Shaping the Future of Nursing Education and Practice: AACN Essentials Revision and the Next Generation NCLEX

In support of our mission “to advance the discipline of nursing/nursology through equitable and rigorous knowledge development using innovative nursing theory in all settings of practice, education, research and policy,” the Nursing Theory Collective (NTC) emailed the workgroup chairs of the American Association of Colleges of Nursing (AACN) Essentials Task Forces on September 16th, 2019. In this email, we as the NTC advanced our support for a strong nursing perspective and theoretical orientation in the planned revisions to the Essentials documents that form the basis for nursing education at all levels of study. To date, we have received positive responses from the chairs of the baccalaureate, master’s, and DNP essentials revision workgroups. We understand that AACN has invited nursing faculty to have discussions regarding the Essentials, both at their universities and future conferences. We have provided our letter below to foster open dialogue regarding the importance of nursing theory in the future of nursing education. Please join these conversations as you are able and feel free to use the points we have developed as a starting point for your thoughts as well.

In addition to the effort regarding the Essentials revision, we also reached out to the National Council of State Boards of Nursing (NCSBN) regarding the Next Generation NCLEX Project (NCSBN, 2019). As you are likely aware, the NCLEX is currently under revision with an eye toward ensuring novice nurses possess the necessary skills to detect the subtle changes in patient status, preventing deterioration, as well as avoiding errors. In pursuit of this project, the NCSBN has underscored the importance of clinical judgment and decision making in the safe practice of newly registered nurses. It is our concern that due to the absence of a framework founded in nursing knowledge and theory, the disciplinary perspective is lost such that clinical reasoning and clinical judgment devolve from a nursing skill to a generic biomedical task orientation (Bender, 2018). Moreover, the absence of nursing theory in the foundation of the Next Generation NCLEX project begs questions about our core values, how we value nursing knowledge, and to what regulation we agree to adhere (Perron & Rudge, 2015). Email communication with NCSBN about theory content and a guiding theoretical framework belied a lack of interest on their part in engaging in discussion of this issue, at least at this time. Given the role that the Essentials play in nursing education, the NTC has decided to focus on our efforts with the Essentials. We hope that, in time, with revision to the Essentials NCSBN will be motivated to consider the role of nursing theory in NCLEX and more readily engage. 

Appended below you will find our Essentials letter to the DNP workgroup, which is similar to the other two Essentials letters. Please share our letter among your colleagues to assist in the facilitation of discourse on this important topic.

Dear members of the DNP Essentials workgroup,

            We are writing to you today because of your role in the workgroup for the Revisions of American Association of Colleges of Nursing (AACN) DNP Essentials. We represent the Nursing Theory Collective. Our collective membership, made up of experienced nurse clinicians, researchers, educators and scholars, as well as graduate students, emerged from the landmark nursing conference that was held at Case Western Reserve University called Nursing Theory: A 50 Year Perspective, Past and Future in March, 2019. 

As future educators and scholars, we represent the next generation of nurses who will implement the DNP Essentials in the process of educating nurses in the decades to come. We recognize that the DNP Essentials will have a substantive influence on the future of nursing education.

We appreciate your efforts as in the DNP Essentials workgroup and the challenges inherent in taking on the task of creating this powerful and empowering nursing document. We understand that this document, when finalized, will significantly influence the curriculum and the education of thousands of nurses in our country for many years.

It is the recognition of the lasting power and influence of the DNP Essentials recommendations that brings us to write to you today. We join with the American Holistic Nurses Credentialing Center and nursing leaders from institutions of nursing education across the country to respectfully ask that you consider the following points of concern:

1. Theory and Competencies
Nursing theory, representing the wide variety of theories, frameworks, and models used in nursing and including those that provide the historical foundations of nursing, are missing from competencies within the DNP Essentials recommendations. We request that nursing theory and nursing history be included in the Essentials at every level because it is anchors us to our past, present, and future knowledge of nursing. Nursing theory, including knowing the connections to its philosophical roots, shapes who we are as nurses and highlights the critical and distinct human service of nursing that is not met by other disciplines. Education in nursing theory, along with other essential educational content, ensures a solid foundation in disciplinary knowledge and perspective for future nurses, nurse scientists, and scholars. The ongoing development of nursing theory can also lead to the creation of knowledge that can be shared across disciplines. 

