LACE and the APRN Consensus Model: Implications for Advancing Nursing Practice.

Understanding the historical context and contemporary trends in advanced practice registered nurse (APRN) education and regulation is pivotal for effective professional advocacy. Until the release of the APRN Consensus Model in 2008, a uniform model for APRN regulation was lacking. Adopting the model's recommendations has implications for APRNs beyond licensure and regulation, including full practice authority, license portability, and patient access to APRN-led care. A comprehensive understanding of APRN education and regulation empowers nurses, APRNs, and stakeholders to drive the profession forward through informed advocacy.

Teaching nursing within a population health context: From concept to exemplars.

As researchers in the health sciences improve their understanding of the underlying causes of poor health to include non-medical factors, nursing practice must expand and adapt to enable nurses to effectively contribute to population health improvement. The concept of population health has been incorporated into the current American Association of Colleges of Nursing (AACN) The Essentials: Core Competencies for Professional Nursing Education (2021) as a set of competencies for nurses at entry and advanced levels. This article provides a description of these competencies, and exemplars of how to include them meaningfully in nursing curricula at the entry level.

Measuring Bachelor of Science in Nursing competencies in public/population health.

Nurses have a long history of practice in public health. More recently basic population health knowledge and skills are being required across all nursing practice settings. To prepare nurses for this practice nursing education has long included public or community health nursing (PHN) content and skills as part of prelicensure education at the baccalaureate level and above. However, little work has been done to document student competency in these areas. Competency-based education is a process whereby students are held accountable for the mastery of knowledge and skills deemed critical for an area of study. The AACN Public/Population Health Workgroup addressed the challenge of measuring baccalaureate student nursing competencies in population health by developing an unfolding case study, with embedded questions assessing selected competencies. Lacking established population health competencies in nursing curriculum at the time of this work but wanting to assess students' basic competencies across the care continuum, the Workgroup selected relevant competencies from the Council of Public Health Nursing Organizations (formerly called the Quad Council) Competencies for Public Health Nurses. Utilizing these selected competencies, the Workgroup devised the unfolding case study and piloted it with 275 baccalaureate nursing education programs across the country. The findings from the Pilot demonstrated nursing student competency achievement and how this achievement changed as students progressed through the curriculum. The authors report implications and recommendations for competency measurement in population health based on the results of the pilot.

Addressing immunizations in nursing education: Immunization resources for undergraduate nursing.

Nursing faculty are challenged to integrate immunization content in prelicensure nursing curricula. Historically, most immunization content has been delivered in pediatrics courses, with less emphasis on other populations across the lifespan. Skills related to vaccine administration may be prioritized over the most current immunization science, such as pathophysiology, immunology, and epidemiology. As the most trusted profession rated by the public (Saad, 2020), nurses are ideally suited to address vaccine hesitancy and promote vaccination in the communities they serve. Nurses apply active listening, problem solving, and communication skills with patients and their families, contributing to a person's confidence in their decision to be vaccinated. The Centers for Disease Control and Prevention and the Association for Prevention Teaching and Research collaborated to develop a framework for immunization content and teaching resources, Immunization Resources for Undergraduate Nursing (IRUN), for faculty to use in designing the nursing curricula. Content includes a curriculum framework, curriculum mapping tool, multiple teaching resources, and a dedicated website (IRUNursing.org). The framework provides guidance for faculty on integrating immunization content into a curriculum. Teaching resources include case studies, simulation scenarios, and PowerPoint slide decks. Although primarily focused on prelicensure nursing education, resources are also relevant to advanced professional nursing education.

Impact of the COVID-19 Pandemic on the Future of Nursing Education.

