Journal of Nursing Education

Major Article 

Promoting Differentiated Competencies Among RN-to-Bachelor of Science in Nursing Program Graduates

Melanie McEwen, PhD, RN, CNE, ANEF

Abstract

Background:

Bolstered by the Institute of Medicine’s employment goal of 80% of baccalaureate (BSN)-prepared RNs by 2020, the number of RN-to-BSN programs has grown dramatically. This rapid growth has led to concerns about lack of standardization and significant variability in requirements related to content and expected competencies.

Method:

The Differentiated Essential Competencies (DECs) of Graduates of Texas Nursing Programs was reviewed to tease out the concepts, content, and competencies that are BSN-level specific and thereby appropriate for RN-to-BSN programs.

Results:

The current review was a compilation of differentiated competencies based on education level. In this article, numerous examples are drawn from the DECs and are organized by the major content areas common to RN-to-BSN programs.

Conclusion:

Faculty should examine the DECs to consider how they may be used to enhance RN-to-BSN programs, to evaluate their congruence with traditional BSN programs, and to ensure that program graduates are educationally prepared for practice in today’s complex health care system. [J Nurs Educ. 2015;54(11):615–623.]

Abstract

Background:

Bolstered by the Institute of Medicine’s employment goal of 80% of baccalaureate (BSN)-prepared RNs by 2020, the number of RN-to-BSN programs has grown dramatically. This rapid growth has led to concerns about lack of standardization and significant variability in requirements related to content and expected competencies.

Method:

The Differentiated Essential Competencies (DECs) of Graduates of Texas Nursing Programs was reviewed to tease out the concepts, content, and competencies that are BSN-level specific and thereby appropriate for RN-to-BSN programs.

Results:

The current review was a compilation of differentiated competencies based on education level. In this article, numerous examples are drawn from the DECs and are organized by the major content areas common to RN-to-BSN programs.

Conclusion:

Faculty should examine the DECs to consider how they may be used to enhance RN-to-BSN programs, to evaluate their congruence with traditional BSN programs, and to ensure that program graduates are educationally prepared for practice in today’s complex health care system. [J Nurs Educ. 2015;54(11):615–623.]

The general consensus that more baccalaureate (BSN)-prepared nurses are needed appears to have been reached. Encouraged by many factors, including the growing body of evidence linking improved patient outcomes with BSN-educated nurses, preference of employers to hire BSN nurses, hospitals seeking Magnet® status, and, most important, the Institute of Medicine’s (IOM, 2010) recommendations, the momentum for associate degree (ADN) and diploma-prepared RNs to continue their formal education to attain a bachelor’s degree has increased exponentially (Allen & Armstrong, 2013; Auerbach, Buerhaus, & Staiger, 2015; Conner & Thielmann, 2013; Duffy et al., 2014; Shipman & Hooten, 2010; Shipman, Roa, & Hooten, 2011). Correspondingly, the growth of RN-to-BSN educational offerings—both in number and in size—over the past few years is remarkable. Indeed, according to the American Association of Colleges of Nursing (AACN, 2014), almost 700 such programs exist.

Several proposals, initiatives, and programs to promote RN-to-BSN education have followed the IOM’s “80 by 2020” recommendation (IOM, 2010, p. 173). These include suggestions to remove barriers for RNs seeking a BSN degree (Stalter, Keister, Ulrich, & Smith, 2014a, 2014b), educational program solutions (e.g., more Web-based programs, accelerated options, creation of academic partnerships; Brown, Kuhn, & Miner, 2012; Hendricks et al., 2012; Sportsman & Allen, 2011), and legislative mandates (Maneval & Teeter, 2010; Matthias, 2010). Although much attention has been focused on how to promote access, remove barriers, and better position ADN- and diploma-educated RNs to obtain their BSN, nurse educators must also give considerable attention to the content, competencies, and clinical experiences that should be included in these programs to ensure they are congruent with traditional prelicensure BSN programs (McEwen, Pullis, White, & Krawtz, 2013), to make them relevant and appropriate for already-licensed RNs who are adult learners (Allen & Armstrong, 2013; Conner & Thielemann, 2013), and to promote quality and effective education (Hooper, McEwen, & Mancini, 2013).

