229CHAPTER 10

Curriculum Planning for Associate Degree Nursing Programs

Karen E. Fontaine

OBJECTIVES

Upon completion of Chapter 10, the reader will be able to:

OVERVIEW

Chapter 10 begins with the history of ADN prelicensure nursing education programs. A description of the current status of this type of nursing program is presented as well as the pressures on this type of program in the context of dramatic health care and education system changes. The process of developing and evaluating ADN education curriculum follows. Sample associate degree curricular components are included.

The development of curricula for associate degree prelicensure programs follows the steps that were previously outlined in Chapter 9. Attention to the process of curriculum development or revision helps ensure that graduates of any type of program meet desired outcomes. The forces that guide the curriculum are the same for all programs: National accreditation and state regulatory standards, social and political climates, the health care industry, economic situations, and the profession of nursing.

230THE HISTORY OF ASSOCIATE DEGREE NURSING

The current model of ADN education providing entry into practice began after World War II when there was a nursing shortage. Haase (1990), in describing the sequence of events leading to the development of associate degree programs, states that in 1948, the Committee on the Functions of Nursing made a recommendation that nursing practice consist of two tiers of nurses, one professional and the other technical. An educational model for the community college setting was developed intended to educate a technical nurse, with a more limited scope of practice than a professional nurse, but broader than that of a practical nurse.

During the same post-wartime period, community colleges were expanding as a result of pressure from veterans and consequent increased funding. Several pilot studies implemented the above nursing education model in the community college setting, and found that there was little difference in the graduates of associate degree programs than those from the existing university and diploma educational systems (Haase, 1990). Although the model was subsequently implemented, the practice issue of technical versus professional nurse was not addressed. The model did, however, provide an evolutionary educational step by moving nursing education from the type of apprentice program (diploma) that was controlled by hospitals and physicians to the college and university system (Orsilini-Hain & Waters, 2009).

CURRENT STATUS OF ASSOCIATE DEGREE NURSING

Today’s nursing workforce in the United States consists of four levels of basic or prelicensure nursing preparation: diploma, associate degree, baccalaureate, and entry-level master’s. ADN programs provide the majority of nursing education, 45% (U.S. Department of Health and Human Services, 2010), comprising 60% of prelicensure programs (National League for Nursing [NLN], 2013), and graduating 63% of all registered nurses. Two thirds of all prelicensure RN enrollees are associate degree students (NLN, 2013).

Part of the attraction of ADN programs is that they are affordable and provide streamlined access to the nursing profession. The Urban Institute (2009) emphasized that many rural and underserved communities rely on community colleges for their nursing workforce. These programs also have the largest number of minorities, educating rural nurses in underserved areas, who are employed where they work (National Organization for Associate Degree Nursing [N-OADN], 2012). The NLN (2013) states that there has been a recent substantial increase in the percentage of associate degree students aged 30 years old, highlighting the maturity and second-degree nature of the students.

All nursing education programs are currently under great pressure to create a more educated nursing workforce due to health care reform. Associate degree programs, however, are also being forced to reduce credit requirements for the degree. These combined forces could result in a “perfect storm,” threatening ADN education itself, according to Sportsman and Allen (2011).

231A more educated nursing workforce is needed in the current health care environment because nurses are expected to fill roles that are increasingly complex, sophisticated, and expanded. The Institute of Medicine (IOM) called for 80% of nurses to hold a bachelor’s nursing degree by 2020 (IOM, 2010). Leaders within the nursing profession call for an increase in the number of nurses prepared at the baccalaureate level due to the need to advance the profession. Donley and Flaherty (2008) state that advanced educational preparation is needed in order for nurses to sit in on policy discussions and as members of governing boards. Smith (2009) concurs, stating that because nurses are the least educated of the major health care professionals, they are currently less likely to be included in discussions on health care policy.

The pressure on nursing education to prepare nurses at a higher educational level comes from research into patient outcomes as well. In 2006, Murray (2006) stated that there was an accumulating body of research showing a positive relationship between increased nursing educational preparation and improved patient outcomes. A landmark study by Aiken, Clarke, Cheung, Sloane, and Silber (2003) found that a 10% increase in nurses with a bachelor’s degree was associated with a 5% decrease in the likelihood of patients dying within 30 days of admission. There was also an increase in the odds of a patient being rescued from a life threatening event. Although the IOM (2010) concludes that the relationship between academic degree and patient outcomes is not established, Zimmerman, Miner, and Zittle (2010) list five research reports as evidence that there is a relationship between the level of nursing education and improved patient outcomes. The National Advisory Council on Nurse Education and Practice (2010) concurs.

Calls for a more educated nurse due to a revised health care system are occurring at the same time that ADN programs are being asked to reduce program length, change structure, and redesign curriculum and content. Recently, under pressure from the U.S. Department of Education, the Accreditation Commission for Education in Nursing (ACEN) revised its standards to require that ADN programs have a curriculum that allows students to complete all requirements, including prerequisites, within five semesters and between 60 and 72 credits (ACEN, 2013).

Most associate degree programs require at least 3 years of study, if not more. Credit creep can easily result when the inclusion of recommendations for content in genetics/genomics, gerontology, community health, perioperative care, pharmacology, bioterrorism, mass casualty response, health economics, cultural competence, health policy, palliative and end-of-life care, evidence-based practice, assessment, interprofessional team management, leadership, and informatics is implemented. There are also the multiple specialty standards from the American Nurses Association (2013) in pediatrics, oncology, critical care, and mental health/psychiatric practice to consider. Regulatory organizations such as the National Council of State Boards of Nursing and individual State Boards of Nursing also require specific content. Finally, general education and sciences courses may be either corequisite or prerequisite for admission into nursing programs.

