Articulation Program. Charting a Course for Healthcare in Missouri

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1 Articulation Program Charting a Course for Healthcare in Missouri

2 Index Executive Summary 1 Background 2 Guiding Principles 3 Articulation Program Definition 5 Transferability of Credits 5 Suggested Course Work 5 Articulation Assumptions 6 Participation as a Signatory Program 6 Principles of Validation 7 Instructions for Participation 7 Publication of Signatory Programs 8 Summary of Differentiated Essential Competencies 8 Recommendations for Practical Nursing Programs 9 Essential Competencies - Practical Nursing Programs 9 Steps for LPN Transition to Associate Degree 11 Essential Competencies - Diploma and Associate Degree Programs 11 Recommendations for BSN Programs 12 Essential Competencies - Baccalaureate Degree Programs 13 Appendix A Math competencies upon completion of the PN Program 14 A1-A7 Executive Summary The purpose of the Missouri Articulation Program is to: Revise the Missouri statewide nursing education articulation plan so that nurses could easily progress from one level of education to another. Create seamless academic progression for nurses--one of the eight recommendations needed to meet future health needs of our nation s citizens, in the 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health. The Missouri Articulation Program is used to: Provide clarity and consistency to outcomes of graduates from nursing education programs to assist in promoting seamless articulation from one level of nursing practice to the next higher level. Give guidance to nursing programs regarding transferability of credits and advanced placement of nursing students in their programs. Serve to clearly define the scope of practice for graduates from a particular level of nursing education by articulating differentiated educational competencies of graduates for that level of nursing education. Differentiate educational competencies for nursing education at the practical, associate or diploma, and baccalaureate levels contained within the Program and serve as a standard for nursing programs to review curricula in order to ensure their graduates provide safe, competent care to the people of Missouri. Assist employers of nurses who may use the competencies to create differentiated roles and responsibilities for entry-level nursing practice. The Missouri Articulation Revision Committee (MOARC) was developed and is maintained and implemented by: The MOARC began as an action step of the Missouri Action Coalition (MOAC), the grass roots effort in Missouri to help implement recommendations of the 2010 Institute of Medicine s Future of Nursing: Leading Change and Advancing Health report. Implementation is part of the Center for Advancing Health, the umbrella organization that administers the State Implementation Grant awarded by the Robert Wood Johnson Foundation and AARP. The director of the Center for Advancing Health maintains records regarding schools participating in the articulation agreement and in tracking signatories for the Articulation Program. Additional implementation steps will be carried out by the Education team of the MOAC as requested by the director of the Center for Advancing Health. The Missouri Nurses Association (MONA), the Missouri League for Nursing (MLN), the Missouri Organization of Nurse Leaders (MONL), and the Missouri State Board of Nursing (MSBN) also support this collaborative effort. Page 1

3 Background History of the Missouri Articulation Program The Missouri Articulation Plan (MAP) for statewide progression within nursing education originally evolved from Missouri Nursing Coalition meetings which generated interest in establishment of a Nursing Education Articulation Task Force sponsored by the Missouri State Board of Nursing. The purpose of the Nursing Articulation Task Force was to develop an articulation model to assure and facilitate educational mobility for individual nurses. Work on the original MAP was initiated in the mid 90s. While many nursing programs signed on to participate and many opportunities for more seamless progression between levels of nursing education were developed, a review of processes indicates that the MAP was not used to its fullest potential. Through inspiration of the Missouri Action Coalition Future of Nursing in Missouri the need for a revitalized and revised MAP became evident. Motivation was spurred by the 2010 Institute of Medicine (IOM) report titled The Future of Nursing: Leading Change, Advancing Health. To advance the nursing education across the state and to meet the goals of the IOM report, a workable program for articulation was needed. Through support of the Missouri State Board of Nursing, the Missouri Articulation Revision Committee (MOARC) was formed in Nurse educators from all levels of nursing education, non-nurse educators, and representatives of the Missouri Department of Higher Education came together to work on academic progression and developed this Articulation Program (the Program). It is the goal of MOARC to inspire and guide articulation and seamless progression within all levels of nursing education for many years to come. While committee members may change, the spirit and guiding principles will remain constant. MOARC Vision and Focus Originally the Nursing Articulation Task Force was formed to develop a seamless progression model that would foster and facilitate educational mobility for nurses in Missouri. The original Missouri Articulation Plan (MAP) was developed and has been recognized as one of the essential tools utilized to promote and foster articulation between levels of nursing education for many years. Today, the Missouri Articulation Revision Committee (MOARC) continues this work in the face of looming nursing shortages, rising financial constraints and ever changing demands on health care professionals. Evidence of improved patient outcomes directly linked to preparation of the nurse, need for much more efficient use of educational resources and the goal for nurses to work at their fullest potential remain at the forefront of goals and discussion. Advanced placement, transferability of credits and sharing of educational resources is a must, not an option. Differentiated essential competencies (DEC) have been developed to ensure that nurses enter the work place with knowledge and skills necessary to practice safe nursing. While seamless progression toward BSN completion is at the forefront of this work; a strong focus on safe nursing practice is emphasized. It is the vision of MOARC that nurse educators across the state will utilize DEC to evaluate their programs to ensure that essential competencies are taught and consistently achieved by their students and graduates. Should nurses in Missouri be inspired to continue their education and work at their fullest potential, continued expansion of the Articulation Program to incorporate programs preparing nurses for advanced nursing practice and research is essential. It is MOARC s vision and future goal to work beyond this basic Articulation Program and pave the way for seamless progression among all levels of nursing education. In order to make that happen, ongoing review, revision and deliberate expansion of the Program is necessary. It is the hope of MOARC to continue to work together, add new committee members, tap into the expertise of nurse educators across the state and to foster and sustain a strong model for excellence in nursing education with increased focus on educational mobility, removal of barriers and much higher level of affordability and progress. Acknowledgements MOARC would like to thank two nursing organizations for their contributions to the revised Articulation Program in Missouri. They are the Texas Board of Nursing and the Oregon Consortium for Nursing Education (OCNE). OCNE granted permission through Dr. Christine Tanner for the