practice and legal/ethical issues. This
14
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
suggests considerable agreement, or perhaps concern, that “professional image” is not sufficiently addressed in ADN/diploma programs.
RI P
T
“Other” Nursing Content. Somewhat surprisingly, problem solving/critical thinking rated as one of the most essential of all of the content areas presented, indicating that RN-BSN
SC
program directors believe those skills are not sufficiently addressed in the initial ADN/diploma program. That “safety” was also in important content area, on the other hand, is not surprising.
NU
While safety concepts are vital in all aspects of nursing and should be a critical component of
MA
ADN and diploma programs, they are truly “essential” components of leadership, management and professional practice, and therefore a key component of RN-BSN programs.
ED
Of all of the content questions, the “Other” section provided the most information as to what is not necessary to include in RN-BSN programs. Considered to be only “somewhat
PT
important” or “not critical” in RN-BSN programs were: high acuity, illness/disease management,
CE
infection control, and care transitions. These content areas are evidently presumed to have been covered in the RN‟s initial licensure program. Interestingly, the responses for four topical areas
AC
– theories, spiritual care, genetics/genomics, and complementary and alternative care were somewhat “mixed” (i.e. some thought it essential; others indicated “not critical”). This might indicate that while these topics may be viewed as important, they may not be “essential” enough to be included in the RN-BSN program, or it is unclear as to whether they were covered in the student‟s initial licensure program.
Genetics/genomics, in particular, is an area that has been
stressed by accrediting bodies, but may or may not have been added as yet into the programs of study.
15
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
Content Needing Additional Emphasis. There appears to be considerable attention to the notion of increasing “informatics” content in RN-BSN programs. What to include and where to
T
place it needs to be examined. For example: Should “informatics” be incorporated in the
RI P
leadership/management course in discussions on electronic health records? Should informatics be part of community/public health nursing during discussions on the use of electronic sources
SC
for gathering population health data? Should informatics be part of nursing research while
NU
discussing how to conduct computerized literature searches? Or all of the above? Enhancing content on geriatrics and genetics/genomics is a widely-recognized need, and follows suggested
MA
curricular changes mentioned earlier and which are seen as integral to BSN education (AACN
ED
2008; Forbes & Hickey 2009; Stowoski, 2011; Tanner, 2010). Summary
PT
The call to dramatically increase the percentage of BSN-prepared RNs has focused
CE
attention on the need to increase the number of RN-BSN programs and the capacity of existing
AC
programs to graduate greater numbers of students. Inherent in this is the need to examine the basic content, concepts, and experiences that are essential to transitioning the ADN/diploma RN into a “professional” nurse. The findings from this survey indicate that there is considerable consensus on the foundational courses to be used as the framework for RN-BSN programs. Further, there is also considerable agreement on basic content areas that need to be addressed within these courses (or elsewhere in the program). The results of this study can be used as a guide for developing new programs or revising existing programs. It can also be used as a starting place for nursing education leaders to dialogue on what content and competencies are indeed “essential” for BSN prepared nurses and where to focus education for RN-BSN programs.
16
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
Limitations Although there was excellent representation from all geographic areas and from many
RI P
T
different types of programs, one limitation of the study was potential bias relating to willingness to complete the survey. Also, specific to the findings reported here, participants were asked to
SC
respond to a researcher-developed list of content areas for each course. In an effort to keep the survey at a reasonable length, content area options for each course were limited. As a result,
NU
several key topics were likely missed in each content area, as was noted several times in the
MA
discussion. Conclusion
ED
It is paramount that nursing educators who teach in RN-BSN programs identify courses,
PT
concepts, and content areas that are needed by this cohort of students to complete their education at the baccalaureate level. From here, more attention needs to be given to delineating
CE
competencies and educational experiences (e.g. clinical) needed y BSN-prepared RNs, and
AC
therefore critical to include in RN-BSN programs. The findings are important to the future of nursing, considering the rapid growth of RN-BSN programs and the anticipated increase in the number of RN-BSN completion students necessary to meet the IOM recommendations. Future work, perhaps in a nation-wide forum or dialogue needs to be considered in order to better streamline and more explicitly focus guidelines and recommendations for RN-BSN programs.
17
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
References American Association of Colleges of Nursing (AACN). (2008). Essentials of Baccalaureate
T
Education for Professional Nursing Practice. http://www.aacn.nche.edu/education-
RI P
resources/BaccEssentials08.pdf
American Association of Colleges of Nursing (AACN). (2011). Schools offering RN to
SC
baccalaureate programs. Retrieved September 25, 2012, from
NU
http://www.aacn.nche.edu/research-data/RNBSN.pdf
MA
Forbes, M.O. & Hickey, M.T. (2009). Curriculum reform in baccalaureate nursing education: Review of the literature. International Journal of Nursing Education Scholarship, 6(1),
ED
1-16.
PT
Institute of Medicine (IOM). (2010). The future of nursing: Leading change, advancing health.
CE
Washington, DC: The National Academies Press.
AC
McEwen, M., White, M.J., Pullis, B., & Krawtz, S. (2012). National survey of RN-to-BSN programs. Journal of Nursing Education, 51(7), 373-380. National League for Nursing (NLN). (2010). Outcomes and competencies for graduates of practical/vocational, diploma, associate degree, baccalaureate, master’s, practice doctorate and research doctoral programs in nursing. New York, NY: NLN.
