Maine Partners in Nursing Education and Practice May 23, 2012 © Oregon Consortium for Nursing Education OCNE Do not replicate without permission Paula Gubrud EdD RN FAAN ◦ Co-director of the Oregon Consortium of Nursing Education ◦ Senior Associate Dean for Education – Oregon Health & Sciences University School of Nursing

Introductions © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Workshop Outcomes Describe the essential components of competency-based nursing education curriculum needed in response to emerging health care needs and the changes in health care delivery. Affirm commitment to use the Maine New Nurse Competencies as a beginning framework for transforming curriculum in Maine’s nursing education programs. Identify new assumptions needed to design competency-based curriculum. © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Workshop Outcomes Identify agreements needed to facilitate transfer of courses from ADN to BSN Agree to a timeline and processes for developing agreements needed to facilitate the full integration of competencies in Maine’s nursing education programs. © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

National Trends Driving Forces: Workforce Shortages Nursing shortage with projected vacancy rate of 50% by 2020 Nursing faculty shortage -Challenges with clinical sites -Education/Practice Gap Magnet Status Need for BSN prepared nurses and beyond in rural areas and in selected areas of practice (e.g. long term care) © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Carnegie Study Findings Shift from decontextualized knowledge to teaching for salience Situated cognition and action in particular situations Integration of clinical and theory Strategies for teaching salience ◦ Spiral learning ◦ Guide thinking through questioning ◦ Rehearse verbally ◦ Ensure reflection Develop a clinical imagination learning to stay open to unfolding cases © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Future of Nursing 4 Key Messages 1) Nurses should practice to the full extent of their education and training. 2) Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Future of Nursing 4 Key Messages 3) Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States. 4) Effective workforce planning and policy making require better data collection and an improved information infrastructure. © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Driving Forces: Emerging Health Care Needs Changing Health Care Needs of Americans Aging population Increasing diversity Increasing prevalence of chronic conditions 1 in 4 families involved in care giving © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Changing nursing practice >50% practicing in community-based, non- acute care settings Advances in technology and information Increased acuity & complexity in all settings Need for the nurse as knowledge worker in rapid change environments Uncertainty of the Affordable Care Act – implications of supreme court decision © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

What does the nurse need to know & be able to do?

Supported by grants from: Northwest Health Foundation DHHS, Health Resource & Services Administration, Division of Nursing William Randolph Hearst Foundations Kaiser Permanente Northwest Meyer Memorial Trust James and Marion Miller Foundation Ford Family Foundation Robert Wood Johnson Foundation US Dept of Education, Fund for Improvement of Post-Secondary Education © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Key Questions in framing Curriculum What is the focus of the practice we are preparing our graduates for. Is it generalist practice? Is it specialty practice? What is foundational (fundamental) to this practice? Oregon Consortium for Nursing Education (OCNE). Do not replicate without permission.14

OCNE Snapshot ~ What has been created: Partnerships and Relationships Curriculum Transformation Pedagogical Reform Clinical Education Redesign always a work in progress © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Partnerships and Relationships ADN (AAS) faculty and BSN (BS) faculty Practice partners in health care agencies College administrators with each other Student support personnel Oregon Dept of Ed, State Board of Nursing. NLNAC, AACN Oregon University System, Northwest Commission of Accreditation of Colleges and Universities © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

OCNE snapshot: Curriculum Transformation © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

OCNE Curriculum Transformation What has been created: © Oregon Consortium for Nursing Education OCNE Do not replicate without permission ONE common competency-based, integrated, baccalaureate curriculum taught on 13 campuses, with CC students having an option to complete AAS & sit for NCLEX-RN and/or transition directly for 4th year courses

OCNE Curriculum Transformation What has been created: © Oregon Consortium for Nursing Education OCNE Do not replicate without permission Common academic standards– admission, progression, transfer standards. Students admitted to community college are co-admitted to University. A COMMON, SHARED CURRICULUM, MORE THAN AN ARTICULATION AGREEMENT

OCNE snapshot: Pedagogy Reform © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Pedagogy Reform What has being created: © Oregon Consortium for Nursing Education OCNE Do not replicate without permission Faculty development started early and ongoing ◦ We learned together – teambuilding Educational evidence base & best practices Case based instruction Sharing of instructional resources linked to curriculum

Shared Agreements Admission and Progression Faculty Sharing Library Standards Financial Aid Disability and Accommodations © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Creating a shared Curriculum between AAS and BS programs © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

OCNE : building a Consortium between AAS and BS programs Creating a shared vision ( ) Creating consensus Processes & Infrastructure ( ) Designing Curriculum ( ) Curriculum Approval & Implementation ( ) Faculty Development (2003…) Conducting a Comprehensive evaluation (2006…) Creating organizational sustainability ( ) © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Creating Consensus Processes Early agreements through frank discussion: changing nursing practice definition of Generalist definition of Nursing Fundamentals – what is foundational education to promote deep learning and “Enduring understanding” of discipline’s most central concepts © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Creating Consensus Processes How OCNE built consensus: Time and Money Regularly scheduled face to face meetings of directors and faculty committees “Hot buttons” to help identify conflict Regularly scheduled fun and celebrations © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Creating Consensus Infrastructure ( ) Development of Interagency agreements necessary to support shared curriculum, admission and co-admission © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Designing a shared Curriculum Consultants in educational evidenced based, best practices and cognitive science of learning Look at both curriculum and pedagogy transformation Built from the ground up. No one partner’s curriculum was used © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Designing a shared Curriculum Organization – Framework ◦ OCNE not based on a particular theory or formal model ◦ Outcomes-based… all courses, all learning directed to same end in view… competencies of graduate. ◦ Integrated & spiraled rather than Blocked & leveled © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Competency & dimension Health & illness context Focus of carePopulation Concepts/content related to focus of care © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

