The Essentials of Baccalaureate Education

The Essentials of Baccalaureate Education
for Professional Nursing Practice
October 20, 2008
Executive Summary 3
Background 5
Nursing Education 6
The Discipline of Nursing 7
Assumptions 8
Roles for the Baccalaureate Generalist Nurse 8
Preparation for the Baccalaureate Generalist Nurse:
Components of the Essentials 10
The Essentials of Baccalaureate Education for Professional Nursing Practice
I. Liberal Education for Baccalaureate Generalist Nursing Practice 10
II. Basic Organizational and Systems Leadership for
Quality Care and Patient Safety 13
III. Scholarship for EvidenceBased Practice 15
IV. Information Management and Application of Patient
Care Technology 17
V. Healthcare Policy, Finance, and Regulatory Environments 20
VI. Interprofessional Communication and Collaboration for
Improving Patient Health Outcomes 22
VII. Clinical Prevention and Population Health 23
VIII. Professionalism and Professional Values 26
IX. Baccalaureate Generalist Nursing Practice 29
Expectations for Clinical Experiences within the Baccalaureate Program 33
Summary 35
Glossary 36
References 40
Appendix A: Task Force on the Revision of the Essentials of Baccalaureate
Education for Professional Nursing Practice 45
Appendix B: Consensus Process to Revise the Essentials of Baccalaureate 46
Education for Professional Nursing Practice
Appendix C: Participants who Attended Stakeholder Meetings 47
Appendix D: Schools of Nursing that Participated in the Regional Meetings 49
Appendix E: Professional Organizations that Participated in the Regional Meetings 60
Appendix F: Healthcare Systems that Participated in the Regional Meetings 61
Executive Summary
The Essentials of Baccalaureate Education
for Professional Nursing Practice (2008)
This Essentials document serves to transform baccalaureate nursing education by providing
the curricular elements and framework for building the baccalaureate nursing curriculum for
the 21 st century. These Essentials address the key stakeholders recommendations and
landmark documents such as the IOMs recommendations for the core knowledge required of
all healthcare professionals. This document emphasizes such concepts as patientcentered
care, interprofessional teams, evidencebased practice, quality improvement, patient safety,
informatics, clinical reasoning/critical thinking, genetics and genomics, cultural sensitivity, professionalism, and practice across the lifespan in an everchanging and complex healthcare
Essentials IIX delineate the outcomes expected of graduates of baccalaureate nursing
programs. Achievement of these outcomes will enable graduates to practice within complex
healthcare systems and assume the roles: provider of care designer/manager/coordinator of
care and member of a profession. Essential IX describes generalist nursing practice at the
completion of baccalaureate nursing education. This Essential includes practicefocused
outcomes that integrate the knowledge, skills, and attitudes delineated in Essentials I VIII. The time needed to accomplish each Essential will vary, and each Essential does not require a
separate course for achievement of the outcomes.
The nine Essentials are: Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice
o A solid base in liberal education provides the cornerstone for the practice and
education of nurses. Essential II: Basic Organizational and Systems Leadership for Quality Care and
Patient Safety
o Knowledge and skills in leadership, quality improvement, and patient safety are
necessary to provide high quality health care. Essential III: Scholarship for Evidence Based Practice
o Professional nursing practice is grounded in the translation of current evidence
into ones practice. Essential IV: Information Management and Application of Patient Care Technology
o Knowledge and skills in information management and patient care technology are
critical in the delivery of quality patient care. Essential V: Health Care Policy, Finance, and Regulatory Environments
o Healthcare policies, including financial and regulatory, directly and indirectly
influence the nature and functioning of the healthcare system and thereby are
important considerations in professional nursing practice. Essential VI: Interprofessional Communication and Collaboration for Improving
Patient Health Outcomes
o Communication and collaboration among healthcare professionals are critical to
delivering high quality and safe patient care.
Essential VII: Clinical Prevention and Population Health
o Health promotion and disease prevention at the individual and population level
are necessary to improve population health and are important components of
baccalaureate generalist nursing practice. Essential VIII: Professionalism and Professional Values
o Professionalism and the inherent values of altruism, autonomy, human dignity,
integrity, and social justice are fundamental to the discipline of nursing. Essential IX: Baccalaureate Generalist Nursing Practice
o The baccalaureategraduate nurse is prepared to practice with patients,
including individuals, families, groups, communities, and populations across
the lifespan and across the continuum of healthcare environments. o The baccalaureate graduate understands and respects the variations of care,
the increased complexity, and the increased use of healthcare resources
inherent in caring for patients.
Learning opportunities, including direct clinical experiences, must be sufficient in
breadth and depth to ensure the baccalaureate graduate attains these practicefocused
outcomes and integrates the delineated knowledge and skills into the graduates
professional nursing practice. Clinical learning is focused on developing and refining the
knowledge and skills necessary to manage care as part of an interprofessional team. Simulation experiences augment clinical learning and are complementary to direct care
opportunities essential to assuming the role of the professional nurse. A clinical
immersion experience provides opportunities for building clinical reasoning,
management, and evaluation skills.
The Essentials of Baccalaureate Education for Professional Nursing Practice provides
the educational framework for the preparation of professional nurses. This document
describes the outcomes expected of graduates of baccalaureate nursing programs.
The Essentials apply to all prelicensure and RN completion programs, whether the
degree is baccalaureate or graduate entry. Program curricula are designed to prepare
students to meet the endofprogram outcomes delineated under each Essential.
The healthcare delivery system has changed dramatically since The Essentials of
Baccalaureate Education for Professional Nursing Practice was endorsed by the
American Association of Colleges of Nursing (AACN, 1998). Building a safer
healthcare system has become the focus of all health professions following numerous
reports from the Institute of Medicine (IOM, 2000, 2001, 2004), American Hospital
Association (2002), Robert Wood Johnson Foundation (Kimball & ONeill, 2002), the
Joint Commission (2002) and other authorities. Nursing has been identified as having the
potential for making the biggest impact on a transformation of healthcare delivery to a
safer, higher quality, and more costeffective system. With the increasing awareness of
the need for change in the healthcare system, the clinical microsystems (small, functional
units where care is provided within the larger system) have become an important focus
for improving healthcare outcomes (Nelson, Batalden, & Godfrey, 2007).
In addition to the concern over healthcare outcomes, the United States and the global
market are experiencing a nursing shortage that is expected to intensify as the demand for
more and different nursing services grows. Buerhaus, Staiger, and Auerbach (2008)
reported that the U.S. may experience a shortage of more than 500,000 registered nurses
by the year 2025. Despite annual increases in enrollments in entrylevel baccalaureate
nursing programs since 2001 (Fang, Htut, & Bednash, 2008), these increases are not
sufficient to meet the projected demand for nurses. According to Buerhaus et al. (2008), enrollment in nursing programs would have to increase at least 40% annually to replace
the nurses expected to leave the workforce through retirement alone. Addressing the need
for an increased number of baccalaureateprepared nurses is critical but not sufficient. Nursing must educate future professionals to deliver patientcentered care as members of
an interprofessional team, emphasizing evidencebased practice, quality improvement
approaches, and informatics (IOM, 2003b). Nursing education and practice must work
together to better align education with practice environments (Joint Commission, 2002,
Kimball & ONeill, 2002).
The environments in which professional nurses practice have become more diverse and
more global in nature. Scientific advances, particularly in the areas of genetics and
genomics, have had and will continue to have a growing and significant impact on
prevention, diagnosis, and treatment of diseases, illnesses, and conditions. The increased
prevalence of chronic illness is a result of an increasingly older adult population, environmental threats, lifestyles that increase risk of disease, and enhanced technological
and therapeutic interventions that prolong life. Increases in longevity of life have made
the older adult the fastest growing segment of the population. In 2003, 12 % of the
population was older than 65 years of age. By 2030, this population will increase to 20%, with a large majority older than 80 years of age (He, Sengupta, Velkoff, & DeBarros, 2005). Those older than 65 years of age had almost four times the number of
hospitalization days than those younger than 65 years of age (Centers for Disease
Control, 2007)
Education for the baccalaureate generalist must include content and experiences across
the lifespan, including the very young who are especially vulnerable. The percentage of
the population under 18 years of age is 24.6% (U.S. Census Bureau, 2008). U.S. infant
mortality in 2006 ranked 38 th in the world (World Health Organization, 2008). Prevention is critical in addressing both acute and chronic conditions across the lifespan. The role of the nurse in prevention continues to be of utmost importance.
Increasing globalization of healthcare and the diversity of this nations population
mandates an attention to diversity in order to provide safe, high quality care. The
professional nurse practices in a multicultural environment and must possess the skills to
provide culturally appropriate care. According to the U.S. Census Bureau (2008), the
nation’s minority population totaled 102 million or 34% of the U.S. population in 2006.
With projections pointing to even greater levels of diversity in the coming years, professional nurses need to demonstrate a sensitivity to and understanding of a variety of
cultures to provide high quality care across settings. Liberal education, including the
study of a second language, facilitates the development of an appreciation for diversity.
Strong forces influencing the role of nurses include: scientific advances, particularly in the area of genetics and genomics, changing demographics of patient populations, new care technologies, and
patient access to healthcare information. These forces call for new ways of thinking and providing health care. Nursing is
uniquely positioned to respond to these major forces, requiring an increased emphasis on
designing and implementing patientcentered care, developing partnerships with the
patient, and a focus on customer service.
Nursing Education
In response to calls for transforming the healthcare system and how healthcare
professionals are educated, AACN has maintained an ongoing dialogue with a broad
representation of stakeholders internal and external to nursing. The dialogue has focused
on the knowledge, skills, and attitudes needed by nurses to practice effectively within this
complex and changing environment. New innovative models of nursing education have
emerged, and AACN has taken a leadership role in crafting a preferred vision for nursing
In 2004, the AACN Board of Directors reaffirmed its position that baccalaureate
education is the minimum level required for entry into professional nursing practice in
todays complex healthcare environment. Baccalaureate generalist education, as defined
in this document, is the foundation upon which all graduate nursing education builds.
The preferred vision for nursing education includes generalist, advanced generalist, and
advanced specialty nursing education. Generalist nurse education occurs at a minimum in
baccalaureatedegree nursing programs. Advanced generalist education occurs in
masters degree nursing programs, including the Clinical Nurse Leader (CNL), which is
an advanced generalist nursing role. Advanced specialty education occurs at the doctoral
level in Doctor of Nursing Practice (DNP) or researchfocused degree programs (PhD,
DNS, or DNSc). Endofprogram outcomes for the baccalaureate, masters, and doctoral
nursing programs build on each other.
The Discipline of Nursing
Roles for the baccalaureate generalist nurse are derived from the discipline of nursing.
The roles of the baccalaureate generalist include: provider of care, designer/manager/coordinator of care, and
member of a profession. Nursing generalist practice includes both direct and indirect care for patients, which
includes individuals, families, groups, communities, and populations. Nursing practice is
built on nursing knowledge, theory, and research. In addition, nursing practice derives
knowledge from a wide array of other fields and professions, adapting and applying this
knowledge as appropriate to professional practice.