2.  Disciplinary Perspective
Competency-based education in nursing must reflect our unique disciplinary perspective with a focus on protecting, promoting and restoring health and well-being, the prevention of illness and injury, the alleviation of suffering (ANA, 2015, p.1) and perspectives on humanizing the health experience (Reed, 1997; Willis, Grace & Roy, 2008). The provision of nursing theory as a foundation for nursing education reinforces our discipline-specific perspective. Nurses need to be competent in articulating the history, voice, and vision of nursing. 

3. Nursing-Centered Frameworks 
Competencies derived from the biomedical models like the Interprofessional Domains of Practice (Englander, Cameron, Ballard, Dodge, Bull, & Aschenbrener, 2013) minimize 100 years of knowledge building that evolved within nursing to define the discipline specific contributions nursing brings to the patient care experience as a science and a discipline. This undermines the existence of the historical work that has been done in nursing theory development, and impedes the future progress of our discipline.

4. Nursing Identity
Interprofessional collaboration must be built upon a strong identity as nurses, so that each nurse can articulate what they bring to the healthcare team, highlighting the priorities that are different from but complementary to the interprofessional team. Without this perspective it will be all too easy for nurses to lose sight of their unique contributions to the interdisciplinary team.

5.  Healthcare Trends 
Healthcare trends and expectations will influence nursing’s roles and practice within healthcare delivery for the next decade, as AACN has articulated, making our strong nursing identity and unique perspective on patient care more important than ever. We are concerned that some current trends in healthcare may emphasize profit, technology and disease over the importance of nursing care, including an alarming shift away from the caring, holistic, scientific, and relationship-based nature of nursing and towards an often profit-driven, technical and biomedical model of interdisciplinary focus where nurses becoming identity-less “health care professionals.”

We envision harnessing the power of nursing through carefully constructed educational essentials to actively shape a just and equitable healthcare service model in the United States of America, and provide future nurses with a clear identity as nurses. However, our future nurses must be educated in the fundamental theoretical and philosophical foundations of nursing in order to preserve the character and ethos of our profession. 

In summary, nursing has always embraced interdisciplinary teamwork. However, we believe that our essential educational competencies must remain firmly grounded in nursing values, nursing theory, and nursing history. Educational essentials and nursing competencies must first reflect our nursing perspective, not those of other disciplines. 

We are nurses and our educational competencies should reflect nursing knowledge and nursing theory. We urge you to consider our recommendations, and how framing of the DNP Essentials within a biomedical, interdisciplinary model would minimize over 100 years of scholarly work by nurses to advance a unique disciplinary perspective and identity. We further recognize the impact that DNP-prepared nurses will have in the future of nursing and the future of healthcare, underscoring the urgency of our concerns.

We acknowledge and appreciate all of the hard work your committee has put forth on this important topic. We hope that you will consider our position in your future revisions of the DNP Essentials. If you wish to have further dialogue on this issue, we as future and present nurse leaders would appreciate the opportunity to engage further.

