c i n h c

California Institute for Nursing & Healthcare

Nursing Education Redesign for California:

New Opportunities for Nurse Educators

Jan Boller, RN, PhD

Project Director,

White Paper on Nursing Education Redesign for California

c i n h c ©2006 Nursing Ed Redesign Summary 2

Goals For This Session1. Examine a recent statewide approach to build

consensus around priorities for nursing education redesign in California.

2. Analyze and respond to seven recommended priorities for nursing education redesign in California based on this consensus process.

3. Explore new opportunities for California’s nurse educators generated by these recommendations.

c i n h c ©2006 Nursing Ed Redesign Summary 3

Project Overview

White Paper: Nursing Education Redesign for California

Funded by a grant from the Gordon and Betty Moore Foundation

Project Objectives:• Examine the need to reshape nursing education,• Make recommendations on elements for redesign,• Define the action steps, and • Provide plans for building consensus to accomplish

redesign

c i n h c ©2006 Nursing Ed Redesign Summary 4

Driving Forces Influencing the Need to Reshape Nursing Education

1. Changing demands from patient care delivery systems requiring new skills and competencies;

2. The impact of clinical simulation on nursing education offering new avenues for learning;

3. The nursing shortage requiring new ways to educate nurses; and

4. Renewed interest in collaboration and articulation between associate and baccalaureate degree nursing education programs.

c i n h c ©2006 Nursing Ed Redesign Summary 5

Nursing Education Redesign for California Cosponsors

• Association of California Nurse Leaders (ACNL)

• California Organization of Associate Degree Nursing Program Directors, North and South (COADN)

• California Association of Colleges of Nursing (CACN)

• American Nurses Association California (ANA\C)

• California Board of Registered Nursing (BRN)

• California Institute for Nursing & Health Care (CINHC) (Grant Administrator)

c i n h c ©2006 Nursing Ed Redesign Summary 6

Nursing Education Redesign Thought Leaders

• ADN Directors and Faculty, Students

• BSN/Higher Education Chairs, Deans, Faculty, Students

• Clinical Service Executives, Educators, Advanced Practice Specialists, New Graduates

• Health Care Professional Organization Leaders

• BRN Executives and Supervisors

• Policy Specialists

c i n h c ©2006 Nursing Ed Redesign Summary 7

Nursing Education Redesign Expert Consultants

• Statewide Collaborative Education Models: Christine Tanner, Paula Gubrud-Howe, Louise Shores, Oregon Consortium for Nursing Education

• Educating Nurses for Complex Care:Patricia Benner & Molly Sutphen, Co-Investigators, Carnegie Study for the Preparation of the Professions: Nursing Education Study

• Evidence-Based Nursing Education: Nancy Spector, National Council of State Boards of Nursing

• Professional Role Competence & Development: Maria O’Rourke

c i n h c ©2006 Nursing Ed Redesign Summary 8

Evidence-Based Approaches forLeading Change & Building Consensus

• World Café, Collaboration (Brown & Isaacs; Himmelman)

• Appreciative Inquiry (Cooperrider & Whitney)

• Nominal Group Process, Delphi (Delbecq, VandeVen, & Gustafson)

• Interactive Audience Response Voting Technology• IHI Model for Improvement (IHI; Langley, Nolan, Nolan,

Norman, & Provost)• Building Communities of Practice/Participatory

Reflection & Action Science/Managing Polarities (Lave & Wenger; Wenger, McDermott, & Snyder; Scott & Cleary)

• Theory “U”: Creating an Emerging Future (Scharmer)• Learning Organizations/Teams (Senge, et al.)

c i n h c ©2006 Nursing Ed Redesign Summary 9

Interactive Audience Response: Using Technology to Build Consensus

86%

0%0%

14%

We must change the way we teach and prepare nurses if we intend to respond to the current and future health care needs of Californians.

a. Strongly Agree

b. Agree

c. Disagree

d. Strongly Disagree

c i n h c ©2006 Nursing Ed Redesign Summary 10

Using All of Our Intelligences• Mind• Body• Heart• Spirit• Creative

c i n h c ©2006 Nursing Ed Redesign Summary 11

Findings+ Strong commitment among

nurse leaders to collaborate and deliver high quality education;

