Nursing on the Edge of Possibility: What will in take to be catalyst for change?

1. Nursing on the Edge of Possibility: What will in take to be catalyst for change? Paula Gubrud Ed.D, RN FAAN Maine Partners in Education and Practice May 22, 2012

2. On the Edge of Possibility • Transforming Nursing Practice and Education will require: • Acknowledging new realities • New Curriculum • New Pedagogy for New Learners • New Models for Clinical Education • New Organizations • New Leadership

3. Nursing is Facing • Increasing complexity of population needs • Constant rapid change in our organizations • Burgeoning use of knowledge and technology required to practice • Paradoxical image at the edge of health care reform

4. Challenges • Essentially static nursing education system • Practice/Education Gap • Immobilized by disputes about “levels of education” • Uninformed by advances in science of learning • Clinical education approaches unchanged since the 1940’s

5. Oregon’s Innovations: In the beginning… • Oregon Nurse Leadership Council/Collaborative • A conflict in practice created opportunity for collaboration • Five Member Organization • Oregon Council for Associate Degree Nursing • Oregon Council of Deans • Oregon Nurses Association • Northwest Organization of Nurse Executives • Oregon State Board of Nursing

6. 2001 ONLC Strategic Plan • 2 Goals related to nursing education • Double Enrollment • Transform Nursing Education to align with today’s practice environment

7. The Edge of Possibility • New Curriculum to Prepare a “New Nurse” • with competencies beyond those in our traditional nursing programs • with deeper understanding of prevalent health care conditions and situations • prepared to function in times of chronic nurse shortage • prepared to lead and influence policy

8. The Oregon Consortium forNursing Education A Partnership of Oregon nursing programs designed to: Prepare the “new” nurse with competencies needed for changing health care demographics Increase capacity in nursing programs Increasing number of baccalaureate graduates by creating shared 4 year curriculum Prepare leaders needed to influence new health care systems

9. Redefining and Redesigning Curriculum • Competency-based, directed toward knowledge & abilities needed to provide: • Patient/relationship centered care • For an aging & increasingly diverse population • In highly complex environments • That increasingly require interdisciplinary teamwork, leadership and use of quality improvement, informatics and technology

10. Developing the OCNE Curriculum: Initial Agreements • Competencies describe a “new” nurse • Preparation of this new nurse will probably take 4 years • Requires a new system of nursing education using all available resources from existing educational programs

11. Living on the Edge: Requires transformation of: • Curriculum – outcomes, selection, organization & sequence of content & learning experiences • Pedagogy – assumptions about the learning and approaches that recognize the continued advances in the science of learning and integrates the characteristics of diverse learners

12. The OCNE Curriculum • Baccalaureate curriculum with opportunity for community college students to complete AAS and sit for NCLEX on the way to BSN • Built on redefined fundamentals • Competency-based • Integrated • Spiral

13. Redefined Fundamentals

14. Redefined Fundamentals • Evidence-Based Practice • Relationship Centered Care • Clinical Judgment • Leadership In the context of Health Promotion

15. Competency-based:10 competencies which reflect - - • Ethical practice • Intentional (self-directed), reflective learner • Engage in teamwork and provide leadership • With strong communication skills and capable of systems thinking • Skillful clinical judgment and evidence-based practice

16. Integrated • Courses organized around foci of care: • Health Promotion • Chronic Illness Management • Acute Care • End-of-Life Care • And “cross-cutting competencies” • Leadership & Outcomes Management • Population Based Care

17. Spiral • providing for multiple encounters with most important concepts, dimensions of competencies, & health & illness context in varying populations & settings

18. The New Pedagogy • Draws on tremendous advances in the science of learning from a variety of disciplines (cognitive science, psychology, higher education) • Emphasizes deep understanding of the discipline’s most central concepts

19. The New Pedagogy • Guides design of learning activities which promote: • Active engagement of the learner • Clear performance expectations, practice and frequent, specific and constructive feedback

20. The New Pedagogy • Guides design of learning activities which promote: • Strong, learning-focused social interactions • Development of habits in metacognition/reflection, self assessment, and self-directed learning