Nursing is the largest health profession, with nearly 4 million providers practicing across acute, primary, and public health care settings. In response to the pandemic, nursing schools halted on-site course delivery and redesigned programs to attenuate risks to students and faculty. Key challenges faced by schools included financial cutbacks, rapid increases in online learning technology, maintaining student academic progression, disruption to clinical learning opportunities, and meeting accreditation standards, while addressing the stress and loss experienced by faculty, staff, and students. Despite challenges, nursing organizations provided guidance for decision making, new learning resources, and faculty development opportunities. Schools of nursing leveraged their resources to redesign nursing curricula, strengthen partnerships for student clinical experiences, and address needs of the community. Nursing education will look different from its prepandemic profile in the future. Lessons learned during the pandemic point to gaps in nursing education, particularly related to disaster and public health preparedness, health equity, and technology. The American Association of Colleges of Nursing's new Essentials-standards for professional nursing education-were finalized during the pandemic and reflect these lessons. The need for nurse scientists to conduct emergency response research was made evident. The importance of strong academic-practice partnerships was highlighted for rapid communication, flexibility, and responses to dynamic environments. For the future, nursing education and practice must collaborate to ensure that students and practicing nurses are prepared to address emergencies and pandemics, as well as the needs of vulnerable populations.

A call to action: next steps to advance diagnosis education in the health professions.

OBJECTIVES: Improving diagnosis-related education in the health professions has great potential to improve the quality and safety of diagnosis in practice. Twelve key diagnostic competencies have been delineated through a previous initiative. The objective of this project was to identify the next steps necessary for these to be incorporated broadly in education and training across the health professions. METHODS: We focused on medicine, nursing, and pharmacy as examples. A literature review was conducted to survey the state of diagnosis education in these fields, and a consensus group was convened to specify next steps, using formal approaches to rank suggestions. RESULTS: The literature review confirmed initial but insufficient progress towards addressing diagnosis-related education. By consensus, we identified the next steps necessary to advance diagnosis education, and five required elements relevant to every profession: 1) Developing a shared, common language for diagnosis, 2) developing the necessary content, 3) developing assessment tools, 4) promoting faculty development, and 5) spreading awareness of the need to improve education in regard to diagnosis. CONCLUSIONS: The primary stakeholders, representing education, certification, accreditation, and licensure, in each profession must now take action in their own areas to encourage, promote, and enable improved diagnosis, and move these recommendations forward.

The critical need for nursing education to address the diagnostic process.

Diagnostic errors are among the most common medical errors and the deadliest. The National Academy of Medicine recently concluded that diagnostic errors represent an urgent national concern. Their first recommendation to address this issue called for promoting the key role of the nurse in the diagnostic process. Registered nurses across clinical settings significantly contribute to the medical diagnostic process, though their role in diagnosis has historically gone unacknowledged. In this paper, we review the history and current state of diagnostic education in pre-licensure registered nurse preparation, introduce interprofessional individual- and team-based competencies to improve diagnostic safety, and discuss the next steps for nursing education. Nurses educated and empowered to fully participate in the diagnostic process are essential for achieving better, safer patient outcomes.

Enhancing primary care and preventive services through Interprofessional practice and education.

Interprofessional (IP) practice and education are important when seeking to respond to the growing demand for primary and preventive care services. Multiple professions with synergistic expertise are needed to effectively provide health promotion, disease prevention, and patient education and to help patients with multiple comorbidities, chronic health conditions, and care coordination. A recent study by Schor et al. titled, "Multidisciplinary work promotes preventive medicine and health education in primary care: a cross-sectional survey," compares the implementation of preventive services in three primary care models. Higher rates of health services, patient education, and health outcomes were documented in two different models of care involving persons in multiple professions when compared with independent solo physicians' practices. In this commentary, we focus on the value of IP team-based care, continuing professional development, and the impact of the team on practice performance and health outcomes. Key components of effective IP teams include using consistent terminology to describe the team composition and function, team structures with purposeful selection of professions to address gaps in care, leadership support, and IP continuing professional development and education.

Advancing the clinical nurse leader model through academic-practice-policy partnership.