Although the nursing education accreditation entities—the AACN (2008) and the Accreditation Commission for Education in Nursing (2015)—present general criteria for content and clinical experiences for BSN programs, they do not directly address what should be included in RN-to-BSN programs. The only exception identified is a white paper published by the AACN (2012), which presents expectations for clinical or practicum experiences for RN-to-BSN programs.

Left with minimal formal direction, the faculty teaching in RN-to-BSN programs must develop programs and curricula based on several factors. Factors often include the parent university’s requirements (e.g., total number of upper-division hours and the number of hours completed at the degree-granting institution) and individual State Board of Nursing mandates (e.g., number of clinical and classroom hours in public health nursing activities). However, the key determinates of what is included in RN-to-BSN curricula appear to be tradition (i.e., “we’ve always done it this way”) and faculty’s perception and understanding of the courses and clinical experiences the prospective students did not have in their initial prelicensure program (McEwen, White, Pullis, & Krawtz, 2012). Typically, those include critical knowledge, skills, and competencies, which will equip the students to meet the challenges of the complex health needs encountered in both inpatient and community-based settings, a population-based perspective, and an understanding of health systems. Key content areas identified in the literature include community/public health, with a population focus and health promotion; leadership, management, and administration skills; an understanding of and application of evidence-based practice; and professionalism and interprofessional experiences and expertise (Conner & Thielemann, 2013; IOM, 2010; McEwen White, Pullis, & Krawtz, 2014).

This article seeks to help fill the gap of what should be included in RN-to-BSN programs. The research was guided by reviewing the concept of differentiated practice and explicitly examining those concepts, competencies, and clinical experiences that separate ADN- and diploma-educated RNs from those educated at the BSN level. The information in this article can be used by nurse educators responsible for RN-to-BSN programs to identify the content, competencies, and clinical experiences that should be included as they design or review their curricula.

Overview of Differentiated Practice

Differentiated practice refers to the structuring of roles and functions of nursing practice based on education, experience, and competence (Matthias, 2010). Differentiation of nursing practice debates began in the late 1940s and early 1950s. During that period, most RNs were graduates of diploma programs, but the call to move nursing education into colleges and universities was growing. By the late 1960s, it was determined that, at minimum, nurses in leadership positions should be prepared at the BSN level (Matthias, 2010; Orsolini-Hain & Waters, 2009; Primm, 1987).

Orsolini-Hain and Waters (2009) discussed the history of the development of ADN programs and traced the evolution of the concept of differentiated practice. Those authors pointed out that during the 1960s, the American Nurses Association (1965) suggested that nurses educated at the ADN or diploma level be designated as technical nurses, and BSN graduates should be designated as professional nurses. Since the initial call by the American Nurses Association in 1965 to have professional nurses educated at the BSN level, numerous committees, commissions, and study groups at the local, state, and national levels have attempted to define, advocate, and legislate the differences among graduates of the various types of programs (Orsolini-Hain & Waters, 2009).

Although those efforts were noteworthy, a widespread agreement never materialized. Subsequent developments, including rapid growth of ADN programs, multiple nursing shortages, scarcity of BSN graduates, and recognition of the value of ADN and diploma program graduates in the provision of patient care, inhibited the distinction among nurses based on education. Indeed, it was observed that actual differentiated practice has rarely occurred, as licensure was identical and hospitals routinely hired BSN, ADN, and diploma RNs to fulfill the same roles and positions (Matthias, 2010; Orsolini-Hain & Waters, 2009). Furthermore, ADN program faculty rejected the designation of technical nurse, and the idea of distinguishing BSN and ADN graduates by technical and professional nurse designation was eventually dropped.

Although little differentiation remains in nursing practice based on educational attainment, there is widespread agreement that BSN graduates are better prepared for the challenges of today’s complex health system, with strong evidence of improved patient outcomes and enhanced patient-centered care (Conner & Thielmann, 2013; IOM, 2010; Tri-Council for Nursing, 2010). Thus, with the rapid growth of RN-to-BSN programs and calls for ADN- and diploma-educated RNs to pursue the BSN degree, it is vital that the completion or bridge programs truly fill the education gap to promote a more advanced, or higher, level of practice. The curricula of RN-to-BSN programs should therefore include content and experiences that enrich nurses’ abilities in their current practice and expand their clinical expertise.