With gratitude,
The Nursing Theory Collective   

Cosigned by:
Brandon Brown, EdD Student, MSN, RN-BC, CNL 
Ellen Buckner PhD, RN, CNE, AE-C, FNAP
Clare Butt, RN, PhD 
Jill Byrne, MSN, RN, CNOR, PhD Student
Gayle L Casterline, PhD, RN, AHN-BC
Peggy L. Chinn, RN, PhD, DSc(Hon), FAAN
Da’Lynn Clayton, PhD, RN 
Catherine Cuchetti, RN, MSN
Jessica Dillard-Wright, PhD Candidate, MA, CNM, RN
Margaret Erickson, PhD, RN, CNS, APRN, APHN-BC
Rosemary W. Eustace, PhD, RN, PHNA-BC
Jacqueline Fawcett, RN; PhD; ScD (hon); FAAN, ANEF
Pamela Grace, RN, PhD, FAAN
Consuelo Grant, PhD Student, BSN, RN
Debra R. Hanna, PhD, RN, ACNS-BC
Jane Hopkins Walsh, PhD Candidate, PNP-BC, RN
Yuanyuan Jin, PhD Student, MSN, RN
Amy Kenefick Moore, PhD, RN, APRN, CNM, FNP-BC, APHN-BC, HWNC-BC
Kan Koffi, RN, AD, B.Sc., M.Sc.
Carrie Langley, PhD Student, MSN, MPH, RN 
Patricia Liehr, PhD, RN
Chloe Littzen, PhD Student, MSN, RN, AE-C
Colleen Maykut, RN, BScN, MN, DNP
Melissa McCoy, MSN, RN
Angela Norton, PhD Student, MSN/Ed, RN
Christina Nyirati, PhD, RN
Judith Pare, PhD, RN
Marilyn Ray, RN, PhD, CTN-A, FSfAA, FAAN, FESPCH (hon.), FNAP
Pamela Reed, PhD, RN, FAAN
M. Kay Sandor, PhD, RN, LPC, AHN-BC
Phyllis Shanley Hansell, DdD
Mike Taylor RN, MHA, CDE
Billie S. Vance, MSN, FNP-BC
Sylvia K. Wood, DNP, ANP-BC, AOCNP
Rorry Zahourek, PhD, RN, PMHCNS-BC (ret), AHN-BC, FAAN

References

American Nurses Association. (2015). Nursing scope and standards of practice (3rd ed.). Silver Spring, MD: American Nurses Association.

Bender, M. (2018). Re-conceptualizing the nursing metaparadigm: Articulating the philosophical ontology of the nursing discipline that orients inquiry and practice. Nursing Inquiry, 25(3), 1-9. doi: 10.1111/nin.12243

Englander, R., Cameron, T., Ballard, A. J., Dodge, J., Bull, J., & Aschenbrener, C. A. (2013). Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Academic Medicine, 88(8), 1088-1094. doi: 10.1097/ACM.0b013e31829a3b2b

NCSBN. (2019). Next generation NCLEX project. Retrieved from https://www.ncsbn.org/next-generation-nclex.htm 

Perron, A., & Rudge, T. (2015). On the Politics of Ignorance in Nursing and Health Care: Knowing Ignorance. New York, NY: Routledge.

Reed, P. G. (1997). Nursing: The ontology of the discipline. Nursing Science Quarterly, 10(2), 76-79. doi: 10.1177/089431849701000207

Willis, D. G., Grace, P. J., & Roy, C. (2008). A central unifying focus for the discipline: facilitating humanization, meaning, choice, quality of life, and healing in living and dying. Advances in Nursing Science, 31(1), E28-E40. doi: 10.1097/01.ANS.0000311534.04059.d9.

An Update from the Nursing Theory Collective

Welcome to Chloe Olivia Rose Littzen, who has now joined our
Nursology.net blogging team!
Chloe is a founding member of the
Nursing Theory Collective and
currently a PhD Student at the University of Arizona (Tuscon)

I. Introduction

In June of this year, a blog post was shared on Nursology.net by the Nursing Theory Collective, a group of scholars and students with a mission to advance the discipline of nursing/nursology through equitable and rigorous knowledge development using innovative nursing theory in all settings of practice, education, research, and policy. (Visit that post here). We are using the term nursing/nursology as at this moment in time as we continue to have discourse on the exact word choice we will use to characterize ourselves as a collective. 

To review, the Nursing Theory Collective was formed after the landmark conference, “Nursing Theory: A 50 Year Perspective Past and Future”, on March 21-22, 2019 at Case Western Reserve University. Since May, the group has met monthly to further discuss pivotal issues related to nursing theory and the identity of nursing/nursology, define their mission and vision statement, and to establish action items to drive their vision forward. Currently, the Nursing Theory Collective has 45 members from around the world including Canada, China, Colombia, and the United States, promoting a global perspective of nursing and nursing theory. 

To promote global connectivity, the Nursing Theory Collective created a WhatsApp (https://www.whatsapp.com) group for an easily accessible format that members in other countries can easily connect via their smartphones. In this WhatsApp group, members discuss pertinent issues related to nursing theory and the identity of nursing, sharing articles, actions in progress, or reminders for actions that evolved from previous meetings. Our meetings have been hosted via Zoom Video Conferencing (https://zoom.us) which enables access to participate in most countries, and has allowed us to record all meetings for future reference. A shared Google Drive was also created, enabling all members to have access previous document, to assist in the development of future action items, and to collaborate in real time. 