The nursing profession is tasked with identifying and evaluating models of care with potential to add value to health care delivery. In consideration of this goal, we describe the Clinical Nurse Leader (CNL) initiative and the activities of a national-level CNL research collaborative. The CNL initiative, launched by the American Association of Colleges of Nursing in collaboration with education and healthcare leaders, has delineated CNL education curriculum and practice competencies, and fostered the creation of academic-practice-policy partnerships to pilot CNL integration into frontline nursing care delivery. The partnership has evolved into an Agency for Healthcare Research and Quality affiliate practice-based research network, the CNL Research Collaborative, which links research, policy, education, and practice stakeholders to advance the CNL evidence base. We summarize foundational CNLRC research to explain CNL practice, quantify CNL effectiveness, and bring clarity to how CNLs can be implemented to consistently influence care, quality, and safety.

Improving the quality of geriatric nursing care: enduring outcomes from the geriatric nursing education consortium.

The nation's aging demography, few nursing faculty with gerontological nursing expertise, and insufficient geriatric content in nursing programs have created a national imperative to increase the supply of nurses qualified to provide care for older adults. Geriatric Nursing Education Consortium (GNEC), a collaborative program of the John A. Hartford Foundation, the American Association of Colleges of Nursing, and the New York University (NYU) Nursing Hartford Institute for Geriatric Nursing, was initiated to provide faculty with the necessary skills, knowledge, and competency to implement sustainable curricular innovations in care of older adults. This article describes the background, step-by-step process approach to the development of GNEC evidence-based curricular materials, and the dissemination of these materials through 6-, 2-, and a half-day national Faculty Development Institutes (FDIs). Eight hundred eight faculty, representing 418 schools of nursing, attended. A total of 479 individuals responded to an evaluation conducted by Baruch College that showed faculty feasibility to incorporate GNEC content into courses, confidence in teaching and incorporating content, and overall high rating of the GNEC materials. The impact of GNEC is discussed along with effects on faculty participants over 2 years. Administrative- and faculty-level recommendations to sustain and expand GNEC are highlighted.

Academic-community partnerships for sustainable preparedness and response systems.

Academic institutions possess tremendous resources that could be important for community disaster response and preparedness activities. In-depth exploration of the role of academic institutions in community disaster response has elicited information about particular academic resources leveraged for and essential to community preparedness and response; factors that contribute to the decision-making process for partner engagement; and facilitators of and barriers to sustainable collaborations from the perspectives of academic institutions, public health and emergency management agencies, and national association and agency leaders. The Academic-Community Partnership Project of the Emory University Preparedness and Emergency Response Research Center in collaboration with the Association of Schools of Public Health convened an invitational summit which included leadership from the National Association of County and City Health Officials, Association of State and Territorial Health Officials, Directors of Public Health Preparedness, Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response, CDC Office of Public Health Preparedness and Response, Association of Schools of Public Health, Association of American Medical Colleges, Association of Academic Health Centers, American Association of Colleges of Nursing, Council of State and Territorial Epidemiologists, and American Association of Poison Control Centers. From this convention, emerged recommendations for building and sustaining academic-public health-community collaborations for preparedness locally and regionally.

Impact of new regulatory standards on advanced practice registered nursing: the APRN Consensus Model and LACE.

Advanced practice registered nurses (APRNs) represent a crucial resource to meeting growing health care needs. Such resources must be used to the full extent and in the most effective way possible. Through the development of the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education (LACE), nursing is assuming a leadership role within the health care system and participating as an equal partner in redesigning health care. When fully implemented, the Consensus Model will allow APRNs to practice to the full scope of their education and more easily move from one state to another, increasing access to quality health care for all populations.

Ensuring a nurse practitioner workforce prepared to care for older adults: findings from a national survey of adult and geriatric nurse practitioner programs.