RN-to-BSN Education: Curricular Content and Competencies

One vital issue in RN-to-BSN education is the base level of experience, or expertise, of the entering students. Due to new mandates and changes in hiring and retention policies of hospitals and other health care settings, a wide continuum exists in the professional experience of RN-to-BSN students. Indeed, it is common for students who just completed their initial pre-licensure program to be in the same class with RNs who have 30 or more years of experience. That fact further challenges RN-to-BSN program faculty to develop curricula and provide learning experiences that help students acquire BSN-level competencies (Hooper et al., 2013). Because of the wide range of experience among students in RN-to-BSN programs, structuring the content and clinical or practicum activities should be directed toward focusing on those competencies expected of all BSN graduates, regardless of years of practice as an RN. The key then is identifying and specifying the differences in what is expected of an ADN and a BSN graduate.

Differentiated Essential Competencies

The Differentiated Essential Competencies (DECs) of Graduates of Texas Nursing Programs (Texas Board of Nursing [TXBON], 2011) was initially proposed in the early 1990s following a mandate and legislative actions from the state’s Advisory Committee on Education to delineate the content and experiences that should be included in nursing education programs. The task force that developed the initial competencies identified key differences in the scope of practice based on educational backgrounds (Hooper et al., 2013; Poster, Curl, & Sportsman, 2011; Sportsman, Poster, Curl, Waller, & Hooper, 2012).

The DECs have been revised twice. The third iteration of the DECs (TXBON, 2011) consists of 25 core competencies categorized under four nursing roles: (a) member of the profession, (b) provider of patient-centered care, (c) patient safety advocate, and (d) member of the health care team. Each core competency was further outlined into specific knowledge areas and clinical judgments and behaviors. Finally, and important for this discussion, each of the DECs was broken down by education level (i.e., vocational nursing, diploma, ADN, BSN), with descriptions of the expectations of each competency’s complexity expanding as the education level is raised (Hooper et al., 2013; TXBON, 2011). Table 1 shows examples of both clinical and didactic competencies by education level, which was excerpted from the DECs (TXBON, 2011). The progression of each competency, moving from vocational nursing to diploma and ADN to BSN levels, should be noted.

Examples of Differentiated Essential Competencies by Education Level

Table 1:

Examples of Differentiated Essential Competencies by Education Level

The DECs are an important and vital effort to comprehensively enumerate and outline nursing education competencies based on education level. However, the DECs are detailed and complex and therefore difficult to implement. Further, they are education-level specific, with a separate set of competencies for each level. Although differentiation based on program type is an effective resource for faculty to evaluate their program, competencies directed toward RN-to-BSN programs are missing. Simply applying or requiring that all BSN competencies to be attained in RN-to-BSN programs would ignore the reality that students should have already attained the ADN- and diploma-level competencies.

DECs and RN-to-BSN Curricular Content and Competencies

The recent literature supports the following four major content areas of RN-to-BSN programs that have traditionally been absent or minimized in ADN and diploma programs: (a) leadership and management; (b) community/public health nursing and population health; (c) evidence-based practice and research; and (d) professionalism, including legal and ethical issues (Conner & Thielemann, 2013; McEwen et al., 2014; Stokowski, 2011; Wros, Wheeler, & Jones, 2011). To tease out the competencies that could be considered specific to RN-to-BSN programs, the DECs were meticulously examined by the author, and the differences in the competencies between ADN and diploma and BSN nurses for these four areas were distilled. In other words, the ADN/diploma and BSN columns were compared, and the differences between the verbiage of the two were identified.

For example, for the DECs shown in Table 1, a difference between the ADN and diploma and BSN competencies related to communication was leadership and management theory, practice, and skills. Mastery of this content is expected of BSN graduates but not graduates of ADN and diploma programs. For the DEC of addressing disaster preparedness and communicable disease prevention, differences between ADN and diploma and BSN competencies include “evidence-based risk reduction, epidemic and pandemic prevention and control, and disaster preparedness response and recovery” (TXBON, 2011, p. 67).

