Advocating for the Nursing Role in Program Design and Implementation Essay

As their names imply, the honeyguide bird and the honey badger both share an affinity for honey. Honeyguide birds specialize in finding beehives but struggle to access the honey within. Honey badgers are well-equipped to raid beehives but cannot always find them. However, these two honey-loving species have learned to collaborate on an effective means to meet their objectives. The honeyguide bird guides honey badgers to newly discovered hives. Once the honey badger has ransacked the hive, the honey guide bird safely enters to enjoy the leftover honey.Advocating for the Nursing Role in Program Design and Implementation Essay

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Much like honeyguide birds and honey badgers, nurses and health professionals from other specialty areas can—and should—collaborate to design effective programs. Nurses bring specialties to the table that make them natural partners to professionals with different specialties. When nurses take the requisite leadership in becoming involved throughout the healthcare system, these partnerships can better design and deliver highly effective programs that meet objectives.
In this Assignment, you will practice this type of leadership by advocating for a healthcare program. Equally as important, you will advocate for a collaborative role of the nurse in the design and implementation of this program. To do this, assume you are preparing to be interviewed by a professional organization/publication regarding your thoughts on the role of the nurse in the design and implementation of new healthcare programs.
To Prepare:
• Review the Resources and reflect on your thinking regarding the role of the nurse in the design and implementation of new healthcare programs.
• Select a healthcare program within your practice and consider the design and implementation of this program.
• Reflect on advocacy efforts and the role of the nurse in relation to healthcare program design and implementation.
The Assignment: (2–4 pages)Advocating for the Nursing Role in Program Design and Implementation Essay
In a 2- to 4-page paper, create an interview transcript of your responses to the following interview questions:
• Tell us about a healthcare program, within your practice. What are the costs and projected outcomes of this program?
• Who is your target population?
• What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?
• What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?
• What is the role of the nurse in healthcare program implementation? How does this role vary between design and implementation of healthcare programs? Can you provide examples?
• Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why?