adaptation of their Guiding Principles and Norms to our Program. The wisdom they expressed in the original document helped guide us in the right direction and spirit as we began this journey. The Texas Board of Nursing graciously allowed us to use the scholarly work they completed over a period of years that defines essential nursing competencies for practical nursing, associate, diploma and baccalaureate levels of nursing education. This enabled us to develop a competency based Program in a timely manner that expertly meets the educational outcomes of today s nurses. We are grateful to them for their work and their willingness to share with us. Guiding Principles Shared Vision with Commitment to Excellence and Innovation The context for all our work communicates our commitment to excellence, innovation, and a shared vision that will ultimately serve the health of all Missourians. We believe that to achieve excellence we focus on outcome and foster nursing education to include scholarship in nursing and in education. The context of our work honors risk taking and achievement. We embrace innovation by honoring it whenever and wherever it happens. We strive to acknowledge and promote excellence and innovations for all nursing programs in the state. We believe Missouri s nursing community must be pivotal in the provision of health care for all Missourians. This involves promoting seamless articulation between all types of nursing programs in the state to advance the education of all Missouri nurses. The principles identified as primary to the committee include Inclusiveness, Beneficence, Collegiality, Courage/Perseverance, Healthy Conflict and Shared Leadership for Transformation. Inclusiveness Inclusiveness is a founding principle for the work of MOARC. The commitment to inclusiveness provides a rich climate for feedback to and from others. We work to honor the contribution each member of our community makes and avoid selfish and self serving behavior. We are committed to seek input and listen intently. We value varying perspectives and incorporate new ideas. We are committed to transforming nursing education in Missouri. We honor the contributions and distinctions that each nursing program offers and welcome new partners. Beneficence We believe that our goal is to serve the greatest good for the greatest number. We acknowledge the benefits of sharing resources in our effort to achieve the greatest good for the greatest number. In the spirit of beneficence, we maintain open sharing of best practices and materials and seek to participate to the fullest extent not only to gain the benefits of full participation, but also to contribute to others. Page 2 Page 3

4 Collegiality Collegiality develops when we create and communicate mutual respect (which extends to all colleagues, other schools and other states) through openness in problem solving, and in dealing with conflict and disagreement. Trust and compassion are paramount. Integrity is valued as being accountable, working through issues, problem solving, honesty, truthfulness, and honoring diverse opinions. We seek to promote a collegial atmosphere to be embraced by the entire nursing education community in Missouri. Courage/Perseverance We believe our work takes courage and perseverance. We seek to be proactive for the profession, and truly feel that our work is the result of a shared commitment for nursing as a profession and for nursing education. We take pride in the opportunity to contribute to it. We are committed to the work to keep nursing education vital and growing. We will listen to those who question our work, seek to understand their perspectives and will integrate change as needed. We acknowledge our shared vision must be dynamic and are committed to supporting each other in our effort to maintain the collective courage that will be required to meet various challenges the future may bring. Healthy Conflict We recognize that conflict is necessary as we continue our process to maintain a shared commitment to common visions and goals. We cannot ignore conflict because to do so would diminish the whole group. Our group will be open about hot issues and share them to problem solve and work towards an agreeable outcome. To manage conflict we will debate on the basis of fact and comprehensive information, develop multiple alternatives to enrich the level of debate, share common agreed upon goals, inject humor into the decision process, maintain a balanced power structure, and resolve issues without forcing consensus. We challenge ourselves to deal with conflict in a direct and timely manner, and then to move on without residual negative reactions. Shared Leadership for Transformation Transformational leadership starts with the development of a vision: we believe our view of the future is exciting and sustainable. We will take every opportunity available to share our vision with others. We acknowledge transformational leadership involves creating and sustaining trust, and are committed to collaboration and creativity as critical values that are necessary for realizing our shared vision. Transformational leadership requires a tolerance for ambiguity. While the details required to implement our vision often include issues that must be negotiated among various constituents, our vision is clear. The development of seamless articulation between all types of nursing programs in the state to advance the education of Missouri nurses is our goal. Shared transformational leadership involves rotating responsibilities that reflect each person using personal areas of expertise. We recognize one another s leadership when we need it; and embrace sharing the leadership role. As transformational leaders we must remain visible and courageous. Our unswerving commitment will keep us, particularly through difficult times when some may question whether the vision can ever be achieved. We are committed to seeking the greatest good for the greatest number by developing seamless articulation between all types of nursing program in Missouri. We strive to inspire each other to a high level of commitment to this vision. Missouri Articulation Program Definition of Articulation A process through which two or more distinct programs cooperate to accommodate the students learning needs and career goals with minimal repetition of learning experiences. Metropolitan Area Nursing Education Consortium, 1980 (cited in Rapson, 1987, p.5) Missouri Policies Regarding Transferability of Credits In developing this Program, MOARC also conferred with statewide and institutional higher education leadership to complete a policy scan with regard to the existing transferability of courses between institutions. The Coordinating Board for Higher Education (CBHE) has developed a set of statewide policy guidelines and principles intended to ensure portability of general education credit among Missouri s colleges and universities. The CBHE s Credit Transfer Guidelines for Student Transfer and Articulation Among Missouri Colleges and Universities specifies that institutions shall designate a 42 hour block of general education credit (often as part of an Associate of Arts degree) that meets statewide curricular goals and competencies and that will be considered equivalent to corresponding blocks of credit at other institutions. Missouri House Bill 1042, recently signed into legislation during the development of this Program, mandates the CHBE develop a transfer course library that includes a minimum of 25 lower division general education courses that transfer seamlessly between two- and four-year higher education institutions. MOARC acknowledges and aligns this Articulatioon Program and subsequent nursing competencies with these statewide policies as appropriate, and within current nursing practice and licensure guidelines. Suggested General Education/Science Course Work Competency Minimum/Maximum Course Examples Credit Hours Communication 3-9 credits English Composition, Speech, Technical/Scientific Writing Managing Information 3-9 credits Computer Technology, Data Management Values 3-9 credits Diversity, Medical Ethics Social and Behavioral Sciences 6-9 credits Psychology, Sociology, Growth and Development, History, Anthropology, Government Course Humanities and Fine Arts 6-9 credits Music, Philosophy, Religion, Foreign Languages, Women s Studies Mathematics 3-9 credits Intermediate Algebra, College Algebra, Statistics Life and Physical Sciences 6-9 credits Chemistry, Nutrition, Microbiology, Anatomy and Physiology Total credits (Adapted with Permission by Dr. Christine Tanner on behalf of the Oregon Consortium for Nursing Education). Page 4 Page 5

