Curricular Innovation at Nursing Schools

Oct 30, 2014, 12:00 PM

With so many aspects of the nation’s health care system undergoing significant change, many of the nation’s nursing schools have implemented curricular innovations aimed at ensuring that new nursing graduates are fully prepared for the challenges they’ll face in practice. These include working collaboratively in teams, providing evidence-based care, managing chronic conditions, coordinating complex care, and promoting a culture of health—and much more transformation lies ahead.

According to the latest issue of Charting Nursing’s Future, the Robert Wood Johnson Foundation’s (RWJF) issue brief series focused on the future of nursing, most clinical nursing education programs still emphasize hospital-based care, as they have for decades, even though much care has shifted to community settings. This results in a widening gap between clinical nursing education and the 21st-century competencies nurses need.

The brief highlights curricular innovations at a number of nursing schools around the nation, including re-sequencing of the curriculum, using a “concept-based” approach, a “coach model” supporting an online baccalaureate (BSN) degree, new types of academic/practice partnerships, and more. Increasingly, nursing schools are restructuring their students’ clinical experiences, embracing:

  • Simulation, using actors posing as patients, complex high-fidelity mannequins, or virtual reality. A newly released and eagerly awaited study by the National Council of State Boards of Nursing (NCSBN) offers powerful support for the trend toward simulation. It found no differences in licensure pass rates or other measures of overall readiness for practice between new graduates who had traditional clinical experiences and those who spent up to 50 percent of their clinical hours in simulation.
  • Interprofessional education with the goal of overcoming learning silos that divide clinicians, thus encouraging the habits of collaboration.
  • Dedicated Education Units (DEUs) that assign a group of nursing students to an entire unit of a care facility and engage staff nurses along with clinical faculty in instructing students over an extended period. Hospitals have a stronger connection to academia and the latest evidence-based nursing methods, as well as access to a tested group of students they might later hire. Students experience a richer clinical learning environment and develop a greater sense of belonging to a health care team. Nursing schools are able to expand their teaching capacity in the midst of a nurse faculty shortage.
  • Nurse residencies fortify clinical competencies with several months of structured guidance and acclimation to the profession, allowing new nurses to hone their clinical abilities and develop confidence, while focusing on the sponsoring employer’s priorities.

The brief notes that while the innovations it describes have begun to take root, “they remain the exception, not the rule.” Innovation is still hampered by a lack of communication between educators and state boards of nursing, sometimes inflexible rules for faculty qualifications, and the often cumbersome process of curriculum change.

This issue of Charting Nursing’s Future, “Innovation in Clinical Nursing Education: Retooling the Old Model for a 21st-Century Workforce,” is a publication of RWJF, created in collaboration with the George Washington University School of Nursing.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.