A competent health workforce is central to achieving universal health coverage (WHO, 2006).
Quality education is the foundation for developing competent health workers who are equipped
with the knowledge, attitudes and skills necessary to deliver quality care. There is evidence,
however, that health workers, including nurses, may not be adequately prepared to meet the
needs of society, especially in developing countries. It is therefore imperative that educational
institutions are provided with support and guidance to develop competence-based curricula for
their education programmes.
In support of this vital cause, the World Health Organization and its partners have compiled a
list of core competencies for nurse educators in support of Member States’ efforts to improve
nursing education and, ultimately, the quality of nursing services. This work is the result of
concerted efforts by key partners in response to World Health Assembly resolutions, in particular:Advocating for the Nursing Role in Program Design and Implementation Essay
WHA59.23 Rapid scaling up of health workforce production (2006); WHA59.27 Strengthening
nursing and midwifery (2006); WHA62.12 Primary health care, including health system
strengthening (2009); WHA64.6 Health workforce strengthening (2011); WHA64.7 Strengthening
nursing and midwifery (2011); and global mandates such as the Sustainable Development Goals
and the commencement and development of competencies for health professionals, beginning
with the Midwifery Educator Core Competencies (WHO, 2014).
This document presents nurse educator core competencies which were developed through
an elaborate consultative process to ensure the competency statements are comprehensive,
relevant, adaptable and accessible globally. It is anticipated that if the competencies are
appropriately adopted and/or adapted, educational institutions will be equipped to prepare
educators to provide high quality nursing education, which meets the needs of their respective
countries in terms of quantity, quality and relevance.
The challenges to be met in the adoption and/or adaptation of these competencies include
diversity in regional nursing and midwifery education programmes and the resources available to
implement the programmes. This document offers a starting point for defining the attributes of
competent nurse teachers as a basis for developing a competence-based curriculum for nurse
educators. Set within a programme framework, the core competencies relate to key cognitive,
affective and psychomotor learning domains.
The process undertaken to develop the competencies is described in this document and various
annexes further catalogue the process. Other relevant documents pertaining to
this initiative are available on the WHO website (http://www.who.int/hrh/nursing_midwifery/
educator_competencies/en/).Advocating for the Nursing Role in Program Design and Implementation Essay
INTRODUCTION
7
NURSE EDUCATOR CORE COMPETENCIES
The process for developing the Nurse Educator Core Competencies (NECC) was participatory and
entailed extensive consultation. The process and stages are outlined below.
Aims
The aim of this publication is to provide a clear outline of Nurse Educator Core Competencies
and performance expectations, which can form the basis for developing a competence-based
curriculum encompassing the cognitive, affective and psychomotor skills and behaviours
expected of nurse teachers. The competencies are intended to help guide the educational
preparation of nurse teachers; ensure educational quality and accountability; and, ultimately,
contribute to improving the provision of nursing care and outcomes of health services.
Partnership and collaboration
In the development of the competencies, a Delphi process was employed, similar to the one used
in developing the Midwifery Educator Core Competencies (WHO, 2014). The first stages involved
drafting a list of suggested competencies, then inviting global input through an iterative process,
until agreement was reached on the final core competencies and domains. Criteria used during
the consultative processes included comprehensiveness, relevancy, adaptability and accessibility.
DEVELOPING THE NURSE EDUCATOR
CORE COMPETENCIES
8
The development of the nurse educator competencies evolved in various stages which are
illustrated below.Advocating for the Nursing Role in Program Design and Implementation Essay
THE PROCESS
The initial process of the Nurse Educator Core Competence development involved reexamining and reviewing a broad collection of publications on the subject, including global
policy documents and literature from professional health councils and associations (American
Association of Colleges of Nursing, 2013; Australian Nurse Teachers Society, 2010; Davis,
Stullenbarger, Dearman and Kelley, 2005; EdCaN, 2008; International Council of Nurses, 2005;
Kalb, 2008; National League for Nursing, 2003, 2005; and others – see References). A review
of research articles examining the competence and preparation of the health practitioner faculty
and competence of teachers of nursing, medicine and physical therapy, was also undertaken
(see Annex 1). This review culminated in the first draft of 28 Nurse Educator Core Competencies.
These competencies were then further developed and refined based on input from nurse
educators.
2. Global Delphi survey
A Delphi process was used to garner expert input on the essential competencies required
of nurse educators. For the first round, the 28 nurse educator competency statements were
converted to survey format using LimeSurvey Version 1.92+, an online OpenSource survey
application. A six point Likert-type scale was used to record the level of agreement with each
statement (strongly disagree, disagree, neutral, agree and strongly agree). Under each statement
and at the end of the survey, comment boxes were available for narrative responses. Participants
1 Literature review
Initial Validation of the Nurse 3 Educator Core Competencies
2 Global Delphi survey
4 Integration
9
NURSE EDUCATOR CORE COMPETENCIES
were asked to provide suggestions for any modifications to the survey format and the proposed
competency statements and/or suggest deletions or additional competencies. In the first round,
13 of the 20 invited nurse educators completed the survey (65% response rate). Based on the
feedback from the participants, some competency statements were revised, some components
were deleted, and some competencies were added, resulting in a total of 49 competencies.
Minor revisions were made to the survey format, based on suggestions to improve ease of use
and clarity.
The revised 49 competency statements were organized under 13 domains (Annex 2) and placed
into a new LimeSurvey for the next round, which took place between August and October 2014.
Distribution included, first, the Technical Working Group with subsequent dissemination to:
• American College of Nurse Midwives (ACNM);
• Canadian Association of Midwives (CAM);
• Global Alliance for Nursing and Midwifery (GANM) web-based discussion group;Advocating for the Nursing Role in Program Design and Implementation Essay
• Health Information for All by 2015 (HIFA 2015) web-based discussion group;
• International Confederation of Midwives (ICM);
• International Council of Nurses (ICN);
• Midwifery and reproductive health research web-based discussion group;
• Midwifery, reproductive and women’s health education web-based discussion group;
• United Nations Population Fund (UNFPA).
In October 2014, 71 participants responded to the survey, with 36 responding to all of the 49
competency statements on the questionnaire. The quantitative results indicated consensus on
most of the core competencies suggested. Participants indicated that further work was required
to refine the competency framework and differentiate the core competencies (those which are
central) from the non-core activities that may be peripheral to the nurse educator role. One
sentiment that appeared consistently in the qualitative data was concern that the lack of funding
and resources may hinder the implementation of the competency framework. The quantitative
results and general comments from this global consultation provided a comprehensive
basis upon which to validate and develop a clear framework for the Nurse Educator Core
Competencies.
3. Initial Validation of the Nurse Educator Core Competencies
The process for the initial validation and development of the NECC to produce Version 3 entailed
detailed review from key informants; the incorporation and consolidation of suggestions and
comments; and the addition of cognitive, affective and psychomotor learning domains. Through
the validation process, almost all the NECC from Version 2 were retained, but some were
integrated with other relevant core competencies.
The final phase in the validation of Version 3 involved 10 countries that were identified by the
WHO Regional Office for East Mediterranean. The countries included Tunisia, Pakistan, Egypt,
Iran, Sudan, the Kingdom of Bahrain, Sultanate of Oman, State of Kuwait, Kingdom of Saudi
Arabia and the United Arab Emirates. The key informants were identified in consultation with the
Regional Nurse Adviser and included 21 qualified nurse educators.
The validation tool was adapted from the New Hampshire Department of Education
Competency Validation Rubric (2010), which was also used to validate the Midwifery Educator
Core Competencies. The validation criteria (Annex 3) included relevancy, concepts, depth
of knowledge, assessment, clarity, comprehensiveness and adaptability. The domains, core
competencies and validation criteria were merged into table format with a space provided for
suggestions (Annex 4). Participants were given the validation criteria explanatory notes, and
asked to review and validate the competency domains and core competencies, indicating their
agreement or disagreement on the competency statements. They were also given open-ended
questions to include their views and suggestions. The final review culminated in the eight broad
competency domains and 37 core competencies listed in Version 3 (Annex 5). Advocating for the Nursing Role in Program Design and Implementation Essay

