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 end of program 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 Associate ion of Colleges of Nursing (AACN, 1998). Building a safer healthcare system has become t he 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 & O’Neill, 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 cost effective system. Wit h the increasing awareness of the need for change in the healthcare system, the clinical micro systems (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 entry level 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 t he workforce through retirement alone. Addressing the need for an increased number of baccalaureate prepared nurses is critical but not sufficient. Nursing must educate future professionals to deliver patient-centered care as members of an inter professional team, emphasizing evidence based 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 & O’Neill, 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 t o have a growing and significant impact on prevent ion, 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). Prevent ion is critical in addressing both acute and chronic conditions across the lifespan. The role of the nurse in prevent ion continues to be of utmost importance. Increasing globalization of healthcare and the diversity of this nation’s 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. Wit h project ions 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 patient-centered care, developing partnerships wit h the patient, and a focus on customer service.
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 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 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 today’s 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 baccalaureate degree nursing programs. Advanced generalist education occurs in master’s 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 research focused degree programs (PhD, DNS, or DNSc). End of program 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, 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 inquiry-based 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 nursing’s dist inctive perspective.