5 Articulation in Nursing Education Assumptions 1. All types of nursing programs have worth and are valuable in achieving goals of access and articulation. 2. There is a common core of knowledge, attitudes, cognitive skills, and psychomotor skills that all types of nursing programs should acquire; however, there are distinct differences in the depth, breadth, scope of preparation and knowledge required for each type of graduate. 3. All levels of nursing education work together to advance nursing knowledge for students and practicing nurses advancing their education. 4. Each educational institution has the prerogative to establish its unique mission, goals and standards for admission, progression and graduation. 5. Nursing programs that choose to participate in the Missouri Articulation Program and whose graduates are prepared to move to another educational level may be designated as sending and/or receiving signatory programs. 6. The discipline of nursing is dynamic, ever changing and continuously evolving to best meet the health care needs of populations served; therefore periodic evaluation of the articulation model is essential. 7. Receiving signatory programs at the BSN level shall transfer credit hours (a combination of nursing and general education courses), leaving an additional 50 to 64 credit hours for completion of the baccalaureate degree. The remaining credit hours shall be divided into two categories. However, a minimum of 24 credit hours shall be devoted to the BSN completion nursing courses. The remaining credit hours shall be used to capture the university s uniqueness, residency requirements, and mission. 8. Should nursing programs participate in the capacity of sending and receiving signatory programs; qualifications for both capacities shall be met. Principles for Validation of Nursing Education to be Articulated The Program is built on the principle of differentiated essential competencies, which are utilized to assess current academic preparation and skills proficiency which in turn articulate credits to the next level of nursing education. In order for nursing programs to actively participate in the Program, each signatory nursing program must provide specific documentation demonstrating how differentiated competencies are achieved/met within the course work/content of the program. Participation as a Signatory Program In order for nursing programs to participate as signatory programs of the Missouri Articulation Program, accreditation or approval is required to ensure instructional integrity, support student progress and ultimately protect the public and impact patient safety: 1. The nursing program s sponsoring institution shall be accredited to operate by an entity recognized by the U.S. Department of Education. 2. Pre-licensure nursing programs shall have Missouri State Board of Nursing approval (the Missouri State Board of Nursing is recognized by the U.S. Department of Education as an approval agency for nursing education). National program-specific accreditation by the National League of Nursing Accrediting Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE) is preferred. 3. Post-licensure nursing programs must have national program-specific accreditation by the National League of Nursing Accrediting Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE). Additional Requirements: 1. The participating nursing program shall accept nursing credits from approved nursing programs, in accordance with this Articulation Program. 2. The participating nursing program and their sponsoring institution shall have clear policies and procedures for acceptance and transfer of general education credits. 3. The participating nursing program must certify that differentiated essential competencies related to the nursing curriculum for the program s level of nursing education are met. 4. Validation of differentiated essential competencies is achieved through submission of a completed program evaluation sheet which indicates course name and number for each competency to be met. General education as well as nursing course work is included. A completed cover sheet as well as respective course descriptions and policies related to acceptance of transfer credits must accompany the completed evaluation sheet. 5. Sending programs, by their participation as a signatory to the Missouri Articulation Program, assure that the differentiated essential competencies are met for graduates through their curriculum plans and selected courses. 6. Receiving signatory programs at the Diploma/ADN level shall, after successful completion of a bridge course, award 20 to 50% nursing credit of associate degree nursing curriculum for PN course work. This percentage is due to the difficulty in equating clock/contact hours of most LPN programs to college credit hours. Page 6 Page 7 Competency Evaluation Forms, indicating differentiated essential competencies (DEC) for each level of nursing education are provided after DEC in each section of the Program. This documentation must be completed and submitted in order to be recognized and participate as a signatory program. Instructions for Completion of Program Evaluation Forms 1. Please carefully review the entire set of instructions prior to completion of the Cover Sheet and the Competence Evaluation Form specific to your program s level of nursing education. 2. Cover Sheet and Competency Evaluation Forms shall be reviewed and filled out collaboratively by all/ majority of nursing faculty. Validation of competencies shall reflect the students abilities upon completion of the program, based upon instruction provided by the nursing program. 3. Please determine whether or not graduates of your program consistently acquire theoretical knowledge and have participated in real or simulated experiences to achieve each competency. It is understood that graduates from all nursing programs may initially need varying degrees of guidance to apply each of the competencies to the practice setting. 4. Once determined that program graduates of your nursing program consistently achieve stated compe tencies, please complete the Cover Sheet and Competency Evaluation Form specific to your program s level of nursing education. 5. Please indicate the specific course(s) during which each competency is addressed and validated. Course name and number for each course listed shall be included. 6. Please submit the following supporting documents along with the Cover Sheet and Competency Evaluation Forms: a) Program admission requirements b) Course descriptions for all course work indicated on the Competency Evaluation Form c) Curriculum plan outlining program requirements advanced placement/acceptance of transfer credits shall be reflected, as applicable. d) Policies related to acceptance of transfer credits, if applicable 7. Upon review of submitted documentation, MOARC representative(s) shall review documentation provided and validate participation of the nursing program as a signatory to the Missouri Articulation Program. Once accepted, the nursing program is added to the list of actively participating signatory nursing programs. Continued program participation may be periodically audited.