+ Best practices in California reveal many points of excellence;

+/▲ Diverse resources exist for education, but limited availability and high demand challenge access;

+/▲ Substantial efforts to increase articulation between ADN & BSN programs, yet only 26% of California’s ADN graduates obtain BSN or higher degrees

▲ Faculty salary disparities thwart recruitment of teachers;

▲ Variations in educational practices and outcomes across the state. Need for statewide collaboration;

▲ Gaps in RN new graduate role performance consistent with national findings: critical thinking, clinical judgment, inter-professional collaboration, evidence-based practice, and working in complex systems;

▲ Persistent disconnect remains between academia and service, compromising student clinical experiences

c i n h c ©2006 Nursing Ed Redesign Summary 12

Nursing Education Redesign for CaliforniaStrategic Action Priorities

• Form a Strong Statewide Academic/Clinical Service Coalition that Sets Standards and Shares Resources:

– Professional and clinical role formation and development based on a novice-to-expert continuum

– Integrate Simulation, Technology, & Informatics into Education– New Graduate Residencies & Transition Programs

• Create a Collaborative Model: California Nursing Education Highway System– Seamless advancement from ADN & BSN to graduate levels,

with multiple “on & off ramps” providing adequate supplies of diverse, well-prepared clinicians & faculty

– Faculty development• Eliminate Academic Salary Disparities

• Create a Center for Knowledge Development– Foster innovation and evaluation of education effectiveness

c i n h c ©2006 Nursing Ed Redesign Summary 13

Nursing Education Redesign for California: Recommendations

VISION: WELL-PREPARED NURSES FOR THE 21ST CENTURY

ACADEMIC/SERVICE PARTNERSHIPS & STANDARDS

NOVICE-TO-EXPERT DEVELOPMENT FRAMEWORK

COLLABORATIVE EDUCATION MODEL: EDUCATION HIGHWAY

FACULTY DEVELOPMENT/RECRUITMENT

NEW GRADUATE RESIDENCIES

SIMULATION & TECHNOLOGY

CENTER FOR KNOWLEDGE

21st CENTURY RN WORKFORCE

c i n h c ©2006 Nursing Ed Redesign Summary 14

1. Academic/Service PartnershipsForge a strong and stable coalition of academic, service, policy, and industry partners to shape nursing education in California.

c i n h c ©2006 Nursing Ed Redesign Summary 15

2. Professional and Clinical RoleEstablish core competencies and guide

professional and clinical role formation based on a novice-to-expert continuum.

(Artwork used with permission: E. Loyd, Nursing Student)

c i n h c ©2006 Nursing Ed Redesign Summary 16

3. Collaborative Education ModelProvide a coordinated statewide system (California Nursing Education Highway) for increased access and seamless advancement in nursing education.

c i n h c ©2006 Nursing Ed Redesign Summary 17

4. Faculty Development & RecruitmentRecruit, develop, and retain well-prepared and diversified faculty.

c i n h c ©2006 Nursing Ed Redesign Summary 18

5. Simulation, Technology, & Informatics

Integrate simulation, technology, & informatics into the nursing education curriculum.

c i n h c ©2006 Nursing Ed Redesign Summary 19

6. ResidenciesAssure safe and effective transition from pre-licensure graduate to entry-level practice through evidence-based residencies.

c i n h c ©2006 Nursing Ed Redesign Summary 20

7. California Center for Nursing Knowledge

Create a resource center and data repository to inform excellence in nursing education and practice.

Show me the Science!

c i n h c ©2006 Nursing Ed Redesign Summary 21

Next Action Steps1. Disseminate

recommendations

2. Build coalition

3. Engage key stakeholders

4. Acquire funding

5. Establish California Center for Nursing Knowledge

Education Redesign

c i n h c ©2006 Nursing Ed Redesign Summary 22

Questions

• What clarifying questions do you have about these recommendations?