The tables in this article provide some of the numerous competencies that can be used by faculty teaching courses to RN-to-BSN students to develop or to evaluate their curriculum. The competencies are categorized first into major subject areas (leadership and management; community/public health; professionalism, and evidence-based practice and research), grouped as didactic or clinical, and then subdivided by topic. It is important to note that neither the content areas nor the competencies are exhaustive and are intended to serve as demonstration purposes. Indeed, the scope of the DECs and the sheer volume and number of competencies prohibits including them all in this article.

In the first example, Table 2 lists both didactic and clinical content and competencies related to leadership and management. The competencies are then subdivided into categories (e.g., theories, quality and safety, staff development and delegation), which are not explicitly found in the DECs, but they are more directly and discreetly congruent with what would be included in a course description or in objectives for a leadership and management course and related clinical activities. As exemplified by the examples in Table 2, the competencies contained in the DECs are specific; therefore, they could be useful in directing faculty with regard to expected outcomes.

Examples of Differentiated Essential Competencies for RN-to-BSN Education: Leadership and Management

Table 2:

Examples of Differentiated Essential Competencies for RN-to-BSN Education: Leadership and Management

Table 3 provides examples of competencies for community/public health nursing (CHN/PHN) courses and clinical experiences. As mentioned previously, these are grouped by knowledge, didactic competencies, or clinical behaviors, as outlined in the DECs. The organization of Table 3 is an attempt to combine the competencies that address related content and organize them under topics that are commonly seen in a CHN/PHN didactic or clinical course (e.g., epidemiology and demography, community and population assessment, health promotion and health education). In addition, the competencies for clinical application shown in Table 3 provide suggestions for specific activities or interventions with which students may be involved in their CHN/PHN practicums. For example, foundational to a CHN/PHN clinical course is the experience of assessing learning needs of populations and communities related to health promotion, maintenance and restoration, and identifying providers and national and community resources to meet the needs of patients.

Examples of Differentiated Essential Competencies for RN-to-BSN Education: Population Health and Community/Public HealthExamples of Differentiated Essential Competencies for RN-to-BSN Education: Population Health and Community/Public Health

Table 3:

Examples of Differentiated Essential Competencies for RN-to-BSN Education: Population Health and Community/Public Health

Similarly, Table 4 provides examples of some of the competencies related to professionalism. Among many others, the didactic content competencies demonstrate the importance of the general education courses that are prerequisites for BSN programs but are not typically required for graduates of ADN and diploma programs. For example, “a broad knowledge base from the liberal arts, humanities, natural, social and behavioral sciences…,” and “theoretical perspectives from many disciplines…that may be applied to the health care system,” nicely elucidate how a wide knowledge base is critical to BSN education. In addition, more advanced content areas to include in RN-to-BSN curricula are communication strategies (e.g., negotiation, conflict resolution, and delegation), health policy and regulation, and legal and ethical issues.

Examples of Differentiated Essential Competencies for RN-to-BSN Education: Professionalism and Legal and Ethical issuesExamples of Differentiated Essential Competencies for RN-to-BSN Education: Professionalism and Legal and Ethical issues

Table 4:

Examples of Differentiated Essential Competencies for RN-to-BSN Education: Professionalism and Legal and Ethical issues

Finally, Table 5 considers some of the DECs that address evidence-based practice and research. Key elements are both the didactic content and clinical experiences that continually consider the importance of “evidence-based practice and research findings” in health care delivery. In clinical application, students may be involved in “designing, conducting and evaluating quality improvement studies,” as well as “assist in the development of clinical practice guidelines, using research findings.”

Examples of Differentiated Essential Competencies for RN-to-BSN Education: Evidence-Based Practice and Research

Table 5:

Examples of Differentiated Essential Competencies for RN-to-BSN Education: Evidence-Based Practice and Research

Application of Differentiated Competencies in Nursing Education

Application of the DECs in developing or revising RN-to-BSN curricula would be beneficial on several levels. First, the application of DECs would decrease concerns about duplication or redundancy of content with the initial prelicensure program. Focusing primarily on the differences between ADN and diploma and BSN levels will help to direct faculty away from content and competencies that the RN should already possess. Second, use of the DECs to develop didactic courses and clinical experiences for RN-to-BSN programs will ensure that what is covered is substantive, timely, and relevant to nurses with varying years of practical experience. Assurance that the differentiated competencies are addressed in both didactic and clinical courses in RN-to-BSN curricula will help to reduce concerns about weak programs. Finally, the goals of improved patient outcomes, patient-centered care, professionalism, interprofessional collaboration, population perspective, evidence-based practice, and focus on quality and safety inherent in the DECs will better prepare RN-to-BSN program graduates to practice in today’s complex health care system, as well as for leadership roles and in graduate education.

