Exponential changes in health care delivery are driving the need to transform how registered nurses are educated (Gorski et al., 2019). Yet, many prelicensure nursing programs continue to focus on acute care settings. In 2015, the California Nursing Workforce Center partnered with more than 50 statewide thought leaders and convened a series of regional meetings to envision the future of nursing, incorporating national, statewide, and regional reports and initiatives. The result was the creation of the Nursing Education Plan White Paper and Recommendations for California (Berg & Orlowski, 2016), which articulated five recommendations to redesign the prelicensure educational system to meet contemporary health care needs. The fifth recommendation was to "provide transformative learning opportunities that prepare nurses for evolving roles in rapidly changing interprofessional practice environments" (p. 19). The associated strategy identified the need to "design curricula with the capacity to fluidly accommodate the evolving healthcare environment and emerging nursing roles encompassing the continuum of care" (p. 19).
In 2018, a cross-sector team came together to support four schools in an innovative pilot program that focused on educating nursing students consistent with the fifth recommendation of the White Paper, with an emphasis on care in the community. The team included: a) leaders from a large regional employer who had extensive experience and interest in nursing workforce needs and provided donor-advised funding; b) two faculty from an out-of-state academic health sciences university who advised and led faculty and administrators of the four pilot schools through the process; c) representatives of the state's Nursing Workforce Center and Action Coalition, who served as subject matter experts consistent with key messages from the Institute of Medicine (2011); and d) nursing education consultants from the state's licensing and regulatory board who helped articulate the statutes and regulations in support of curriculum redesign. This article describes the innovative collaboration that resulted in a redesigned curriculum to educate nursing students for community-focused health care delivery.
REQUEST FOR PROPOSALS AND SELECTION
To launch the work, over $400,000 in grant funding was made available to the schools of nursing, faculty consultants, and state nursing workforce center. A total of seven schools were invited to apply for funding based on several factors: their creative and open institutional culture; their broad representation of rural and urban settings; their student population of underrepresented groups in nursing in community colleges and four-year schools; and their demonstrated ability to advance innovation within their organization and community. Based on the strength of their responses, four schools were selected: two baccalaureate and two associate degree programs. The schools represent geographically and compositionally different parts of the state.
The effort was funded as follows: 1) $46,000 for project setup and preparation/hosting kickoff event, 2) $80,000 to each pilot school to allocate as deemed best to collaborate on curriculum redesign and participation in community learning activities, and 3) $58,000 to the state Nursing Workforce Center and faculty experts for project support (webinars, monthly coaching calls) and dissemination of activity/outcomes.
PROJECT TEAM AND MEETINGS
Over the course of 15 months, schools were guided and supported by a team that included two faculty members who successfully transformed the prelicensure curriculum at their academic health sciences university and served as coaches for faculty; the state's Nursing Workforce Center and Action Coalition; three licensing board nursing education consultants; and key leaders from the funding/employer organization. Five major components were used to help facilitate the work of the participant school: a) monthly individual school coaching calls with school directors and faculty representatives; b) quarterly webinars open to all school faculty and interested stakeholders; c) two in-person, full-day intensive educational, community-building sessions; d) oversight/risk mitigation calls for the support team; and e) an online learning community.
Initial Meeting
A one-day meeting, Redefining RN Curriculum to Impact Health of Communities, was held to kick off the process in June 2018. Seventy people were in attendance, including direct grantees and other stakeholders interested in nursing education redesign. The goals of the meeting were to energize, inspire, and inform the next steps in a curriculum redesign process. This was accomplished by leveraging the exemplar from the faculty advisors and providing a unique experience such that participants left with new ways of thinking and a new community with which to collaborate.
The four grantee schools each brought a team of up to 10 people (directors, faculty, students, existing clinical partners, and community stakeholders). Activities included: a) leveraging the innovation center of the funder/employer organization to foster new thinking around nursing education encompassing knowledge, skills, and competencies across settings and the lifespan; b) sharing examples of recent curriculum development successes; c) creating a framework for the design process with standardization and local needs; and d) building a learning community.
