Nurse Educator Vol. 38, No. 6, pp. 230-232 Copyright * 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nurse Educator
Rx for Deans
Jana L. Pressler
Carole A. Kenner
Thoughts Regarding Innovations in Nursing Education, Part 2 Jana L. Pressler, PhD, RN Carole A. Kenner, PhD, RNC-NIC, FAAN
Many new nursing leaders assuming deanships or assistant or interim deanships have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, the authors of this department offer survival tips based on their personal experiences and insights. They address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. The authors welcome counterpoint discussions with readers.
Innovation—any new idea—by definition will not be accepted at first. It takes repeated attempts, endless demonstrations, and monotonous rehearsals before innovation can be accepted and internalized by an organization. This requires courageous patience. —Warren Bennis
I
nnovative changes are occurring in higher education, with more on the horizon. Nursing education is no exception. This article presents some thoughts about rethinking assessment, nursing faculty members’ responsibilities with respect to innovative changes, and strategies for initiating innovation in higher education along faculty interest areas.
Rethinking Assessment Distance education technology and online learning, preludes to other changes, serve as grounding marks for innovative changes in higher education. Rapid growth using online learning is mainstream and ongoing in & for-profit and nonprofit universities and colleges, & self-paced competency-based programs, & intelligent tutoring, Author Affiliations: Assistant Dean (Dr Pressler), College of Nursing, University of Nebraska, Lincoln; Dean (Dr Kenner), School of Nursing, Associate Dean, Bouve´ College of Health Sciences, Northeastern University, Boston, Massachusetts. The authors declare no conflicts of interest. Correspondence: Dr Pressler, College of Nursing, University of Nebraska Medical Center, Lincoln, NE 68588 ([email protected]). DOI: 10.1097/01.NNE.0000435277.06085.64
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Volume 38 & Number 6 & November/December 2013
& peer-to-peer learning platforms, & third-party service providers, and & programs delivered outside traditional campuses. Nursing faculty have been progressively establishing and relying on concept-driven undergraduate curricula1 and competencies for advanced nursing practice curricula.2 As they develop approaches based on these trends, they must concomitantly do the same for assessments of these programs’ quality.
Basing Assessment on Concepts and Competencies Faculty who already use concepts to build and drive undergraduate curricula3 are now exploring how they can use expected student competencies to create new higher education delivery models. Using competencies in this way is new. For example, students pass or fail based on their progress with achieving specific competencies in lieu of receiving letter grades for completing college courses’ objectives. With concept-based curricula and the American Association of Colleges of Nursing (AACN’s) Essentials of Baccalaureate Education for Professional Nursing Practice for undergraduate students,4 the National Organization of Nurse Practitioner Faculties (NONPF) competencies for advanced practice,5 and AACN’s Doctor of Nursing Practice Essentials6 for graduate students, students are expected to achieve novice, competent, or expert levels. The NONPF nurse practitioner core competencies include scientific foundation, leadership, quality, practice, technology and information literacy, policy, home delivery system, ethics, and independent practice.5 Nurse Educator
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Taking a Leveling Approach to Documenting Progress Future approaches to higher education might exist in terms of competency levels rather than specific courses that imply ‘‘seat time’’ in a class.7 For example, undergraduate students might be expected to progress through both the novice and competent levels of achievement before graduating with a baccalaureate degree in nursing. Graduate students might be expected to progress through the novice, competent, and expert levels of achievement before graduating with a master’s or doctoral degree in nursing. This level of achievement approach for nursing dually emphasizes the nursing process and practice outcomes.
examine and evaluate how well faculty members are meeting their scholarly goals to secure an accurate portrayal of how well faculty and students are achieving desired goals. As an example, nursing faculty might be pursuing ways to make healthcare more accessible to rural populations, ways to integrate specific preventive interventions within healthcare, and/or new patient educational delivery models to restore health after surgery. The accreditation process will be expected to move to looking at smaller segments comprising the whole to evaluate specific goal achievement of faculty and students. Accreditors will have to become innovative in how they accomplish this in matching universities’ innovations.