The current pressures on ADN programs provide an opportunity to improve educational models, and clarify their purpose. There is widespread support for creating models within the nursing education system that honor and preserve the 232existing associate and baccalaureate nursing education programs and increase the percentage of bachelor of science in nursing (BSNs). The National Advisory Council on Nurse Education and Practice (2010), a group that advises the federal government and Congress, suggests that partnerships between ADN and BSN programs are methods for attaining the goal of increasing the proportion of BSNs in the workforce. Several states allow community colleges to confer baccalaureate degrees in nursing (Orsilini-Hain & Waters, 2009).

A curriculum that fosters dual enrollment of students from the start of their nursing education is suggested by Hall, Causey, Johnson, and Hayes, (2012). The IOM (2010) concurs, promoting a seamless transition for all levels of nursing into higher degree programs, believing that the capacity exists within the system. An example of such a transition is provided by the Oregon Consortium for Nursing Education (OCNE) whose member schools allow for seamless and automatic enrollment for ADN to BSN programs (Munkvold, Tanner, & Hendrickx, 2012). A shared pathway, combined with agreements among the community colleges and universities that participate in the consortium, creates the expectation and availability for students to continue their education and receive their BS degree (OCNE, 2013).

CURRICULUM REFORM IN ASSOCIATE DEGREE EDUCATION

Health care reform is driving the need for a changed nursing education model as care is moved from the hospital to different practice settings (IOM, 2010). The IOM believes that nursing students need to be to competent in such areas as health policy, financing, leadership, quality improvement, and systems thinking since graduates are called on to work within teams and lead care coordination efforts. No longer can nurses learn everything they need to know about content areas of maternity, mental health, pediatrics, and medical–surgical nursing.

Benner, Sutphen, and Day (2009), in a study of professional nursing education, found that schools of nursing were not current in responding to changes in the practice setting, nor were they successful in teaching nursing science, natural sciences, social sciences, technology, and the humanities. The authors issued a “call to action” for nursing education, stating that the profound changes in nursing practice demand equally profound changes in nursing education (Benner et al., 2009). Curricular reform is needed for all of nursing education, but the requirement is intensified for associate degree programs that must accomplish this with fewer credits and in a context of radical change.

COMPONENTS OF AN ASSOCIATE DEGREE CURRICULUM

Nursing programs exist within a context of regulation, accreditation, professional standards, and an educational milieu. Any nursing program that educates prelicensure candidates for registered nursing must adhere to regulations and standards. At the national level, the National Council of State Boards of Nursing (2012) developed a model nurse practice act that offers guiding principles to all state boards 233of nursing for regulation of education and practice. ADN programs are offered accreditation status by ACEN, which maintains and updates national accreditation standards. Current standards for associate degree programs can be found at www.acenursing.net/manuals/SC2013_ASSOCIATE.pdf.

Nursing programs that exist within a public or private educational institution may also need to meet regional accreditation standards for the parent institution, such as the Northwest Commission on Colleges and Universities or national accrediting agencies such as the Accreditation Commission for Independent Colleges and Schools. Both public and privately funded schools may belong to a larger national or statewide system that has additional requirements.

MISSION OR VISION

ACEN (2013) accreditation standards for ADN programs require that the nursing program’s mission and/or philosophy reflect the governing organization’s core values and be congruent with the outcomes, strategic goals, and objectives. When developing or revising the mission and philosophy statements, the faculty and leaders of the nursing program should develop the program’s mission in relation to those of the institution. Recommended sources of guidance are other programs within a system or programs that are similar or have good reputations. An ongoing program evaluation process ensures that the mission statement is continuously evaluated, both for congruence and currency. A sample mission statement presented with permission from Western Nevada College in Carson City, Nevada, a state-funded community college, reflects the program’s purpose. “The mission of the nursing program at Western Nevada College is to meet the nursing educational needs of the service area. The program prepares qualified students to function as entry-level registered nurses and to transfer to higher degree programs” (Western Nevada College, 2013). Samples of the curriculum from Western Nevada College will be used to illustrate a traditional model of ADN education in this chapter.

In an effort to meet the challenges posed by the IOM, Carnegie Foundation, and the NLN, the NLN Education Competencies Work Group (NLN, 2010) was formed. The group developed program outcomes and competencies for each type of educational program in nursing and an Education Competencies Model that can be used as a framework to develop curriculum. The model is also used in this chapter to illustrate the development of parts of a fictional ADN program’s curriculum based on the model. A mission statement for a college based on the work of the NLN Education Competencies Model might be “to provide students with the knowledge, practice, and ethical comportment competencies needed to practice within the nursing profession.”

PHILOSOPHY STATEMENTS

The philosophy flows from the mission statement and reflects the beliefs of the program’s faculty and staff about nursing, nursing education, students, 234teaching and learning, critical thinking, and evidence-based practice. These are generally longer statements that help guide curricular development and content. Table 10.1 offers sample philosophy statements from the fictional ADN program that were developed based on the NLN Education Competencies Model (NLN, 2010).

TABLE 10.1 PHILOSOPHY OF A FICTIONAL ADN PROGRAM BASED ON THE NLN EDUCATION COMPETENCIES MODEL

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