In the senior college and university setting, every academic discipline is grounded in
discrete inquirybased applications that are distinctive to that discipline. Scientific
advances, (particularly in the area of genetics and genomics), changing demographics of
patient populations, new care technologies, and patient access to health care information
call for new ways of thinking and doing in the provision of health care. The academic
setting provides a forum for contemplating physical, psychological, social, cultural, behavioral, ethical, and spiritual problems within and across disciplines. Faculty have a
responsibility to facilitate the translation of knowledge from a liberal education base into
the practice of nursing. Nursing faculty introduce nursing science and theories, and guide
the student in developing an understanding of the discipline of nursings distinctive
Baccalaureateprepared nurses provide patientcentered care that identifies, respects, and
addresses patients differences, values, preferences, and expressed needs (IOM, 2003a).
Patientcentered care also involves the coordination of continuous care, listening to,
communicating with, and educating patients and caregivers regarding health, wellness, and disease management and prevention. The generalist nurse provides the human link
between the healthcare system and the patient by translating the plan of care to the
patient. A broadbased skill set is required to fill this human interface role. Patient centered care also requires the development of a nursepatient partnership. Patients, as
consumers of healthcare services, and as integral members of the healthcare team, have
an increasing role and responsibility for the mutual planning of care and healthcare
decision making.
The fundamental aspects of generalist nursing practice are: direct care of the sick in and
across all environments, health promotion and clinical prevention, and populationbased
health care. A defining feature of professional nursing practice is the focus on health
promotion and risk reduction. Advances in science and technology will continue to
emerge, which will help to predict future health problems. Nurses will design and
implement measures to modify risk factors and promote healthy lifestyles. These same
advances in science and technology also have allowed individuals to live longer and often
with increasing numbers of chronic illnesses and conditions. With an increasing emphasis
on costsavings and costbenefits, nurses will play a leading role in the provision of care.
The baccalaureate generalist graduate is prepared to: practice from a holistic, caring framework practice from an evidence base promote safe, quality patient care use clinical/critical reasoning to address simple to complex situations assume accountability for ones own and delegated nursing care practice in a variety of healthcare settings care for patients across the healthillness continuum care for patients across the lifespan care for diverse populations engage in care of self in order to care for others and
engage in continuous professional development.
Roles for the Baccalaureate Generalist Nurse
Baccalaureate Generalist nurses are providers of direct and indirect care. In this role,
nurses are patient advocates and educators. Historically, the nursing role has emphasized
partnerships with patients whether individuals, families, groups, communities, or
populations in order to foster and support the patients active participation in
determining healthcare decisions. Patient advocacy is a hallmark of the professional
nursing role and requires that nurses deliver high quality care, evaluate care outcomes, and provide leadership in improving care.
Changing demographics and ongoing advances in science and technology are a reality of
healthcare practice. The generalist nurse provides evidencebased care to patients within
this changing environment. This clinician uses research findings and other evidence in
designing and implementing care that is multidimensional, high quality, and cost effective. The generalist nurse also is prepared for the ethical dilemmas that arise in
practice and will be able to make and assist others in making decisions within a
professional ethical framework. Understanding advances in science and technology and
the influence these advances have on health care and individual wellbeing is essential. Understanding patients and the values they bring to the healthcare relationship is equally
The generalist nurse practices from a holistic, caring framework. Holistic nursing care is
comprehensive and focuses on the mind, body, and spirit, as well as emotions. The
generalist nurse recognizes the important distinction between disease and the individuals
illness experience. Assisting patients to understand this distinction is an important aspect
of nursing. In addition, nurses recognize that determining the health status of the patient
within the context of the patients values is essential in providing a framework for
planning, implementing, and evaluating outcomes of care.
The generalist nurse provides care in and across all environments. Nurses focus on
individual, family, community, and population health care, as they monitor and manage
aspects of the environment to foster health.
Baccalaureate generalist nurses are designers, coordinators, and managers of care. The
generalist nurse, prepared at the baccalaureatedegree level, will have the knowledge and
authority to delegate tasks to other healthcare personnel, as well as to supervise and
evaluate these personnel. As healthcare providers who function autonomously and
interdependently within the healthcare team, nurses are accountable for their professional
practice and image, as well as for outcomes of their own and delegated nursing care.
Nurses are members of healthcare teams, composed of professionals and other personnel
that deliver treatment and services in complex, evolving healthcare systems. Nurses bring
a unique blend of knowledge, judgment, skills, and caring to the healthcare team.
Baccalaureate generalist nurses are members of the profession and in this role are
advocates for the patient and the profession. The use of the term professional implies
the formation of a professional identity and accountability for ones professional image.
As professionals, nurses are knowledge workers who use a welldelineated and broad
knowledge base for practice. Professional nursing requires strong critical reasoning,
clinical judgment, communication, and assessment skills. The professional nurse also
requires the development and demonstration of an appropriate set of values and ethical
framework for practice. As advocates for high quality care for all patients, nurses are
knowledgeable and active in the policy processes defining healthcare delivery and
systems of care. The generalist nurse also is committed to lifelong learning, including
career planning, which increasingly will include graduate level study.
Preparation for the Baccalaureate Generalist Nurse Roles: Components of The
This section outlines the nine Essentials of Baccalaureate Education for Professional
Nursing Practice. These Essentials are the curricular elements that provide the
framework for baccalaureate nursing education. Each Essential is operationalized through
the programs curriculum and is not intended to represent a course. Essential IX describes
baccalaureate nursing practice and integrates the knowledge, skills, and attitudes from
Essentials IVIII. Each Essential includes a rationale explaining its relevance for the
education of the professional nurse today and in the future. The rationale for each
Essential is followed by outcomes that delineate the knowledge, skills, and attitudes
expected of new baccalaureate generalist graduates. These outcomes serve as a guide to
help faculty identify program and course objectives that are specific and measurable.
Next, sample content is listed to aid faculty in selecting material suited to achieving the
specific Essential. The list of content is not inclusive, nor is it intended as required. A
vast selection of content is available for each Essential, and the specific baccalaureate
programs curriculum will specify the content as appropriate to their mission, community
served, and student population. The Essential outcomes can be obtained through a
variety of content approaches, and potential content can and will evolve over time as new
knowledge develops. The sample content is offered as a guide to programs or to further
elucidate the nature of the Essential with which the content is listed.
The Essentials of Baccalaureate Education for Professional Nursing Practice
Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice
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 highlevel 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). For
the purposes of this document, a liberal education includes both the sciences and the arts. The sciences include: physical sciences (e.g., physics and chemistry), life sciences (e.g., biology and genetics), mathematical sciences, and
social sciences (e.g., psychology and sociology). The arts include: fine arts (e.g., painting and sculpture), performing arts (e.g., dance and music), and
humanities (e.g., literature and theology).
Liberal education is critical to the generation of responsible citizens in a global society.
In addition, liberal education is needed for the development of intellectual and innovative
capacities for current and emergent generalist nursing practice. Liberally educated nurses
work within a healthcare team to address issues important to the profession of nursing,
question dominant assumptions, and solve complex problems related to individuals and
populationbased health care. Nursing graduates with a liberal education exercise
appropriate clinical judgment, understand the reasoning behind policies and standards,
and accept responsibility for continued development of self and the discipline of nursing.
A solid base in liberal education provides the distinguishing cornerstone for the study and
practice of professional nursing. Studying the humanities, social sciences, and natural
sciences expands the learners capacity to engage in socially valued work and civic
leadership in society. A strong foundation in liberal arts includes a general education
curriculum that provides broad exposure to multiple disciplines and ways of knowing.
Other than the nursing major, some aspects of liberal arts study will be provided as
discrete parts of the full educational curriculum however the rich and diverse
perspectives and knowledge embedded in the liberal arts and sciences will be integrated
throughout the nursing curriculum, as these perspectives are integral to the full spectrum
of professional nursing practice (Hermann, 2004).
Successful integration of liberal education and nursing education provides graduates with
knowledge of human cultures, including spiritual beliefs, and the physical and natural
worlds supporting an inclusive approach to practice. The study of history, fine arts,
literature, and languages are important building blocks for developing cultural
competence and clinical reasoning. Furthermore, the integration of concepts from
behavioral, biological, and natural sciences throughout the nursing curriculum promotes
the understanding of self and others and contributes to safe, quality care. The integration
of concepts from the arts and sciences provides the foundation for understanding health
as well as disease processes, and forms the basis for clinical reasoning. As noted by the
Carnegie Foundation for the Advancement of Teaching, the sciences are a critical aspect
of liberal education for nurses. Sciences that have clinical relevance are especially
important to the profession of nursing to ensure that graduates have the ability to keep
pace with changes driven by research and new technologies (Carnegie Foundation, in
A liberal education for nurses forms the basis for intellectual and practical abilities for
nursing practice as well as for engagement with the larger community, both locally and
globally. Skills of inquiry, analysis, critical thinking, and communication in a variety of
modes, including the written and spoken word, prepare baccalaureate graduates to
involve others in the common good through use of information technologies, team work,
and interprofessional problem solving. Liberal education, including the study of a second
language, facilitates the development of an appreciation for cultural and ethnic diversity.
Strong emphasis on the development of a personal values system that includes the
capacity to make and act upon ethical judgments is a hallmark of liberal education. Students educated in a liberal education environment are encouraged to pursue
meaningful personal and professional goals as well as to commit to honesty in
relationships and the search for truth. The development of leadership skills and
acceptance of responsibility to promote social justice are expected outcomes of a liberal
Liberal education allows the graduate to form the values and standards needed to address
twentyfirst century changes in technology, demographics, and economics. These trends
include an aging population, diverse family and community structures, and increasing
global interdependence, as well as economic and political changes in the United States
healthcare system. Liberal education provides the baccalaureate graduate with the ability
to integrate knowledge, skills, and values from the arts and sciences to provide
humanistic, safe quality care to act as advocates for individuals, families, groups, communities, and/or populations and to promote social justice. Liberally educated
graduates practice from a foundation of professional values and standards.
The baccalaureate program prepares the graduate to:
1. Integrate theories and concepts from liberal education into nursing practice.
2. Synthesize theories and concepts from liberal education to build an understanding of
the human experience.
3. Use skills of inquiry, analysis, and information literacy to address practice issues.
4. Use written, verbal, nonverbal, and emerging technology methods to communicate
5. Apply knowledge of social and cultural factors to the care of diverse populations.
6. Engage in ethical reasoning and actions to provide leadership in promoting advocacy, collaboration, and social justice as a socially responsible citizen.
7. Integrate the knowledge and methods of a variety of disciplines to inform decision
8. Demonstrate tolerance for the ambiguity and unpredictability of the world and its
effect on the healthcare system.
9. Value the ideal of lifelong learning to support excellence in nursing practice.
Sample Content
selected concepts and ways of knowing from the sciences selected concepts and ways of knowing from the arts principles related to working with peoples from diverse cultures
concepts related to intellectual diversity, tolerance, and social justice concepts related to globalization and migration of populations
Essential II: Basic Organizational and Systems Leadership for Quality Care and
Patient Safety
Organizational and systems leadership, quality improvement, and safety are critical to
promoting high quality patient care. Leadership skills are needed that emphasize ethical
and critical decisionmaking, initiating and maintaining effective working relationships, using mutually respectful communication and collaboration within interprofessional
teams, care coordination, delegation, and developing conflict resolution strategies. Basic
nursing leadership includes an awareness of complex systems, and the impact of power, politics, policy, and regulatory guidelines on these systems. To be effective,
baccalaureate graduates must be able to practice at the microsystem level within an everchanging healthcare system. This practice requires creativity and effective leadership and
communication skills to work productively within interprofessional teams in various
healthcare settings.