Becoming More Dynamic and Less Static Accrediting organizations are going to be faced with examining and evaluating nursing education programs by concepts and competencies with multiple, ongoing, learning guideposts and fewer culminating end points.8 More than 1 correct approach and a disappearance of only 1 right answer to higher education for undergraduates and graduates are reality. The classroom is being revised 180 degrees to be more studentcentric using a model of engagement, whether learning is on site or online. As a consequence of having many more guideposts to assess, progress reports will need to document more frequently what is going well with students’ learning experiences and where there are weaknesses. How weaknesses are being addressed and remedied will be a key part of assessments. The assessment reports will need to be readily accessible to all faculty at all times. The rationale for this is that when a student has a new faculty member teaching him/her or completing an assessment, the reports about progress documented by previous faculty can be reviewed. Faculty and students will work together when assessments reports are conducted so that students being evaluated can take advantage of the learning opportunity and ask for specific clarification pertinent to the assessment and subsequently improve their knowledge and/or skills.
Strategies for Initiating Innovations That Match Faculty Interest Areas
Nursing Faculty Members’ Responsibilities for Implementation To address the new innovative educational approaches, faculty members will be asked to broaden their thinking pertaining to their own scholarship.9 With concepts and competencies as the new foci, faculty will be accountable for knowledge development and delivery of concepts and competencies. Faculty must have a program of scholarship. Faculty research programs will need to expand to include other types of scholarship (eg, teaching, practice, health policy, evaluation, administration) and include students to better accommodate new higher education delivery models, such as interprofessional education that reflects a team approach similar to that seen in healthcare settings. Faculty Must Adhere Closely to a Goal Timeline Faculty members will have to abide closely to meeting predetermined deadlines and timelines for identified scholarly goals. In the past, regional accrediting agencies based their assessments largely on a review of an integrated university or college and its activities. Now, accreditors will need to Nurse Educator
For many decades, accreditors have placed a heavy emphasis on learning outcomes and assessment. The competencybased movement threatens traditional higher education with loss of control over delivery models while at the same time aiding faculty with endorsing individualized student learning and learning experiences.
Financially Affordable Start-up Approaches Competency-based education will produce innovative educational approaches because education will not be connected to the 3–credit hour Carnegie unit. In lieu of, so to speak, reinventing the ‘‘topical’’ wheel, 2 possibilities for start-up might include using some of the 231 NEXus10 courses as a template for identifying learning topics and faculty experts in addition to the Qualitative Methods and Measures summer institute educational programs offered by the University of North Carolina-Chapel Hill.11 Concepts and Competencies, But No Courses The traditional 3–credit hour Carnegie unit previously pervaded and had a hold on higher education. Concept and competency-based education allows time to be variable while making learning fixed. The concepts driving curricula are well-defined terms that describe processes and outcomes. Students are given what might resemble a glossary of concepts with a variety of examples. Competencies are affirmative statements with carefully defined performance measures. Students demonstrate mastery of competencies by completing assignments that are then evaluated by faculty using specific performance measures. Students are graded as either passing or failing and are graded as not passed if they have not mastered the competencies according to the corresponding novice, competent, or expert levels. Students’ assessments can be maintained in a Web-based learning portfolio. Students can begin with any competency at any of 3 increasingly complex competency levels and proceed as quickly or as slowly as they need to be successful.
Summary Today’s agenda for higher education needs to focus on providing quality education using 1 or more variations of current and emerging technologies and forcing regional accreditors to update and revise accreditation pathways, respectively. As educators accomplish changes in providing quality education, Volume 38 & Number 6 & November/December 2013
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
231
accreditors need to prepare for the future by facilitating needed change.