6 Publication of Signatory Programs A list of signatory programs will be maintained by the Missouri Action Coalition. The Missouri Articulation Program, a list of signatory programs with their contact information for each signatory nursing program, and their sponsoring institutions shall be made accessible to the public. Publication sites include MSBN, MONA, Missouri Action Coalition and MLN websites. Additional publications may be explored as applicable. Summary of the Differentiated Essential Competencies (DEC) Nursing practice in Missouri by licensed nurses flows along a scope of practice continuum based upon educational preparation from the Licensed Practical Nurse (LPN) to the doctorally prepared Registered Nurse (RN). While selected aspects of nursing care may be assigned or delegated by licensed practicing nurses to ancillary persons, such as nursing assistants or aides, LPNs and RNs currently form the core in the roles identified as members of the profession, providers of patient-centered care, patient safety advocates, and members of the health care team. Basic educational preparation for the LPN examination is provided at the practical level in Missouri State Board of Nursing (MSBN or Board) approved programs. Educational preparation for the RN licensure examination may be obtained through MSBN approved diploma, associate degree, and baccalaureate degree programs. Each of these programs provides the necessary preparation for practice as a registered professional nurse. The curricula of nursing programs differ and the outcomes of the educational levels dictate a differentiated set of essential competencies of graduates. The competency statements describe progression in expected behaviors across the types of programs from practical nursing (PN) to diploma and associate degree nursing (ADN) to baccalaureate degree nursing (BSN). The competencies of each educational level build upon the previous level. Purpose and Definition The competencies are written to guide nursing programs to meet the approval criteria established by the MSBN and to ensure programs prepare graduates to provide safe, competent care to the people of Missouri. A competency is described as an expected level of performance that integrates knowledge, skills, abilities, and judgment (American Nurses Association, 2008, p. 3). Competencies were designed to demonstrate the progression of expectations across the types of nursing programs based upon educational preparation. The scope of nursing practice for which the student is being prepared is reflected in the competencies. The scope of practice defines the extent of the provision of care within each level of educational preparation. Patients for the LPN are individuals in the context of their families; patients for the diploma graduate or the ADN are individuals and their families; and patients for the BSN are individuals, families, populations, and communities. The DEC include twenty-five core competencies categorized under four main nursing roles for each level of nursing education. The roles include: Member of the Profession Provider of Patient-Centered Care Patient Safety Advocate Member of the Health Care Team Implications of the DEC This document has the potential to add clarity and consistency to educational outcomes. It may be used by nursing programs to review curricula through content mapping for evidence that knowledge, clinical judgments and behaviors, and skills of new graduates are relevant and consistent with the education program. This document provides a foundation for the state s nursing educational programs to design seamless articulation plans for education mobility and for employers to create differentiated job descriptions for entry-level nursing practice. For additional detail in curriculum description and development, the above competencies are further delineated in a separate document into specific knowledge areas and clinical judgments and behaviors based upon the knowledge areas. Recommendations for Practical Nursing Programs In order to promote patient safety and seamless articulation between practical nursing programs and associate degree nursing programs the following recommendations are made: 1. Use of nationally normed admission tests to aid in selection of students for PN programs. Included with this recommendation are examples of tests with recommended cut scores established as the state-wide standard for community colleges. General Education COMPASS sub-scores Math 66 Writing 70 Reading 81 ASSET sub-scores Algebra 23 Writing 41 Reading 41 ACT sub-scores Math 23 Writing 18 Reading 18 SAT sub-scores Math 460 Writing 450 Reading 460 Nursing Education ATI-TEAS V Minimum Composite 58% HESI A2 Admission Readiness for RN Programs 75% 2. Required college level Anatomy and Physiology courses either as prerequisites to the PN program or completion during the PN program. 3. Achievement of medication calculation skills within the PN program A list of recommended math competencies to be achieved prior or while in the PN program is provided as Appendix A. Essential Competencies of Graduates of Missouri Practical Nursing Educational Programs I. Member of the Profession: A. Function within the nurse s legal scope of practice and in accordance with the policies and procedures of the employing health care institution or practice setting. B. Assume responsibility and accountability for the quality of nursing care provided to patients and their families. C. Contribute to activities that promote the development and practice of practical nursing. D. Demonstrate responsibility for continued competence in nursing practice, and develop insight through reflection, self-analysis, self-care, and lifelong learning. II. Provider of Patient-Centered Care: A. Use clinical reasoning and established evidence-based policies as the basis for decision-making in nursing practice. B. Assist in determining the physical and mental health status, needs, and preferences of culturally, ethnically, and socially diverse patients and their families based on interpretation of healthrelated data. C. Report data to assist in the identification of problems and formulation of goals/outcomes and patient-centered plans of care in collaboration with patients, their families, and the interdisciplinary health care team. D. Provide safe, compassionate, basic nursing care to assigned patients with predictable health care needs through a supervised, directed scope of practice. Page 8 Page 9

7 E. Implement aspects of the plan of care within legal, ethical, and regulatory parameters and in consideration of patient factors. F. Identify and report alterations in patient responses to therapeutic interventions in comparison to expected outcomes. G. Implement teaching plans for patients and their families with common health problems and well-defined health learning needs. H. Assist in the coordination of human, information, and material resources in providing care for assigned patients and their families. III. Patient Safety Advocate: A. Demonstrate knowledge of the Missouri Nursing Practice Act (NPA) and the Missouri Board of Nursing Rules that emphasize safety, as well as all federal, state, and local government and accreditation organization safety requirements and standards. B. Implement measures to promote quality and a safe environment for patients, self, and others. C. Assist in the formulation of goals and outcomes to reduce patient risks. D. Obtain instruction, supervision, or training as needed when implementing nursing procedures or practices. E. Comply with mandatory reporting requirements of the Missouri NPA. F. Accept and make assignments that take into consideration patient safety and organizational policy. IV. Member of the Health Care Team: A. Communicate and collaborate with patients, their families, and the interdisciplinary health care team to assist in the planning, delivery, and coordination of patient-centered care to assigned patients. B. Participate as an advocate in activities that focus on improving the health care of patients and their families. C. Participate in the identification of patient needs for referral to resources that facilitate continuity of care, and ensure confidentiality. D. Communicate and collaborate in a timely manner with members of the interdisciplinary health care team to promote and maintain optimal health status of patients and their families. E. Communicate patient data using technology to support decision-making to improve patient care. F. Assign nursing care to LPNs or unlicensed personnel based upon an analysis of patient or unit need. G. Supervise nursing care provided by others for whom the nurse is responsible. (Differentiated competency statements were extracted from the Texas Articulation Document with permission of the Texas Board of Nursing). Steps for LPN Transition to Associate Degree Nursing Education Based on the understanding that LPN to RN transition requires a change in scope of practice the following steps are recommended: 1. Licensure as a practical nurse and completion of all admission requirements of the accepting associate degree program. 