Transcript OCNE Formative Evaluation Review Feb 19

Maine Partners in Nursing Education and
Practice
May 23, 2012

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
© Oregon Consortium for Nursing Education OCNE Do not replicate without permission
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:
•
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
© Oregon Consortium for Nursing Education OCNE Do not replicate without permission
OCNE Curriculum Transformation
What has been created:
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
© Oregon Consortium for Nursing Education OCNE Do not replicate without permission
OCNE snapshot:
Pedagogy Reform
© Oregon Consortium for Nursing Education OCNE Do not replicate without permission
Pedagogy Reform
What has being created:

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
© Oregon Consortium for Nursing Education OCNE Do not replicate without permission
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 (2001-03)
 Creating consensus Processes & Infrastructure

(2002-06)





Designing Curriculum (2003-05)
Curriculum Approval & Implementation (2004-06)
Faculty Development (2003…)
Conducting a Comprehensive evaluation (2006…)
Creating organizational sustainability (2010...)
© 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”

Regularly scheduled fun and celebrations
to help identify conflict
© Oregon Consortium for Nursing Education OCNE Do not replicate without permission
Creating Consensus Infrastructure
(2002-2006)

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
Concepts/content
related to focus of
care
Population
Health & illness
context
Focus of care
© Oregon Consortium for Nursing Education OCNE Do not replicate without permission
OCNE Framework for Content
Organization & Selection
Focus
Of
Care
Competency
&
Dimensions
Population
Concepts
&
Content
© 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


Appoint a scribe

Appoint a spokesperson
to share
#2. Curriculum
transformation
◦ What is compelling about
Oregon’s curriculum
transformation
◦ What is the ideal approach
to integrating Maine’s
competencies into nursing
programs
© 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
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.
1.
.
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, 496-503.
January 2007.
© Oregon Consortium for Nursing Education OCNE Do not replicate without permission
Questions/Clarifications:
© Oregon Consortium for Nursing
Education OCNE Do not replicate
without permission
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)
www.ocne.org
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 relationshipcentered 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
Evidence-basedpractice
Professionalism
Quality
Improvement
Leadership
Safety
System-Based
Practice
Teamwork and
Collaboration
Informatics and
Technology
Communication
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