NUR 7000 Module 2 Competency Paper: Mapping a BSN Curriculum to the AACN Essentials and QSEN Example

Taught, Not Assessed: Mapping a Mercer County BSN to the 2021 Essentials and Closing the Gaps

Student Name

M.S. in Nursing, Nurse Educator, Thomas Edison State University

NUR-7000: Curriculum Theory and Development in Nursing Education

Mentor Name

Month Day, Year

Taught, Not Assessed: Mapping a Mercer County BSN to the 2021 Essentials and Closing the Gaps

Why Map Now

Nothing about this Mercer County program is real. A BSN program at a university in Mercer County admits about 120 students a year. Its curriculum was last revised a decade ago around course objectives written by individual faculty. The accrediting body now expects programs to show how graduates achieve the competencies in the 2021 Essentials. The committee's chair, who is completing an MSN in education, was asked to map the curriculum and recommend changes.

The Essentials

The Essentials (American Association of Colleges of Nursing, 2021) moved nursing's academic standards to a competency-based model with two levels, one for entry into practice and one for advanced practice. Its ten domains begin with the knowledge that underpins nursing and with care centered on each person. They extend to the health of populations, to scholarship, to quality and safety and to partnerships with other professions. The final four cover systems-based practice, informatics and health care technologies, professionalism, and personal, professional and leadership development. Running through all ten are eight concepts, among them clinical judgment, communication, ethics and social determinants of health. Each domain lists competencies and sub-competencies, and programs are expected to show that students achieve them through assessment, not only through exposure.

Earlier Frameworks

A national report (Institute of Medicine, 2003) proposed that all health professionals be educated in five core competencies: providing patient-centered care, working in interdisciplinary teams, employing evidence-based practice, applying quality improvement and using informatics. The report argued that education had not kept pace with the needs of patients and the health system and called for oversight bodies to hold programs accountable for these competencies.

Cronenwett et al. (2007) carried these ideas into nursing through the project known as QSEN, setting out six competencies for students before licensure. Two concern working with people (care centered on the patient, and teamwork with collaboration); four concern how care is improved and protected, namely practice grounded in evidence, ongoing improvement of quality, protection from harm and fluency with clinical information systems. For each, they specified the knowledge, skills and attitudes a graduate should have. QSEN gave faculty concrete targets and became widely used in nursing curricula.

The three frameworks overlap heavily, and the 2021 Essentials absorbed much of QSEN, which let the committee map once and see all three.

The Map

The chair asked each course coordinator to list where each Essentials domain was taught and where it was assessed, with the assignment or evaluation tool named. She then reviewed syllabi and assignments herself to confirm.

Several domains were taught but never assessed. Interprofessional partnerships appeared in lectures but no student had to show the competency with another profession. Informatics was mentioned in several courses, but no assignment asked students to use data from a record or evaluate a technology. Quality and safety was assessed only by exam items, so students never showed they could carry out an improvement or a safety analysis.

Levels of Achievement

Competency-based education asks not only whether students can perform a competency but how well at each stage. The committee agreed on three levels for each domain: introduced, where students learn the competency and practice it with guidance; developing, where they perform it with some support; and achieved, where they perform it independently at the level expected of a new graduate. Each course states which level it addresses for each domain. The map then showed a second kind of gap: several domains were introduced in the first year and expected at the achieved level in the final semester with nothing in between, leaving students without the developing stage. The committee placed developing-level assessments in the second-year courses to close that gap.

Closing the Gaps

The committee proposed four assessments. An interprofessional simulation each year with pharmacy and social work students, evaluated with a team performance tool. An informatics assignment in the second-year medical-surgical course in which students review a patient's record data, identify a documentation problem and propose a fix. A quality improvement project in the senior practicum, using a small test of change on the student's unit with a run chart. And a cumulative portfolio in which students collect evidence of competency across the program, reviewed by faculty at the end of each year.

Each new assessment uses a rubric aligned with the sub-competencies it measures, and course coordinators agreed which level of achievement is expected at each year of the program.

Students' Part

The portfolio gives students responsibility for collecting evidence of their own competence. Each student keeps examples of work for each domain, adds a few lines on what that work demonstrates and names what they still need to develop. Faculty advisors review the portfolio with each student at the end of each year. Students in a pilot group said the portfolio helped them see how separate courses fit together, and several used it to prepare for job interviews by describing specific evidence of their competence.

Working With Faculty

Faculty worried that competency assessments would add work. The chair proposed replacing, not adding: the informatics assignment replaced a research paper that duplicated another course, and the quality improvement project replaced a reflective journal in the practicum. She also offered two workshops on writing competency rubrics.

Timeline

The committee set a two-year timeline. In the first semester, faculty write rubrics for the four new assessments and pilot the informatics assignment in one section. In the second, the interprofessional simulation runs with partner programs and the portfolio is introduced to first-year students. In the second year, all assessments run in every section, and the committee reviews results by domain at the end of each semester to find where students fall short.

Limits

Mapping relies on coordinators' reports, which may be optimistic. Competency assessments are only as good as their rubrics and the consistency of raters. The Essentials allow programs flexibility, and accreditors' expectations may become clearer over time.

Conclusion

The map showed that the program taught most of the Essentials but assessed several domains weakly or not at all. Earlier frameworks from the Institute of Medicine and QSEN gave the committee concrete competencies and helped interpret the new domains. Four new assessments, built to replace rather than add work, give the program evidence that graduates can do what the Essentials expect.

References

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. American Association of Colleges of Nursing.

Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D. T., & Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3), 122-131. https://doi.org/10.1016/j.outlook.2007.02.006

Institute of Medicine. (2003). Health professions education: A bridge to quality. National Academies Press. https://doi.org/10.17226/10681