2. Upon successful completion of a bridge course taken prior to or concurrent with associate degree nursing courses, award 20-50% nursing credit of associate degree nursing curriculum for PN course work. 3. Note that some institutions may not transcript these credit hours until the degree program is completed at the accepting associate degree program. 4. Successful completion of remaining general education and nursing courses required for the associate degree in nursing, as defined by the accepting associate degree nursing program. 5. A minimum of 60 credit hours (a combination of nursing and general education courses) shall be transferable to future completion of the baccalaureate degree in nursing. Essential Competencies of Graduates of Missouri Diploma and Associate Degree Nursing Education Programs I. Member of the Profession: A. Function within the nurse s legal scope of practice and in accordance with the policies and procedures of the employing health care institution or practice setting. B. Assume responsibility and accountability for the quality of nursing care provided to patients and their families. C. Participate in activities that promote the development and practice of professional nursing. D. Demonstrate responsibility for continued competence in nursing practice, and develop insight through reflection, self- analysis, self-care, and lifelong learning. II. Provider of Patient-Centered Care: A. Use clinical reasoning and knowledge based on the diploma or associate degree nursing program of study and evidence-based practice outcomes as a basis for decision-making in nursing practice. B. Determine the physical and mental health status, needs, and preferences of culturally, ethnically, and socially diverse patients and their families based upon interpretation of comprehensive health assessment findings compared with evidence-based health data derived from the diploma or associate degree nursing program of study. C. Analyze assessment data to identify problems, formulate goals/outcomes, and develop plans of care for patients and their families using information from evidence-based practice in collaboration with patients, their families, and the interdisciplinary health care team. D. Provide safe, compassionate, comprehensive nursing care to patients and their families through a broad array of health care services. E. Implement the plan of care for patients and their families within legal, ethical, and regulatory parameters and in consideration of disease prevention, wellness, and promotion of healthy life styles. F. Evaluate and report patient outcomes and responses to therapeutic interventions in comparison to benchmarks from evidence-based practice, and plan follow-up nursing care. G. Develop, implement, and evaluate teaching plans for patients and their families to address health promotion, maintenance, and restoration. H. Coordinate human, information, and material resources in providing care for patients and their families. Page 10 Page 11

8 III. Patient Safety Advocate: A. Demonstrate knowledge of the Missouri Nursing Practice Act (NPA) and the Missouri Board of Nursing Rules that emphasize safety, as well as all federal, state, and local government and accreditation organization safety requirements and standards. B. Implement measures to promote quality and a safe environment for patients, self, and others. C. Formulate goals and outcomes using evidence-based data to reduce patient risks. D. Obtain instruction, supervision, or training as needed when implementing nursing procedures or practices. E. Comply with mandatory reporting requirements of the Missouri NPA. F. Accept and make assignments and delegate tasks that take into consideration patient safety and organizational policy. IV. Member of the Health Care Team: A. Coordinate, collaborate, and communicate with patients, their families, and the interdisciplinary health care team to plan, deliver, and evaluate patient-centered care. B. Serve as a health care advocate in monitoring and promoting quality and access to health care for patients and their families. C. Refer patients and their families to resources that facilitate continuity of care; health promotion, maintenance, and restoration; and ensure confidentiality. D. Communicate and collaborate in a timely manner with members of the interdisciplinary health care team to promote and maintain the optimal health status of patients and their families. E. Communicate and manage information using technology to support decision-making to improve patient care. F. Assign and/or delegate nursing care to other members of the health care team based upon an analysis of patient or unit need. G. Supervise nursing care provided by others for whom the nurse is responsible by using evidence-based nursing practice. (Differentiated competency statements were extracted from the Texas Articulation Document with permission of the Texas Board of Nursing). Recommendations for BSN Programs Steps for Diploma/ADN Transition to BSN level Nursing Education: 1. Active licensure as a registered nurse and completion of all admission requirements of the accepting baccalaureate nursing program. 2. A minimum of credit hours (a combination of nursing and general education courses) shall transfer from Diploma/ADN level education. 3. An additional 50 to 64 credit hours shall be required for completion of the baccalaureate degree. The remaining credit hours shall be divided into two categories. However, a minimum of 24 credit hours shall be devoted to the BSN completion nursing courses. 4. Remaining credit hours may be used to capture the university s uniqueness, residency requirements, and mission. Page 12 Page 13 Essential Competencies of Graduates of Missouri Baccalaureate Degree Nursing Education Programs I. Member of the Profession: A. Function within the nurse s legal scope of practice and in accordance with the policies and procedures of the employing health care institution or practice setting. B. Assume responsibility and accountability for the quality of nursing care provided to patients, families, populations, and communities. C. Promote the practice of professional nursing through leadership activities and advocacy. D. Demonstrate responsibility for continued competence in nursing practice, and develop insight through reflection, self-analysis, self-care, and lifelong learning. II. Provider of Patient-Centered Care: A. Use clinical reasoning and knowledge based on the baccalaureate degree nursing program of study, evidence-based practice outcomes, and research studies as the basis for decision-making and comprehensive patient care. B. Determine the physical and mental health status, needs, and preferences of culturally, ethnically, and socially diverse patients, families, populations, and communities based upon interpretation of comprehensive assessment findings compared with evidence-based health data and a synthesis of knowledge derived from a baccalaureate degree nursing program of study. C. Synthesize comprehensive assessment data to identify problems, formulate goals/outcomes, and develop plans of care for patients, families, populations, and communities using information from evidence-based practice and published research in collaboration with the above groups and the interdisciplinary health care team. D. Provide safe, compassionate, comprehensive nursing care to patients, families, populations, and communities through a broad array of health care services. E. Implement the plan of care for patients, families, populations, and communities within legal, ethical, and regulatory parameters and in consideration of disease prevention, wellness, and promotion of healthy lifestyles. F. Evaluate and report patient, family, population, and community outcomes and responses to therapeutic interventions in comparison to benchmarks from evidence-based practice and re search findings, and plan follow-up nursing care. G. Develop, implement, and evaluate teaching plans for patients, families, populations, and communities to address health promotion, maintenance, restoration, and population risk reduction. H. Coordinate human, information, and material management resources in providing care for patients, families, populations, and communities. III. Patient Safety Advocate: A. Demonstrate knowledge of the Missouri Nursing Practice Act (NPA) and the Missouri Board of Nursing Rules that emphasize safety, as well as all federal, state, and local government and accreditation organization safety requirements and standards. B. Implement measures, including the use of technology, to promote quality and a safe environment for patients, self, and others. C. Formulate goals and outcomes using an evidence-based and theoretical analysis of available data to reduce patient and community risks. D. Obtain instruction, supervision, or training as needed when implementing nursing procedures or practices. E. Comply with mandatory reporting requirements of the Missouri NPA. F. Accept and make assignments and delegate tasks that take into consideration patient safety and organizational policy.