As a member of a healthcare team, baccalaureate graduates will understand and use
quality improvement concepts, processes, and outcome measures. In addition, graduates
will be able to assist or initiate basic quality and safety investigations assist in the
development of quality improvement action plans and assist in monitoring the results of
these action plans within the clinical microsystem, which is embedded within a larger
system of care.
An important component of quality is safety. Safety in health care is defined as the
minimization of risk of harm to patients and providers through both system effectiveness
and individual performance (Cronenwett et al., 2007). Research has demonstrated that
nurses more than any other healthcare professional are able to recognize, interrupt,
evaluate, and correct healthcare errors (Rothschild et al., 2006) The baccalaureate
graduate implements safety principles and works with others on the interprofessional
healthcare team to create a safe, caring environment for care delivery.
Baccalaureate graduates will be skilled in working within organizational and community
arenas and in the actual provision of care by themselves and/or supervising care provided
by other licensed and nonlicensed assistive personnel. They will be able to recognize
safety and quality concerns and apply evidencebased knowledge from the nursing
profession and other clinical sciences to their practice. Baccalaureate nursing graduates
are distinguished by their abilities to identify, assess, and evaluate practice in care
delivery models that are based in contemporary nursing science and are feasible within
current cultural, economic, organizational, and political perspectives.
The baccalaureate program prepares the graduate to:
1. Apply leadership concepts, skills, and decision making in the provision of high quality
nursing care, healthcare team coordination, and the oversight and accountability for care
delivery in a variety of settings.
2. Demonstrate leadership and communication skills to effectively implement patient
safety and quality improvement initiatives within the context of the interprofessional
3. Demonstrate an awareness of complex organizational systems.
4. Demonstrate a basic understanding of organizational structure, mission, vision, philosophy, and values.
5. Participate in quality and patient safety initiatives, recognizing that these are complex system
issues, which involve individuals, families, groups, communities, populations, and other
members of the healthcare team.
6. Apply concepts of quality and safety using structure, process, and outcome measures to
identify clinical questions and describe the process of changing current practice.
7. Promote factors that create a culture of safety and caring.
8. Promote achievement of safe and quality outcomes of care for diverse populations.
9. Apply quality improvement processes to effectively implement patient safety initiatives and
monitor performance measures, including nursesensitive indicators in the microsystem of
10. Use improvement methods, based on data from the outcomes of care processes, to design and
test changes to continuously improve the quality and safety of health care.
11. Employ principles of quality improvement, healthcare policy, and costeffectiveness to assist
in the development and initiation of effective plans for the microsystem and/or systemwide
practice improvements that will improve the quality of healthcare delivery.
12. Participate in the development and implementation of imaginative and creative
strategies to enable systems to change.
Sample Content
leadership, including theory, behaviors, characteristics, contemporary
approaches, leadership development, and styles of leadership
leadership skills and strategies (negotiating, collaborating, coordinating)
decision making to promote quality patient care in a variety of healthcare settings change theory and complexity science community organizing models social change theories creative and imaginative strategies in problem solving
communication, including elements, channels, levels, barriers, models, organizational communication, skill development, workplace communication, conflict resolution, optimizing patient care outcomes, and chainofcommand
principles of interpersonal interactions/communication
healthcare systems (structure and finance) and organizational structures and
relationships (e.g., between finance, organizational structure, and delivery of
care, particularly at the microsystem level, including mission/vision/philosophy
and values) reliability and reliability sciences in health care operations research, queuing theory, and systems designs in health care teamwork skills, including effective teams/characteristics, application to patient
care teams, team process, conflict resolution, delegation, supervision, and
microsystems and their relationship to complex systems, quality care, and patient
patient safety principles, including safety standards, organizational safety
processes, reporting processes, departmental responsibilities, ownership, national
initiatives, and financial implications quality improvement (QI), including history, elements, Continuous Quality
Improvement (CQI) models, concepts, principles, benchmarking, processes,
tools, departmental ownership, roles/responsibility, methodologies, regulatory
requirements, organizational structures for QI, outcomes, monitoring, Quality
Assurance (QA) vs. QI, beginning resource need assessment, and resource
identification, acquisition, and evaluation
overview of QI process techniques, including benchmarks, basic statistics, root
cause analyses, and Failure Mode Effects Analysis (FMEA) in the quality
improvement process principles of nursing care delivery management and evaluation
Essential III: Scholarship for EvidenceBased Practice
Professional nursing practice is grounded in the translation of current evidence into
practice. Scholarship for the baccalaureate graduate involves identification of practice
issues appraisal and integration of evidence and evaluation of outcomes. As
practitioners at the point of care, baccalaureate nurses are uniquely positioned to monitor
patient outcomes and identify practice issues. Evidencebased practice models provide a
systematic process for the evaluation and application of scientific evidence surrounding
practice issues (IOM, 2003b). Dissemination is a critical element of scholarly practice
baccalaureate graduates are prepared to share evidence of best practices with the
interprofessional team.
Baccalaureate education provides a basic understanding of how evidence is developed,
including the research process, clinical judgment, interprofessional perspectives, and
patient preference as applied to practice. This basic understanding serves as a foundation
for more complex applications at the graduate level (AACN, 2006a). Baccalaureate
nurses integrate reliable evidence from multiple ways of knowing to inform practice and
make clinical judgments. In collaboration with other healthcare team members, graduates
participate in documenting and interpreting evidence for improving patient outcomes
(AACN, 2006b).
In all healthcare settings, ethical and legal precepts guide research conduct to protect the
rights of patients eligible for, or participating in, investigations. Professional nurses
safeguard patient rights, including those of the most vulnerable patients, in situations
where an actual or potential conflict of interest, misconduct, or the potential for harm are
The baccalaureate program prepares the graduate to:
1. Explain the interrelationships among theory, practice, and research.
2. Demonstrate an understanding of the basic elements of the research process and
models for applying evidence to clinical practice.
3. Advocate for the protection of human subjects in the conduct of research.
4. Evaluate the credibility of sources of information, including but not limited to
databases and Internet resources.
5. Participate in the process of retrieval, appraisal, and synthesis of evidence in
collaboration with other members of the healthcare team to improve patient outcomes.
6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient
preferences in planning, implementing, and evaluating outcomes of care.
7. Collaborate in the collection, documentation, and dissemination of evidence.
8. Acquire an understanding of the process for how nursing and related healthcare quality
and safety measures are developed, validated, and endorsed.
9. Describe mechanisms to resolve identified practice discrepancies between identified
standards and practice that may adversely impact patient outcomes.
Sample Content
principles and models of evidencebased practice nursesensitive quality indicators (National Quality Forum, 2004), performance
measures overview of qualitative and quantitative research processes methods for locating and appraising health and other relevant research literature
and other sources of evidence basic applied statistics basic designs, corresponding questions, analytical methods related to research
questions, and limits on implications of findings (e.g., causal vs. relational) ethical conduct of research and scholarly work
linkages among practice, research evidence, patient outcomes, and cost
containment forces driving research agendas locating and evaluating sources of evidence electronic database search strategies (e.g., CINAHL, PubMed) systematic application of information
levels of evidence: textbooks, case studies, reviews of literature, research
critiques, controlled trials, evidencebased clinical practice guidelines (, metaanalyses, and systematic reviews (e.g., the Cochrane
Database of Systematic Reviews) differentiation of clinical opinion from research and evidence summaries scholarship dissemination methods: oral/visual presentations, publications, newsletters, etc.
Essential IV: Information Management and Application of Patient Care Technology
Knowledge and skills in information and patient care technology are critical in preparing
baccalaureate nursing graduates to deliver quality patient care in a variety of healthcare
settings (IOM, 2003a). Graduates must have basic competence in technical skills, which
includes the use of computers, as well as the application of patient care technologies such
as monitors, data gathering devices, and other technological supports for patient care
interventions. In addition, baccalaureate graduates must have competence in the use of
information technology systems, including decisionsupport systems, to gather evidence
to guide practice. Specific introductory level nursing informatics competencies include
the ability to use selected applications in a comfortable and knowledgeable way.
Computer and information literacy are crucial to the future of nursing. Improvement of
cost effectiveness and safety depend on evidencebased practice, outcomes research,
interprofessional care coordination, and electronic health records, all of which involve
information management and technology (McNeil et al., 2006). Therefore, graduates of
baccalaureate programs must have competence in using both patient care technologies
and information management systems.
In addition, baccalaureate graduates ethically manage data, information, knowledge, and
technology to communicate effectively provide safe and effective patient care and use
research and clinical evidence to inform practice decisions. Graduates will be aware that
new technology often requires new workflow patterns and changes in practice approaches
to patient care prior to implementation.
The use and understanding of standardized terminologies are foundational to the
development of effective clinical information systems (CIS). Integration of standardized
terminologies into the CIS not only supports daytoday nursing practice but also the
capacity to enhance interprofessional communication and automatically generate
standardized data to continuously evaluate and improve practice (American Nurses
Association, 2008). Baccalaureate graduates are prepared to gather and document care
data that serve as a foundation for decision making for the healthcare team.
Course work and clinical experiences will provide the baccalaureate graduate with
knowledge and skills to use information management and patient care technologies to
deliver safe and effective care. Graduates will have exposure to information systems that
provide data about quality improvement and required regulatory reporting through
information systems. Course work and clinical experiences will expose graduates to a
range of technologies that facilitate clinical care, including patient monitoring systems, medication administration systems, and other technologies to support patient care.
Integral to these basic skills is an attitude of openness to innovation and continual
learning, as information systems and patient care technologies are constantly changing.
The baccalaureate program prepares the graduate to:
1. Demonstrate skills in using patient care technologies, information systems, and
communication devices that support safe nursing practice.
2. Use telecommunication technologies to assist in effective communication in a variety
of healthcare settings.
3. Apply safeguards and decision making support tools embedded in patient care
technologies and information systems to support a safe practice environment for both
patients and healthcare workers.
4. Understand the use of CIS systems to document interventions related to achieving
nurse sensitive outcomes.
5. Use standardized terminology in a care environment that reflects nursings unique
contribution to patient outcomes.
6. Evaluate data from all relevant sources, including technology, to inform the delivery
of care.
7. Recognize the role of information technology in improving patient care outcomes and
creating a safe care environment.
8. Uphold ethical standards related to data security, regulatory requirements, confidentiality, and clients right to privacy.
9. Apply patientcare technologies as appropriate to address the needs of a diverse
patient population.
10. Advocate for the use of new patient care technologies for safe, quality care.
11. Recognize that redesign of workflow and care processes should precede
implementation of care technology to facilitate nursing practice.
12. Participate in evaluation of information systems in practice settings through policy
and procedure development.
Sample Content
use of patient care technologies (e.g., monitors, pumps, computerassisted
devices) use of technology and information systems for clinical decisionmaking
computer skills that may include basic software, spreadsheet, and healthcare
databases information management for patient safety
regulatory requirements through electronic data monitoring systems ethical and legal issues related to the use of information technology, including
copyright, privacy, and confidentiality issues retrieval information systems, including access, evaluation of data, and
application of relevant data to patient care online literature searches technological resources for evidencebased practice webbased learning and online literature searches for self and patient use technology and information systems safeguards (e.g., patient monitoring,
equipment, patient identification systems, drug alerts and IV systems, and
barcoding) interstate practice regulations (e.g., licensure, telehealth) technology for virtual care delivery and monitoring
principles related to nursing workload measurement/resources and information
systems information literacy
electronic health record/physician order entry
decisionsupport tools role of the nurse informaticist in the context of health informatics and information
Essential V: Healthcare Policy, Finance, and Regulatory Environments
Healthcare policies, including financial and regulatory policies, directly and indirectly
influence nursing practice as well as the nature and functioning of the healthcare system. These policies shape responses to organizational, local, national, and global issues of
equity, access, affordability, and social justice in health care. Healthcare policies also are
central to any discussion about quality and safety in the practice environment.