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10
1
THEORIES AND
PRINCIPLES OF
ADULT
LEARNING
2
CURRICULUM AND
IMPLEMENTATION
3
NURSING
PRACTICE
4
RESEARCH AND
EVIDENCE
5
COMMUNICATION,
COLLABORATION
AND
PARTNERSHIP
6
ETHICAL/LEGAL
PRINCIPLES AND
PROFESSIONALISM
7
MONITORING AND
EVALUATION
8
MANAGEMENT,
LEADERSHIP AND
ADVOCACY THE NURSE
EDUCATOR
COMPETENCIES
The nurse educator competencies
4. Integration
Following the validation process, the Nurse Educator Core Competencies were further
categorized within cognitive (knowledge), affective (attitudes and behaviours) and psychomotor
(skills) domains of learning. It is expected that integrating the competency domains and
core competencies within the domains of learning will help facilitate the development of
comprehensive educational programmes, better assessment methods and reduce repetition of
learning outcomes within curricula.
Cognitive, affective and psychomotor learning domains were identified across the eight
competency domains and the related core competencies (Table 1). For example, under
Domain 5: Communication, collaboration and partnership there is one core competency and
three core competencies, which are directed towards a single goal, i.e. to improve nurse
educators’ collaborative communication and partnership. In reality, nurse educators will
merge their knowledge, skills and behaviours in any given situation towards an optimum or
ideal performance. Such performance complexity calls for integration of teaching and learning
domains to reduce repetitious and redundant elements in the design of curricula.Advocating for the Nursing Role in Program Design and Implementation Essay

Advocacy means using one’s position to support, protect, or speak out for the rights and interests of another. Nurses have long claimed patient advocacy as fundamental to their practice. The American Nurses Association’s Code of Ethics for Nurses and Scope and Standards of Nursing Practice clearly identify nurses’ ethical and professional responsibility for protecting the safety and rights of their patients. State nursing practice acts may establish a legal duty for patient advocacy as well.

Why must nurses advocate?
Patient safety depends on nurse advocacy. Over 10 years ago, the Institute of Medicine (IOM) shocked the nation when it reported in To Err is Human: Building a Safer Health System that an amazing 100,000 deaths each year were attributable to medical errors. In 2004, the IOM report Keeping Patients Safe: Transforming the Work Environment of Nurses highlighted the critical role of nurses in safety efforts and challenged organizations to design work environments in which nurses can provide safe care.Advocating for the Nursing Role in Program Design and Implementation Essay

Nurses are at the “sharp end” of errors in health care. Because of their proximity and continuity with patients, nurses are often the last opportunity to prevent an error—to spot a mislabeled I.V. bag before it’s infused, to recognize that a patient’s allergy band doesn’t match the medication administration record, to identify slight changes in a patient’s condition that could signal a significant complication.