References 1. Giddens JF, Brady DP. Rescuing nursing education from content saturation: the case for a concept-based curriculum. J Nurs Educ. 2007;46(2):65-69. 2. The National Organization of Nurse Practitioner Faculties Task Force. Nurse practitioner core competencies. June 2011. Available at http://www.goshen.edu/nursing/files/2011/09/NONPF-corecompetencies.pdf. Accessed August 6, 2013. 3. National League for Nursing Board of Governors. Position statement: innovation in nursing education: a call to reform. 2003. Available at http://www.nln.org/aboutnln/PositionStatements/ innovation.htm. Accessed August 6, 2013. 4. American Association of Colleges of Nursing. The Essentials of Baccalaureate Education for Professional Nursing Practice. Washington, DC: Author; 1998. 5. APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee. Consensus model
for APRN regulation: licensure, accreditation, certification, and education. July 7, 2008. Available at http://nursingworld.org/ DocumentVault/APRN-Resource-Section/ConsensusModel forAPRNRegulation.pdf. Accessed August 6, 2013. 6. American Association of Colleges of Nursing. The essentials of doctor of nursing practice education for advanced nursing practice. 2006. Available at http://www.aacn.nche.edu/publications/ position/DNPEssentials.pdf. Accessed August 5, 2013. 7. Gutlerner JL, Van Vactor D. Catalyzing curriculum evolution in graduate science education. Cell. 2013;153(4):731-736. doi:10.1016/ j.cell.2013.04.027 8. Benner P, Sutphen M, Leonard V, Day L. A new approach to nursing education. In Educating Nurses: A Call For Radical Transformation. San Francisco, CA: Jossey-Bass; 2009:81-91. 9. Boyer EL. Scholarship Reconsidered: Priorities of the Professoriate. San Francisco, CA: Jossey-Bass; 1997. 10. The Nursing Education Xchange. NEXus. 2006. Available at http:// www.winnexus.org/?query=170. Accessed August 6, 2013. 11. UNC-Chapel Hill School of Nursing summer institutes. Available at http://nursing.unc.edu/lifelong/summer-institutes-courseschedules/. Accessed August 6, 2013.
2014 Changes to the Affordable Care Act Adding to its first YouTube video, ‘‘Health Reform Hits Main Street,’’ the Kaiser Family Foundation has released its second video, ‘‘The YouToons Get Ready for Obamacare: Health Insurance Changes Coming Your Way Under the Affordable Care Act.’’ The short video does an outstanding job of explaining 2014 coverage and cost changes. A simple breakdown covers obtaining access through employers, government, and individuals; however, the mandate for companies with more than 50 employees to provide insurance to full-time workers has been postponed until 2015. Medicare recipients will be offered more preventative services and better prescription drug coverage. Medicaid also is expanding, with 26 states (as of June 2013) supporting expansion. In those states, key beneficiaries of the expansion are adults who are not currently eligible. The federal poverty level is set at $11,490 for individuals (http://aspe.hhs.gov/poverty/ 13poverty.cfm). Expansion allows adults to make up to 138% of federal poverty level and still qualify. Tax credits will be available to most individuals who fall to 400% of the poverty level. All coverage must include basic levels of hospitalization and medical visits, maternity care, mental healthcare, and prescription drug coverage. Individuals then choose from 4 plan tiers from bronze (minimum mandated services and costs) to platinum. Students should be able to direct individuals seeking coverage to their state’s health insurance marketplace. Open enrollment extends from October 2013 through March 2014. Faculty who add this second Kaiser Family Foundation film to their curriculum will ensure that their students get the latest, most accurate information in an easy-to-understand format. Preparing students with basic information will help them educate their patients on changes effecting care, access, and expanded services. Source: Kaiser Family Foundation Press Release, June 18, 2013. The YouToons Get Ready for Obamacare: Health Insurance Changes Coming Your Way Under the Affordable Care Act. Available at http://kff.org/health-reform/pressrelease/new-animation-explains-changes-coming-for-americans-under-obamacare/. Accessed July 29, 2013. Submitted by: Alma Jackson, PhD, RN, COHN-S, News Editor at [email protected]. DOI: 10.1097/01.NNE.0000435275.24011.58
232
Volume 38 & Number 6 & November/December 2013
Nurse Educator
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Nurse Educator
Rx for Deans
Jana L. Pressler
Carole A. Kenner
Thoughts Regarding Innovations in Nursing Education, Part 2 Jana L. Pressler, PhD, RN Carole A. Kenner, PhD, RNC-NIC, FAAN
Many new nursing leaders assuming deanships or assistant or interim deanships have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, the authors of this department offer survival tips based on their personal experiences and insights. They address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. The authors welcome counterpoint discussions with readers.