The baccalaureateeducated graduate will have a solid understanding of the broader
context of health care, including how patient care services are organized and financed,
and how reimbursement is structured. Regulatory agencies define boundaries of nursing
practice, and graduates need to understand the scope and role of these agencies. Baccalaureate graduates also will understand how healthcare issues are identified, how
healthcare policy is both developed and changed, and how that process can be influenced
through the efforts of nurses, and other healthcare professionals, as well as lay and
special advocacy groups.
Healthcare policy shapes the nature, quality, and safety of the practice environment and
all professional nurses have the responsibility to participate in the political process and
advocate for patients, families, communities, the nursing profession, and changes in the
healthcare system as needed. Advocacy for vulnerable populations with the goal of
promoting social justice is recognized as moral and ethical responsibilities of the nurse.
The baccalaureate program prepares the graduate to:
1. Demonstrate basic knowledge of healthcare policy, finance, and regulatory
environments, including local, state, national, and global healthcare trends.
2. Describe how health care is organized and financed, including the implications of
business principles, such as patient and system cost factors.
3. Compare the benefits and limitations of the major forms of reimbursement on the
delivery of health care services.
4. Examine legislative and regulatory processes relevant to the provision of health
5. Describe state and national statutes, rules, and regulations that authorize and
define professional nursing practice.
6. Explore the impact of sociocultural, economic, legal, and political factors
influencing healthcare delivery and practice.
7. Examine the roles and responsibilities of the regulatory agencies and their effect
on patient care quality, workplace safety, and the scope of nursing and other health
professionals practice.
8. Discuss the implications of healthcare policy on issues of access, equity, affordability, and social justice in healthcare delivery.
9. Use an ethical framework to evaluate the impact of social policies on health care,
especially for vulnerable populations.
10. Articulate, through a nursing perspective, issues concerning healthcare delivery
to decision makers within healthcare organizations and other policy arenas.
11. Participate as a nursing professional in political processes and grassroots
legislative efforts to influence healthcare policy.
12. Advocate for consumers and the nursing profession.
Sample Content
policy development and the legislative process policy development and the regulatory process licensure and regulation of nursing practice social policy/public policy
policy analysis and evaluation
healthcare financing and reimbursement economics of health care consumerism and advocacy
political activism and professional organizations disparities in the healthcare system
impact of social trends such as genetics and genomics, childhood obesity, and
aging on health policy
role of nurse as patient advocate ethical and legal issues professional organizations role in healthcare policy, finance and regulatory
environments scope of practice and policy perspectives of other health professionals negligence, malpractice, and risk management Nurse Practice Act
Essential VI: Interprofessional Communication and Collaboration for Improving
Patient Health Outcomes
Effective communication and collaboration among health professionals is imperative to
providing patientcentered care. All health professions are challenged to educate future
clinicians to deliver patientcentered care as members of an interprofessional team, emphasizing communication, evidencebased practice, quality improvement approaches, and informatics (IOM, 2003a). Interprofessional education is defined as interactive
educational activities involving two or more professions that foster collaboration to
improve patient care (Freeth, Hammick, Koppel, & Reeves, 2002). Teamwork among
healthcare professionals is associated with delivering high quality and safe patient care
(Barnsteiner, Disch, Hall, Mayer, & Moore, 2007). Collaboration is based on the
complementarities of roles and the understanding of these roles by the members of the
healthcare teams.
Interprofessional education enables the baccalaureate graduate to enter the workplace
with baseline competencies and confidence for interactions and with communication
skills that will improve practice, thus yielding better patient outcomes. Interprofessional
education can occur in a variety of settings. An essential component for the
establishment of collegial relationships is recognition of the unique disciplinespecific
practice spheres. Fundamental to effective interprofessional and intraprofessional
collaboration is a definition of shared goals clear role expectations of members a
flexible decisionmaking process and the establishment of open communication patterns
and leadership. Thus, interprofessional education optimizes opportunities for the
development of respect and trust for other members of the healthcare team.
The baccalaureate program prepares the graduate to:
1. Compare/contrast the roles and perspectives of the nursing profession with other
care professionals on the healthcare team (i.e., scope of discipline, education and
licensure requirements).
2. Use inter and intraprofessional communication and collaborative skills to deliver
evidencebased, patientcentered care.
3. Incorporate effective communication techniques, including negotiation and
conflict resolution to produce positive professional working relationships.
4. Contribute the unique nursing perspective to interprofessional teams to optimize
patient outcomes.
5. Demonstrate appropriate teambuilding and collaborative strategies when working
with interprofessional teams.
6. Advocate for high quality and safe patient care as a member of the
interprofessional team.
Sample Content
interprofessional and intraprofessional communication, collaboration, and
socialization, with consideration of principles related to communication with
diverse cultures teamwork/concepts of teambuilding/cooperative learning
professional roles, knowledge translation, role boundaries, and diverse
disciplinary perspectives relationship building
navigating complex systems, system facilitation
interdependence and resource sharing of healthcare professions individual accountability/shared accountability
ethical codes and core values of different healthcare professions autonomy
scopes of practice conflict management, conflict resolution strategies, and negotiation
group dynamics principles of referral process for specialized services participatory decisionmaking
Essential VII: Clinical Prevention and Population Health
Health promotion, disease, and injury prevention across the lifespan are essential
elements of baccalaureate nursing practice at the individual and population levels. These
concepts are necessary to improve population health. Epidemiologic studies show that
lifestyle, environmental, and genetic factors are major determinants of population health
in areas of health, illness, disease, disability, and mortality (U.S. Department of Health
and Human Services, 2000a). Thus, acute care and diseasebased episodic interventions
alone are inadequate for improving health (Allan et al., 2004 Allan, Stanley, Crabtree, Werner, & Swenson, 2005). Health promotion along with disease and injury prevention
are important throughout the lifespan and include assisting individuals, families, groups, communities, and populations to prepare for and minimize health consequences of
emergencies, including mass casualty disasters.
Clinical prevention refers to individually focused interventions such as immunizations, screenings, and counseling aimed at preventing escalation of diseases and conditions.
(Allan, Stanley, Crabtree, Werner, & Swenson, 2005) Because these interventions are
relevant across the lifespan, nurses need knowledge about growth and development as
well as evidencebased clinical prevention practices. Nurses collaborate with other
healthcare professionals and patients for improving health through clinical prevention.
In populationfocused nursing, the aggregate, community, or population is the unit of
care. Emphasis is placed on health promotion and disease prevention. Because
populationfocused care is fundamental to nursing practice, and because a baccalaureate
degree in nursing is the recommended minimal educational credential for populationfocused care, baccalaureate programs prepare graduates for population health as well as
clinical prevention (AACN, 1998 American Public Health Association, 1996 Quad
Council of Public Health Nursing Organizations, 2004). Populationfocused nursing
involves identifying determinants of health, prioritizing primary prevention when
possible, actively identifying and reaching out to those who might benefit from a service, and using available resources to assure best overall improvement in the health of the
population (American Nurses Association, 2007). For instance, populationfocused
interventions involve reaching an appropriate level of herd immunity in the community
and ensuring that information about appropriate screenings reach the entire population, not just those who choose to come to healthcare facilities. Collaboration with other
healthcare professionals and populations is necessary to promote conditions and healthy
behaviors that improve population health.
The baccalaureate program prepares the graduate to:
1. Assess protective and predictive factors, including genetics, which influence the
health of individuals, families, groups, communities, and populations.
2. Conduct a health history, including environmental exposure and a family history
that recognizes genetic risks, to identify current and future health problems.
3. Assess health/illness beliefs, values, attitudes, and practices of individuals,
families, groups, communities, and populations.
4. Use behavioral change techniques to promote health and manage illness.
5. Use evidencebased practices to guide health teaching, health counseling,
screening, outreach, disease and outbreak investigation, referral, and followup
throughout the lifespan.
6. Use information and communication technologies in preventive care.
7. Collaborate with other healthcare professionals and patients to provide spiritually
and culturally appropriate health promotion and disease and injury prevention
8. Assess the health, healthcare, and emergency preparedness needs of a defined
9. Use clinical judgment and decisionmaking skills in appropriate, timely nursing
care during disaster, mass casualty, and other emergency situations.
10. Collaborate with others to develop an intervention plan that takes into account
determinants of health, available resources, and the range of activities that
contribute to health and the prevention of illness, injury, disability, and premature
11. Participate in clinical prevention and populationfocused interventions with
attention to effectiveness, efficiency, costeffectiveness, and equity.
12. Advocate for social justice, including a commitment to the health of vulnerable
populations and the elimination of health disparities.
13. Use evaluation results to influence the delivery of care, deployment of resources, and to provide input into the development of policies to promote health and
prevent disease.
Sample Content
prevention and harm reduction
ecological model as framework for understanding determinants of health
public health principles fundamentals of epidemiology and biostatistics (distribution, incidence, prevalence,
rates, risk factors, health status indicators, and control of disease in populations) public health core functions systems theory
ethical, legal, and economic principles related to clinical prevention and population
cultural, psychological, and spiritual implications of clinical prevention and
population health
environmental health risks health literacy
health behavior change theories theoretical foundations and principles of individual and populationfocused
education and counseling
genetics and genomics nutrition
global health
occupational health, including ergonomics
evidencebased clinical prevention practices complementary and alternative therapies population assessment individual and populationfocused interventions (e.g. weight control, nicotine
management, social marketing, policy development) health surveillance health disparities and vulnerable populations screening
pharmaceutical preventive strategies communicating and sharing health information with the public risk communication
emergency preparedness and disaster response including self protection
using technology in population focused care and clinical prevention
outcome measurement pedigree from a threegeneration family health history using standardized symbols
and terminology
Essential VIII: Professionalism and Professional Values
Professional values and their associated behaviors are foundational to the practice of
nursing. Inherent in professional practice is an understanding of the historical, legal, and
contemporary context of nursing practice. Professionalism is defined as the consistent
demonstration of core values evidenced by nurses working with other professionals to
achieve optimal health and wellness outcomes in patients, families, and communities by
wisely applying principles of altruism, excellence, caring, ethics, respect, communication, and accountability (Interprofessional Professionalism Measurement
Group, 2008). Professionalism also involves accountability for ones self and nursing
practice, including continuous professional engagement and lifelong learning. As
discussed in the American Nurses Association Code of Ethics for Nursing (2005, p.16), The nurse is responsible for individual nursing practice and determines the appropriate
delegation of tasks consistent with the nurses obligation to provide optimum patient
care. Also, inherent in accountability is responsibility for individual actions and
behaviors, including civility. In order to demonstrate professionalism, civility must be
present. Civility is a fundamental set of accepted behaviors for a society/culture upon
which professional behaviors are based (Hammer, 2003).
