2. Nursing Education in the U.S.: Academic, Orientation, Staff development, & Continuing Education Martha Highfield, PhD, RN, AOCN Associate Professor Nursing California State University, Northridge, USA

3. Presented at the invitation of the Guangzhou Municipal Health Bureau Guangzhou, China August 2001

4. mefh 8/013 Basic nursing education in the U.S. Clinical competence & quality care How additional nursing competence is gained through Orientation Staff development Continuing education Assessing & monitoring the quality of nursing care Topics of Discussion

5. mefh 8/014

6. 5 U.S. Nursing Education & Practice Guided by Professional Standards: American Nurses Association & other professional nursing organizations Law: Nurse Practice Acts

7. mefh 8/016 Professional Standards: Education & Licensure Knowledge base: –Human experiences and responses to birth, health, illness, and death. Nurses focus on these phenomena within the context of individuals, families, groups, and communities –Diagnosis, Interventions, Outcomes Scope of Practice: –Basic & Advanced

8. mefh 8/017 Professional Standards: Basic Nursing Practice Graduate of approved school of nursing Qualified by national exam to be RN Baccalaureate degree Caregivers for patients, families, groups, & communities Interventions based on desired outcomes Coordinators of care Integrate patient service delivery Prepare for tests/procedures Monitor responses to interventions

9. mefh 8/018 Law: Education & Licensure Establishes education & licensure criteria –To protect public –To hold those with licenses accountable for practice

10. mefh 8/019 Law: Education & Licensure Activities of state Board of Registered Nursing –Approves all basic & advanced nursing education programs –Issues RN license based on passing national exam –Oversees those with RN license

11. mefh 8/0110 Law: Education & Licensure Beyond basic education, requires: –Orientation & staff development related to work setting –Continuing education related to professional advances

12. mefh 8/0111 Law: Program Director Qualifications Masters degree or higher One year's experience in administration Two years' experience teaching nursing One year providing direct patient care; or Equivalent experience and/or education

13. mefh 8/0112 Law: Faculty Qualifications INSTRUCTOR Qualifications –Names to Board of Registered Nurses –Valid, active license –Masters degree or higher –One year providing direct patient care –One year's experience teaching courses related to nursing or a course which includes practice in teaching nursing.

14. mefh 8/0113 Law: Faculty Qualifications ASSISTANT INSTRUCTOR Qualifications –Baccalaureate including courses in nursing, or in sciences relevant to nursing practice; –One year's continuous, full-time experience in direct patient care practice as a registered nurse. CLINICAL TEACHING ASSISTANT qualifications –One year's experience, within the previous five years, as a registered nurse providing direct patient care.

15. mefh 8/0114 Law: Faculty Clinical Competence “ Nursing faculty members whose teaching responsibilities include subject matter directly related to the practice of nursing shall be clinically competent in the areas to which they are assigned.”... ‘Clinically competent’ means that a nursing program faculty member possesses and exercises the degree of learning, skill, care and experience ordinarily possessed and exercised by staff level registered nurses of the clinical unit to which the instructor is assigned; “

16. mefh 8/0115 Law: Faculty Responsibilities Instruction Evaluation of students Planning Implementing curriculum content. Clinical supervision only of enrolled students

17. mefh 8/0116 Law: Curriculum Minimum 58 semester units (about 2 years) 36 of units (62% of total) in nursing courses –1/2 (18 units) theory –1/2 ( 18 units) clinical –Theory & clinical taught at the same time for medical-surgical, maternal/child, mental health, psychiatric nursing, and geriatrics 6 units communication 16 units natural, behavioral, social sciences

18. mefh 8/0117 Law: Curriculum must include: Personal hygiene Human sexuality Client abuse Cultural diversity Nutrition (including therapeutic aspects) Pharmacology Legal, social and ethical aspects of nursing Nursing leadership and management.

19. mefh 8/0118 Law: Curriculum must include: Integrated concepts Nursing process Basic nursing skills Human development Interdisciplinary skills Communication Natural sciences Related behavioral and social sciences

20. mefh 8/0119 Competence is KEY to Quality Practice Competence = knowledge & skills to do job Basic competence from nursing program Job-related competence established during employment & orientation Maintained by monitoring performance & ongoing education

21. mefh 8/0120 Law: Education After Licensure Continuing education within profession Orientation to workplace Staff development within workplace

22. mefh 8/0121 Law: Continuing Education Relevant to RN practice & consumer needs Content above that required for licensure. Course must meet educational standards set by a State Board or Professional Association. Required in many states

23. mefh 8/0122 Examples of CE Content Academic courses in nursing Other examples  Physical sciences  Social science  Behavioral sciences  Professional educational meetings  Patient education skills  Nursing administration skills  NOT included: basic knowledge like CPR

24. mefh 8/0123

25. mefh 8/0124 Orientation Requirements RN must be qualified by experience, education, licensure, and credentials for specific job Oriented to job & role Assessed as competent

26. mefh 8/0125 Orientation Requirements (cont.) Cross-training Transfer training

27. mefh 8/0126 Orientation & Competence Establishing new competence beyond basic education through: –Classes & assessment of knowledge –Clinical orientation & assessment of skills Validating prior education (knowledge) & experience (skills)

28. mefh 8/0127 Orientation for Competence Includes information about particular –Healthcare agency –Nursing department –Clinical specialty area –Job role It is NOT a repeat of basic nursing education.

29. mefh 8/0128 Experts Guide Orientation Hospital/Healthcare agency Department Job-Specific –Classes –Preceptors

30. mefh 8/0129 General Hospital Orientation The Mission, Vision, Values, & Goals of Agency General Personnel Policies Overview of Orientation & Competency Assessment Safety Sexual Harassment Equal Employment Opportunity (EEO) process Customer Service Patient Rights, Confidentiality, Ethics, etc. Performance Improvement (QA) Basic Infection Control for Non Clinical Staff, etc.