PURPOSE: To present the findings from a needs assessment of adult primary care (ANP), gerontological (GNP), and adult acute care (ACNP) nurse practitioner faculty regarding the transition to adult-gerontology NP (A-GNP) programs. DATA SOURCES: Data were obtained from two sources: (a) an online survey to identify the faculty's primary needs in order to facilitate success in this transition and (b) telephone focus groups to explore survey responses in greater depth. CONCLUSIONS: The survey and the focus group findings indicate that there is a strong need for (a) access to a set of nationally recognized competencies for A-GNPs; (b) teaching/learning resources to support faculty in implementation of A-GNP programs; and (c) formal faculty development opportunities to facilitate faculty efforts to engage in curricular redesign and innovations and assure that NP students acquire strong competence in gerontology content. IMPLICATIONS FOR PRACTICE: The transition to A-GNP has implications not only for NP faculty but also for practicing NPs. Almost all NPs care for older adults in a variety of settings. However, most of these NPs are not specialists in geriatrics. This article provides a context for self-assessment by these NPs of their own needs related to this transition.

Department of Health and Human Services releases new immersive simulation experience to improve infection control knowledge and practices among health care workers and students.

In this article, we review a newly developed evidence-based immersive simulation experience for use with health care personnel and students. The article provides information necessary for infection control professionals to understand the development process of the training. Evidence supporting the use of such training is provided, and opportunities to integrate this training into the health care setting and classroom are discussed.

Using the Clinical Prevention and Population Health Curriculum Framework to encourage curricular change.

The Healthy People Curriculum Task Force was established in 2002 to encourage implementation of Healthy People 2010 Objective 1.7: "To increase the proportion of schools of medicine, schools of nursing and health professional training schools whose basic curriculum for healthcare providers includes the core competencies in health promotion and disease prevention." In 2004, the Task Force published a Clinical Prevention and Population Health Curriculum Framework ("Framework") to help each profession assess and develop more robust approaches to this content in their training. During the 6 years since the publication of the Framework, the Task Force members introduced and disseminated it to constituents, facilitated its implementation at member schools, integrated it into initiatives that would influence training across schools, and adapted and applied the Framework to meet the data needs of the Healthy People 2010 Objective 1.7. The Framework has been incorporated into initiatives that help promote curricular change, such as accreditation standards and national board examination content, and efforts to disseminate the experiences of peers, expert recommendations, and activities to monitor and update curricular content. The publication of the revised Framework and the release of Healthy People 2020 (and the associated Education for Health Framework) provide an opportunity to review the efforts of the health professions groups to advance the kind of curricular change recommended in Healthy People 2010 and Healthy People 2020 and to appreciate the many strategies required to influence health professions curricula.

The roles of healthcare professionals in implementing clinical prevention and population health.

Across the health disciplines, clinical prevention and population health activities increasingly are recognized as integral to the practice of their professions. Most of the major clinical health professions organizations have begun incorporating clinical prevention and population health activities and services into educational curricula, the accreditation process, and training to affect clinical practice. Students in each health profession need to understand the roles played by those in other health professions. This understanding is a prerequisite for better communication and collaboration among the professions and for accomplishing the educational objectives included in Healthy People 2020 and organized using the Education for Health framework. To help accomplish these goals, this article summarizes each health profession's contributions to the field of prevention and population health, explains how the profession contributes to interprofessional education or practice, reviews specific challenges faced in the provision of these types of services, and highlights future opportunities to expand the provision of these services. Several general themes emerge from a review of the different health professions' contributions to this area. First, having well-trained prevention and population health professionals outside of the traditional public health field is important because prevention and population health activities occur in almost all healthcare settings. Second, because health professionals work in interprofessional teams in the clinical setting, training and educating all health professionals within interprofessional models would be prudent. Third, in order to expand services, reimbursement for health promotion counseling, preventive medicine, and disease management assistance needs to be appropriate for each of the professions.

Positioning advanced practice registered nurses for health care reform: consensus on APRN regulation.

