NUR6003 Module 2 competency framework alignment example

Eight Old Outcomes, Ten New Domains: A Crosswalk of a Rural BSN Program's End-of-Program Outcomes to the AACN Essentials, the Gaps It Found and What Changes First

Student Name

American College of Education

NUR6003: Influencing Forces in Nursing Education

Module 2 Assignment

Instructor Name

January 21, 2030

Why the Outcomes Need Aligning

Our BSN program's eight end-of-program student learning outcomes were written in 2011 against the previous version of the AACN Essentials and have been edited only lightly since. In 2021 the American Association of Colleges of Nursing (AACN) replaced that document with a competency-based framework of ten domains, eight featured concepts threaded through every domain, and a set of competencies, each broken into smaller sub-competencies, defined separately for the first professional degree and for advanced levels (AACN, 2021). Accreditors now expect programs to show how their curricula incorporate the current Essentials, and our next accreditation visit is three years away. The alignment is therefore required. But it is also an opportunity to ask whether our graduates can do what the partner hospitals need them to do on their first day.

What Competency-Based Education Requires

The shift is not simply a matter of new wording. An international consensus group on competency-based medical education described it as an outcomes-based approach, organized around competencies, that focuses on accountability, gives more attention to the learner and less to time spent in the curriculum, and treats competence as developmental and dependent on context (Frank et al., 2010). For our program, that has two consequences. Outcomes must describe what a graduate can do, observably, rather than what they know or value. And each outcome needs assessments at several points in the program, so that faculty can show a student's progression toward it rather than inferring it from course grades. Our 2011 outcomes fail the first test in several places. One reads, for example, that the graduate will value lifelong learning, which describes an attitude that no assessment in our program actually measures.

The Crosswalk

I mapped each of our eight outcomes to the Essentials domains it addresses, using the domain descriptors and the entry-level competencies as the test, and marking a domain as covered only when one or more course-level assessments measure it. Outcome 1, on synthesizing knowledge from nursing and the sciences, maps to Domain 1, Knowledge for Nursing Practice. Outcome 2, on providing safe, holistic care, maps to Domain 2, Person-Centered Care, and partly to Domain 5, Quality and Safety. Outcome 3, on community and population health, maps to Domain 3, Population Health. Outcome 4, on applying research, maps to Domain 4, Scholarship for the Nursing Discipline. Outcome 5, on communication and collaboration, maps to Domain 6, Interprofessional Partnerships. Outcome 6, on leadership in health systems, maps partly to Domain 7, Systems-Based Practice. Outcome 7, on ethical and legal practice, maps to Domain 9, Professionalism. Outcome 8, on lifelong learning, maps in intention to Domain 10, Personal, Professional, and Leadership Development, but has no assessment.

The crosswalk shows three gaps. Domain 8, Informatics and Healthcare Technologies, has no outcome of its own; informatics content is spread across three courses, but no assessment measures whether students can use data and technology to support care. Domain 5 is only partly covered: we assess safe medication administration thoroughly, but not the competencies of quality improvement, such as using data to identify a problem and test a change. And Domain 10 is unmeasured. The gaps are not where our faculty expected them; they are in the domains we assumed were taught because they appear in syllabi.

Checking the Gaps Against the Workforce

A professional framework is one force; the needs of employers are another, and they do not always agree. At a large academic medical center, performance-based assessments given over five years to new graduate hires numbering above 5,000 showed that just 23% demonstrated entry-level competencies and practice readiness (Kavanagh & Szweda, 2017), a finding that suggests licensure pass rates alone give an incomplete picture of readiness. I asked the education director of our largest partner which weaknesses their residency program sees most in our graduates. The answer matched our gaps more closely than I expected: recognizing and acting on early deterioration, using the electronic record's early-warning scores and dashboards, and knowing how to raise a safety concern and follow it through. These are Domain 5 and Domain 8 competencies. The partner's residency program also expects new nurses to set their own development goals, which touches Domain 10, but the director did not rank it as a first-year concern.

Residency programs cannot be relied on to close every gap. In the regulators' transition to practice study, new nurses working where a structured transition program was already established reported fewer errors and negative safety practices and more competence than those in hospitals without them (Spector et al., 2015), but not all of our graduates go to hospitals with such programs; many take jobs in small rural hospitals and long-term care, where support is thin.

What Changes First

The evidence supports ranking the gaps by their consequence for patients in a new graduate's first year. Domain 5 comes first. We will add an outcome on recognizing and escalating clinical deterioration and participating in quality improvement, assessed in Adult Health II through a simulation scored against escalation criteria and in the senior practicum through a small improvement project on the student's unit. Domain 8 comes second. We will add an outcome on using clinical data and technology to support decisions, assessed through a simulated electronic record assignment in which students interpret early-warning scores and trends. Domain 10 comes third. We will rewrite Outcome 8 so that it describes an observable behavior, a graduate who assesses their own practice and sets and pursues development goals, and assess it through a professional development plan in the final semester, reviewed by the practicum preceptor.

The faculty will revise the outcomes this spring, map every course's assessments to the new outcomes over the summer, and pilot the new assessments next academic year. We will judge success by the proportion of students meeting each new outcome at the first and final assessment points, and by the partner's residency feedback on the first graduating class assessed against them.

The Featured Concepts and the Faculty

The domains are only half of the framework. The Essentials also name eight featured concepts that are meant to run through every domain: from clinical judgment and communication through ethics, health policy and the social determinants of health, with compassionate care, evidence-based practice and diversity, equity and inclusion among the rest (AACN, 2021). I repeated the crosswalk for the concepts, asking in which courses each is assessed. Six appear in several courses. Health policy appears in only one, a senior seminar, and clinical judgment, although it is the concept our partners care most about, is assessed mainly through examination questions rather than performance. The Domain 5 and Domain 8 changes above will add performance assessment of clinical judgment in two courses, which addresses the second weakness without a separate change. Health policy will be threaded into the community health course, where the county's loss of obstetric services gives students a concrete policy question.

None of this will happen unless the faculty own it. Twelve full-time and nine part-time faculty teach in the program, and mapping assessments to outcomes is slow work that competes with teaching. I will propose that each course coordinator map only their own course, using a one-page template, with two paid workshop days in the summer to review the maps together, and that the curriculum committee approve the new outcomes before any course is revised. Faculty who teach the clinical courses, where the new assessments will sit, will pilot them first, because their feedback will decide whether the assessments are practical at the scale of 96 students a year.

References

American Association of Colleges of Nursing. (2021). The Essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/essentials

Frank, J. R., Snell, L. S., Cate, O. T., Holmboe, E. S., Carraccio, C., Swing, S. R., Harris, P., Glasgow, N. J., Campbell, C., Dath, D., Harden, R. M., Iobst, W., Long, D. M., Mungroo, R., Richardson, D. L., Sherbino, J., Silver, I., Taber, S., Talbot, M., & Harris, K. A. (2010). Competency-based medical education: Theory to practice. Medical Teacher, 32(8), 638-645. https://doi.org/10.3109/0142159X.2010.501190

Kavanagh, J. M., & Szweda, C. (2017). A crisis in competency: The strategic and ethical imperative to assessing new graduate nurses' clinical reasoning. Nursing Education Perspectives, 38(2), 57-62. https://doi.org/10.1097/01.NEP.0000000000000112

Spector, N., Blegen, M. A., Silvestre, J., Barnsteiner, J., Lynn, M. R., Ulrich, B., Fogg, L., & Alexander, M. (2015). Transition to practice study in hospital settings. Journal of Nursing Regulation, 5(4), 24-38. https://doi.org/10.1016/S2155-8256(15)30031-4