21. Active engagement in authentic practice situations: Case-based . • CORE/Mega Cases that integrate across competencies, relate to highly prevalent health problems, across age span and diverse populations • Dilemma cases underscoring ethical issues • Unfolding cases, demonstrated clinical situations as they unfold • Student narratives of their own experience

22. Reforming Clinical Education: From Mother Duck to Mother Lode (Tanner 2010)

23. OCNE Clinical Education Model • Purposeful Design of Clinical Education • Considering development of • Practical knowledge • Skilled Know-how • Habits of Thought • Understanding of self as caring clinician

24. Focused Direct Client Care Integrative Experience Intervention Skill Based Experiences CLINICAL LEARNING Concept Based Case Based Simulation CLINICAL LEARNING MODEL

25. CLINICAL LEARNING MODEL

26. CLINICAL LEARNING MODEL

27. CLINICAL LEARNING MODEL

28. CLINICAL LEARNING MODEL

29. CLINICAL LEARNING MODEL

30. Early Clinical Learning Experiences Concept Based Case Based Intervention-Skill Based Direct- Focused Care

31. Mid-Program Learning Experiences Case Based Focused Direct Patient Care Concept Based Intervention- Skill Based

32. End-of-program clinical experiences II Integrative Experience Concept- Based Intervention- Skill Based Case-Based

33. OCNE Front Story: Planned Processes • Coordinating Council • Faculty committees • Stakeholder involvement • Agreement for a new kind of leadership • Consortium-wide consensus building approach • Faculty development & involvement

34. Back Story:The Lived Experience • Developing trusting relationships • Keeping the vision alive • Setting the common good above individual interests • Celebration and humor (Buttons) • Inclusiveness • Facilitation to smooth rough edges & move forward

35. The OCNE Vision • Front story – the statement of vision, tag line “Working together for healthy communities” • Back story – commitment to collaborative process and preparing a new kind of nurse for future health care

36. Adaptive Leadership to Transform • Embrace ambiguity and tolerate false starts – to enjoy the “unfolding” process • A “good enough vision” • Paradox and Tension • Multiple Actions • Risk Taking • Boundary Spanning

37. Catalyst for Transformative Change: Requires the Whole Story • Guiding principles for working together • Develop and Document (sometimes a facilitator will be needed) • Front story – formal document • Back story – living to the agreement

39. Maine Nurse Leaders will be pouring… • Commitment to excellence • Inclusiveness • Beneficence, collegiality • Courage/perseverance • Healthy conflict, and most importantly- support, embrace and celebrate your commitment to the health of Maine’s Citizens

40. Ancient Proverb If you want to go quickly, go alone. If you want to go far, go together.

41. For more information Visit us at www.ocne.org

42. References Gubrud, P., & Schoessler, M. (2010). OCNE clinical education model. In N. Ard & TM Valiga (Eds) Clinical nursing education: Current reflections (pp. 39-58). New York: National League for Nursing Gubrud-Howe, P., & Schoessler, M. (2008). From random access opportunity to a clinical education curriculum. Journal of Nursing Education, 47(1), 3-4. Gubrud-Howe P. Shaver KS. Tanner CA. Bennett-Stillmaker J. Davidson SB. Flaherty-Robb M. Goudreau K. Hardham L. Hayden C. Hendy S. Omel S. Potempa K. Shores L. Theis S. Wheeler P. (2003) A challenge to meet the future: nursing education in Oregon, 2010. Journal of Nursing Education. 42(4):163-7 Heifetz, R., Grashow, A., & Linsky, M. (2009). The Practice of Adaptive Leadership. Boston MA: Harvard Business Press Lindberg, C., Nash, S. & Lindberg, C. (2008). On the Edge: Nursing in the Age of Complexity. Bordentown, New Jersey: Plexus Press

43. References continued Tanner, C. A. (2010). From mother duck to mother lode: Clinical education for deep learning. Journal of Nursing Education, 49,(1), 3-4. Tanner, C.A., Gubrud-Howe, P., & Shores, L. (2008). The Oregon Consortium for Nursing Education: A Response to the Nursing Shortage. Policy, Politics and Nursing Practice, 9(3):203-09. Zimmerman, B., Lindberg, C., & Plsek. (2008). Edgeware: Lessons from complexity science for health care leaders.