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Massachusetts Nurse of the Future Nursing Core Competencies©

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PRACTICE ENVIROMENT

SA K K ASNURSING KNOWLEDGE

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Safety

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Massachusetts Department of Higher Education Nursing Initiative Revised March 2016

Nurse of the Future: Nursing Core Competencies© | 1

Table of Contents Background 2

Defining NOF Nursing Core Competencies: Assumptions, Nursing Core Competencies, and the Nursing Core Competency Model

3

Nursing Knowledge 8

The Nurse of the Future Nursing Core Competencies

>> Patient-Centered Care 10

>> Professionalism 14

>> Leadership 18

>> Systems-Based Practice 22

>> Informatics and Technology 26

>> Communication 32

>> Teamwork and Collaboration 37

>> Safety 42

>> Quality Improvement 45

>> Evidence-Based Practice 47

Glossary 51

Professional Standards 55

General Bibliography 56

Nurse of the Future: Nursing Core Competencies© | 2

Background

This third edition of the Nurse of the Future Core Nursing Competencies is a result of review and updating process since the original publication. The purpose of the review was to ensure that the competencies reflect the many changes that have occurred in the health care environment and nursing practice over the past five years. The competencies still represent the minimum expectations for all nurses as they complete their pre-licensure education. As nursing education and practice continue to evolve in response to the needs of patients and the health care environment, these competencies will require ongoing review and evaluation to ensure that they continue to define the expectations for entry into nursing practice.

In March 2006, the Massachusetts Department of Higher Education (DHE) and the Massa chusetts Organization of Nurse Executives (MONE) convened a facilitated work ing session entitled Creativity and Connections: Building the Framework for the Future of Nursing Education and Practice. This invitational session brought together 32 experienced professionals from the major statewide stakeholders in nursing education and practice. The group included nurse leaders from a variety of prac tice settings, educators from both public and private higher education representing all degree levels, and representatives from the Department of Higher Education, the Board of Registration in Nursing, the Massachusetts Center for Nursing (MCN), the Massachusetts Association of Colleges of Nursing (MACN), the Massachusetts/Rhode Island League for Nursing (MARILN), and other national accrediting agencies, including the National League for Nursing Accrediting Commission (NLNAC) and the Commission on Collegiate Nursing Education (CCNE).

An important outcome of the conference was the development of the following mission statement to guide future work: Establish a formal coalition to create a seamless progression through all levels of nursing that is based on consensus competencies which include transitioning nurses into their practice settings. An additional key outcome involved the establishment of the following top priorities:

n Creation of a seamless progression through all levels of nursing education n Development of sufficient consensus on competencies to serve as a framework for educational curriculum n Development of a statewide nurse internship/preceptor program

At the end of the conference a working group was formed composed of deans and faculty representing all segments of nursing education, and nursing practice leaders and clinical nursing staff representing the continuum of care. From 2006 through 2009, the working group researched and reviewed standards, initiatives, and best practices in nursing education and formed a foundation for moving the priorities forward. To expedite the process, the group formed two working committees: the Massachusetts Nurse of the Future (NOF) Competency Committee (see membership list, back cover), which was charged with furthering the development of a seamless continuum of nursing education by identifying a core set of nursing competencies; and the MONE Academic Practice Integration Committee, which was charged with using the identified competencies as a framework for developing a statewide transition into practice model.

This report summarizes the work of the NOF Competency Committee. In the report, the committee describes the process it used to identify NOF Nursing Core Competencies, presents the NOF Nursing Core Competency Model©, and defines the ten NOF Nursing Core Competencies and the knowledge, attitudes and skills associated with each. Key terms used in the document are highlighted in bold and are defined in the Glossary.

Nurse of the Future: Nursing Core Competencies© | 3

Defining the Nurse of the Future Nursing Core Competencies and Core Competency Model

