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7 Educating Nurses for the Future
Pages 189-246

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From page 189...
... Nursing school curricula need to be strengthened so that nurses are prepared to help promote health equity, reduce health disparities, and improve the health and well-being of ev eryone. Nursing schools will need to ensure that nurses are prepared to understand and identify the social determinants of health, have expand ed learning experiences in the community so they can work with different people with varied life experiences and cultural values, have the compe tencies to care for an aging and more diverse population, can engage in new professional roles, are nimble enough to adapt continually to new technologies, and can lead and collaborate with other professions and sectors.
From page 190...
... The committee's charge included examining whether nursing education provides the competencies and skills nurses will need -- the capacity to acquire new competencies, to work outside of acute care settings, and to lead efforts to build a culture of health and health equity -- as they enter the workforce and throughout their careers. A thorough review of the current status and future needs of nursing education in the United States was beyond the scope of this study, but in this chapter, the committee identifies priorities for the content and nature of the education nurses will need to meet the challenge of addressing SDOH, advancing health equity, and improving population health.
From page 191...
... . In addition, the NCLEX is heavily focused on acute care rather than on such areas of nursing as primary care, disease prevention, SDOH, and health equity (NCSBN, 2019)
From page 192...
... . The Need for Nursing Education on Social Determinants of Health and Health Equity A report of the Institute of Medicine (IOM)
From page 193...
... , agencies that serve rural and frontier areas, to increase students' exposure to different competencies, experiences, and environments. In concert with these perspectives and recommendations, nursing organizations have developed guidelines for how nursing education should prepare nurses to work on health equity issues and address SDOH.
From page 194...
... • Develop curricula that strengthen the links between SDH, health equity, and nursing's social mission. For Leadership in Nursing Programs • Engage faculty and staff in conversations directed toward addressing ex plicit and implicit bias related to SDH to foster a more inclusive understand ing of the SDH and their effects on health and wellness.
From page 195...
... . While Essentials only guides baccalaureate, master's, and DNP programs, the document's emphasis on health equity and SDOH demonstrates the importance of these topics to the nursing profession as a whole.
From page 196...
... " Figure 7-1 shows the percentage of six different training topics that RNs said would help them do their job better. Overall, RNs working in schools, public health, community health, and emergency and urgent care were more likely than RNs working in all other employment settings listed in Figure 7-1 to indicate that they could have done their job better if they had received training in SDOH, population health, working in underserved communities, caring for individuals with complex health and social needs, and especially mental health.
From page 197...
... have also indicated the need for more training in SDOH. In response to the 2018 NSSRN question described above, NPs working in public health and community health, emergency and urgent care, education, and long-term care reported that they could have done their job better if they had received training in SDOH, mental health, working in underserved communities, and providing care for medically complex/special needs.
From page 198...
... . CNEA's accreditation standards likewise include no mention of population health, SDOH, or health equity (NLN, 2016)
From page 199...
... NACNEP has also examined exemplars of nursing programs that incorporate health equity and SDOH into their curricula (NACNEP, 2019)
From page 200...
... . Moreover, schools and programs have limited capacity for first-time nursing students and ADN, LPN nurses, or RNs without BSN degrees (Spetz, 2018)
From page 201...
... . The slow growth in PhD-prepared nurses is a major concern for the profession and for the nation, because it is these nurses who serve as faculty at many universities and who systematically study issues related to health and health care, including the impact of SDOH on health outcomes, health disparities, and health equity.
From page 202...
... Drawing on all of these recommendations, guidelines, and perspectives, as well as looking at the anticipated roles and responsibilities outlined in other chapters of this report, the committee identified the core concepts pertaining to SDOH, health equity, and population health that need to be covered in nursing school and the core knowledge and skills that nurses need to have upon graduation. For consistency with the language used by the AACN, these are referred to, respectively, as "domains" (see Box 7-2)
From page 203...
... EDUCATING NURSES FOR THE FUTURE 203 BOX 7-2 Domains for Nursing Education • Health equity and health care equity • Social determinants of health • Social needs • Social justice • Racism, ageism, classism, sexism • Implicit bias • Ethics • Population health • Environmental health • Disasters/public health emergencies • Nurse well-being BOX 7-3 Competencies for Nursing Education, Depending on Preparation Level • Population health ° Aging competencies ° Mental and behavioral health competencies ° Community/public health nursing competencies • Health systems (domestic and international) ° Health economics • Human-centered design thinking ° Innovation mindset ° Developing, implementing, and scaling interventions • Continually adapting to new technologies ° Using digital health tools • Delivering person-centered care to diverse populations ° Cultural humility ° Awareness of implicit bias ° Trauma-informed care ° Motivational interviewing • Collaborating across professions, disciplines, and sectors ° Teamwork among health care providers and community partners ° Interpersonal communication skills ° Conflict resolution skills ° Partnership development (interprofessional and multisector)
From page 204...