9 IV. Member of the Health Care Team: A. Coordinate, collaborate, and communicate with patients, families, populations, communities, and the interdisciplinary health care team to plan, deliver, and evaluate care. B. Serve as a health care advocate in monitoring and promoting quality and access to health care for patients, families, populations, and communities. C. Use multiple referral resources for patients, families, populations, and communities considering cost, confidentiality, effectiveness and efficiency of care, continuity and continuum of care, and health promotion, maintenance, and restoration. D. Communicate and collaborate in a timely manner with members of the interdisciplinary health care team to promote and maintain the optimal health status of patients, families, populations, and communities. E. Communicate and manage information using technology to support decision-making to improve patient care and delivery systems. F. Assign and/or delegate nursing care to other members of the health care team based upon an analysis of patient or organizational need. G. Supervise nursing care provided by others for whom the nurse is responsible by using best practices of management, leadership, and evaluation. (Differentiated competency statements were extracted from the Texas Articulation Document with permission of the Texas Board of Nursing). Charting a Course for Healthcare in Missouri Page 14 Appendix A Math competencies upon completion of the PN Program Roman Numerals Recognize the symbols used to represent numbers in the Roman numeral system. Convert Roman numerals to Arabic numbers. Convert Arabic numbers to Roman numerals. Fractions Compare the size of fractions. Add, subtract, divide, and multiply fractions. Reduce fractions to lowest terms. Decimals Read and write decimals. Compare the size of decimals. Convert decimals to fractions. Add, subtract, multiply, and divide decimals. Round decimals to the nearest tenth and nearest hundredth. Ratios and Proportions Define ratio and proportion. Define mean and extreme. Calculate problems for a missing term (x) using ration and proportion. Percentages Define percent. Convert percent to fraction. Convert percent to decimal. Convert percent to ratio. Convert decimal to percent. Convert fraction to percent. Convert fraction to ratio. Determine the percent of numbers. Metric System Express metric measures correctly using rules of the metri system. State common equivalents in the metric system. Convert measures within the metric system. Apothecary and Household Systems State the common apothecary equivalents. State the common household equivalents. State specific rules that relate to the apothecary system. State specific rules that relate to the household system. Identify symbols and measure in the apothecary system. Identify measure in the household system. Convert Within and Between Systems Convert a unit of measure to its equivalent within the same system. Convert approximate equivalents among the metric, apothecary, and household systems of measure. Additional Conversion Useful in the Healthcare Setting. Convert between Celsius and Fahrenheit temperature. Convert between units of length (inches, centimeters, millimeters). Convert between units of weight (pounds and kilograms, pounds and ounces to kilograms). Convert between traditional and military (international) time. Dosage Calculation Dosage calculation using the ratio and proportion method: State a ratio and proportion to solve a given dosage calculation problem. Solve simple calculation problems using the ratio and proportion method. Dosage calculation using the formula method: Identify the information from a calculation problem to place into the formula given. Calculate medication dosages using the formula D/H x Q = x. Calculate the number of tablets or capsules to administer. Calculate the volume to administer for mediations in a solution. Dosage calculation using the dimensional analysis method: Define dimensional analysis. Implement unit cancellation in dimensional analysis. Perform conversions using dimensional analysis. Use dimensional analysis to calculate dosages. Calculate with Confidence 5th ed, Gray Morris, Deborah Mosby Elsevier 2010 (Chapters 1-9, 14-16) Page 15

10 Missouri Articulation Program General Information Institution Information Official Name: Date Received For Internal Use Only Missouri Articulation Program Differentiated Essential Competencies Practical Nursing Education Complete the tables below. Include course name(s) and number(s) for course(s) in which each essential competency is met by the graduates of your nursing program. Type of Institution: Public Independent Proprietary Chief Executive Officer Name/Title: Web address (URL) of Institution: School/Department of Nursing Information Official Name: Chief Nurse Administrator Name/Title: Address: Web address (URL) of nursing unit: Institutional Accreditation Information Institutional Accreditation Agency: Current Accreditation Status: National and State Nursing Accreditation Information Phone: Program # Enrolled # Graduated Is distance education offered? (IPEDS data) (IPEDS data) If yes, what percent of students? LPN Associate s BSN - Generic BSN - Fast Track/Accelerated RN - BSN Other: Identify any additional campuses/sites where the nursing degree program is offered, the distance from the main campus, and the average number of students enrolled at each location. Received by Reviewed by Date Accepted Start/End Dates for Accreditation Status: Nursing Accreditation/Approval Agency: CCNE ACEN MO State Board None For each program, indicate last review year and current status (initial/full/conditional/ probation) Program Last Review Year Current Status Practical Nursing Diploma in Nursing Associate s in Nursing Baccalaureate in Nursing Nursing Degree Programs Offered and Student Data Charting a Course for Healthcare in Missouri Application Page 1 Member of the Profession Course Name Course # Function within the nurse s legal scope of practice and in accordance with the policies and procedures of the employing health care institution or practice setting. Assume responsibility and accountability for the quality of nursing care provided to patients and their families. Contribute to activities that promote the development and practice of practical nursing. Demonstrate responsibility for continued competence in nursing practice, and develop insight through reflection, self-analysis, self-care, and lifelong learning. Provider of Patient-Centered Care Course Name Course # Use clinical reasoning and established evidence-based policies as the basis for decision-making in nursing practice. Assist in determining the physical and mental health status, needs, and preferences of culturally, ethnically, and socially diverse patients and their families based on interpretation of health-related data. Report data to assist in the identification of problems and formulation of goals/ outcomes and patient-centered plans of care in collaboration with patients, their families, and the interdisciplinary health care team. Provide safe, compassionate, basic nursing care to assigned patients with predictable health care needs through a supervised, directed scope of practice. Implement aspects