The NOF Competency Committee used a multi-step process to define a core set of nursing competencies for the nurse of the future. As a first step, the group identified and synthesized competencies obtained from other states, current practice standards, education accreditation standards, national initiatives, and projected patient demographic and health care profiles for Massachusetts. The committee also reviewed the Institute of Medicine’s core competencies for all health care professionals (Institute of Medicine [IOM], 2003) and the Quality and Safety Education for Nurses model (Quality and Safety Education for Nurses [QSEN], 2007). Information and data obtained through this process of research, analysis, and dialogue formed the basis for the development of a preliminary set of NOF Nursing Core Competencies. The committee then used a formalized process to obtain feedback on the preliminary set of core competencies from the nursing education and practice community throughout the state. The feedback process included online opportunities, two statewide summits, on-campus meetings with faculty from public and private associate and baccalaureate nursing education programs, and meetings with nursing leadership groups and nursing practice councils from a variety of health care organizations across the state. Feedback was also obtained through a gap analysis process developed in consultation with a nurse expert involved with the development of the QSEN competencies. Through this process, nursing programs and their clinical practice partners evaluated their curriculum and identified gaps between what is currently being taught and what they determined should be taught for students to master the NOF Nursing Core Competencies by graduation. Eight nursing programs in collaboration with their clinical practice partners participated in this funded activity. After synthesizing the feedback, the committee conducted another review of the literature, comparing the preliminary set of core competencies against nationally accepted models, guidelines, and standards. The preliminary set of competencies was also compared to the CCNE Essentials of Baccalaureate of Education (American Association of Colleges of Nursing [AACN], 2008), the Bologna Accords (Zabalegui, Loreto, & Josefa et al., 2006; Davies, 2008), the Competency Outcomes and Performance Assessment (COPA) model (Lenburg, 1999), the National League for Nursing’s educational competencies for graduates of associate degree nursing programs (National League for Nursing [NLN], 2000), and the Accreditation Council for Graduate Medical Education competencies (Accreditation Council for Graduate Medical Education [ACGME], n.d.). Information and data obtained by the review and feedback process was then incorporated into an updated version of the NOF Nursing Core Competencies. The updated version of the core competencies is presented in this report and is also available online at www.mass.edu/nursing. The NOF Competency Committee encourages nurses from practice, academe, and professional nursing organizations to review and disseminate the competencies. To help monitor how they are used, the committee asks users of the NOF Nursing Core Competencies to complete the Tracking and Permission Form, also available on the website.

Nurse of the Future: Nursing Core Competencies© | 4

ASSUMPTIONS In developing the NOF Nursing Core Competencies, the Competency Committee identified a set of assumptions to serve as a framework for its work and as guiding principles for the design of a competency-based education and practice partnership model. With the 2015 updating of the competencies, the Nurse of the Future Working Group added some additional assumptions to reflect the changes in the health care and nursing education environment that have emerged over the past 5 years. The assumptions include the following: n Education and practice partnerships are key to developing an effective model. • Nursing education and practice settings should facilitate individuals in moving more effectively through the educational system • An integrated practice/education competency model will positively impact patient safety and improve patient care • Nursing practice should be differentiated according to the registered nurse’s educational preparation and level of practice and further

defined by the role of the nurse and the work setting • Practice environments that support and enhance professional competence across the continuum of care are essential n It is imperative that leaders in nursing education and practice develop collaborative curriculum models to facilitate the achievement of a minimum

of a baccalaureate degree in nursing by all nurses. • Advancing the education of all nurses is increasingly recognized as essential to the future of nursing practice • Evidence has demonstrated that nurses with higher education levels have a positive impact on patient care n A more effective educational system must be developed, one capable of incorporating shifting demographics and preparing the nursing

workforce to respond to current and future health care needs and population health issues. • The NOF Nursing Core Competencies are designed to be applicable across all care settings and to encompass all patient populations across

the lifespan • Evidence-based knowledge and sensitivity to variables such as age, gender, culture, health disparities, socioeconomic status, race and

spirituality are essential for caring for diverse populations in this global society n The nurse of the future will be proficient in a core set of competencies. • There is a differentiation in competencies among practicing nurses at various levels • Competence is developed over a continuum and can be measured n Nurse educators in education and in practice settings will need to use a different set of knowledge and teaching strategies to effectively integrate

the Nurse of the Future Nursing Core Competencies© into curriculum. n The nurses’ role is integral in recognizing the social and cultural determinants of health that are essential to disease prevention and health

promotion efforts needed to improve health and health care and to build a culture of health across the Commonwealth and the nation. n With societal shifts, information-related innovations and a focus on teamwork and collaboration, health professions education will be inter-

professional and focused on collaborative practice. n To create competencies for the future, there must be an ongoing process of evaluation and updating of the competencies to insure that they are

reflective of contemporary health care practice.

