June 2014 Vol 99 No 6 • AORN Connections | C7http://dx.doi.org/10.1016/S0001-2092(14)00534-1© AORN, Inc, 2014

NURSING EDUCATION Continued on C8

Nurses represent the largest percentage of health care providers in our country and have been identified by the Institute of

Medicine (IOM) as the country’s greatest resource for implementing the objectives of the Affordable Care Act.1 Following a two-year initiative implemented in response to the need for assessing and transforming the nursing profession to meet this challenge, in late 2010, the IOM published The Future of Nursing: Leading Change, Advancing Health.1 The report contains action-oriented recommendations for the future of nursing with four key messages:

• “Nurses should practice to the full extent of their education and training.

• Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.

• Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.

• Effective workforce planning and policy making require better data collection and information infrastructure.”1

Focusing on nursing education, the IOM recommends increasing the percentage of RNs who hold a Bachelor of Science in Nursing (BSN) or a higher degree to 80 percent by 2020. By 2020, the provisions of the Affordable Care Act will have made access to health care available to a significantly larger percentage of our population. This growth in patient population creates the need for a larger nursing workforce, which in turn requires an increase in the availability of high quality, affordable nursing education. Collaboration between the nation’s universities and community college systems will play a key role in achieving this crucial objective.

One current initiative, Academic Progression In Nursing (APIN)2 promotes the value of increased access to high quality, affordable nursing education and consistent pursuit of all nurses of higher levels of academic education, regardless of their entry level into nursing. The APIN initiative is funded by the Robert Wood Johnson Foundation and provides grants to state action coalitions (i.e., organizations chaired by a major nursing organization and a major business entity that are working to advance IOM recommendations) that have developed or made substantial progress on statewide or regional action plans to achieve the IOM’s 80 percent BSN or higher workforce goal.

Advances in nursing education focus on providing educational opportunities for individuals choosing to enter the profession and for nurses seeking faculty positions. To increase the availability of high quality, affordable nursing education, community college leaders are developing concept-based nursing curricula that will enhance the preparation of nurses entering health care. The concept-based curriculum addresses the challenge of content overload, the ever-increasing body of knowledge required for nursing practice promulgated by research and advancing technology. While there is a consistent stream of new information to incorporate into the nursing curriculum, there is no corresponding decrease in the current knowledge base required. Educational leaders believe there is not enough time to cover the material using the traditional curriculum paradigm.

The emerging concept-based curriculum focuses on mastering concepts in four domains: biophysical, psychosocial, professional, and the health care system.3 The curriculum is designed to provide knowledge that can be applied to the wide variety of clinical and professional

Nursing education moves to a concept-based curriculumTerri Goodman, PhD, RN, CNOR

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challenges that nurses must address. Instead of studying specific disease processes, an understanding of the 20 biophysical processes (e.g., metabolism, gas exchange, perfusion, fluid and electrolyte balance) allows the nurse to manage patients with any condition or disease that involves an aberration in these processes. Similarly, applying the eight psychosocial concepts (e.g., cognition, coping, human development, grief) prepares the nurse to manage the more holistic aspects of patient care. The six concepts related to professionalism (e.g., clinical judgment, communication, health promotion) and the nine concepts related to the health care system (e.g., ethics, legal precepts, health policy, leadership and management) provide the background for personal and professional growth, career advancement, and professional fulfillment.

The current educational initiative is also focused on seamless progression from one level of academic achievement to the next. Community college leaders are working closely with leaders in the university system to help ensure that the nursing curriculum in the Associate Degree in Nursing (ADN) program is equivalent to the first two years of nursing education at the university level. Nurses graduating from a concept-based ADN program are considered “core complete,” which means that universities consider their preparation complete for acceptance into a RN to BSN program.4 This promotes seamless progression from ADN to BSN, overcoming the current barriers associated with different entry requirements among universities and inconsistent preparation at the ADN level.

Universities are encouraged to develop more advanced nursing curricula, especially in the clinical arena so that nurses have the choice of pursuing a Doctor of Philosophy (PhD) with more emphasis on education and research or a Doctor of Nursing Practice (DNP) that prepares the nurse for the role of advanced clinician. The DNP curriculum facilitates nurses’ ability to lead health care innovations and influence policy at the highest organizational levels, improve health care systems, and influence patient outcomes. The increase of advanced practice nurses is expected to help transition our health care culture from a model that focuses on curing to one that focuses on prevention. There is a role for every nurse in transitioning our health care system.

Additional resourcesTo learn more about concept-based curriculum,

the Academic Consulting Group offers four unique webinars that explore different aspects of a concept-based curriculum, including “Individual and Aggregate Evaluation in a Concept-Based Curriculum,” “Preparing Preceptors for a Concept-Based Curriculum,” “Classroom and Clinical Testing in a Concept-Based Curriculum,” and “Implementing a Concept-Based Curriculum: A Practical Approach.” Access the webinars at http://academicconsulting.elsevier.com/resources webinars.php.

References1. The future of nursing: leading change,

advancing health. Institute of Medicine. http://www.iom.edu/Reports/2010/The-future-of-nursing-leading-change-advancing-health.aspx. Published October 5, 2010. Accessed April 29, 2014.

2. Robert Wood Johnson Foundation launches initiative to support academic progression in nursing. Robert Wood Johnson Foundation. http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2012/03/robert-wood-johnson-foundation-launches-initiative-to-support-ac.html. Published March 21, 2012. Accessed April 29, 2014.

3. Pierce L, Laverentz D. Selecting concepts. The University of Kansas School of Nursing. http://www.continuinged.ku.edu/kumc/pneg/sessions/pdfs/100 Lynelle%20PierceSelectingConcepts.pdf. Accessed April 29, 2014.

4. Academic progression in nursing. Texas Academic Progression in Nursing Grant. http://www.texasapin.org/APIN/AboutAPIN.html. Accessed April 29, 2014.

NURSING EDUCATION Continued from C7

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