of the plan of care within legal, ethical, and regulatory parameters and in consideration of patient factors. Identify and report alterations in patient responses to therapeutic interventions in comparison to expected outcomes. Implement teaching plans for patients and their families with common health problems and well-defined health learning needs. Assist in the coordination of human, information, and material resources in providing care for assigned patients and their families. Patient Safety Advocate Course Name Course # Demonstrate knowledge of the Missouri Nursing Practice Act (NPA) and the Missouri Board of Nursing Rules that emphasize safety, as well as all federal, state, and local government and accreditation organization safety requirements and standards. Implement measures to promote quality and a safe environment for patients, self, and others. Assist in the formulation of goals and outcomes to reduce patient risks. Obtain instruction, supervision, or training as needed when implementing nursing procedures or practices. Comply with mandatory reporting requirements of the Missouri NPA. Accept and make assignments that take into consideration patient safety and organizational policy. Application Page 2

11 Missouri Articulation Program Differentiated Essential Competencies Practical Nursing Education (continued) Complete the tables below. Include course name(s) and number(s) for course(s) in which each essential competency is met by the graduates of your nursing program. Member of the Health Care Team Course Name Course # Communicate and collaborate with patients, their families, and the interdisciplinary health care team to assist in the planning, delivery, and coordination of patient-centered care to assigned patients. Participate as an advocate in activities that focus on improving the health care of patients and their families. Participate in the identification of patient needs for referral to resources that facilitate continuity of care, and ensure confidentiality. Communicate and collaborate in a timely manner with members of the interdisciplinary health care team to promote and maintain optimal health status of patients and their families. Communicate patient data using technology to support decision-making to improve patient care. Assign nursing care to LPNs or unlicensed personnel based upon an analysis of patient or unit need. Supervise nursing care provided by others for whom the nurse is responsible. Authorization I hereby certify that the nursing program consistently prepares its graduates to meet differentiated essential competencies as outlined in the Missouri Articulation Program specific to Practical Nursing Education. Program requirements follow guidelines outlined in the MAP. I hereby request recognition of this nursing program as a signatory to the MPA in the capacity of sending institution. Permission is hereby granted to include information about this nursing program in publications related to participation in the MAP. Name and Title of Nursing Program Administrator Signature of Nursing Program Administrator Name and Title of Institution Representative Signature of Institution Representative Application Page 3 Date Date Missouri Articulation Program Differentiated Essential Competencies Diploma/Associate Degree Nursing Education Complete the tables below. Include course name(s) and number(s) for course(s) in which each essential competency is met by the graduates of your nursing program. Member of the Profession Course Name Course # Function within the nurse s legal scope of practice and in accordance with the policies and procedures of the employing health care institution or practice setting. Assume responsibility and accountability for the quality of nursing care provided to patients and their families. Participate in activities that promote the development and practice of professional nursing. Demonstrate responsibility for continued competence in nursing practice, and develop insight through reflection, self- analysis, self-care, and lifelong learning. Provider of Patient-Centered Care Course Name Course # Use clinical reasoning and knowledge based on the diploma or associate degree nursing program of study and evidence-based practice outcomes as a basis for decision-making in nursing practice. Determine the physical and mental health status, needs, and preferences of culturally, ethnically, and socially diverse patients and their families based upon interpretation of comprehensive health assessment findings compared with evidence-based health data derived from the diploma or associate degree nursing program of study. Analyze assessment data to identify problems, formulate goals/outcomes, and develop plans of care for patients and their families using information from evidence-based practice in collaboration with patients, their families, and the interdisciplinary health care team. Provide safe, compassionate, comprehensive nursing care to patients and their families through a broad array of health care services. Implement the plan of care for patients and their families within legal, ethical, and regulatory parameters and in consideration of disease prevention, wellness, and promotion of healthy lifestyles. Evaluate and report patient outcomes and responses to therapeutic interventions in comparison to benchmarks from evidence-based practice, and plan follow-up nursing care. Develop, implement, and evaluate teaching plans for patients and their families to address health promotion, maintenance, and restoration. Coordinate human, information, and material resources in providing care for patients and their families. Patient Safety Advocate Course Name Course # Demonstrate knowledge of the Missouri Nursing Practice Act (NPA) and the Missouri Board of Nursing Rules that emphasize safety, as well as all federal, state, and local government and accreditation organization safety requirements and standards. Implement measures to promote quality and a safe environment for patients, self, and others. Formulate goals and outcomes using evidence-based data to reduce patient risks. Application Page 4

12 Missouri Articulation Program Differentiated Essential Competencies Diploma/Associate Degree Nursing Education (continued) Complete the tables below. Include course name(s) and number(s) for course(s) in which each essential competency is met by the graduates of your nursing program. Patient Safety Advocate (continued) Course Name Course # Obtain instruction, supervision, or training as needed when implementing nursing procedures or practices. Comply with mandatory reporting requirements of the Missouri NPA. Accept and make assignments and delegate tasks that take into consideration patient safety and organizational policy. Member of the Health Care Team Course Name Course # Coordinate, collaborate, and communicate with patients, their families, and the interdisciplinary health care team to plan, deliver, and evaluate patient-centered care. Serve as a health care advocate in monitoring and promoting quality and access to health care for patients and their families. Refer patients and their families to resources that facilitate continuity of care; health promotion, maintenance, and restoration; and ensure