Innovation—any new idea—by definition will not be accepted at first. It takes repeated attempts, endless demonstrations, and monotonous rehearsals before innovation can be accepted and internalized by an organization. This requires courageous patience. —Warren Bennis
I
nnovative changes are occurring in higher education, with more on the horizon. Nursing education is no exception. This article presents some thoughts about rethinking assessment, nursing faculty members’ responsibilities with respect to innovative changes, and strategies for initiating innovation in higher education along faculty interest areas.
Rethinking Assessment Distance education technology and online learning, preludes to other changes, serve as grounding marks for innovative changes in higher education. Rapid growth using online learning is mainstream and ongoing in & for-profit and nonprofit universities and colleges, & self-paced competency-based programs, & intelligent tutoring, Author Affiliations: Assistant Dean (Dr Pressler), College of Nursing, University of Nebraska, Lincoln; Dean (Dr Kenner), School of Nursing, Associate Dean, Bouve´ College of Health Sciences, Northeastern University, Boston, Massachusetts. The authors declare no conflicts of interest. Correspondence: Dr Pressler, College of Nursing, University of Nebraska Medical Center, Lincoln, NE 68588 ([email protected]). DOI: 10.1097/01.NNE.0000435277.06085.64
230
Volume 38 & Number 6 & November/December 2013
& peer-to-peer learning platforms, & third-party service providers, and & programs delivered outside traditional campuses. Nursing faculty have been progressively establishing and relying on concept-driven undergraduate curricula1 and competencies for advanced nursing practice curricula.2 As they develop approaches based on these trends, they must concomitantly do the same for assessments of these programs’ quality.
Basing Assessment on Concepts and Competencies Faculty who already use concepts to build and drive undergraduate curricula3 are now exploring how they can use expected student competencies to create new higher education delivery models. Using competencies in this way is new. For example, students pass or fail based on their progress with achieving specific competencies in lieu of receiving letter grades for completing college courses’ objectives. With concept-based curricula and the American Association of Colleges of Nursing (AACN’s) Essentials of Baccalaureate Education for Professional Nursing Practice for undergraduate students,4 the National Organization of Nurse Practitioner Faculties (NONPF) competencies for advanced practice,5 and AACN’s Doctor of Nursing Practice Essentials6 for graduate students, students are expected to achieve novice, competent, or expert levels. The NONPF nurse practitioner core competencies include scientific foundation, leadership, quality, practice, technology and information literacy, policy, home delivery system, ethics, and independent practice.5 Nurse Educator
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Taking a Leveling Approach to Documenting Progress Future approaches to higher education might exist in terms of competency levels rather than specific courses that imply ‘‘seat time’’ in a class.7 For example, undergraduate students might be expected to progress through both the novice and competent levels of achievement before graduating with a baccalaureate degree in nursing. Graduate students might be expected to progress through the novice, competent, and expert levels of achievement before graduating with a master’s or doctoral degree in nursing. This level of achievement approach for nursing dually emphasizes the nursing process and practice outcomes.
examine and evaluate how well faculty members are meeting their scholarly goals to secure an accurate portrayal of how well faculty and students are achieving desired goals. As an example, nursing faculty might be pursuing ways to make healthcare more accessible to rural populations, ways to integrate specific preventive interventions within healthcare, and/or new patient educational delivery models to restore health after surgery. The accreditation process will be expected to move to looking at smaller segments comprising the whole to evaluate specific goal achievement of faculty and students. Accreditors will have to become innovative in how they accomplish this in matching universities’ innovations.