• Merits?• Concerns?• What’s Missing?• What new opportunities for nurse educators do

you see in these recommendations?• How can nurse educators be involved moving

these recommendations forward?

c i n h c ©2006 Nursing Ed Redesign Summary 23

Thank You!Celebrating Nurse Educators

c i n h c ©2006 Nursing Ed Redesign Summary 24

Contact Information• Jan Boller

Project Director, Nursing Education Redesign jan@cinhc.org

• Deloras JonesExecutive Director, California Institute for Nursing & Health Caredeloras@cinhc.org

• Information about the White Paper on Nursing Education Redesign for California can be accessed at:

www.cinhc.org Located in the CINHC@Work Section

c i n h c ©2006 Nursing Ed Redesign Summary 25

References• Access www.cinhc.org/atWork for references on:

– Academic/Service Partnerships– Professional and Role Competence & Novice-to-

Expert Development– Collaborative Education Models– Faculty Development & Recruitment– New Graduate Residencies– Simulation and Technology– Building Knowledge for Evidence-Based

Education & Curriculum Reform

c i n h c ©2006 Nursing Ed Redesign Summary 26

References: Building Consensus for Change, Improvement, and Innovation

• Brown, J. Isaacs., D., World Cafe Community (2005). The world cafe: Shaping futures through conversations that matter. San Francisco: Berrett Koehler.

• Cooperrider, D. L. & Whitney, D. (2005). Appreciative Inquiry: A Positive Revolution in Change. San Francisco: Berrett-Koehler Publishers, Inc.

• Delbecq, A., Van de Ven, A., & Gustafson. (1975). Group techniques for program planning: A guide to nominal group and Delphi processes. Glenview, IL: Scott, Foresman and Co.

• Himmelman, A. T. (1994). Communities working collaboratively for a change. Resolving conflict: Strategies for local government. M. Herrman. Washington, D.C., International City/County Management Association: 27-47.

• Himmelman, A. T. (2004). Collaboration for a change: Definitions, decision-making models, roles, and collaboration process guide. Himmelman Consulting: 1-26.

• Institute for Healthcare Improvement. www.ihi.org

c i n h c ©2006 Nursing Ed Redesign Summary 27

References: Building Consensus for Change, Improvement, and Innovation

(continued)

• Langley, G. J., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (1996). The improvement guide: A practical approach to enhancing organizational performance. San Francisco, Jossey-Bass.

• Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. New York, Cambridge University Press.

• Scharmer, C. O. (2007). Theory U: Leading from the future as it emerges. Cambridge, MA, Society for Organizational Learning.

• Scott, E. S., & Cleary, B. L. (2007). Professional polarities in nursing. Nursing Outlook, 55(6), September/October, 250-256.

• Senge, P. M. (2006). The fifth discipline: The art and practice of the learning organization. (2nd. Ed). New York: Currency Doubleday.

• Senge, Cambron-McCabe, N., Lucas, T., Smith, B., Dutton, & Kleiner, A. (2000). Schools that learn: A fifth discipline fieldbook for educators, parents, and everyone who cares about education. New York: Currency Doubleday.

c i n h c ©2006 Nursing Ed Redesign Summary 28

References: Building Consensus for Change, Improvement, and Innovation

(continued)

• Senge, P. M. Kleiner, A., Roberts, C., Ross, R. B., & Smith, B. J. (1994). The fifth discipline fieldbook: Strategies and tools for building a learning organization. New York, Currency Doubleday.

• Senge, P. M. Kleiner, A., Roberts, C., Ross, R.B., Roth, G., & Smith, B.J. (1999). The dance of change: A fifth discipline fieldbook for mastering the challenges of learning organizations. New York, Currency Doubleday.

• Senge, P. Scharmer., C. O., Jaworski, J., & Flowers, B. S. (2005). Presence: An exploration of profound change in people, organizations, and society. New York,:Currency Doubleday.

• Wenger, E., McDermott, Richard, Snyder, William M. (2002). Cultivating communities of practice. Boston, Harvard Business School Press.

• Whitney, D., Trosten-Bloom, Amanda (2003). The power of appreciative inquiry: A practical guide to positive change. San Francisco, Berrett-Koehler Publishers, Inc.