From an individual program perspective, nursing faculty responsible for teaching in RN-to-BSN programs should review the DECs to identify the competencies and content that need to be added or strengthened in their courses. For example, deficiencies might be identified in areas such as health policy, referral, communication, theoretical perspective, quality improvement, and staff development. The DECs can provide specific direction regarding expectations that can readily be applied in didactic courses to address those deficiencies. Further, the clinical application competencies will provide ideas for specific activities that are appropriate for RN-to-BSN students. These include participation in committees that promote quality, safety, and risk management; communicating with state legislators and representatives to promote a competent workforce; and analyzing the impact of professional organizations and regulation on the nursing profession and roles of nurses.

Finally, the DECs can be used on a national level. As mentioned, in general, neither the Accreditation Commission for Education in Nursing, the Commission on Collegiate Nursing Education, nor the State Boards of Nursing provide guidelines specific to RN-to-BSN programs. Because there is no national metric (i.e., NCLEX-RN®) to ensure that students attain BSN-level competencies following completion of an RN-to-BSN program, clear expectations need to be established. The DECs would be an excellent starting point for the development of a core curriculum for RN-to-BSN programs. The distilled sections outlined in this article highlight the key areas for both didactic and clinical courses, which would promote standardization and ensure effectiveness and quality among programs nationwide (Hooper et al., 2013).

Summary

Nursing faculty who teach in RN-to-BSN programs and who desire assistance in the identification of what to include in their curricula should consider the DECs as one key source. Although explicit and challenging to apply, the DECs are nonetheless an outstanding resource. It is important to note that this article presents only selected examples of the competencies. The reader is challenged to review the full document to identify additional competencies in both knowledge and clinical application that have been deemed essential for BSN-prepared nurses and are therefore vital for inclusion in RN-to-BSN curricula.

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Examples of Differentiated Essential Competencies by Education Level

Vocational NursingDiploma and Associate Degree NursingBaccalaureate in Nursing
Issues affecting the development and practice of vocational nursing (p. 26)Issues and trends affecting nursing practice, the nursing professional, and health care delivery (p. 26)

Issues and trends affecting nursing practice, the nursing profession, and health care delivery systems

Inquiry, analysis, and information approaches in addressing practice issues (p. 26)

Participate in implementing changes that lead to improvement in the work setting (p. 58)Identify and participate in activities to improve health care delivery within the work setting (p. 58)

Identify and participate in activities to improve health care delivery within the work setting

Assess the management structure and nursing care delivery system within a health care organization and recommend changes for improvement (p. 58)

Communication within an organizational framework (p. 59)Basics principles of management and communication within an organization (p. 59)

Management and communication within an organization

Leadership and management theory, practice, and skills (p. 59)

Principles of disaster preparedness and fundamental principles of communicable disease prevention for patients and their families (p. 67)Principles of disaster preparedness and communicable disease prevention and control for patients and their families (p. 67)

Principles and theoretical models of epidemiology and communicable disease prevention and control for patients, families, populations, and communities

Evidence-based risk reduction

Epidemic and pandemic prevention and control

Disaster preparedness, response, and recovery (p. 67)

Examples of Differentiated Essential Competencies for RN-to-BSN Education: Leadership and Management

Leadership and Management: Didactic Content

Didactic ContentExample: Area of Competency

Leadership/management theories

Theories and principles of leadership and management (e.g., critical thinking, group dynamics, systems theory, assertiveness, principles of delegation, supervision, collaboration, performance appraisal)

Models and theories of stress, crisis response, and conflict management

Change theory, change agent role, and methods for evaluating the effectiveness of change

Quality and safety

Environmental management and promoting a culture of safety

Quality improvement and risk management, with a focus on patient safety

Designing systems that promote quality nursing practice

Staff development and delegation

Management of group processes to facilitate meeting patient goals

Human resource management and processes for performance evaluation

Principles of staff development

Resource management and organizational behavior.