II. Updates 

To date, the meetings for our collective have revolved around discussions on actions items that can be taken to move the discipline of nursing and nursing theory into the future. In order to accomplish our collective goals, we have been working to define our mission, vision and values, and establishing logical action plans in the forms of scholarly writing and policy letters. In the following paragraphs, you will find a brief synopsis of all the action items that are in progress or completed. 

Mission, Vision, and Values. We have been working diligently on defining our mission, vision, and values as a collective. We recognize that this is a work in progress. We have been inspired by the vast body of prior nursing knowledge and theory work in the United States and abroad, as well as our individual philosophies of nursing. Guiding our mission, vision, and values is a concise definition of nursing theory first advanced by a working group of international nurse theorists, who proposed that nursing theory is simply “a description of what is going on” (Petrovskya, Purvis, & Bjornsdottir, 2019, p.2). Petrovskya, Purvis, and Bjornsdottir’s (2019), elegant definition, adopted from Rolland Munro, invites nurses to engage ideas beyond the theoretical paradigms most familiar to nurses educated in the United States. As this is an ongoing and open process, we invite you into the discussion and to add to our mission, vision, and values.

King Conference. In June 2019, the Nursing Theory Collective submitted an abstract that was accepted to the upcoming King Theory Conference in Washington, D.C. (King International Nursing Group, 2019). The topic of our abstract is, “Driving the Future of Nursing: A Collective Approach to Nursing Theory.” We look forward to being a part of this landmark conference. We plan to arrange a meeting of the Nursing Theory Collective at the King conference, and we welcome all members and non-members to join us for important discussions in driving nursing and nursing theory into the future. We will post details about the time and place for this get together as the date gets closer. One action item of this in-person meeting at the King Conference will be to continue the debate surrounding the adoption of the term nursology to characterize ourselves. 

III. Collaborative Efforts 

As we are a collective, we understand the importance of branching out and collaborating with individuals and groups to enable us to accomplish our mission and vision. To date, collaborative efforts have been placed into two categories: 1) Nursology, and 2) policy items related to nursing education and the future of nursing. Below is a brief synopsis of both of these efforts. 

Nursology. In 2015, Dr. Jacqueline Fawcett presented a case for changing the name of nursing to nursology (Fawcett et al., 2015). A variety of nursing scholars have echoed support for this change, but others have been questioning how this impacts on the discipline as we know it (Parse, 2019). To be mindful of all members views, we held an anonymous survey in June – July 2019 to adopt the term Nursology in our name, mission, vision and values. A total of eighteen votes were received, with 11 (61.1%) in support of adopting Nursology, and 7 (38.9%) in opposition. Members also had the option to write-in anonymously a rationale for their vote, and a variety of comments were received. For example, one member who was in support of the adoption asked “if there was an opposition for the collective to have an open discussion as to why this was.” Concerns that were raised by members in opposition included the marginalization of practicing and non-academic nurses, the validity and legitimacy of the term, and the belief that Nursology should be a term reserved for higher degrees in nursing such as the PhD. Supporters of the adoption argued that the term Nursology, while radical, would improve the strength of the identity of nursing, and has powerful implications for the general public and legislation.

Prior to the results being discussed, Dr. Fawcett kindly agreed to participate in our meeting where we discussed the adoption of the term Nursology, as well as the rationale for members in support or opposition. With this discussion, members had opportunities to further voice their opinion, and ask important questions related to the term and its meaning. For example, one member asked for whom the title nursologist should be reserved. Dr. Fawcett and other members designated the adoption of the term nursologist for all members, who have passed their licensing examination and are a registered nurse. At the end of the meeting, it was proposed as the group was undecided to adopt the term nursology into the mission, vision, and values, but also include nursing. We thank Dr. Fawcett for her involvement, and plan to keep the Nursology group updated as we move forward. Our next discussion on this topic will be in November at the King Conference in Washington, D.C.