OCNE Framework for Content Organization & Selection Competency & Dimensions Focus Of Care Concepts & Content Population © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Designing a shared Curriculum Control of content expansion  Use of data such as IOM, Healthy People…  Clinical partner input  Use of exemplars  Course selection teams  Large amounts of faculty development © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Table Talk WHERE do you see Maine in each area? #1. Partnerships ◦ Strengths ◦ Challenges #2. Curriculum transformation ◦ What is compelling about Oregon’s curriculum transformation ◦ What is the ideal approach to integrating Maine’s competencies into nursing programs Appoint a scribe Appoint a spokesperson to share © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Refresh

Lunch & Networking © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Nuts & Bolts of the OCNE Curriculum © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

OCNE Competencies 1. Ethical reasoning and practice 2. Insight through reflection; self-care; 3. Intentional learning; 4. Leadership in nursing and health care; 5. Collaboration as part of health care team; 6. Practice within the health care system; 7. Relationship-centered care; 8. Effective communication; 9. Sound clinical judgments; 10. Practice decisions using best available evidence..

Curriculum Year 1 – Pre-requisites – Full Time- 45 quarter credits ◦ Full Year of Anatomy and Physiology ◦ Nutrition ◦ Human Growth and Development ◦ Social Sciences ◦ Writing ◦ Math ◦ Electives © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Year 2 – Fall Quarter Health Promotion – 9 credits ◦ Redefined fundamentals introduced ◦ Health promotion across the life span ◦ Skills Microbiology – 4 credits Genetics- 2 credits © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Year 2 – Winter Quarter Chronic Care I -6 Credits Pharmacology I – 3 Credits Pathophysiology 1- 3 Credits © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Year 2 – Quarter 3 Acute Care I -6 Credits Pharmacology I – 3 Credits Pathophysiology 1- 3 Credits General Electives – 3-4 credits Year 1 Benchmarks © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Year 3 – Quarter 1 Acute Care II -9 Credits End-of-Life Care General Electives – 3-4 credits © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Year 3 – Quarter 2 Chronic Care II -9 Credits End-of-Life Care General Electives – 3-4 credits Year 2 Benchmarks © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Year 3 Quarter 3 Community College Students ◦ Integrated Practicum 1 – 9 Credits ◦ Electives 3 Credits University Students ◦ Population Based Nursing – 9 credits ◦ Epidemiology – 3 Credits ◦ Statistics – 3 Credits © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Year 4 Quarter 1 University Students ◦ Leadership and Outcomes Management – 10 Credits ◦ General Electives – 3 Community College Transfer students join University Students or take Pop & Epi © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Year 4 – Quarter 2 University Students – 9 credits ◦ Integrated Practicum 1 –  Specialty focus 1 ◦ General Electives 3-6 credits Transfer Students ◦ Pop & Epi OR Leadership & Care Management © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Year 4 – Quarter 3 All Students Integrated Practicum II – 9 Credits ◦ Specialty Practice – 1 Credits Electives 3-6 credits Year 3 Benchmarks © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

OCNE : Competency Rubrics Faculty teams built rubrics to identify expected level of student competency throughout courses. Example-Modified with permission from the Lasater Clinical Judgment Rubric©. Lasater, K. (2007) Clinical judgment development: Using simulation to create a rubric. Journal of Nursing Education, 46, January © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Questions/Clarifications:

Table Talk What is the preferred model for Maine Shared curriculum Robust Articulation What is the needed Resources Barriers © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Transforming Nursing Education in Maine 7 Highly Effective Habits (lessons learned from your Oregon colleagues)

Hot House Effect (Kunstler, 2004) © Oregon Consortium for Nursing Education OCNE Do not replicate without permission

Habit 1 – Keep the vision of the new nurse front and center

Habit 2 – Nourish relationship- centered leadership Create and communicate group norms Revisit and renew them frequently Provide visible symbols of your commitments to work together

Habit 3 – Embrace Ambiguity! Flexible and goal oriented Take risks – Extrapolate from your successes Refine your mission and vision as emerging roles become evident (due to the ACA IOM, Carnegie)

Habit 4 -KNOW your Competencies Patient Centered Care ProfessionalismLeadership System-Based Practice Informatics and Technology Communication Teamwork and Collaboration Safety Quality Improvement Evidence-based- practice

Habit 5 – Learn from successes, false starts, mistakes, and failures Give me a fruitful error any time, full of seeds, bursting with its own corrections. You can keep your sterile truth for yourself. Vilfredo Pareto

Habit 6 – Recognize and respond to the Black Swans that come your way

Habit 7 Acknowledge and celebrate your accomplishments at regular intervals

Table Top Discussion List 4-6 next steps Prioritize your list Create an abbreviated timeline of your prioritized list. © Oregon Consortium for Nursing Education OCNE Do not replicate without permission