Monthly Coaching Calls/Quarterly Webinars
Every month, the two faculty coaches met with each school team individually, along with the consultant from the school's licensing board and Nursing Workforce Center. The teams were asked to prepare responses to three prompts for each call. Prompts for the first call were as follows: a) How did you and your faculty get started after the in-person meeting? b) Who are the members of your curriculum redesign team? c) How are you engaging external stakeholders, community organizations, and nonprofits in your curriculum redesign? Additional prompts included: a) What is one mutually beneficial goal that is shared between your nursing program and the community organization? b) What message(s) do you want to communicate? What is unique, different about your redesign? c) What are your talking points when meeting with your community partners? d) Identify a success story and describe the "backstory" in creating the win-win with the partner. Topics for the quarterly webinars were: a) Moving Beyond the Obvious: Community Engagement in Curriculum Redesign, b) Transitioning to a Concept-Based Curriculum: Connecting the Dots, c) Bring Your Plan of Study Working Session, and d) Teaching the New Curriculum: Strategies to Get Faculty and Students on Board.
The licensing board consultants actively participated in the coaching sessions and webinars, connecting regularly with the schools. Communication established early in the collaboration continued with excellent results, fostering problem-solving and reducing barriers. This unique aspect of the project has made a significant difference in the success of the redesign process and the final curriculum approval process from the licensing board.
One Year Follow-Up Meeting
A one-day in-person learning community session took place in May 2019 to share accomplishments and provide input on next steps. The event, Transforming Nursing Curriculum: Preparing Nurses for Evolving Roles, was held at a community foundation. All four schools, their community partners, and the licensing board participated. The keynote speaker was Dr. Patricia Benner.
Schools were asked to invite nontraditional clinical partners and their new community partners to contribute to the discussion and shape future direction. Each school presented a comparison of their legacy curriculum and transformed curriculum. Using the power of the learning community, each school received ideas from peers and thought leaders.
Online Learning Community
The state Nursing Workforce Center and Action Coalition manages the online learning community. This resource repository is dynamic and provides access to materials and important documents to facilitate their success on an ongoing basis. As new information, reports, and articles become available, they are added to the collection.
ADVANCING FUTURE OF NURSING RECOMMENDATIONS
Faculty and administrators at the four participating schools represented a range of expertise and experience with curriculum redesign (13 respondents). Over 92 percent agreed that curriculum change was clearly needed and that the schools would benefit from curriculum redesign. Eighty-five percent agreed that real stakeholders needs make this change necessary, that the change will help faculty/programs become better equipped to meet students' needs, and that a clear vision regarding the change project was formulated. All faculty and administrators agreed the curriculum redesign project had a high priority for success.
Each school made progress in reaching its goal of transforming their curriculum with changes guided by recommendations from the Institute of Medicine (2011)Future of Nursing report. For example, the schools implemented changes to improve nursing education by focusing beyond acute care across settings of care, including the community, primary care, and public health, and across the life span. A curriculum redesign exemplar linked to the Future of Nursing recommendations is described in Table 1. The schools built higher levels of engagement with an expanded number of clinical partners, both traditional and new. With increased engagement, ideas were generated to create nontraditional community placements (e.g., county health departments, health centers, nonprofits providing care coordination for special populations). Schools are more intentionally focusing on the social determinants of health, health equity, and culture of health concepts in their curricula.
The project is ongoing; to date, two of the four pilot schools have submitted and received approval from the state licensing board for completing a major curriculum redesign. Three of the four schools have moved to a concept-based curriculum, an approach that differs from the traditional method of learning specific facts in isolation, to achieve understanding of broader principles that can be applied to a variety of specific examples and settings.
An unexpected, positive result is the relationship built between the schools and their assigned licensing board nursing education consultants. Together, the schools and nursing education consultants are collaborating to define new, creative, and relevant ways to educate that adhere to regulations. Openness to change and trust have been established among participants through the monthly coaching calls. Innovative ideas were generated, and real/perceived barriers were resolved in real time. Together, the participants gained a new appreciation that the curriculum change process is long and nonlinear, with some quick wins and no easy fixes.
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