Nurse of the Future: Nursing Core Competencies© | 5

ThE NURSE OF ThE FUTURE NURSING CORE COMPETENCIES The NOF Nursing Core Competencies emanate from the foundation of nursing knowledge. The competencies, which will inform future nursing practice and curricula, consist of the following: n Patient-Centered Care n Leadership n Communication n Professionalism n Systems-Based Practice n Teamwork and Collaboration n Informatics and Technology n Safety n Quality Improvement n Evidenced-Based Practice (EBP)

ThE NURSE OF ThE FUTURE CORE COMPETENCy MODEL The Nurse of the Future Nursing Core Competency© model is a graphic representation of the NOF Nursing Core Competencies and their relationship to nursing knowledge. In the model, nursing knowledge has been placed at the core to represent how nursing knowledge in its totality reflects the overarching art and science of the nursing profession and discipline. The ten essential competencies, which guide nursing curricula and practice, emanate from this central core and include patient-centered care, professionalism, leadership, systems-based practice, informatics and technology, communication, teamwork and collaboration, safety, quality improvement, and evidence-based practice. The order of the competencies does not indicate any hierarchy, as all the competencies are of equal importance. The competencies are connected by broken lines because distinction between individual competencies may be blurred; the competencies overlap and are not mutually exclusive. The competencies are similarly connected to the core by a broken line to indicate the reciprocal and continuous relationship between each of the competencies and nursing knowledge. Nursing knowledge and each of the ten competencies are described in more detail in the following sections of this report. For each competency, a definition is provided that identifies expectations for all professional nurses of the future. Essential knowledge, attitudes, and skills (KAS), reflecting the cognitive, affective, and psycho-motor domains of learning, are also specified for each competency. The KAS identify expectations for initial nursing practice following completion of a pre-licensure professional nursing educational program.

Nurse of the Future: Nursing Core Competencies© | 6

MASSAChUSETTS DEPARTMENT OF hIGhER EDUCATION Nurse of the Future Nursing Core Competencies©

The Art and Science of Nursing

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Nurse of the Future: Nursing Core Competencies© | 7

NOF CORE COMPETENCIES AND MODEL DEVELOPMENT REFERENCES

Accreditation Council for Graduate Medical Education. (n.d.). ACGME Outcome Project. Retrieved from http://cores33webs.mede.uic.edu/GMEmilestone/ui/portal/external/gc_about.aspx

American Association of Colleges of Nursing. (2008). The essentials of baccalaureate education for professional nursing practice (Rev. ed.). Washington, DC: Author. Retrieved from http://www.aacn.nche.edu/education-resources/baccessentials08.pdf

Davies, R. (2008). The Bologna process: The quiet revolution in nursing higher education. Nurse Education Today, 28(8), 935-942.

Institute of Medicine. (2003). Health professions education: A bridge to quality. Washington, DC: National Academies Press.

Lenburg, C. (1999). The framework, concepts, and methods of the Competency Outcomes and Performance (COPA) Model. Online Journal of Issues in Nursing, 4(2). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals /OJIN/TableofContents/Volume41999/No2Sep1999/COPAModel.html

National League for Nursing Council of Associate Degree Nursing Competencies Task Force. (2000). Educational competencies for graduates of associate degree nursing programs. New York, NY: Author.

Quality and Safety Education for Nursing. (2007). Quality and safety competencies. Retrieved from http://qsen.org/competencies/pre-licensure-ksas/

Zabalegui, A., Loreto, M., Josefa, M., Ricoma, R., Nuin, C., Mariscal, I., . . . Moncho, J. (2006). Changes in nursing education in the European Union. Journal of Nursing Scholarship. 38(2), 114-118.

Nurse of the Future: Nursing Core Competencies© | 8

Nursing Knowledge

Nursing is a scholarly profession and practice-based discipline and is built on a foundation of knowledge that reflects nursing’s dual components of science and art. Nursing knowledge in conjunction with a liberal education prepares learners to enter practice with identified core competencies.

A solid base in liberal education provides the distinguishing cornerstone for the study and practice of professional nursing (American Association of Colleges of Nursing [AACN], 2008, p. 11). A strong foundation in liberal arts includes a general education curriculum that provides broad exposure to multiple disciplines and ways of knowing. As defined by the Association of American Colleges and Universities (AAC&U), a liberal education is one that intentionally fosters, across multiple fields of study, wide ranging knowledge of science, cultures, and society; high level intellectual and practical skills; an active commitment to personal and social responsibility; and the demonstrated ability to apply learning to complex problems and challenges (AAC&U, 2007, p. 4). A liberal education includes both the sciences and the arts (AACN, 2008, p.10).