Keeping Patients Safe urged the establishment of “cultures of safety” within healthcare organizations to achieve safe practice environments. An organization committed to a culture of safety makes safety an explicit priority and responsibility shared by every individual at every level of the organization. Everyone is expected to participate in identifying and resolving safety issues.Advocating for the Nursing Role in Program Design and Implementation Essay

Nurse advocacy challenges
Direct-care nurses are poised especially well to identify and speak up about conditions that may result in near misses or actual adverse events. Cultures of safety promote and encourage staff to raise issues, yet most workplace cultures are imperfect and nurses may face challenges in their advocacy efforts. For example:

Nurses may lack communication skills to clearly articulate their concerns in such a manner that others are able to respond. A nurse who complains that “staffing is always unsafe” leaves a supervisor in a poor position to respond. However, by specifically describing the nature of the concern—for example, “I’m concerned that our planned staffing didn’t account for an ICU patient being transferred in and two additional patients being admitted from the ED. How can we adjust to accommodate these changes?”—the problem and potential solutions become clearer.Advocating for the Nursing Role in Program Design and Implementation Essay

Nurses may be uncertain about how to address an issue. Reporting structures may vary depending on the issue: a physician who fails to respond adequately to a patient issue at 2:00 A.M.; chronically late medication delivery from the pharmacy; a medical device that repeatedly fails during patient use. The chain of command through departments (risk management, corporate compliance, medical staff) or individuals (direct supervisors, the chief nursing officer) may not be well established. Further, nurses, especially those in direct-care roles, may not be adept at negotiating the inherent power gradients in healthcare organizations.Advocating for the Nursing Role in Program Design and Implementation Essay

Nurses may fear retaliation and lack knowledge about established processes and protections for patient advocacy activities. Raising a concern disrupts the status quo and challenges the organization to confront problems. If identifying concerns or opportunities for improvement is viewed as complaining, those raising concerns may be labeled “troublemakers.”

One of the most egregious examples of retaliation for patient advocacy activities occurred recently in Winkler County, Texas, when two nurses, Vickilyn Galle and Anne Mitchell, were criminally indicted by the county attorney for reporting a physician to the Texas Medical Board because of patient-safety concerns. One week before trial, charges against Galle were dropped. A jury found Mitchell not guilty. Subsequently, the Texas Medical Board took action against the physician for witness intimidation as well as practice violations. Further, the Texas Attorney General’s office indicted the hospital administrator, Winkler County sheriff, county prosecutor, and physician for retaliation and other charges. (See www.texasnurses.org for more information.)

Nurses may have limited opportunities to advocate proactively in organizations lacking shared decision-making processes. Decision-making opportunities concerning patient care include performance-improvement activities, staffing committees, and product evaluation teams. This is a missed opportunity for improving safety.Advocating for the Nursing Role in Program Design and Implementation Essay

The nurse’s duty to patient safety is well established and is reflected in the nurse’s role of patient advocate. The value of patient advocacy in supporting an organizational culture of safety isn’t always appreciated, yet the knowledge and response to nursing concerns about patient safety can make a powerful contribution to patient outcomes.

Speak to be heard
Nurses in all roles and at all levels of the organization have a duty to patient safety, although each may have different circles of influence. To be effective in advocacy efforts, nurses first need to understand the laws and regulations governing their practice. For example, the Texas Nursing Practice Act (NPA) has specific provisions to protect nurses who raise concerns about patient safety. It’s illegal to retaliate against a nurse who reports a licensed healthcare practitioner, agency, or facility to a licensing board (such as the Texas Department of Aging and Disability Services, which licenses nursing homes), to an accrediting agency (such as The Joint Commission), or internally (within the facility) because he or she believes they have exposed a patient to a substantial risk of harm. Another provision in the Texas NPA protects nurses who report staffing concerns to nurse staffing committees, who are then responsible for evaluating and responding to the concern. A unique provision in Texas, called Safe Harbor, provides an avenue for resolving situations in which a nurse believes an assignment or directive may violate his or her duty to the patient. (See Safe Harbor.) Nurses who understand their state practice acts are best able to use established processes to advocate effectively for their patients while protecting themselves from retaliation and from violations against their license. Advocating for the Nursing Role in Program Design and Implementation Essay