Professional nursing has enjoyed a long tradition of high respect from the public (Gallup
Poll, 2006). A primary reason for this recognition is the caring and compassion of the
nurse. Caring is a concept central to professional nursing practice. Caring as related to
this Essential encompasses the nurses empathy for, connection to, and being with the
patient, as well as the ability to translate these affective characteristics into
compassionate, sensitive, and patientcentered care. Historically, nurses have provided
care for patients within a context of privileged intimacy a space into which a nurse is
allowed and in partnership with the patient creates a unique, healing relationship.
Through this connection, the nurse and patient work toward an understanding of a wide
variety of physical, psychosocial, cultural, and spiritual needs, healthillness decisions, and life challenges. Professional nursing requires a balance between evidencebased
knowledge, skills, and attitudes and professional confidence, maturity, caring, and
compassion. In this global society, patient populations are increasingly diverse.
Therefore, essential to the care of diverse populations is the need for evidencebased
knowledge and sensitivity to variables such as age, gender, culture, health disparities, socioeconomic status, race, and spirituality. Baccalaureate graduates are prepared to care
for atrisk patients, including the very young and the frail elderly, and to assist patients
with decisionmaking about endoflife concerns within the context of the patients value
system. In addition, nurses are prepared to work with patients across the lifespan who
require genetic technologies and treatments.
Baccalaureate education includes the development of professional values and valuebased
behavior. Understanding the values that patients and other health professionals bring to
the therapeutic relationship is critically important to providing quality patient care.
Baccalaureate graduates are prepared for the numerous dilemmas that will arise in
practice and are able to make and assist others in making decisions within a professional
ethical framework. Ethics is an integral part of nursing practice and has always involved
respect and advocacy for the rights and needs of patients regardless of setting. Honesty
and acting ethically are two key elements of professional behavior, which have a major
impact on patient safety. A blamefree culture of accountability and an environment of
safety are important for encouraging team members to report errors. Such an environment
enhances the safety of all patients.
The following professional values epitomize the caring, professional nurse. Nurses, guided by these values, demonstrate ethical behavior in patient care.
Altruism is a concern for the welfare and well being of others. In professional practice, altruism is reflected by the nurses concern and advocacy for the welfare of patients, other nurses, and other healthcare providers.
Autonomy is the right to selfdetermination. Professional practice reflects autonomy
when the nurse respects patients rights to make decisions about their health care.
Human Dignity is respect for the inherent worth and uniqueness of individuals and
populations. In professional practice, concern for human dignity is reflected when the
nurse values and respects all patients and colleagues.
Integrity is acting in accordance with an appropriate code of ethics and accepted
standards of practice. Integrity is reflected in professional practice when the nurse is
honest and provides care based on an ethical framework that is accepted within the
Social Justice is acting in accordance with fair treatment regardless of economic status,
race, ethnicity, age, citizenship, disability, or sexual orientation.
The baccalaureate program prepares the graduate to:
1. Demonstrate the professional standards of moral, ethical, and legal conduct.
2. Assume accountability for personal and professional behaviors.
3. Promote the image of nursing by modeling the values and articulating the
knowledge, skills, and attitudes of the nursing profession.
4. Demonstrate professionalism, including attention to appearance, demeanor,
respect for self and others, and attention to professional boundaries with patients
and families as well as among caregivers.
5. Demonstrate an appreciation of the history of and contemporary issues in nursing
and their impact on current nursing practice.
6. Reflect on ones own beliefs and values as they relate to professional practice.
7. Identify personal, professional, and environmental risks that impact personal and
professional choices and behaviors.
8. Communicate to the healthcare team ones personal bias on difficult healthcare
decisions that impact ones ability to provide care.
9. Recognize the impact of attitudes, values, and expectations on the care of the very
young, frail older adults, and other vulnerable populations.
10. Protect patient privacy and confidentiality of patient records and other privileged
11. Access interprofessional and intraprofessional resources to resolve ethical and
other practice dilemmas.
12. Act to prevent unsafe, illegal, or unethical care practices.
13. Articulate the value of pursuing practice excellence, lifelong learning, and
professional engagement to foster professional growth and development.
14. Recognize the relationship between personal health, self renewal, and the ability
to deliver sustained quality care.
Sample Content
Nurse Practice Acts and scope of practice professional codes of conduct and professional standards (e.g., ANA, Code of
Ethics for Nurses with Interpretive Statements, 2005 International Council of
Nursing, Code of Ethics for Nurses, 2006, and AACNs Hallmarks of the
Professional Nursing Practice Environment, 2002) ethical and legal frameworks and social implications communication
interprofessional teams and team building concepts cultural humility and spiritual awareness health disparities history of nursing
contemporary nursing issues problem solving methods such as appreciative inquiry
professional accountability
stereotypes and biases, such as gender, race, and age discrimination
nurse self care/stress management strategies human rights informed consent professional identity formation
privacy, confidentiality
moral agency
professional image self reflection, personal knowing, personal selfcare plan
professional organizations, particularly nursing and healthcare organizations
Essential IX: Baccalaureate Generalist Nursing Practice
Essential IX describes generalist nursing practice at the completion of baccalaureate
nursing education. This Essential includes practicefocused outcomes that integrate the
knowledge, skills, and attitudes delineated in Essentials I VIII into the nursing care of
individuals, families, groups, communities, and populations in a variety of settings. Because professional nurses are the human link between the patient and the complex
healthcare environment, they must provide compassionate care informed by a scientific
base of knowledge, including current evidence from nursing research. Essential IX
recognizes that the integration of knowledge and skills is critical to practice. Practice
occurs across the lifespan and in the continuum of healthcare environments. The
baccalaureate graduate demonstrates clinical reasoning within the context of patient centered care to form the basis for nursing practice that reflects ethical values.
Knowledge acquisition related to wellness, health promotion, illness, disease
management and care of the dying is core to nursing practice. In addition, acquisition of
communication and psychomotor skills is critical to providing nursing care. Skill
development will focus on the mastery of core scientific principles that underlie all skills,
thus preparing the baccalaureate graduate to incorporate current and future technical
skills into other nursing responsibilities and apply skills in diverse contexts of healthcare
delivery. Direct care may be delivered in person or virtually and that care is based on a
shared understanding with the patient and the healthcare team. This base of knowledge
and skills prepares the graduate for practice as a member and leader of the
interprofessional healthcare team.
Baccalaureateeducated nurses will be prepared to care for patients across the lifespan,
from the very young to the older adult. Special attention will be paid to changing
demographics. Among these demographics are the increased prevalence of chronic
illnesses and comorbidities among all ages, including those related to mental disorders, specifically depression. However, there is clear evidence that the largest group seeking
and receiving healthcare services is the older adult population. The graduate will
understand and respect the variations of care, the increased complexity, and the increased
use of healthcare resources inherent in caring for patients who are vulnerable due to age,
the very young and very old, as well as disabilities and chronic disease.
The increasing diversity of this nations population mandates an attention to diversity in
order to provide safe, humanistic high quality care. This includes cultural, spiritual, ethnic, gender, and sexual orientation diversity. In addition, the increasing globalization
of healthcare requires that professional nurses be prepared to practice in a multicultural
environment and possess the skills needed to provide culturally competent care.
Baccalaureate graduates will have knowledge, skills, and attitudes that prepare them for a
longterm career in a changing practice environment. The increased prevalence of chronic
illness is a result of an increasingly older adult population, environmental threats,
lifestyles that increase risk of disease, and enhanced technological and therapeutic
interventions that prolong life. In addition to primary prevention, the professional nurse
provides support for management of chronic illness, health education, and patient centered care in partnership with the patient and the interprofessional team. Patients and
their families often are knowledgeable about health care therefore, the graduate will be
able to communicate with these consumers and appreciate the importance of the care
Graduates translate, integrate, and apply knowledge that leads to improvements in patient
outcomes. Knowledge is increasingly complex and evolving rapidly. For example,
genetics and genomics are areas where knowledge is escalating and the graduate will be
cognizant of customized therapies designed to improve care outcomes. Therefore,
baccalaureate graduates will be expected to focus on continuous selfevaluation and
lifelong learning.
The baccalaureate program prepares the graduate to:
1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness
parameters in patients, using developmentally and culturally appropriate
2. Recognize the relationship of genetics and genomics to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of
treatment effectiveness, using a constructed pedigree from collected family
history information as well as standardized symbols and terminology.
3. Implement holistic, patientcentered care that reflects an understanding of human
growth and development, pathophysiology, pharmacology, medical management, and nursing management across the healthillness continuum, across the lifespan, and in all healthcare settings.
4. Communicate effectively with all members of the healthcare team, including the
patient and the patients support network.
5. Deliver compassionate, patientcentered, evidencebased care that respects patient
and family preferences.
6. Implement patient and family care around resolution of endoflife and palliative
care issues, such as symptom management, support of rituals, and respect for
patient and family preferences.
7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to
foster patient engagement in their care.
8. Implement evidencebased nursing interventions as appropriate for managing the
acute and chronic care of patients and promoting health across the lifespan.
9. Monitor client outcomes to evaluate the effectiveness of psychobiological
10. Facilitate patientcentered transitions of care, including discharge planning and
ensuring the caregivers knowledge of care requirements to promote safe care.
11. Provide nursing care based on evidence that contributes to safe and high quality
patient outcomes within healthcare microsystems.
12. Create a safe care environment that results in high quality patient outcomes.
13. Revise the plan of care based on an ongoing evaluation of patient outcomes.
14. Demonstrate clinical judgment and accountability for patient outcomes when
delegating to and supervising other members of the healthcare team.
15. Manage care to maximize health, independence, and quality of life for a group of
individuals that approximates a beginning practitioners workload
16. Demonstrate the application of psychomotor skills for the efficient, safe, and
compassionate delivery of patient care.
17. Develop a beginning understanding of complementary and alternative modalities
and their role in health care.
18. Develop an awareness of patients as well as healthcare professionals spiritual
beliefs and values and how those beliefs and values impact health care.
19. Manage the interaction of multiple functional problems affecting patients across
the lifespan, including common geriatric syndromes.
20. Understand ones role and participation in emergency preparedness and disaster
response with an awareness of environmental factors and the risks they pose to
self and patients.
21. Engage in caring and healing techniques that promote a therapeutic nursepatient
22. Demonstrate tolerance for the ambiguity and unpredictability of the world and its
effect on the healthcare system as related to nursing practice.
Sample Content
theories of human growth and development principles of basic nursing care (e.g., skin, mobility, pain management, immediate
patient care environment, etc.) patient and familycentered care management of acute and chronic physical and psychosocial conditions across the
integration of pathophysiology into care care across the lifespan focusing on changing demographics with an emphasis on
care of older adults and the very young. palliative and endoflife care common geriatric syndromes genetics and genomics
emergency preparedness and disaster response bioterrorism
infection control issues, such as drug resistant organisms and management caring and healing techniques psychobiological interventions milieu therapy
depression screening
health promotion
patient advocacy
disparities complementary and alternative therapies spiritual care therapeutic communication
culturally diverse care evidencebased practice pharmacology/pharmacogenetics nursing care management prioritization of patient care needs principles of delegating and monitoring care leadership
information management systems integrating technology into practice resource management teaching/learning principles
Expectations for Clinical Experiences within the Baccalaureate Program
Baccalaureate programs provide rich and varied opportunities for practice experiences
designed to assist graduates to achieve the Baccalaureate Essentials upon completion of
their program. Clinical experiences are essential for baccalaureate nursing programs to
prepare students to care for a variety of patients across the lifespan and across the
continuum of care. In addition clinical experiences assist the graduate to: develop proficiency in performing psychomotor skills apply professional communication strategies to client and interprofessional
interactions and
acquire a professional identity.