... . It is important to note as well that some of these topics, including the connections among implicit biases, structural racism, and health equity, may be difficult for educators and students to discuss (see Box 7-4)
From page 205...
... Given the limited scope of this report, the committee has chosen to highlight three of the competencies from Box 7-3 in this section.3 The first is delivering person-centered care to diverse populations. As the United States becomes increasingly diverse, nurses will need to be aware of their own implicit biases and be able to interact with diverse patients, families, and communities with empathy and humility.
From page 206...
... . This idea has been explored in the context of education in health professions and has been identified as a valuable way to foster understanding of health equity and SDOH (IOM, 2016b; Mann et al., 2007)
From page 207...
... . One effective approach to cultivating cultural humility is to accompany experiential learning opportunities or case studies with reflection that expands learning beyond skills and knowledge.
From page 208...
... . If nursing students are to be prepared to practice interprofessionally after graduation, they must be given opportunities to collaborate with others before graduation (IOM, 2013)
From page 209...
... There are opportunities for nursing students to gain interprofessional and multisector collaborative competencies through both experiential learning in the community (discussed in detail below) and classroom work.
From page 210...
... She observed that although all individuals should have the right to achieve their highest level of health, every day that fundamental right is denied to more than a few individuals. Discussing technology that can help improve health equity, she described the benefits of apps that help manage a patient's condition, inform patients whether their symptoms warrant a visit to the emergency room, and allow patients to confirm appointments and view test results.
From page 211...
... . Educating nurses to understand and assess the benefits and drawbacks of health care technologies and have the capacity to help shape and revamp them can ultimately improve patient care and the well-being of health professionals.
From page 212...
... As noted, however, despite its promise for improving patient care and community health, technology can also exacerbate existing disparities (Ibrahim et al., 2020)
From page 213...
... First, experience in the community is essential to understanding SDOH and gaining the competencies necessary to advance health equity (IOM, 2016b)
From page 214...
... . In addition to clinical education, nursing students can participate in nontraditional clinical community engagement and service learning opportunities, such as volunteering at a homeless shelter or working in a service internship for a community organization.
From page 215...
... The goal of the center is to meet the needs of commu nity members and to address multiple social determinants of health. The center was built from the ground up through a collaboration among the university, the housing authority, the local community, local organizations, and residents of the public housing neighborhood in which the center is situated.
From page 216...
... In addi tion to improving understanding of the challenges of living in poverty, the exposure to multiple agencies through the simulation introduces students to many of the sectors that work collaboratively to create health equity. SOURCE: The Poverty Simulation, n.d.
From page 217...
... RECRUITING AND SUPPORTING DIVERSE PROSPECTIVE NURSES The composition of the population of prospective nurses and the ways they are supported throughout their education are important factors in how prepared the future nursing workforce will be to address SDOH and health equity. As discussed in prior chapters, developing a more diverse nursing workforce will be key to achieving the goals of reducing health disparities, providing culturally relevant care for all populations, and fostering health equity (Center for Health Affairs, 2018; IOM, 2011, 2016; Williams et al., 2014)
From page 218...
... is significantly lower than the proportion of graduates with other degrees who are male. Diversifying and strengthening the nursing student body -- and eventually, the nursing workforce -- requires cultivating an inclusive environment, recruiting and admitting a diverse group of students, and providing students with support and addressing barriers to their success throughout their academic career and into practice.
From page 219...
... Cultivating an Inclusive Environment Efforts to recruit and educate prospective nurses to serve a diverse population and advance health equity will be fruitless unless accompanied by efforts to acknowledge and dismantle racism within nursing education and nursing practice (Burnett et al., 2020; Schroeder and DiAngelo, 2010; Villaruel and Broome, 2020; Waite and Nardi, 2019)
From page 220...
... Yes Yes Yes -- Yes -- Liaison Committee on Medical Education (LCME) Yes Yes Yes Yes Yes -- SOURCE: Batra and Orban, 2020.
From page 221...
... In a study of fourth-year baccalaureate nursing students, both groups described an inclusive classroom as one where they felt comfortable and respected and had a sense of belonging, but underrepresented minority students also noted the importance of feeling safe, feeling free from hostility, and being seen as themselves and not a representative of their group (Metzger and Taggart, 2020)
From page 222...
... . Several approaches can be taken to improve access for prospective underrepresented students and, by extension, increase the diversity of the nursing workforce.
From page 223...
... An example is Ohio's College Credit Plus program, in which students in grades 7 to 12 have the opportunity to earn college and high school credits simultaneously, thus preparing them for postsecondary success.6 Once students have applied to nursing school, a system of holistic admissions can improve the diversity of the incoming class (Glazer et al., 2016, 2020)
From page 224...