Policy Items. In July, two members of the Nursing Theory Collective participated in a Zoom meeting with board members from the American Holistic Nurses Credentialing Corporation (AHNCC, 2019). The purpose of this meeting was to begin a discussion and collaborate on a campaign to express the need for nursing theory to be a core part of the current educational essentials, as they are being revised by the American Association of Colleges of Nursing (AACN) and the National Council of State Boards of Nursing (NCSBN). Action items from this meeting included the development of two letters focused on the educational essentials, as well as the revising of the National Council Licensure Examination for Registered Nurses (NCLEX-RN). To date, the letter to the AACN has been completed and is pending to be emailed out to key members of the essentials committee. After this, we plan to submit this letter for publication to spread the word of this important change that may impact the future of nursing. Our next step will be devising the letter the the NCSBN, we invite anyone who is interested in participating in developing this important letter. We thank the AHNCC for collaborating with us on this important project, and support them in their work as they promote a more holistic space for nurses to practice globally. 

IV. Future Efforts

While we have a significant to-do list as follow up from previous efforts, we continue to strive towards future actions in order to drive our vision for nursing and nursing theory into the future. We intend to remain vigilant about the AACN essentials, the NCSBN revision of the NCLEX, and will continue our activism aimed toward promotion of nursing theory at all levels of education. Our future actions include continuing our monthly meetings to have open discourse on the topic on nursing and nursing theory, we invite all members and non-members alike to participate. Additionally, we plan to write and submit manuscripts focused on demystifying nursing theory for practicing nurses and the educational environment. We welcome any and all ideas on how we can move forward with our goals, and hope that you would consider being a part of this movement. 

V. Conclusion and Invitation – Join us!

The next meeting for the Nursing Theory Collective is August 27th, at 2:00 PM Eastern Standard Time. We encourage all nurses and students, regardless of setting, experience, or educational level, to join us by contacting clittzen@email.arizona.edu to participate. If you are interested in joining the WhatsApp group, please email us to let us know and we will add you promptly. We also have a twitter handle, @NursingTheoryCo, and you are welcome to follow us as we plan future social media events. We plan to continue to update the community here on Nursology.net to keep everyone informed, as well as promote a movement of inclusivity to drive nursing and nursing theory into the future.

With gratitude,
The Nursing Theory Collective

References

American Holistic Nurses Credentialing Corporation. (2019). About AHNCC. Retrieved from https://www.ahncc.org/about-ahncc/

Fawcett, J., Aronowitz, T., AbuFannouneh, A., Al Usta, M., Fraley, H. E., Howlett, M. S. L., . . . Zhang, Y. (2015). Thoughts about the name of our discipline. Nursing Science Quarterly, 28(4), 330-333. doi: 10.1177/0894318415599224

King International Nursing Group. (2019). Events. Retrieved from https://kingnursing.org/content.aspx?page_id=4002&club_id=459369&item_id=976945

The Nursing Theory Collective. (2019, June 18). Moving Towards the Next Fifty Years Together [Blog post]. Retreived from https://nursology.net/2019/06/18/moving-towards-the-next-fifty-years-together/

Parse, R. R. (2019). Nursology: What’s in a name? Nursing Science Quarterly, 32(2). doi: 10.1177/0894318419831619

Petrovskaya, O., Purkis, M. E., & Bjornsdottir, K. (2019). Revisiting “Intelligent Nursing”: Olga Petrovskaya in conversation with Mary Ellen Purkis and Kristin Bjornsdottir. Nursing Philosophy, 20(3), e12259. doi: 10.1111/nup.12259.

Moving Towards the Next Fifty Years Together

We are delighted to welcome guest bloggers representing the  Nursing Theory Collective
formed March 2019 Case Western Reserve
Nursing Theory Conference:
Chloe Littzen, Jane Hopkins Walsh  and Jessica Dillard Wright

I. Introduction

Chloe Littzen

Jessica Dillard-Wright (L) and Jane Hopkins-Walsh (R)

In March 2019, 130 nurses from all over the world gathered at Case Western Reserve University Frances Payne Bolton School of Nursing in Cleveland, Ohio for Nursing Theory: A 50 Year Perspective, Past, and Future, a landmark conference to celebrate the history of nursing theory and elicit discussion for the future of nursing. The attendees were diverse, comprised of seasoned nursing theorists and doctoral students in equal measure, participating in lively and thoughtful conversation across many domains. The future of nursing theory quickly emerged as a critical issue as nurses working at all levels of expertise expressed their concern over the loss of nursing theory at the institutional level, both academic and clinical. What is at stake in this erosion is discipline-specific nursing knowledge, in particular at this 50-year juncture as the great theorists of nursing like Drs. Peggy Chinn, Joyce Fitzpatrick, Pamela Reed, Callista Roy, Marlaine Smith, and many others approach the end of their illustrious careers. The question resonated, “who will carry the nursing theory torch forward?”