Becoming More Dynamic and Less Static Accrediting organizations are going to be faced with examining and evaluating nursing education programs by concepts and competencies with multiple, ongoing, learning guideposts and fewer culminating end points.8 More than 1 correct approach and a disappearance of only 1 right answer to higher education for undergraduates and graduates are reality. The classroom is being revised 180 degrees to be more studentcentric using a model of engagement, whether learning is on site or online. As a consequence of having many more guideposts to assess, progress reports will need to document more frequently what is going well with students’ learning experiences and where there are weaknesses. How weaknesses are being addressed and remedied will be a key part of assessments. The assessment reports will need to be readily accessible to all faculty at all times. The rationale for this is that when a student has a new faculty member teaching him/her or completing an assessment, the reports about progress documented by previous faculty can be reviewed. Faculty and students will work together when assessments reports are conducted so that students being evaluated can take advantage of the learning opportunity and ask for specific clarification pertinent to the assessment and subsequently improve their knowledge and/or skills.
Strategies for Initiating Innovations That Match Faculty Interest Areas
Nursing Faculty Members’ Responsibilities for Implementation To address the new innovative educational approaches, faculty members will be asked to broaden their thinking pertaining to their own scholarship.9 With concepts and competencies as the new foci, faculty will be accountable for knowledge development and delivery of concepts and competencies. Faculty must have a program of scholarship. Faculty research programs will need to expand to include other types of scholarship (eg, teaching, practice, health policy, evaluation, administration) and include students to better accommodate new higher education delivery models, such as interprofessional education that reflects a team approach similar to that seen in healthcare settings. Faculty Must Adhere Closely to a Goal Timeline Faculty members will have to abide closely to meeting predetermined deadlines and timelines for identified scholarly goals. In the past, regional accrediting agencies based their assessments largely on a review of an integrated university or college and its activities. Now, accreditors will need to Nurse Educator
For many decades, accreditors have placed a heavy emphasis on learning outcomes and assessment. The competencybased movement threatens traditional higher education with loss of control over delivery models while at the same time aiding faculty with endorsing individualized student learning and learning experiences.
Financially Affordable Start-up Approaches Competency-based education will produce innovative educational approaches because education will not be connected to the 3–credit hour Carnegie unit. In lieu of, so to speak, reinventing the ‘‘topical’’ wheel, 2 possibilities for start-up might include using some of the 231 NEXus10 courses as a template for identifying learning topics and faculty experts in addition to the Qualitative Methods and Measures summer institute educational programs offered by the University of North Carolina-Chapel Hill.11 Concepts and Competencies, But No Courses The traditional 3–credit hour Carnegie unit previously pervaded and had a hold on higher education. Concept and competency-based education allows time to be variable while making learning fixed. The concepts driving curricula are well-defined terms that describe processes and outcomes. Students are given what might resemble a glossary of concepts with a variety of examples. Competencies are affirmative statements with carefully defined performance measures. Students demonstrate mastery of competencies by completing assignments that are then evaluated by faculty using specific performance measures. Students are graded as either passing or failing and are graded as not passed if they have not mastered the competencies according to the corresponding novice, competent, or expert levels. Students’ assessments can be maintained in a Web-based learning portfolio. Students can begin with any competency at any of 3 increasingly complex competency levels and proceed as quickly or as slowly as they need to be successful.
Summary Today’s agenda for higher education needs to focus on providing quality education using 1 or more variations of current and emerging technologies and forcing regional accreditors to update and revise accreditation pathways, respectively. As educators accomplish changes in providing quality education, Volume 38 & Number 6 & November/December 2013
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
231
accreditors need to prepare for the future by facilitating needed change.