... interviewed associate's degree nursing students in a Midwestern state and found that the total cost of a baccalaureate degree and student debt was the greatest barrier to pursuing a degree, followed by family and personal, such as head-of-household, responsibilities. This challenge is pervasive in higher education, and there are indications that the problem is growing (Advisory Committee on Student Financial Assistance, 2013)
From page 225...
... Social and Academic Supports Once students have been admitted, some nursing schools offer programs, such as summer programs that bridge high school and college, designed to prepare them academically and socially for the rigors of nursing education. Some of these programs are designed specifically for underrepresented and/or first-generation college students (Pritchard et al., 2016)
From page 226...
... These programs include HRSA pipeline programs; HOSA-Future Health Professionals; and university-based programs such as the Niganawenimaanaanig program at Bemidji State University in Minnesota, created to support American Indian nursing students (HOSA, 2012; HRSA, 2017; Wilkie, 2020)
From page 227...
... As discussed above, NCSBN identified additional quality indicators for nursing education; as these indicators begin to be measured and reported, the data can help prospective students make more informed choices. Educational Pathways and Options As nursing education programs adapt their curricula and other learning experiences to better address SDOH and health equity, it will be important to consider the educational pathways students may follow, both in their initial preparation and as they progress in their careers.
From page 228...
... STRENGTHENING AND DIVERSIFYING THE NURSING FACULTY A system of nursing education that can prepare students from diverse backgrounds to address SDOH and health equity requires a diverse faculty (NACNEP, 2019; Thornton and Persaud, 2018)
From page 229...
... . Finally, faculty must have the knowledge, skills, and competencies to prepare their students for the challenges of advancing health equity and fully understanding the implications of SDOH for their daily practice (NACNEP, 2019)
From page 230...
... For example, educators involved in developing innovative models of classroom and experiential learning could focus on disseminating these models with the assistance of nursing associations and organizations, including through publication, continuing education programs, or faculty-to-faculty education and mentoring. Finally, institutions can provide in-depth and sustained learning opportunities for faculty, staff, and preceptors focused on how they can support their students in learning about SDOH and health equity both within and outside of the classroom (IOM, 2016b)
From page 231...
... These challenges have underscored the limitations of traditional ways of educating nurses even as they have presented unique opportunities for innovation. To translate these short-term challenges into long-term improvements in nursing education will require • evaluation of such practices as distance learning and virtual experiential learning to identify and disseminate best practices; • a sense of urgency in the development of substantial changes, such as modifications of curriculum and the adoption of new technologies; and • partnership with public- and private-sector organizations, associations, and researchers that can bring both resources and expertise to the tasks of strengthening nursing education.
From page 232...
... . Conclusion 7-3: Learning experiences that develop nursing students' understanding of health equity, social determinants of health, and population health and prepare them to incorporate that understanding into their professional practice include opportunities to • learn cultural humility and recognize one's own implicit biases; • gain experience with interprofessional collaboration and mul tisector partnerships to enable them to address social needs comprehensively and drive structural improvements;
From page 233...
... While the nursing workforce has steadily grown more diverse, nursing schools need to continue and expand their efforts to recruit, support, and mentor diverse students. Conclusion 7-4: Successfully diversifying the nursing workforce will depend on holistic efforts to support and mentor/sponsor students and faculty from a wide range of backgrounds, including cultivating an inclusive environment; providing economic, social, professional, and academic supports; ensuring access to information on school quality; and minimizing inequities.
From page 234...
... 2014. Using career nurse mentors to support minority nursing students and facilitate their transition to practice.  Journal of Professional Nursing 30(4)
From page 235...
... 2019. Advancing health equity and social justice in forensic nursing research, education, practice, and policy: Introducing structural violence and trauma-and violence-informed care. Journal of Forensic Nursing 15(4)
From page 236...
... 2018. LPNs crucial to nursing workforce diversity.
From page 237...
... 2020. Integrating population health into nursing education: The process of gaining commitment from Washing ton's nursing deans and directors. Journal of Professional Nursing 36(2)
From page 238...
... 2020. Big data analytics and the struggle for equity in health care: The promise and perils. Health Equity I(1)
From page 239...
... 2012. Baccalaureate nursing students' intention to choose a public health career.
From page 240...
... 2017. Communities in action: Pathways to health equity.
From page 241...
... Increasing racial/ethnic diversity in nursing to reduce health disparities and achieve Health Equity. Public Health Reports 129(Suppl 2)
From page 242...
... 2019. Addressing social determinants of health through community engagement: An undergraduate nursing course. Journal of Nursing Education 58(7)
From page 243...
... 2018. Using simulation to help beginning nursing students learn about the experience of poverty: A descriptive study.
From page 244...
... 2014. Using social determinants of health to link health workforce diversity, care quality and access, and health disparities to achieve health equity in nursing. Public Health Reports 129(1)
From page 245...
... 2020. An academic–fire department partnership to address social determinants of health. Journal of Nursing Education 59(1)


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