Leadership and Management: Clinical Application

Clinical ExperienceExample: Area of Competency and Experience

Leadership

Develop and revise policies and procedures

Apply concepts and skills from management theory to assign and delegate nursing care in a variety of settings

Use current technology and informatics to enhance patient care

Provide leadership in collaboration with the interprofessional health care team

Quality and safety

Participate in committees that promote quality, safety, and risk management

Assess the management structure and nursing care delivery system within a health care organization and recommend changes for improvement

Design and implement strategies to promote a safe work environment

Staff development and delegation

Use management, leadership, team building, and administrative skills to manage and evaluate staff

Provide staff education to members of the health care team

Evaluate the effectiveness of staff development

Use best practices of management, leadership, and evaluation to supervise others

Examples of Differentiated Essential Competencies for RN-to-BSN Education: Population Health and Community/Public Health

Populations and Communities: Didactic Content

Didactic ContentExample: Area of Competency

Community/public health models and theories

Theoretical models of epidemiology and communicable disease prevention and control for populations and communities

Processes to promote disease prevention, risk reduction, health promotion, and health education

Strategies of health behavior change

Epidemiology and demography

Prevention and control of epidemics

Implications of demographic, epidemiological, and genetics data on the changing needs for health care resources and services

Utilization of comprehensive databases for data collection, health screening, and case finding

Community/population assessment

Analysis of nursing research, epidemiological, and social data to draw inferences about the health of populations and communities

Systematic approach to performing a community assessment

Political, economic, and social forces affecting population health care

Assessment of the health literacy, learning needs, and factors affecting quality of life for populations and communities

Advocacy and leadership in health planning and intervention

Leadership roles to improve the health of populations and communities

Role of the nurse as advocate for populations and communities

Public health strategies

Disaster preparedness, response, and recovery

Health literacy and learning theories; methods for evaluating outcomes of teaching and learning

Resources for risk reduction and health promotion, maintenance, and restoration


Populations and Communities: Clinical Application

Clinical ExperienceExample: Area of Competency and Experiences

Population health care delivery

Provide direct and indirect care for disease prevention and health promotion or restoration for patients, families, and populations

Serve as a member of the health care team to provide services to communities with unmet needs

Health promotion and health education

Assess learning needs related to health promotion, maintenance, and restoration for populations and communities

Develop, implement, and modify teaching plans and strategies for health promotion, maintenance, and restoration, and risk reduction of communities, focusing on vulnerable populations

Evaluate learning outcomes of educational interventions for populations and communities

Community and population assessment, analysis, planning, implementation, and evaluation

Perform comprehensive assessments and monitor changes to address factors impacting the health status and health needs of populations and communities

Identify unmet needs and risks of populations and communities from a holistic perspective

Formulate goals and outcomes, using an evidence-based analysis of data to reduce community risks

Implement plans of care to assist vulnerable populations to meet physical and mental health care needs in multiple settings

Coordination, referral, and community resources

Provide leadership in coordinating services to patients

Work with family and community resources to develop and strengthen patient support systems

Identify providers and national and community resources to meet patients’ needs

Use informatics and information systems to promote health care delivery and reduce risks in populations and communities

Communicable disease prevention and control

Anticipate risks for exposure to infectious pathogens in populations and communities

Assist in developing policies and procedures to prevent exposure to infectious pathogens and communicable conditions

Formulate goals and outcomes to reduce the risk of health care–associated infections using available data

Epidemiological processes

Assess genetic, protective, and predictive factors that influence the learning needs of patients, families, populations, and communities related to risk reduction, and health promotion, maintenance, and restoration

Implement risk reduction strategies to address social and public health issues

Identify links between physical and mental health, lifestyles, prevention, and access to health care

Health policy

Participate in meetings and organizations addressing issues affecting health care services, programs, and cost to patients, families, populations, and communities

Advocate for public policies to support health care access for vulnerable populations