Clinical learning is focused on developing and refining the knowledge and skills
necessary to manage care as part of an interprofessional team. Theoretical learning
becomes reality as students are coached to make connections between the standard case
or situation that is presented in the classroom or laboratory setting and the constantly
shifting reality of actual patient care. Clinical educators for baccalaureate programs are
well informed about the specific learning that is taking place in the classroom and
laboratory setting and find clinical education opportunities to reinforce and apply that
learning. Programs provide clinical placements across the range of practice settings and
across the continuum of care that are safe, supportive, and conducive for groups of
students to practice and learn professional roles. Clinical practice opportunities expose
students to practice issues such as technological innovations, accelerated care transitions, an unpredictable fastpaced environment, and complex system issues, which are all
important in preparing the students for practice following graduation. In addition, clinical
practice opportunities provide students with experiences and nursing role models that
prepare them for practice in complex, changing healthcare environments.
Simulation experiences augment clinical learning and are complementary to direct care
opportunities essential to assuming the role of the professional nurse. Laboratory and
simulation experiences provide an effective, safe environment for learning and applying
the cognitive and performance skills needed for practice. Realitybased, simulated patient
care experiences increase selfconfidence in communication and psychomotor skills, and
professional role development. Beginning research supports the use of simulation in
nursing education. Nehring, Ellis, and Lashley (2001) describe the use of human patient
simulators in nursing education as an excellent tool to measure competency in the
application of knowledge and technical skills. Debriefing, or feedback to the students, is
as essential for simulation as it is for instruction in the clinical setting (National Council
of State Boards of Nursing, 2005). Simulation is a valuable element of clinical
preparation. However, patient care experiences with actual patients form the most
important component of clinical education. Over time, as evidence emerges regarding the
use of simulation as a substitute for actual patient experience, the balance between actual
and simulated patient care may change.
Direct patient care clinical experiences provide valuable opportunities for student
learning not found in other experiences. Early learning experiences, including providing
care for a limited number of patients, allow students to explore the challenging world of
clinical practice. As students become more experienced, increasingly complex clinical
learning opportunities are selected to provide a sufficient breadth and depth of learning to
develop the competence necessary for entrylevel practice with diverse patients across the
life span in various types of settings. Through an immersion experience, students have
the opportunity to develop increasing autonomy and assume an assignment that more
closely approximates a realistic workload of a novice nurse in that environment. A clinical immersion experience provides opportunities for building clinical reasoning,
management, and evaluation skills. These opportunities increase the students self confidence, professional image, and sense of belonging that facilitate the transition to
competent and confident practice. Immersion experiences allow students to integrate
previous learning and more fully develop the roles of the baccalaureate generalist nurse: provider of care
evaluate client changes and progress over time
develop a beginning proficiency and efficiency in delivering safe care designer/manager/coordinator of care
manage care transitions
be an active participant on the interprofessional team
identify system issues
develop working skills in delegation, prioritization, and oversight of care member of a profession
evaluate ones own practice
assume responsibility for supporting the profession
An immersion experience provides faculty opportunities to observe student performance
over time and more effectively evaluate the students professional development.
Graduates of all types of baccalaureate programs need sufficient didactic, laboratory, and
clinical experiences to attain the endofprogram outcomes of these Essentials. The
nursing program determines and assesses clinical sites to ensure the clinical experiences
for students provide: patients from diverse backgrounds, cultures, and of differing gender, religious, and
spiritual practices the continuum of care, including populationfocused care all age groups, including the very young and the frail elderly and
comprehensive learning opportunities to promote integration of baccalaureate
learning outcomes that prepare the graduate for professional nursing practice.
The Essentials for Baccalaureate Education for Professional Nursing Practice serves to
transform baccalaureate nursing education and are a dramatic revision of the 1998
version. Further, these Essentials meet the IOMs recommendations for core knowledge
needed for all healthcare professionals (IOM, 2003b). Due to the everchanging and
complex healthcare environment, this document emphasizes such concepts as patient centered care, interprofessional teams, evidencebased practice, quality improvement, patient safety, informatics, clinical reasoning/critical thinking, genetics and genomics, cultural sensitivity, professionalism, practice across the lifespan, and endoflife care.
Essentials IIX delineate the outcomes expected for baccalaureate nursing program
graduates. Achievement of these outcomes will enable the baccalaureateprepared
generalist nurse to practice within complex healthcare systems and assume the roles: provider of care
evaluate client changes and progress over time
develop a beginning proficiency and efficiency in delivering safe care designer/manager/coordinator of care
manage care transitions
be an active participant on the interprofessional team
identify system issues
develop working skills in delegation, prioritization, and oversight of care member of a profession
evaluate ones own practice
assume responsibility for supporting the profession
Essential IX describes generalist nursing practice at the completion of baccalaureate
nursing education. This Essential includes practicefocused outcomes that integrate the
knowledge, skills, and attitudes delineated in Essentials I VIII. The time needed to
accomplish each Essential will vary, and each Essential does not require a separate course
for achievement of the outcomes. Learning opportunities, including clinical experiences, must be sufficient in breadth and depth to ensure the graduate attains these practice
focused outcomes and integrates this knowledge and these skills into ones professional
nursing practice.
Baccalaureate graduates translate, integrate, and apply knowledge that leads to
improvements in patient outcomes. Knowledge is increasingly complex and evolving
rapidly. Therefore, baccalaureate graduates are expected to focus on continuous self evaluation and lifelong learning.
Critical Thinking: All or part of the process of questioning, analysis, synthesis,
interpretation, inference, inductive and deductive reasoning, intuition, application, and
creativity (AACN, 1998). Critical thinking underlies independent and interdependent
decision making.
Clinical Judgment: The outcomes of critical thinking in nursing practice. Clinical
judgments begin with an end in mind. Judgments are about evidence, meaning and
outcomes achieved (Pesut, 2001).
Clinical Reasoning: The process used to assimilate information, analyze data, and make
decisions regarding patient care (Simmons, Lanuza, Fonteyn, & Hicks, 2003).
Clinical Prevention: Individually focused interventions such as immunizations, screenings, and counseling, aimed at preventing escalation of diseases and conditions.
Cultural Humility: Incorporates a lifelong commitment to selfevaluation and self critique, to redressing the power imbalances in the patientclinician dynamic, and to
developing mutually beneficial and advocacy partnerships with communities on behalf of
individuals and defined populations. Cultural humility is proposed as a more suitable goal
than cultural competence in healthcare education (Tervalon & MurrayGarcia, 1998).
Cultural Sensitivity: Cultural sensitivity is experienced when neutral language, both
verbal and not verbal, is used in a way that reflects sensitivity and appreciation for the
diversity of another. Cultural sensitivity may be conveyed through words, phrases, and
categorizations that are intentionally avoided, especially when referring to any individual
who may be interpreted as impolite or offensive (American Academy of Nursing Expert
Panel on Cultural Competence, 2007).
DecisionSupport System (Clinical): Interactive computer programs designed to assist
clinicians with decision making tasks. Clinical decisionsupport systems link health
observations with health knowledge to influence choices by clinicians for improved
health care.
Diversity: The range of human variation, including age, race, gender, disability, ethnicity, nationality, religious and spiritual beliefs, sexual orientation, political beliefs, economic status, native language, and geographical background.
Evidencebased Practice: Care that integrates the best research with clinical expertise
and patient values for optimum care (IOM, 2003b). Health Determinants: Complex interrelationships of factors, such as the social and
economic environment, the physical environment, individual characteristics, and
behaviors that influence health. Health Literacy: The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health
decisions (U.S. Department of Health and Human Services, 2000b)
Healthcare Team: The patient plus all of the healthcare professionals who care for the
patient. The patient is an integral member of the healthcare team. Herd Immunity: Immunity of a sufficient proportion of the population to reduce the
probability of infection of susceptible members of that population.
Immersion Experience: Clinical experiences with a substantive number of hours in a
consistent clinical setting over a concentrated period of time.
Information Technology: The study, design, development implementation, support, or
management of computerbased information systems, particularly software applications
and computer hardware.
Integrative Strategies for Learning: Coherent organization of educational practices that
integrate general education concepts throughout the major, through the widespread use of
powerful, active, and collaborative instructional methods (Association of American
Colleges and Universities, 2004) .
Interprofessional: Working across healthcare professions to cooperate, collaborate,
communicate, and integrate care in teams to ensure that care is continuous and reliable.
The team consists of the patient, the nurse, and other healthcare providers as appropriate
(IOM, 2003b).
Intraprofessional: Working with healthcare team members within the profession to
ensure that care is continuous and reliable.
Microsystem: The structural unit responsible for delivering care to specific patient
populations or the frontline places where patients, families, and care teams meet (Nelson, Batalden, Godfrey, 2007). Moral Agency: A persons capacity for making ethical judgments. Most philosophers
suggest that only rational beings, people who can reason and form selfinterested
judgments, are capable of being moral agents. Multidimensional Care: Relating to or having several dimensions it speaks to the
fullness of the patientclinician experience, but also to peoples lives in general. Spirituality is one of those many dimensions.
Nurse Sensitive Indicators: Measures of processes and outcomesand structural
proxies for these processes and outcomes (e.g., skill mix, nurse staffing hours)that are
affected, provided, and influenced by nursing personnel, but for which nursing is not
exclusively responsible (National Quality Forum, 2003). Outcome: Broad performance indicator, related to the knowledge, skills, and attitudes, needed by a baccalaureate graduate.
Patient: The recipient of nursing care or services. This term was selected for consistency
and in recognition and support of the historically established tradition of the nursepatient
relationship. 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 endoflife 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).
Patientcentered Care: Includes actions to identify, respect and care about patients differences, values, preferences, and expressed needs relieve pain and suffering
coordinate continuous care listen to, clearly inform, communicate with, and educate
patients share decision making and management and continuously advocate disease
prevention, wellness, and promotion of healthy lifestyles, including a focus on population
health (IOM, 2003b).
Population Health Interventions: Actions intended to improve the health of a collection
of individuals having personal or environmental characteristics in common. Population
health interventions are based on populationfocused assessments.
Professional Nurse: An individual prepared with a minimum of a baccalaureate in
nursing but is also inclusive of one who enters professional practice with a masters
degree in nursing or a nursing doctorate (AACN, 1998).
Simulation: An activity that mimics the reality of a clinical environment and is designed
to demonstrate procedures, decisionmaking, and critical thinking through techniques
such as roleplaying and the use of devices (e.g., interactive videos, mannequins)
(National Council of State Boards of Nursing, 2005).
Spiritual Care: Interventions, individual or communal, that facilitate the ability to
experience the integration of the body, mind, and spirit to achieve wholeness, health, and
a sense of connection to self, others, and a higher power (American Nurses Association
and Health Ministries Association, 2005, p. 38).