As a scientific discipline, nursing draws on a discrete body of knowledge that incorporates an understanding of the relationships among nurses, patients, and environments within the context of health, nursing concepts and theories, and concepts and theories derived from the basic sciences, humanities, and other disciplines. The science of nursing is applied in practice through a critical thinking framework known as the nursing process that is composed of assessment, diagnosis, planning, implementation, and evaluation. The steps of the nursing process serve as a foundation for clinical decision-making and evidence-based practice. Nurses use critical thinking to integrate objective data with knowledge gained from an assessment of the subjective experiences of patients and groups, and to apply the best available evidence and research data to the processes of diagnosis and treatment. Nurses use clinical reasoning to respond to the needs of the populations they serve and to develop strategies to support optimal outcomes that are most appropriate to the patient or situation while being mindful of resource utilization. Nurses continually evaluate the quality and effectiveness of nursing practice and seek to optimize outcomes (American Nurses Association [ANA], 2004).

The art of nursing is based on a framework of caring and respect for human dignity. The art and science of nursing are inextricably linked, as a compassionate approach to patient care carries a mandate to provide that care competently. Competent care is provided and accomplished through delegated, independent and interdependent practice (Koloroutis, 2004, pp. 123-25), and through collaborative practice (Tomey, 2009, p. 397) involving other colleagues and/or the individuals seeking support or assistance with their health care needs (ANA, 2004, p. 12).

With the globalization of health care and the development of collaborative teams to address and sustain effective quality care, nursing knowledge can serve as the foundation to engage other professionals in interprofessionality and link to interprofessional competencies, knowledge and practice (Meleis, 2015).

The distinctive focus of the discipline of nursing is on nursing actions and processes, which are directed toward human beings and take into account the environment in which individuals reside and in which nursing practice occurs (Fawcett & Garity, 2009). This distinctive focus is reflected in the metaparadigm of nursing, which identifies human beings (patients), the environment, health, and nursing as the subjective matter of interest to nurses (ANA, 2004). In the context of nursing knowledge, these constructs are defined as follows:

Nurse of the Future: Nursing Core Competencies© | 9

Human beings/patients – the recipient of nursing care or services. This term was selected for consistency and recognition and support of the historically established tradition of the nurse-patient relationship and recipients of nursing care. Patients may be individuals, families, groups, communities, or populations. Further, patients may function in independent, interdependent, or dependent roles, and may seek or receive nursing interventions related to disease prevention, health promotion, or health maintenance, as well as illness and end-of-life care. Depending on the context or setting, patients may at times more appropriately be termed clients, consumers, or customers of nursing services (AACN, 1998, p. 2).

Environment – the atmosphere, milieu, or conditions in which an individual lives, works, or plays (ANA, 2004, p. 47).

Health – an experience that is often expressed in terms of wellness and illness, and may occur in the presence or absence of disease or injury (ANA, 2004, p. 48).

Nursing – is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations (ANA, 2001, p. 5).

NURSING KNOWLEDGE REFERENCES

American Association of Colleges of Nursing. (1998). The essentials of baccalaureate education for professional nursing practice. Washington, DC: Author.

American Association of Colleges of Nursing. (2008). The essentials of baccalaureate education for professional nursing practice (Rev. ed.). Washington, DC: Author. Retrieved from http://www.aacn.nche.edu/education-resources/baccessentials08.pdf

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Silver Springs, MD: Author.

American Nurses Association. (2004). Nursing scope and standards of practice. Silver Springs, MD: Author.

Association of American Colleges and Universities. (2007). College learning for the new global century. Washington, DC: Author.

Fawcett, J., & Garity, J. (2009). Evaluating research for evidence-based nursing practice. Philadelphia, PA: F.A. Davis.

Koloroutis, M. (Ed.). (2004). Relationship-based care: A model for transforming practice. New York, NY: Springer.

Meleis A. (2015). Interprofessional Education: A summary of reports and barriers to recommendations. Journal of Nursing Scholarship 48(1), 106-11.

Tomey, A. M. (2009). Guide to nursing management and leadership (8th ed.). St. Louis, MO: Mosby Elsevier.

Nurse of the Future: Nursing Core Competencies© | 10

Patient-Centered Care The Nurse of the Future wil

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