References 1. Giddens JF, Brady DP. Rescuing nursing education from content saturation: the case for a concept-based curriculum. J Nurs Educ. 2007;46(2):65-69. 2. The National Organization of Nurse Practitioner Faculties Task Force. Nurse practitioner core competencies. June 2011. Available at http://www.goshen.edu/nursing/files/2011/09/NONPF-corecompetencies.pdf. Accessed August 6, 2013. 3. National League for Nursing Board of Governors. Position statement: innovation in nursing education: a call to reform. 2003. Available at http://www.nln.org/aboutnln/PositionStatements/ innovation.htm. Accessed August 6, 2013. 4. American Association of Colleges of Nursing. The Essentials of Baccalaureate Education for Professional Nursing Practice. Washington, DC: Author; 1998. 5. APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee. Consensus model
for APRN regulation: licensure, accreditation, certification, and education. July 7, 2008. Available at http://nursingworld.org/ DocumentVault/APRN-Resource-Section/ConsensusModel forAPRNRegulation.pdf. Accessed August 6, 2013. 6. American Association of Colleges of Nursing. The essentials of doctor of nursing practice education for advanced nursing practice. 2006. Available at http://www.aacn.nche.edu/publications/ position/DNPEssentials.pdf. Accessed August 5, 2013. 7. Gutlerner JL, Van Vactor D. Catalyzing curriculum evolution in graduate science education. Cell. 2013;153(4):731-736. doi:10.1016/ j.cell.2013.04.027 8. Benner P, Sutphen M, Leonard V, Day L. A new approach to nursing education. In Educating Nurses: A Call For Radical Transformation. San Francisco, CA: Jossey-Bass; 2009:81-91. 9. Boyer EL. Scholarship Reconsidered: Priorities of the Professoriate. San Francisco, CA: Jossey-Bass; 1997. 10. The Nursing Education Xchange. NEXus. 2006. Available at http:// www.winnexus.org/?query=170. Accessed August 6, 2013. 11. UNC-Chapel Hill School of Nursing summer institutes. Available at http://nursing.unc.edu/lifelong/summer-institutes-courseschedules/. Accessed August 6, 2013.
2014 Changes to the Affordable Care Act Adding to its first YouTube video, ‘‘Health Reform Hits Main Street,’’ the Kaiser Family Foundation has released its second video, ‘‘The YouToons Get Ready for Obamacare: Health Insurance Changes Coming Your Way Under the Affordable Care Act.’’ The short video does an outstanding job of explaining 2014 coverage and cost changes. A simple breakdown covers obtaining access through employers, government, and individuals; however, the mandate for companies with more than 50 employees to provide insurance to full-time workers has been postponed until 2015. Medicare recipients will be offered more preventative services and better prescription drug coverage. Medicaid also is expanding, with 26 states (as of June 2013) supporting expansion. In those states, key beneficiaries of the expansion are adults who are not currently eligible. The federal poverty level is set at $11,490 for individuals (http://aspe.hhs.gov/poverty/ 13poverty.cfm). Expansion allows adults to make up to 138% of federal poverty level and still qualify. Tax credits will be available to most individuals who fall to 400% of the poverty level. All coverage must include basic levels of hospitalization and medical visits, maternity care, mental healthcare, and prescription drug coverage. Individuals then choose from 4 plan tiers from bronze (minimum mandated services and costs) to platinum. Students should be able to direct individuals seeking coverage to their state’s health insurance marketplace. Open enrollment extends from October 2013 through March 2014. Faculty who add this second Kaiser Family Foundation film to their curriculum will ensure that their students get the latest, most accurate information in an easy-to-understand format. Preparing students with basic information will help them educate their patients on changes effecting care, access, and expanded services. Source: Kaiser Family Foundation Press Release, June 18, 2013. The YouToons Get Ready for Obamacare: Health Insurance Changes Coming Your Way Under the Affordable Care Act. Available at http://kff.org/health-reform/pressrelease/new-animation-explains-changes-coming-for-americans-under-obamacare/. Accessed July 29, 2013. Submitted by: Alma Jackson, PhD, RN, COHN-S, News Editor at [email protected]. DOI: 10.1097/01.NNE.0000435275.24011.58
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Volume 38 & Number 6 & November/December 2013
Nurse Educator
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
