WASHINGTON, D.C., April 2, 1998 -- As providers, designers, and managers of care in an evolving health system, nurses who graduate from bachelor's-degree programs should possess the skills to "communicate, collaborate, and negotiate" in delivering high-quality care to patients and families, says a major new set of educational standards by the American Association of Colleges of Nursing (AACN).

Moreover, while nursing schools should continue their strong focus on physical and social sciences, as well as on learning in the humanities, arts, and philosophy, recent changes in health care "require particular emphasis on learning related to economics, epidemiology, genetics, gerontology, global perspectives, and telecommunications," AACN recommends in the long-awaited new document, The Essentials of Baccalaureate Education for Professional Nursing Practice.

The Essentials is a comprehensive revision to AACN's landmark set of core standards for baccalaureate-degree nursing education first released in 1986. The first national effort to define the fundamental knowledge, values, and professional behaviors expected of the bachelor's-degree nursing graduate, the 1986 document has provided a central framework for designing baccalaureate nursing programs nationwide. Several thousand copies are purchased annually by nurse educators to develop and refine nursing curricula.

Keeping Pace with Dramatic Change

However, health care delivery has changed dramatically over the past decade, and the environments in which professional nurses practice have become more dynamic and diverse," says AACN President Andrea R. Lindell, DNSc, RN.

"As hospital stays have shortened markedly, home care has experienced rocketing growth. The trend to move patients out of the hospital 'quicker and sicker' has been augmented by rapidly expanding managed care networks with a strong focus on "bottom-line" cost-effectiveness. Meanwhile, scientific advances have posed major new ethical dilemmas, increased travel and advanced communication technologies have created a more global environment in which individuals live and work, while rising population worldwide and increased incidence of chronic and infectious diseases have added to the complexities of health care delivery," Dr. Lindell explains. "Nursing education must keep pace with these changes, and new graduates must expect to continue learning in order to keep pace themselves."

AACN's new Essentials provides direction for the preparation of professional nurses for practice into the 21st century. While written primarily for baccalaureate nursing educators and nurse executives, the Essentials' recommendations also will benefit others who employ nurses throughout the health care system. The Essentials is the outcome of a series of roundtable conferences and regional hearings held throughout 1997 and coordinated by an AACN task force. Created by the AACN Board of Directors, the task force reviewed the 1986 document for its relevance to current and future nursing practice.

In view of the far-reaching changes occurring in health care and health professions education, it was apparent to the task force that the 1986 document required major updating. "Clearly," says Dr. Lindell, "new skills have become central for RNs to practice in a health system that now focuses more intensively on cost, quality control, interdisciplinary preparation, expanding roles, technological breakthroughs, and effective delegation and referral. Today's entry-level professional nurse must be a clinician who can function in a health care environment with markedly different conditions and values than just a decade ago."

A Consensus-Building Process

In a two-phase review process, AACN sponsored two invitational roundtable meetings that assembled nurses and other experts in areas bearing on nursing now and in the foreseeable future, including genetics, gerontology, rural health, interdisciplinary practice, health care financing, and integrated health care delivery. Participants identified the core knowledge and skills that baccalaureate-prepared nurses must attain to practice in today's changing health system.

Following the roundtables, five regional meetings invited comment on a draft Essentials document -- developed from the roundtables -- from nurse educators, clinicians, administrators, and researchers representing a broad range of educational programs, specialties, and organizations. More than 770 individuals representing 49 states, the District of Columbia, and Puerto Rico, as well as representatives from 349 schools of nursing, 23 professional organizations, and 19 health care delivery systems participated in the consensus- building regional hearings. "The goal of this broad input was to assure that we produce not only the type of entry-level professional RN that the health system now requires, but also a document backed by wide professional support," Dr. Lindell stresses.

Preparing for "New Realities"

New realities of health care require nurses to "master complex information, coordinate a variety of care experiences, use technology for health care delivery and evaluation of patient outcomes, and assist patients with managing an increasingly complex system of care," AACN notes in the new Essentials. The document focuses on preparing entry-level RNs to deal effectively with, among other new trends, technological advances that "will have a profound effect on disease prevention and detection, information management, and clinical decision making." Nurses also must address the needs of an increasing aging population that will bring "new challenges related to lifelong health promotion and management of the chronically ill and those at the end of life."

In addition, the increasing diversity of the U.S. population requires a fuller understanding of how health is influenced by such factors as age, gender, culture, ethnicity, religion, lifestyle, and functional ability level. At the same time, nurses must understand how a more interconnected global environment affects the health of individuals and the delivery of care, the AACN document points out.

The Essentials details standards for preparing bachelor's-degree nurses to assume roles as care providers; as designers, managers, and coordinators of care; and as members of a profession. Within these roles, the document provides specific standards for educational components that are essential for all baccalaureate nursing programs, including liberal education, professional values, core competencies, core knowledge, and role development.

To build core competencies, the Essentials recommends a range of course work and clinical experiences in such areas as critical thinking, communication, assessment of patients' health status, and technical skills. Under core knowledge, AACN suggests specific course content in key areas including health promotion, risk reduction, and disease prevention; management of illness and disease; ethics; human diversity; managing information and patient care technology; global health care issues; and health care systems and policy. For example, the Essentials urges that baccalaureate nursing students acquire the skills to initiate community partnerships in health promotion programs, understand how health care systems are organized and financed, use communication technology to improve the accessibility of care, provide care that addresses the needs of diverse populations across the life span, and identify the political and economic factors that influence health care services.

Tips on Teaching Strategies

The Essentials not only recommends the content of what is taught, but also suggests strategies for how to teach it. To motivate students to be active, creative learners, AACN encourages educators, among other tips, to use "actual communications, such as written or verbal testimony to legislative bodies, that are more engaging or relevant" than those based on data on unknown individuals.

The American Association of Colleges of Nursing is the national voice for university and four-year-college education programs in nursing -- the nation's largest health care profession. Representing more than 500 member schools of nursing at public and private institutions nationwide, AACN's educational, research, governmental advocacy, data collection, publications, and other programs work to establish quality standards for bachelor's- and graduate- degree nursing education, assist deans and directors to implement those standards, influence the nursing profession to improve health care, and promote public support of baccalaureate and graduate nursing education, research, and practice.

EDITORS: News media can obtain a copy of the AACN Essentials by contacting the AACN Office of Public Affairs at 202-463-6930, x231, or rosseter@aacn.nche.ed

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