31. mefh 8/0130 Nursing Orientation Organization of Nursing Safety & Emergencies: CPR, codes, fire, etc. Communications & documentation –Paper & electronic –With other departments & disciplines Nursing specific role: provider, educator, administrator, researcher

32. mefh 8/0131 Job Specific Orientation RN Direct care provider  Age specific characteristics & needs  Medications  Equipment  Role in quality of care  Admission & discharge  Ongoing assessment and documentation  Rounds & Shift reports  Preceptor  Other duties: check crash cart, returning & obtaining equipment

33. mefh 8/0132 Job Specific Orientation for Competence RN Educator: Role in supporting competence of staff –Collaboration –Curriculum expertise –Orientation responsibilities –Staff development responsibilities –CE responsibilities

34. mefh 8/0133 Job Specific Orientation for Competence RN Administrator: Leadership role –Managing staff & budget –Monitoring quality of care –Monitoring & maintaining staff competence –Procedure & policy development

35. mefh 8/0134 Job Specific Orientation for Competence RN Researcher: Advance knowledge –Conduct research –Role in staff education –Collaboration with administration & education –Evaluate programs

36. mefh 8/0135 Orientation Outcome: Assessing Competence Competence statements –Specific, measurable, objective, behavioral –Equipment & practice –Example: “RN will correctly hang & monitor IV fluids” Competency checklists –Used to assess & document competence –Example: “1. Obtains correct equipment. 2. Uses aseptic technique. 3. Checks fluid against MD orders. 4. Explains procedure to patient,” etc….

37. mefh 8/0136 Education for Clinical Specialty: Example of Critical Care Basic RN education outcomes –Communication skills –Therapeutic intervention skills –Critical thinking skills Orientation content (3 parts): General Hospital, Nursing Department, Specific Job Role

38. mefh 8/0137 Education for Clinical Specialty: Example of Critical Care Job Role Basic critical care specialty knowledge –Validated through BKAT –OR Taught through critical care classes & validated by examination THEN Basic critical care specialty skills are taught and/or validated through preceptorship using competence checklists

39. mefh 8/0138 Competence Statements & Checklists Multiple checklists –One for each skill Preceptor uses checklists –Giving time for development of each skill –Developing simple skills to complex skills Let’s look at example of developing a checklist

40. mefh 8/0139 American Association of Critical Care Nurses (AACCN) Standards of Care for Critical Care Nursing EXAMPLE Standard of Care 1: Assessment The nurse caring for acute and critically ill patients collects relevant patient health data

41. mefh 8/0140 AACN Standard I: Assessment (cont.) Measurement Criteria 1. Data collection involves the patient, family, and other healthcare providers as appropriate to develop a holistic picture of the patient's needs. 2. The priority of data collection activities is driven by the patient's needs. 3. Pertinent data are collected using appropriate assessment techniques and instruments. 4. Data are documented in a retrievable form. 5. Data collection process is systematic and ongoing.

42. mefh 8/0141

43. mefh 8/0142 Example of Checklist Use “We have developed 2 competency checklists. One for removing femoral arterial/venous sheaths using manual compression and one for the Femostop. All ICU nurses are required to watch a video on the procedure, observe the skill being performed by a "competent RN", and then performs skill herself supervised by an instructor throughout the procedure. The learner must perform the skill according to the competency standard at least 3 times to perform the skill alone.”

44. mefh 8/0143 Education for Clinical Specialty: Example of Oncology Nursing Scope of oncology nursing practice includes clinical practice, education, consultation, research, & administration Oncology nursing is directed toward care of –individuals, –families, –groups, & communities with potential or actual diagnoses of cancer

45. mefh 8/0144 Oncology Nursing Society (ONS) Standards Oncology Nursing Practice Advanced Oncology Nursing Practice Oncology Nursing Education

46. mefh 8/0145 ONS Oncology Nursing Practice Standards EXAMPLE Standard 1: Assessment The oncology nurse systematically and continually collects data regarding the health status of the client

47. mefh 8/0146 ONS Oncology Nursing Practice Standards (cont.) Measurement Criteria 1. Collects pertinent objective & subjective data in timely, ongoing, systematic, & culturally competent manner 2. Collects data from multiple sources, including patient, family, healthcare team, community using appropriate techniques

48. mefh 8/0147 3-5. Collects, communicates to healthcare team, & documents data in the following eleven high-incidence problem areas: –Prevention & early detection –Information –Coping –Comfort –Nutrition –Protective mechanisms –Mobility –Elimination –Sexuality –Ventilation –Circulation

49. mefh 8/0148 Developing Competence Checklists e.g., Prevention & early detection –Assesses environmental risk factors –Documents environmental risk factors –Communicates environmental risk factors to healthcare team as needed –Assesses personal risk factors –Documents personal risk factors –Communicates personal risk factors to team prn –Assesses early detection practice, etc. –Assesses cultural & social factors, etc.

50. mefh 8/0149

51. mefh 8/0150 Future of Nursing Education: 10 Trends 1. Changing demographics and increasing diversity 2. Technological explosion 3. Globalization of the World's Economy & Society

52. mefh 8/0151 Future of Nursing Education (cont.) 4. The Era of the Educated Consumer, Alternative Therapies and Genomics, and Palliative Care 5. Shift to Population-based care and the increasing complexity of patient care 6. Cost of health Care and Challenge of Managed Care

53. mefh 8/0152 Future of Nursing Education (cont.) 7. Impact of Health Policy & Regulation 8. Growing need for interdisciplinary education for collaborative practice 9. Current nursing shortage/opportunities for lifelong learning and workforce development 10. Significant advances in nursing sciences & research