Advanced practice registered nurses (APRNs) have positioned themselves to serve an integral role in national health care reform. This article addresses both the policy and the process to develop this policy that has placed them in a strategic position. A successful transformation of the nation's health system will require utilization of all clinicians, particularly primary care providers, to the full extent of their education and scope of practice. APRNs are highly qualified clinicians who provide cost-effective, accessible, patient-centered care and have the education to provide the range of services at the heart of the reform movement, including care coordination, chronic care management, and wellness and preventive care. The APRN community faces many challenges amidst the opportunities of health reform. However, the APRN community's triumph in reaching consensus on APRN regulation signifies a cohesive approach to overcoming the obstacles. The consensus model for APRN regulation, endorsed by 44 national nursing organizations, will serve as a beacon for nursing, as well as a guidepost for consumers and policymakers, on titling, education, certification, accreditation, and licensing for all four APRN roles.

The clinical nurse leader: a catalyst for improving quality and patient safety.

AIM: The clinical nurse leader (CNL) is a new nursing role introduced by the American Association of Colleges of Nursing (AACN). This paper describes its potential impact in practice. BACKGROUND: Significant pressures are being placed on health care delivery systems to improve patient care outcomes and lower costs in an environment of diminishing resources. METHOD: A naturalistic approach is used to evaluate the impact the CNL has had on outcomes of care. Case studies describe the CNL implementation experiences at three different practice settings within the same geographic region. RESULTS: Cost savings, including improvement on Centers for Medicare and Medicaid Services (CMS) core measures, are realized quickly in settings where the CNL role has been integrated into the care delivery model. CONCLUSIONS: With the growing calls for improved outcomes and more cost-effective care, the CNL role provides an opportunity for nursing to lead innovation by maximizing health care quality while minimizing costs. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing is in a unique position to address problems that plague the nation's health system. The CNL represents an exciting and promising opportunity for nursing to take a leadership role, in collaboration with multiple practice partners, and implement quality improvement and patient safety initiatives across all health care settings.

Changing the face of nursing faculty: minority faculty recruitment and retention.

Critical shortages in the nursing workforce pose life-and-death decisions for health care institutions. Similar shortages of nursing faculty, particularly nursing faculty with doctoral degrees, confront schools of nursing. Competition among health care institutions and schools of nursing for master's- and doctorally prepared nurses is fierce. Credentialed minority faculty are in even greater demand. Rising salaries and increasing opportunities outside of academia present significant barriers to schools of nursing seeking to recruit and retain minority nursing faculty. Challenges to increasing the number of minority nursing faculty surface very early in the pipeline and include competition among health professions and other disciplines for minority students. Successful long-term strategies to increase the number of minority nursing faculty must include strategies to attract higher numbers of minority students into baccalaureate, master's, and doctoral nursing programs. Several initiatives to increase minority student enrollment in the health professions are highlighted. Finally, strategies for recruiting, empowering, and retaining minority nursing faculty by schools of nursing are presented.

Implementing innovation through education-practice partnerships.

Calls to transform the healthcare system and evolve the preparation of healthcare professionals have increased in recent years. In response to the concerns and recommendations voiced in the series of national reports, the American Association of Colleges of Nursing (AACN) Board of Directors initiated a series of task forces from 1999-present. The pilot Clinical Nurse Leader (CNL(trade mark)) initiative which grew out of the work of the task forces represents an exemplary national partnership between nursing education and practice. The CNL is a new nursing role being developed and piloted by the AACN in collaboration with education and practice leaders. An AACN task force, comprised of equal representation from education and practice, is currently working with 86 partnerships, including 92 schools of nursing and 191 health care institutions, to implement the CNL initiative. All of the partnerships have committed to collaboratively develop a master's CNL degree program and to transform one or more units within the healthcare institution utilizing the new CNL role. Early patient care outcomes from the initiative are positive. However, one additional outcome realized from the initiative has been the coming together of nursing education and practice to achieve a common goal-improved patient care outcomes.