Spirituality: Speaks to what gives ultimate meaning and purpose to ones life. It is that
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evidenced in higher comparative mortality rates, lower life expectancy, reduced access to
care, and diminished quality of life (Center for Vulnerable Populations Research, UCLA
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Task Force on the Revision of The Essentials of Baccalaureate
Education for Professional Nursing
Patricia Martin, PhD, RN chair
Dean, Wright State University
College of Nursing and Health
Carol A. Ashton, PhD, RN
Associate Dean and Director,
Idaho State University
School of Nursing
Derryl Block, PhD, MPH, RN
Chair, University of WisconsinGreen
Professional Program in Nursing
Daisy CruzRichman, PhD, RN
Dean, SUNY Downstate Medical Center
College of Nursing
Teri Murray, PhD, RN
Dean, Saint Louis University
School of Nursing
Linda Niedringhaus, PhD, RN, faculty
Elmhurst College
Deicke Center for Nursing Education
Donald “Chip” Bailey, PhD, RN, faculty
Duke University
School of Nursing
Jean W. Lange, PhD, RN, CNL, faculty
Fairfield University
School of Nursing
Roxanne A. Moutafis, MS, RN, BC,
faculty representative
The University of Arizona
College of Nursing
Judith Sands, EdD, RN, faculty
University of Virginia
School of Nursing
Karen Drenkard, PhD, RN, NEABC, practice representative
Chief Nurse Executive,
INOVA Health Systems
Polly Bednash, PhD, RN, FAAN, staff
Executive Director
Kathy McGuinn, MSN, RN, CPHQ, staff
Director of Special Projects
Joan Stanley, PhD, RN, FAAN, staff
Senior Director of Education Policy
Horacio Oliveira, staff liaison
Education Policy and Special Projects
Consensus Process to Revise the Essentials of
Baccalaureate Education for Professional Nursing Practice
In 2006, the AACN Board of Directors established a task force and charged this group to
revise and update the 1998 Essentials document. This task force was comprised of
individuals representing an array of experts in baccalaureate nursing education, including
deans and faculty representatives. Additionally, a chief nurse executive represented the
practice setting on the committee (see Appendix A). The task force began their work by
reviewing the literature and considering the changes occurring in health care, higher
education, and health professions education. In February 2007, the task force convened a
group of 20 stakeholders representing leaders from higher education, professional
nursing, and interprofessional education in June 2007, three additional stakeholders met
with the task force (see Appendix C). These leaders were asked to identify, from their
own perspectives, the anticipated role of the professional nurse in the future healthcare
system and the critical competencies needed to function in this role. These wideranging
and lively discussions served as the basis for the development of a draft document that
was then shared with nursing professionals on the AACN Web site in August 2007, prior
to the beginning of the next phase of the revision process.
The next phase consisted of a series of five regional meetings from September 2007 to
April 2008. The purpose of these meetings was to gather feedback and to build consensus
about the Essentials draft document. Participants, including nurse educators, clinicians, administrators, and researchers representing a range of nursing programs, specialties, and
organizations, discussed, debated, and made recommendations regarding the draft
document. Over 700 individuals, representing all 50 states and the District of Columbia,
participated in the consensusbuilding process. In addition, 329 schools of nursing, 11
professional organizations, and 13 healthcare delivery systems were represented (see
Appendices D, E, & F). To ensure a broad base of nursing input, the task force sought the
participation of a wide range of nursing organizations and many of these organizations
such as the American Academy of Nursing, Sigma Theta Tau, and American
Organization of Nurse Executives sent written feedback to the task force. Nursing
administrators and clinicians were specifically asked to participate to ensure that the
recommendations for nursing education would address future healthcare practice. Participants in the regional meetings were asked to focus on the rationale supporting each
Essential and a list of end of program outcomes. In addition, the participants provided
input into the development of supporting documents including a list of integrative
learning strategies, quality indicators, and clinical learning environments. The process
was iterative and following each of the regional meetings, an updated document was
posted on the AACN Web site for review and comment. AACN member schools and the
nursing community at large were able to provide ongoing feedback.
On July 19, 2008, the AACN Board unanimously approved the revised Essentials of
Baccalaureate Nursing Education.
Appendix C
Participants who attended Stakeholder Meetings (N=23)
Amy Berman
John A. Hartford Foundation, Inc. Program Officer
New York, NY
Linda Cronenwett
Quality and Safety Education for Nurses
Chapel Hill, NC
Lisa Day
The Carnegie Foundation for the
Advancement of Teaching
San Francisco, CA
Jerry Gaff
Association of American Colleges &
Universities (AAC&U)
Senior Fellow
Washington, DC
Jody Gandy
Interprofessional Professionalism Group,
American Physical Therapy Association
Director, Physical Therapy Education
Alexandria, VA
Pam Hagan
American Nurses Association (ANA)
Chief Programs Officer
Silver Spring, MD
Janie E. Heath
American Association of CriticalCare
Nurses (AACN)
Past Board Member
Aliso Viejo, CA
Jean Jenkins
Advisory Group for Genetics and Genomics
National Institutes of Health (NIH), National
Human Genome Research Institute
Senior Clinical Advisor
Bethesda, MD
Linda Olson Keller
Association of State and Territorial
Directors of Nursing (ASTDN)
Project Director
Arlington, VA
Darrell Kirch
Association of American Medical Colleges
Washington, DC
Ellen Kurtzman
National Quality Forum (NQF)
Senior Program Director
Washington, DC
Pam Malloy
EndofLife Nursing Education Consortium
Project Director, AACN
Washington, DC
Jeanne Matthews
Quad Council of Public Health Nursing
Chairelect, APHA Public Health Nursing
(PHN) Section for the Quad Council
Washington, DC
Leyla McCurdy
National Environmental Education &
Training Foundation (NEETF)
Senior Director
Washington, DC
Dula Pacquiao
AACN Cultural Advisory Group,
Associate Professor and Director School of
University of Medicine & Dentistry of NJ
Newark, NJ
Patricia Rutherford
Institute for Health Care Improvement (IHI)
Vice President
Cambridge, MA
Douglas Scheckelhoff
American Society of HealthSystem
Pharmacists (ASHP)
Director, Pharmacy Practice Sections
Bethesda, MD
Nancy Spector
National Council of State Boards of Nursing
Director of Education
Chicago, IL
Molly Sutphen
The Carnegie Foundation for the
Advancement of Teaching
Research Scholar
Stanford, CA
Todd Uhlmann
National Student Nurses Association
Brooklyn, NY
Tener Veneema
Disaster Preparedness Expert
Associate Professor of Clinical Nursing
University of Rochester
Rochester, NY
Mary Wakefield
Institute of Medicine (IOM) Chair of
Quality Chasm Series
Health Care Services Board, Associate Dean for Rural Health, University of North Dakota
Washington, DC
Julia Watkins
Council on Social Work Education
Executive Director
Alexandria, VA
Schools of Nursing that Participated in the Regional Meetings (N=329)
Adelphi University
Garden City, NY
Arizona State University
Phoenix, AZ
Arkansas State University
State University, AR
Armstrong Atlantic State University
Savannah, GA
Ashland University
Ashland, OH
Auburn University
Auburn, AL
Auburn University at Montgomery
Montgomery, AL
Avila University
Kansas City, MO
Azusa Pacific University
Azusa, CA
Baker University
Topeka, KS
Ball State University
Muncie, IN
of Health
Memphis, TN
BarnesJewish College of Nursing
St. Louis, MO
Barry University
Miami Shores, FL
Baylor University
Dallas, TX
Becker College
Worcester, MA
Bemidji State University
Bemidji, MN
BethuneCookman University
Daytona Beach, FL
Binghamton University
Binghamton, NY
Biola University
La Mirada, CA
Boise State University
Boise, ID
Boston College
Chestnut Hill, MA
Bradley University
Peoria, IL
Brenau University
Gainesville, GA
Brigham Young University
Provo, UT
BryanLGH College of Health Sciences
Lincoln, NE
California Baptist University
Riverside, CA
California State University Channel
Camarillo, CA
California State UniversityBakersfield
Bakersfield, CA
California State UniversityChico
Chico, CA
California State UniversityDominguez
Carson, CA
California State UniversityEast Bay
Hayward, CA
California State UniversityFullerton
Fullerton, CA
California State UniversityLong Beach
Long Beach, CA
California State UniversityLos Angeles
Los Angeles, CA
California State UniversitySan
San Bernardino, CA
California State UniversitySan Marcos
San Marcos, CA
California State UniversityStanislaus
Turlock, CA
Capital University
Columbus, OH
Carlow University
Pittsburgh, PA
CarsonNewman College
Jefferson City, TN
Cedar Crest College
Allentown, PA
Central Connecticut State University
New Britain, CT
Chamberlain College of Nursing
Columbus, OH
Charleston Southern University
Charleston, SC
Clayton State University
Morro, GA
Clemson University
Clemson, SC
Coe College
Cedar Rapids, IA
ColbySawyer College
New London, NH
College of Saint Catherine
St. Paul, MN
Creighton University
Omaha,, NE
Cumberland University
Lebanon, TN
Curry College
Milton, MA
Drexel University
Philadelphia, PA
Duke University
Durham, NC
Duquesne University
Pittsburgh, PA
East Carolina University
Greenville, NC
East Tennessee State University
Johnson City, TN
Eastern Illinois University
Charleston, IL
Eastern Kentucky University
Richmond, KY
Eastern Mennonite University
Harrisonburg, VA
Eastern Michigan University
Ypsilanti, MI
Elmhurst College
Elmhurst, IL
Elms College
Chicopee, MA
Emmanuel College
Boston, MA
Emory University
Atlanta, GA
Excelsior College
Albany, NY
Fairfield University
Fairfield, CT
Fairleigh Dickinson University
Teaneck, NJ
Fairmont State University
Fairmont, WV
Felician College
Lodi, NJ
Florida A&M University
Tallahassee, FL
Florida Atlantic University
Boca Raton, FL
Florida International University
Miami, FL
Florida Southern College
Lakeland, FL
Fort Hays State University
Hays, KS
Francis Marion University
Florence, SC
George Mason University
Fairfax, VA
Georgetown University
Washington, DC
Georgia College & State University
Milledgeville, GA
Georgia Southern University
Statesboro, GA
Georgia State University
Atlanta, GA
Gonzaga University
Spokane, WA
Governors State University
University Park, IL
Grand Valley State University
Grand Rapids, MI
Grand View College
Des Moines, IA
Hope College
Holland, MI
Hunter College of CUNY
New York, NY
Huntington University
Huntington, IN
Husson College
Bangor, ME
Idaho State University
Pocatello, ID
Illinois Wesleyan University
Bloomington, IL
Indiana University Bloomington
Bloomington, IL
Indiana University Northwest
Gary, IN
Indiana University South Bend
South Bend, IN
Indiana University Southeast
New Albany, IN
Indiana Wesleyan University
Marion, IN
Jacksonville State University
Jacksonville, AL
Jacksonville University
Jacksonville, FL
James Madison University
Harrisonburg, VA
Johns Hopkins University
Baltimore, MD
Kaplan University
Chicago, IL
Kean University
Union, NJ
Kennesaw State University
Kennesaw, GA
Keuka College
Keuka Park, NY
Lakeview College of Nursing
Danville, IL
Lamar University
Beaumont, TX
Le Moyne College
Syracuse, NY
Linfield College
Portland, OR
Loma Linda University
Loma Linda, CA
Louisiana College
Pineville, LA
Louisiana State University Health
Sciences Ctr
New Orleans, LA
Lourdes College
Sylvania, OH
Luther College
Decorah, IA
Lycoming College
Williamsport, PA
Lynchburg College
Lynchburg, VA
Macon State College
Macon, GA
Madonna University
Livonia, MI
Martin Methodist College
Pulaski, TN
Maryville UniversitySaint Louis
St. Louis, MO
Massachusetts College of Pharmacy and
Allied Health Sciences
Boston, MA
McKendree College
Lebanon, IL
McNeese State University
Lake Charles, LA
Medcenter One College of Nursing
Bismarck, ND
MedCentral College of Nursing
Mansfield, OH
Medical College of Georgia
Augusta, GA
Medical University of South Carolina
Charleston, SC
Mercy College
Dobbs Ferry, NY
Metropolitan State University
St. Paul, MN
MGH Institute of Health Professions
Boston, MA
Michigan State University
East Lansing, MI
Milwaukee School of Engineering
Milwaukee, WI
Minnesota Intercollegiate Nursing
Northfield, MN
Minnesota State University Mankato
Mankato, MN
Mississippi College
Clinton, MS
Mississippi University for Women
Columbus, MS
Missouri Western State University
St. Joseph, MO
Montana State University Bozeman
Bozeman, MT
Moravian College
Bethlehem, PA
Mount Carmel College of Nursing
Columbus, OH
Mount Mercy College
Cedar Rapids, IA
Mount Saint Mary’s College
Los Angeles, Ca
Muskingum College
New Concord, OH
National University
La Jolla, CA
Neumann College
Aston, PA
New Jersey City University
Jersey City, NJ
New Mexico Highlands University
Las Vegas, NM
New York University
New York, NY
Nicholls State University
Thibodaux, LA
North Park University
Chicago, IL
Northeastern University
Boston, Mass.