National League for Nursing Accrediting Commission (NLNAC). (2008). NLNAC
Accreditation Manual: Includes the 2008 Standards and Criteria. http://www.nlnac.org/manuals/NLNACManual2008.pdf 18
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs
National League for Nursing Accrediting Commission (NLN-AC) (2011). NLNAC accredited nursing programs. Retrieved from: http://www.nlnac.org/Forms/directory_search.htm
RI P
T
National League for Nursing Accrediting Commission (NLNAC). (2012). NLNAC Standards and Criteria – Baccalaureate.
SC
http://www.nlnac.org/manuals/SC2008_BACCALAUREATE.pdf
NU
Stokowski, LA. (2011). Overhauling nursing education. Medscape Nurses News. Accessed
MA
August 22, 2012 from: http://www.medscape.com/viewarticle/736236 Tanner, C.A. (2010). Transforming prelicensure nursing education: Preparing the new nurse to
ED
meet emerging health care needs. Nursing Education Perspectives, 31(6), 347-353.
PT
Texas Board of Nursing (TX-BON) (2011). Differentiated Essential Competencies of Graduates
CE
of Texas Nursing Programs http://www.bon.texas.gov/about/pdfs/delc-2010.pdf Wros, P., Wheeler, P., & Jones, M. (2011). Curriculum planning for baccalaureate nursing
AC
programs. In S.B. Keating (ed). Curriculum development and evaluation in nursing (2nd ed., pp 209-240). New York, NY: Springer Publishing Co.
19
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs Table 1 – RN-BSN Programs Key Content in Leadership/Management Percent reporting
Percent reporting
content as:
content as
content as
“Essential” or
“Important”
“Somewhat
T
Percent reporting
RI P
Content area
SC
“Very Important”
91
“Not Critical” 7
2
89
10
1
89
10
1
82
14
4
74
21
5
72
22
6
71
26
3
71
25
4
69
26
5
67
25
8
Electronic health records
61
28
11
Budgeting
55
34
11
NU
Communication/collaboration/socialization
Important” or
Quality care/quality improvement
MA
Leadership theories/concepts/models/skills Coordination of care/ delegation/
ED
supervision/performance appraisal Health care systems
PT
Patient satisfaction
Health care reform
CE
Organizational theories and models
Practice models
AC
Health care financing and reimbursement
20
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs Table 2 – RN-BSN Programs Key Content in Community/Public Health Nursing Percent reporting
Percent reporting
content as:
content as
content as
“Essential” or
“important”
“Somewhat
95
Important” or “Not Critical”
5
0
94
6
0
93
6
1
92
5
3
88
11
1
88
11
1
85
14
1
80
18
2
76
20
4
72
21
7
Emergency preparedness/disaster response
71
25
4
Bioterrorism
62
28
10
49
40
11
NU
Population health
SC
“Very Important”
T
Percent reporting
RI P
Content area
Population/community assessment
MA
Health disparities/diversity Health promotion/risk reduction
Population-focused interventions
PT
Environmental health
ED
Public Health Core Functions
CE
Global health Screening
AC
Epidemiology and biostatistics
Occupational health
21
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs Table 3 – RN-BSN Programs Key Content in Nursing Research Percent reporting
Percent reporting
content as:
content as
content as
“Essential” or “Very
“important”
“Somewhat
Levels of evidence
Electronic data based search strategies
Basic applied statistics
PT
Forces driving research agendas
ED
Research process/methods/designs
AC
CE
Scholarship dissemination methods
22
“Not Critical” 0
90
10
0
89
10
1
88
10
2
86
13
1
68
27
5
63
31
6
63
31
6
MA
Protection of human subjects
Important” or
2
NU
98
SC
Important”
Evidence-based practice
T
Percent reporting
RI P
Content area
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs Table 4 – RN-BSN Programs Key Content Related to Professionalism and Legal/ethical Issues Percent reporting
Percent reporting
content as:
content as
content as
“Essential” or
“important”
“Somewhat
T
Percent reporting
RI P
Content area
SC
“Very Important”
96
Legal and ethical issues
MA
Scope of practice/Nurse Practice Acts Professional image
ED
Contemporary nursing issues Policy development
PT
Self care
AC
History of nursing
CE
Political activism
23
“Not Critical” 4
0
93
7
0
90
9
1
88
10
2
87
11
2
71
26
3
67
24
9
64
31
5
44
40
26
NU
Professional accountability
Important” or
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs Table 5 – RN-BSN Programs - “Other” Key Content Percent reporting
Percent reporting
content as:
content as
content as
“Essential” or
“important”
“Somewhat
95
Important” or “Not Critical” 5
0
NU
Problem solving/critical thinking
SC
“Very Important”
T
Percent reporting
RI P
Content area
92
6
2
86
13
2
83
11
5
77
20
2
73
18
9
73
19
7
69
20
12
Illness/disease management
65
17
18
Care transition (e.g. discharge planning)
65
23
13
63
24
12
Genetics/genomics
55
31
14
Complementary & alternative therapies
53
35
11
Infection control
50
24
16
Nursing theories
47
33
10
Borrowed/shared theories
47
40
13
High acuity/critical care
46
29
14
Safety (patient, organizational safety)
MA
Culture/cross cultural care Patient education/health literacy
ED
Information systems Geriatrics/care of elders
PT
Web-based learning
Spiritual care
AC
CE
End of life care/palliative care
24
ACCEPTED MANUSCRIPT Essential Content in RN-BSN Programs Table 6 – RN-BSN Programs – Key Content Areas Needing Enhancement Content area
Number of Respondents Noting
RI P
T
Emphasis should increase Informatics Geriatrics
SC
Genetics/genomics
NU
Health policy/health economics/health care reform QSEN/quality/safety
MA
Ethics Global health
ED
Writing
15 14 12 7 4 3 3 3
AC
CE
PT
Professional expectations/accountability
21
25