To advance the discipline of nursing, the next wave of nursing theorists and thought leaders must actively engage to advance nursing theory, improve nursing praxis, and articulate nursing’s identity leading our profession into the future. This is the rallying cry that led to the blog post you are reading today. In follow-up to this conference, doctoral student Chloe Littzen engaged other students who attended to embark on a collaborative effort to articulate our vision for the future of nursing theory. What follows is a brief discussion of our course so far, the background, plan, and desired outcomes for convening a nursing theory working group as we envision the next fifty years of nursing theory and beyond.

lI. Background

After the landmark conference concluded, a collaborative effort ensued to form a theory working group focused on promoting nursing theory and advancing nursing’s identity. This group is comprised of both scholars and students and is open to all nurses practicing in all settings. Our first meeting was held online via video-conferencing on May 18th, with a total of six participants from Arizona, Massachusetts, and West Virginia. This first meeting was an experimental think-tank where we considered ideas about the future of nursing and our professional identity. Below, we outline our mission and vision for this nursing theory working group.

III. Plan

The primary mission, as established by our working group, is to promote nursing theory and advance the identity of nursing through knowledge development for all nurses in all settings, including practice, education, research, and policy. As a group, we believe that nursing and nursing theory are dynamic and evolving to meet the needs of an increasingly complex healthcare landscape and global environment. In order to keep nursing theory and nursing relevant and current, thinking about theory must be on-going and iterative, with a continuous cycle of critique, testing, and scholarship. Failure to seriously engage these questions has dire consequences for nursing theory and the profession as nursing as it slowly cedes its identity to the economic pressures of the healthcare environment and the supremacy of biomedicine.

The following bullets summarize our discussion and desired outcomes from the first nursing theory workgroup meeting:

  • Discussion Points:
    1. We need a plan to sustain and evolve nursing theory and nursing’s identity with discipline-specific knowledge.
    2. Nursing theory must be derived from and applicable to the practice environment, not just academia.
    3. The purpose of nursing theory must be clarified for nursing practice, education, research, and policy.
    4. Nurses in clinical practice must have an educational foundation grounded in nursing theory that empowers the application of theory in practice.
    5. Nursing students must be educated and mentored in nursing theory, beginning at the pre-licensure level.
    6. This discussion must include considerations of how nursing theory is taught in the academic environment and how that can be linked to and informed by nursing practice.
    7. The need for nursing theory is global, making this an international, even planetary problem.
  • Desired Outcomes:
    1. To write a manuscript demystifying nursing theory for the nurse in the practice environment.
    2. Write a second manuscript demystifying nursing theory for the nurse educator in academia.
    3. Explore the potential of a future study identifying and describing the barriers and facilitators for using nursing theory in practice, education, research, and policy settings.
    4. Share the discussions, experiences, and findings with the community at Nursology.net.

IV. Invitation – Join us!

While we are a new workgroup, we welcome and encourage all nurses, both advanced scholars and novice theorists alike, to consider joining us in this journey in promoting nursing and nursing theory into the future. We currently meet monthly over Zoom video-conferencing. If you are interested, please contact form below to be placed on the email list for future meetings and content.

If you are planning to go to the 2019 Collaborative K.I.N.G. conference in Washington D.C. from November 14th-15th, we are planning an in-person meeting to take place. We hope to see you there as we drive nursing and nursing theory into the future. Join us!

With optimism and gratitude for the future,
Nursing Theory Collective
(Final group name pending vote at next meeting)

Footnotes:

See more information on the King Conference here.

See more information on the landmark theory conference at Case Western Reserve University Frances Payne School of Nursing here.

Please use this form to contact us if you want to join us, or for more information!