Northern Arizona University
Flagstaff, AZ
Northern Illinois University
DeKalb, IL
Northwest University
Kirkland, WA
Notre Dame College
South Euclid, OH
Oakland University
Rochester, MI
Old Dominion University
Norfolk, VA
Oregon Health and Science University
Portland, OR
Otterbein College
Westerville, OH
Pace University
New York, NY
Patty Hanks Shelton School of Nursing
Abilene, TX
Piedmont College
Demorest, GA
Platt College
Aurora, Co
Point Loma Nazarene University
San Diego, CA
Purdue University
West Lafayette, IN
Queens University of Charlotte
Charlotte, NC
Research College of Nursing
Kansas City. MO
Regis College
Weston, MA
Rhode Island College
Providence, RI
Rivier College
Nashua, NH
Robert Morris University
Moon Township, PA
Rutgers, The State University of New
Camden, NJ
Sacred Heart University
Fairfield, CT
Saginaw Valley State University
University Center, MI
Saint Ambrose University
Davenport, IA
Saint Anselm College
Manchester, NH
Saint Anthony College of Nursing
Rockford, IL
Saint Francis Medical Center College of
Peoria, IL
Saint John Fisher College
Rochester, NY
Saint Joseph’s College of Maine
Standish, ME
Saint Louis University
Saint Louis, MO
Saint Luke’s College of Nursing
Kansas City, MO
Saint Xavier University
Chicago, IL
Samford University
Birmingham, AL
Samuel Merritt College
Oakland, CA
San Diego State University
San Diego, CA
San Francisco State University
San Francisco, CA
Seattle Pacific University
Seattle, WA
Seattle University
Seattle, WA
Shenandoah University
Winchester, VA
Simmons College
Boston, MA
South Dakota State University
Brookings, SD
Southeast Missouri State University
Cape Girardeau, MO
Southern Illinois University
Edwardsville, IL
Southern Nazarene University
Bethany, OK
Southern Utah University
Cedar City, UT
Stony Brook University
Stony Brook, NY
SUNY Downstate Medical Center
Brooklyn, NY
SUNY Institute of Technology at
Utica, NY
SUNY Plattsburgh
Plattsburgh, NY
SUNY Upstate Medical University
Syracuse, NY
Temple University
Philadelphia, PA
Tennessee Technological University
Cookeville, TN
Tennessee Wesleyan College
Knoxville, TN
Texas A&M Health Science Center
College Station, TX
Texas A&M UniversityCorpus Christi
Corpus Christi, TX
Texas Christian University
Fort Worth, TX
Texas Tech University Health Sciences
Lubbock, TX
Texas Woman’s University
Denton, TX
The Catholic University of America
Washington, DC
The College of St. Scholastica
Duluth, MN
The Ohio State University
Columbus, OH
The Sage Colleges
Troy, NY
The University of Alabama
Tuscaloosa, AL
The University of Alabama in Huntsville
Huntsville, AL
The University of Louisiana at Lafayette
Lafayette, LA
The University of Louisiana at Monroe
Monroe, LA
The University of North Carolina
Chapel Hill
Chapel Hill, NC
Thomas Jefferson University
Philadelphia, PA
Touro University
Henderson, NV
Tuskegee University
Tuskegee, AL
University at Buffalo
Buffalo, NY
University of Alabama at Birmingham
Birmingham, AL
University of Alabama in Huntsville
Huntsville, AL
University of Alaska Anchorage
Anchorage, AK
University of Arizona
Tuscon, AZ
University of Arkansas for Medical
Little Rock, AR
University of ArkansasFayetteville
Fayetteville, AR
University of California Davis
Davis, CA
University of CaliforniaLos Angeles
Los Angeles, CA
University of Central Arkansas
Conway, AR
University of Cincinnati
Cincinnati, OH
University of Colorado at Colorado
Colorado Springs, CO
University of Colorado Denver
Aurora, CO
University of Connecticut
Storrs, CT
University of Delaware
Newark, DE
University of Detroit Mercy
Detroit, MI
University of Florida
Gainesville, FL
University of Hawaii at Manoa
Honolulu, HI
University of Illinois at Chicago
Chicago, IL
University of Iowa
Iowa City, IA
University of Kansas
Kansas City, KS
University of Louisiana at Monroe
Monroe, LA
University of Louisville
Louisville, KY
University of Mary
Bismark, ND
University of Maryland
Baltimore, MD
University of MassachusettsAmherst
Amherst, MA
University of MassachusettsLowell
Lowell, MA
University of Medicine & Dentistry of
New Jersey
Newark, NJ
University of Memphis
Memphis, TN
University of Michigan
Ann Arbor, MI
University of Minnesota
Minneapolis, MN
University of Mississippi Medical
Jackson, MS
University of MissouriColumbia
Columbia, MO
University of MissouriKansas City
Kansas City, MO
University of MissouriSaint Louis
St. Louis, MO
University of NevadaLas Vegas
Las Vegas, NV
University of NevadaReno
Reno, NV
University of New Hampshire
Durham, NH
University of New Mexico
Albuquerque, NM
University of North Carolina at
Greensboro, NC
University of North CarolinaCharlotte
Charlotte, NC
University of North Dakota
Grand Forks, ND
University of North Florida
Jacksonville, FL
University of Northern Colorado
Greeley, CO
University of Oklahoma
Oklahoma City, OK
University of Pennsylvania
Philadelphia, PA
University of Phoenix
Phoenix, AZ
University of Pittsburgh
Pittsburgh, PA
University of Portland
Portland, OR
University of Rhode Island
Kingston, RI
University of Saint Francis Indiana
Fort Wayne, IN
University of Saint Mary
Leavenworth, KS
University of San Diego
San Diego, CA
University of San Francisco
San Francisco, CA
University of South Alabama
Mobile, AL
University of South Carolina
Columbia, SC
University of South Carolina Aiken
Aiken, SC
University of South Carolina Upstate
Spartanburg, SC
University of Southern Maine
Portland, ME
University of Southern Mississippi
Hattiesburg, MS
University of St. Francis Illinois
Joliet, IL
University of Tennessee Knoxville
Knoxville, TN
University of Tennessee Health Science
Memphis, TN
University of TennesseeChattanooga
Chattanooga, TN
University of Texas Health Science
Center Houston
Houston, TX
University of Texas Health Science
CenterSan Antonio
San Antonio, TX
University of TexasEl Paso
El Paso, TX
University of TexasTyler
Tyler, TX
University of the Incarnate Word
San Antonio, TX
University of Toledo
Toledo, OH
University of Utah
Salt Lake City, UT
University of Vermont
Burlington, VT
University of Virginia
Charlottesville, VA
University of West Georgia
Carrollton, GA
University of WisconsinEau Claire
Eau Claire, WI
University of WisconsinGreen Bay
Green Bay, WI
University of WisconsinMilwaukee
Milwaukee, WI
University of WisconsinOshkosh
Oshkosh, WI
University of Wyoming
Laramie, WY
Upper Iowa University
Fayette, IA
Ursuline College
Pepper Pike, OH
Utica College
Utica, NY
Valdosta State University
Valdosta, GA
Valparaiso University
Valparaiso, IN
Vanguard University of Southern
Costa Mesa, CA
Villa Julie College
Stevenson, MD
Wagner College
Staten Island, NY
Washburn University
Topeka, KS
Washington State University
Spokane, WA
Waynesburg University
Waynesburg, PA
West Chester University
West Chester, PA
West Texas A&M University
Canyon, TX
West Virginia University
Morgantown, WV
Western Carolina University
Cullowhee, NC
Western Kentucky University
Bowling Green, KY
Western Michigan University
Kalamazoo, MI
Wichita State University
Wichita, KS
Widener University
Chester, PA
Wilkes University
WilkesBarre, PA
William Carey University
Hattiesburg, MS
William Jewell College
Liberty, MO
William Paterson University
Wayne, NJ
Wilmington University
New Castle, DE
WinstonSalem State University
WinstonSalem, NC
Wisconsin Lutheran College
Milwaukee, WI
Wright State University
Dayton, OH
Xavier University
Cincinnati, OH
Yale University
New Haven, CT
York College of Pennsylvania
York, PA
Professional Organizations that Participated in the Regional Meetings (N=11)
American Holistic Nurses Association
Flagstaff, Arizona
American Nurses Association
Silver Spring, MD
Association of Community Health Nursing Educators
Wheat Ridge, CO
Association of Perioperative Registered Nurses
Denver, CO
Association of Rehabilitation Nurses
Glenview, IL
Commission on Graduates of Foreign Nursing Schools International
Philadelphia, PA
International Society of Nurses in Genetics
Pittsburgh, PA
Kentucky Board of Nursing
Louisville, KY
Minnesota Board of Nursing
Minneapolis, MN
National Council of State Boards of Nursing
Chicago, IL
National League for Nursing
New York, NY
Oncology Nursing Society
Pittsburgh, PA
Society of Pediatric Nurses
Pensacola, FL
Healthcare Systems that Participated in the Regional Meetings (N= 13)
Advocate Christ Medical Center
Oak Lawn, IL
Baptist Memorial Health Care Corporation
Memphis, TN
Baptist Memorial Health Care Corporation DeSoto
Southaven, MS
Bon Secours Hampton Roads Health System
Norfolk, VA
Children’s Healthcare of Atlanta
Atlanta, GA
Dartmouth Hitchcock Medical Center
Lebanon, NH
Hospital Corporation of America
Nashville, TN
INOVA Health Systems
Falls Church, VA
Ovations/ Evercare
Minnetonka, MN
Southeast Health District
Waycross, GA
St. Mary’s Hospital
Passaic, NJ
UPMC St. Margaret’s
Pittsburgh, PA
Miriam Hospital
Providence, RI
One Dupont Circle Suite 530
Washington, DC 20036
(p) 202.463.6930

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