Introduction 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 prellcensure and RN complet Ion programs, whether the degree is baccalaureate or graduate entry. Program curricula are designed to prepare students to meet the endofprogram outcomes delineated under each Essent ial. Background The healthcare delivery system has changed dramatically since The Essentials ot
Baccalaureate Education for Professional Nursing Practice was endorsed by the American Associat ion of Colleges of Nursing (AACN, 1998). Building a safer healt hcare system has become t he focus of all health professions following numerous reports from the Institute of Medicine (10M, 2000, 2001 , 2004), American Hospital Associat Ion (2002), Robert Wood Johnson Foundation (Kimball & C)’Neill, 2002b the Joint Commission (2002) and other authorit les. Nursing has been Identified as having the potential for making the biggest Impact on a transformation of healthcare delivery toa safer, higher qualit y, and more costeffect
Ive system. Wit h the increasing awareness of the need for change in the healthcare system, the clinical microsystems (small, funct tonal units where care is provided within the larger system) have become an important focus for improving healt hcare outcomes (Nelson, Batalden, & Godfrey, 2007). In addit ion to the concern over healt hcare outcomes, the United St ates 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 ore 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 suffcient 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 t he workforce through retirement alone.
Addressing the need for an increased ‘ Off numDer 0T Daccalaureatepreparea nurses Is crlt Ical out not sumclent. Nursing must educate future professionals to deliver patientcentered care as members of n interprofessional team, emphasizing evidencebased practice, qualit y improvement approaches, and informat ics (10M, 2003b). Nursing education and practice must work together to better align educat ion with practice environments Coint Commission, 2002, Kimball & O’Neill, 2002;). The environments in which professional nurses practice have become more diverse and more global in nature.
Scient iflc advances, particularly in the areas of genet ics and genomics, have had and will cont inue t o have a growing and significant impact on prevent ion, diagnosis, and treatment of diseases, illnesses, and condit ions. The increased revalence of chronic illness is a result of an increasingly older adult population, environmental threats, lifestyles that increase r isk of disease, and enhanced technological and therapeut ic intervent ions that prolong life. Increases in longevity of life have made the older adult the fastest growing segment of the populat ion. In 2003, 12 % of the population was older than 65 years of age.
By 2030, this populat ion 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 ounger 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 mortalit y in 2006 ranked 38 th in the world (World Health Organizat ion, 2008).
Prevent ion is crit ical in addressing both acute and chronic condit ions across the lifespan. The role of the nurse in prevent ion cont inues to be of utmost importance. Increasing globalizat ion of healthcare and the diversit y of this nat ion’s populat ion mandates an attention to diversity in order to provide safe, high qualit y care. The professional nurse practices in a mult icultural environment and must possess the skills to provide culturally appropriate care. According to the U. S. Census Bureau (2008), the nat ion’s minorit y population totaled 102 million or 34% of the U. S. populat ion in 2006.
Wit h project ions point ing to even greater levels of diversity in the coming years, professional nurses need to demonstrate a sensit vity to and understanding of a variety of cultures to provide high qualit y care across settings. Liberal educat ion, including the study of a second language, facilitates the development of an appreciation for diversit y. Strong forces influencing the role of nurses include: scientific advances, particularly in the area of genetics and genomics, changing demographics of pat lent populat ions, new care tecnnologles, ana patient access to healthcare informat ion.
These forces call for new ways of thinking and providing health care. Nursing is uniquely posit toned to respond to these major forces, requiring an ncreased emphasis on designing and implement ing pat ientcentered care, developing partnerships wit h 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 wit h 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 effect ively within this complex and changing environment. New innovative models of nursing educat ion have emerged, and AACN has taken a leadership role in craft nga preferred vision for nursing education. In 2004, the AACN Board of Directors reaffirmed its posit ion that baccalaureate education is the minimum level required for entry into professional nursing practice in todays complex healthcare environment. Baccalaureate generalist education, as defl ned in this document, is the foundat ion upon which all graduate nursing education builds.
The preferred vision for nursing educat ion includes generalist, advanced generalist, and advanced specialty nursing educat ion. Generalist nurse education occurs ata minimum in baccalaureate degree nursing programs. Advanced generalist educat ion occurs in master’s degree nursing programs, including the Clinical Nurse Leader ([email protected]), which is an advanced generalist nursing role. Advanced specialt y educat ion occurs at the doctoral level in Doctor of Nursing Practice (DNP) or research focused degree programs (PhD, DNS, or DNSc).
Endofprogram outcomes for the baccalaureate, master’s, 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, esigner/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, communit ies, and populat ions. Nursing pract ice is built on nursing knowledge, theory, and research.
In addit ion, nursing pract ice derives knowledge Trom a w10e array 0T otner TlelOs ana proTesslons, aaaptlng ana applying tnls knowledge as appropriate to professional pract ice. In the senior college and university setting, every academic discipline is grounded in discrete inquirybased applications that are distinctive to that discipline. Scient iflc advances, (particularly in the area of genet ics and genomics), changing demographics of patient populations, new care t echnologies, and patient access to health care information call for new ways of thinking and doing in the provision of healt h care.
The academic setting provides a forum for contemplat ing physical, psychological, social, cultural, behavioral, ethical, and spiritual problems wit hin and across disciplines. Facult y have a responsibility to facilitate the t ranslat ion of knowledge from a liberal educat ion base into the practice of nursing. Nursing faculty introduce nursing science and theories, and guide he student in developing an understanding of the discipline of nursing’s dist inct Ive perspective.
Baccalaureate prepared nurses provide pat ientcentered care that identifies, respects, and addresses patients’ differences, values, preferences, and expressed needs (10M, 2003a). Patient centered care also involves the coordinat ion of cont inuous care, listening to, communicat ing with, and educating pat tents and caregivers regarding healt h, wellness, and disease management and prevent ion. The generalist nurse provides the human link between the healt hcare system and the patient by translating the plan of care to the patient. A broad based skill set is required to fill this human interface role.
Patient centered care also requires the development of a nurse patient partnership. Patients, as consumers of healt hcare services, and as integral members of the healt hcare team, have an increasing role and responsibilit y for the mutual planning of care and healt hcare 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 populat ion based healt h care. A defining feature of professional nursing practice is the ocus on health promotion and risk reduct ion.