confidentiality. Communicate and collaborate in a timely manner with members of the interdisciplinary health care team to promote and maintain the optimal health status of patients and their families. Communicate and manage information using technology to support decisionmaking to improve patient care. Assign and/or delegate nursing care to other members of the health care team based upon an analysis of patient or unit need. Supervise nursing care provided by others for whom the nurse is responsible by using evidence-based nursing practice. Authorization I hereby certify that the nursing program consistently prepares its graduates to meet differentiated essential competencies as outlined in the Missouri Articulation Program specific to Diploma/Associate Degree Nursing Education. Program requirements follow guidelines outlined in the MAP. I hereby request recognition of this nursing program as a signatory to the MPA in the capacity of sending institution. Permission is hereby granted to include information about this nursing program in publications related to participation in the MAP. Name and Title of Nursing Program Administrator Signature of Nursing Program Administrator Name and Title of Institution Representative Signature of Institution Representative Application Page 5 Date Date Missouri Articulation Program Differentiated Essential Competencies Baccalaureate Degree Nursing Education Complete the tables below. Include course name(s) and number(s) for course(s) in which each essential competency is met by the graduates of your nursing program. Member of the Profession Course Name Course # Function within the nurse s legal scope of practice and in accordance with the policies and procedures of the employing health care institution or practice setting. Assume responsibility and accountability for the quality of nursing care provided to patients, families, populations, and communities. Participate in activities that promote the development and practice of professional nursing. Demonstrate responsibility for continued competence in nursing practice, and develop insight through reflection, self- analysis, self-care, and lifelong learning. Provider of Patient-Centered Care Course Name Course # Use clinical reasoning and knowledge based on the baccalaureate degree nursing program of study, evidence-based practice outcomes, and research studies as the basis for decision-making and comprehensive patient care. Determine the physical and mental health status, needs, and preferences of culturally, ethnically, and socially diverse patients, families, populations, and communities based upon interpretation of comprehensive assessment findings compared with evidence-based health data and a synthesis of knowledge derived from a baccalaureate degree nursing program of study. Synthesize comprehensive assessment data to identify problems, formulate goals/ outcomes, and develop plans of care for patients, families, populations, and communities using information from evidence-based practice and published research in collaboration with the above groups and the interdisciplinary health care team. Provide safe, compassionate, comprehensive nursing care to patients, families, populations, and communities through a broad array of health care services. Implement the plan of care for patients, families, populations, and communities within legal, ethical, and regulatory parameters and in consideration of disease prevention, wellness, and promotion of healthy lifestyles. Evaluate and report patient, family, population, and community outcomes and responses to therapeutic interventions in comparison to benchmarks from evidence-based practice and research findings, and plan follow-up nursing care. Develop, implement, and evaluate teaching plans for patients, families, populations, and communities to address health promotion, maintenance, restoration, and population risk reduction. Coordinate human, information, and material management resources in providing care for patients, families, populations, and communities. Patient Safety Advocate Course Name Course # Demonstrate knowledge of the Missouri Nursing Practice Act (NPA) and the Missouri Board of Nursing Rules that emphasize safety, as well as all federal, state, and local government and accreditation organization safety requirements and standards. Implement measures, including the use of technology, to promote quality and a safe environment for patients, self, and others. Application Page 6

13 Missouri Articulation Program Differentiated Essential Competencies Baccalaureate Degree Nursing Education (continued) Complete the tables below. Include course name(s) and number(s) for course(s) in which each essential competency is met by the graduates of your nursing program. Patient Safety Advocate (continued) Course Name Course # Formulate goals and outcomes using an evidence-based and theoretical analysis of available data to reduce patient and community risks. Obtain instruction, supervision, or training as needed when implementing nursing procedures or practices. Comply with mandatory reporting requirements of the Missouri NPA. Accept and make assignments and delegate tasks that take into consideration patient safety and organizational policy. Member of the Health Care Team Course Name Course # Coordinate, collaborate, and communicate with patients, families, populations, communities, and the interdisciplinary health care team to plan, deliver, and evaluate care. Serve as a health care advocate in monitoring and promoting quality and access to health care for patients, families, populations, and communities. Use multiple referral resources for patients, families, populations, and communities considering cost, confidentiality, effectiveness and efficiency of care, continuity and continuum of care, and health promotion, maintenance, and restoration. Communicate and collaborate in a timely manner with members of the interdisciplinary health care team to promote and maintain the optimal health status of patients, families, populations, and communities. Communicate and manage information using technology to support decision-making to improve patient care and delivery systems. Assign and/or delegate nursing care to other members of the health care team based upon an analysis of patient or organizational need. Supervise nursing care provided by others for whom the nurse is responsible by using best practices of management, leadership, and evaluation. Authorization I hereby certify that the nursing program consistently prepares its graduates to meet differentiated essential competencies as outlined in the Missouri Articulation Program specific to Baccalaureate Degree Nursing Education. Program requirements follow guidelines outlined in the MAP. I hereby request recognition of this nursing program as a signatory to the MPA in the capacity of sending institution. Permission is hereby granted to include information about this nursing program in publications related to participation in the MAP. Name and Title of Nursing Program Administrator Signature of Nursing Program Administrator Date Name and Title of Institution Representative Signature of Institution Representative Date Application Page 7

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