Communicate with state legislators and representatives of regulatory agencies to promote a competent nursing workforce

Examples of Differentiated Essential Competencies for RN-to-BSN Education: Professionalism and Legal and Ethical issues

Professionalism and Legal and Ethical: Didactic Content

Didactic ContentExample: Area of Competency

General foundational concepts for professional practice

A broad knowledge base from the liberal arts, humanities, and natural, social, and behavioral sciences as they apply to planning care and reducing risks for patients, families, populations, and communities

Theoretical perspectives from many disciplines (e.g., stress and crisis, change, conflict management, human resource management, teaching and learning, family systems theory organizational behavior, information systems management) that may be applied to the health care system

Nursing frameworks, theories, and models that relate to managing and evaluating health care delivery, for patients, families, populations, and communities

Health care system

Links between nursing history, and medical, social, political, religious, and cultural influences

Models for health care delivery

Utilization of health care delivery system resources

Legal and ethical issues

Ethics and ethical reasoning

Code of ethics, ethical practices, current issues, and patients’ rights in the health care delivery system

Legal principles and practice relative to health care

Communication

Communication and collaboration theories and strategies, such as assertiveness, negotiation, conflict resolution, and delegation

Information and communication systems for managing population-based data

Communication skills, including writing, speaking, and presenting, which are necessary for leadership

Health policy

Economic and political factors that influence population health and health care delivery

Health care policies and regulations related to public safety and welfare and development of the future workforce

Strategies to influence public policy

Interprofessional collaboration

Models for understanding functional and dysfunctional relationships

Formal and informal sources of power and the process of negotiation

Interdisciplinary interventions across all settings

Scope of practice

Processes for developing standards of nursing practice and care

Distinction of roles and scopes of practice among nursing and other health care professions

How nursing theories, research findings, and interprofessional roles influence nursing practice


Professionalism: Clinical Application

Clinical ExperienceExample: Area of Competency and Experience

Theoretical and historical basis for practice

Use of change theory and strategies for effective and efficient resource management and improvement of patient care

Promotion of professional nursing practice by consideration of the links between nursing history and medical, social, political, religious, and cultural influences

Interdisciplinary team and collaboration

Collaborate with others inside and outside the health care industry to promote nursing

Facilitate communication among clients and the interprofessional team to use resources to meet health care needs

Advocate with members of the health care team and community resources on behalf of vulnerable populations

Legal and ethical issues

Guide others toward safe and legal clinical practice

Analyze the impact of professional organizations and regulating bodies on the nursing profession and nursing roles

Examples of Differentiated Essential Competencies for RN-to-BSN Education: Evidence-Based Practice and Research

Evidence-Based Practice and Research: Didactic Content

Didactic ContentExample: Area of Competency

Research process

Informed consent for participation in research

Research and evaluation methodologies

Research of organizational and societal change

Evidence-based practice

Systematic processes to assess methods for evaluating patient outcomes

Evidence-based practice and research findings related to health care

Process of translating evidence into practice


Research and Evidence-Based Practice: Clinical Application

Clinical ExperienceExample: Area of Competency and Experience

Application of research in practice

Provide nursing interventions using current research findings and evidence-based outcomes

Modify plan of care based on research findings and evaluation data

Evidence-based practice

Analyze patient data using research findings, evidence-based practice guidelines, and systematic processes to compare expected and achieved outcomes

Assist in the development of clinical practice guidelines, using research findings

Collaborate in the development of standards of care based on evidence-based practice that is congruent with organizational structure and goals

Participation in the research process

Modify data collection tools using evidence-based practice

Participate in designing, conducting, and evaluating quality improvement studies

Authors

Dr. McEwen is Associate Professor, Department of Nursing Systems, The University of Texas Health Science Center at Houston, School of Nursing, Houston, Texas.

The author has disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Melanie McEwen, PhD, RN, CNE, ANEF, Associate Professor, Department of Nursing Systems, The University of Texas Health Science Center at Houston, School of Nursing, 6901 Bertner, #730, Houston, TX 77030; e-mail: Melanie.M.McEwen@uth.tmc.edu.

Received: February 03, 2015
Accepted: July 08, 2015

 

10.3928/01484834-20151016-02

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