key: cord-0029948-90wr4nhy authors: Shellenbarger, Teresa title: Accreditors stepping up to the challenge: Reimaging the future of nursing date: 2022-04-15 journal: Teach Learn Nurs DOI: 10.1016/j.teln.2022.03.004 sha: b28f6e82556657039a186eedf6a3a81b30177457 doc_id: 29948 cord_uid: 90wr4nhy nan In 2010, the Institute of Medicine published the Future of Nursing Report: Leading Change in Advancing Health. This report offered suggestions for advancing the nursing profession and health care delivery from 2010 to 2020. Reflecting on the 10th anniversary of this document, leaders report advancement in some areas, such as academic progression, but ongoing work is needed to advance health (Hassmiller et al., 2020) . The National Academies of Sciences, Engineering, and Medicine (NAM) completed further study about the needed next steps for nursing. Their latest report entitled, The Future of Nursing, 2020-2030: Charting a Path to Achieve Health Equity, offers an analysis of the ongoing issues confronting nursing and health care. The latest report suggests needed changes related to practice, policy, accreditation, regulation, and other areas that will help reimagine the future of nursing (National Academies of Sciences, Engineering, and Medicine, 2021). As the largest and most respected profession of the health care workforce, nurses play an essential role in achieving health equity and the goals suggested by the NAM (Reinhart, 2020 ; United States Department of Health and Human Services Health Resources and Services Administration National Center for Health Workforce Analysis, 2020). To help ensure health equity, nursing must address the influence of social determinants of health and focus on reducing health disparities and inequities, thereby helping to ensure fair and appropriate care is provided to systematically marginalized populations. This imperative has become even more evident as the COVID-19 pandemic continues and the public becomes more aware of ongoing social challenges, while nurses are intensifying their focus on diversity, equity, and inclusion. The latest NAM report suggests that nurse educators, leaders, and accreditors must address critical aspects of education and health care that impact workforce preparation and health outcomes. Specifically, one recommendation suggests that "nursing education programs, including continuing education and accreditors and the National Council of State Boards of Nursing [,] should ensure that nurses are prepared to address social determinants of health and achieve health equity" (National Academies of Sciences, Engineering, and Medicine, 2021, pp. 13-14) . Also relevant is a recommendation suggesting critical interventions are needed to promote nurses' health and well-being. Health profession accreditation standards were also discussed in the current Future of Nursing report. Professional accreditors establish standards of quality for programs. Since programs seek accreditation to demonstrate program quality, they use these accreditation standards as guiding documents to inform program, curriculum, and teaching and learning approaches. Frequently, changes in accreditation standards will drive curriculum and other nursing education changes. Therefore, the standards of quality that accreditors use should reflect current best practices, timely research, and emerging issues that will help guide educational change. Accreditors typically update standards by using a process that seeks input from various stakeholders. The Association of Specialized and Professional Accreditors reports that most accrediting agencies review their standards on a 6-year cycle or as changes are needed (Association of Specialized and Professional Accreditors, 2021). Once standards are revised, programs have a transition period, which may vary by accreditors, in which they need to demonstrate compliance with the updated standards. Sometimes these standard changes require curriculum revisions or operational changes within nursing education that may take some time for programs to adopt and implement. The National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA), one of the national nursing program accreditors, was conducting a standards review when the latest Future of Nursing report was released, thus providing an opportune time to quickly respond to the suggestions offered and incorporate these changes into the updated standards. The NAM report identified significant areas that needed to be addressed by accreditors, including social determinants of health, health equity, and the health and well-being of nurses. The NLN CNEA has embedded these recommended items into the updated accreditation standards and quality indicators (National League for Nursing Commission for Nursing Education Accreditation, 2021). Table 1 provides some of the areas where report suggestions have been incorporated. Each NLN CNEA standard provides quality indicators or specific items that should be demonstrated to illustrate compliance with the standard. Additionally, the NLN CNEA provides interpretive guidelines to explain the quality indicators. As can also be seen in Table 1 , the concepts of diversity, equity, inclusion, and nurse well-being were incorporated into the standards pertaining to students, faculty, curriculum, and evaluation processes. The table provides the specific language in these relevant quality indicators and interpretative guidelines. Standard three requires that programs demonstrate an inclusive organization with resources that support the recruitment and retention of diverse educators. Faculty must also Teaching and Learning in Nursing journal homepage: www.journals.elsevier.com/ teaching-and-learning-in-nursing demonstrate expertise in social determinants of health, population health, health equity, and technological competence. Additionally, preceptors in the clinical setting must support students' diverse learning needs and student well-being. Culturally responsive and inclusive support services should be available for students. Lastly, the curriculum should offer opportunities for students to learn about and deliver culturally responsive care to diverse populations via experiential learning experiences. Both the classroom and experiential learning experiences should offer education based on health care quality, social determinants of health, health equity, population health, and ethical practice. Another federal report also addressed the importance of social determinants of health in nursing education. The report by the National Advisory Council on Nurse Education and Practice (NACNEP, 2019) focused on Integration of Social Determinants of Health in Nursing Education, Practice, and Research and suggested that nursing programs have been slow to incorporate social determinants of health into their curricula. The report also emphasized that only providing theoretical content about social determinants of health is inadequate. Therefore, programs are encouraged to augment classroom learning by including these vital learning opportunities in simulation and clinical learning situations. To help ensure that graduates are adequately prepared for the challenging work situations they will face in health care settings, nursing curricula should also incorporate content related to nurse well-being, resilience, and self-care. Even though these standards provide some specificity about curriculum requirements, the way that a program incorporates content and offers learning experiences is entirely up to the program. Each program has unique students, faculty, and community demographics that may drive how programs demonstrate compliance with these standards and quality indicators. Programs seeking accreditation may provide evidence of participation in ongoing professional development and continuing education for faculty related to the knowledge and skills needed to implement these changes. For example, for quality indicator III A, faculty workshops or training related to social determinants of health or diversity issues would provide evidence supporting faculty qualifications. Programs may also provide examples of actions related to the recruitment and retention of diverse faculty. Offering training and orientation to preceptors could demonstrate to accreditors that programs have provided the needed resources for preceptors to fulfill their roles and responsibilities as required for quality indicator III B. To demonstrate compliance with quality indicator IV A (Table 1) , programs could provide descriptions of the support services available to students or offer examples of strategies that foster a culturally responsive learning environment that demonstrates the inclusivity of diverse learners. Program may also want to offer examples of teaching-learning strategies (e.g., clinical experiences, lab/simulation experiences, case discussions, case studies, online experiences, etc.) to illustrate how content is incorporated into the curriculum and learning experiences related to these topics are provided as required for quality indicators V D and V F. Course syllabi can provide further evidence that the program is integrating information about culturally responsive care appropriate for diverse and vulnerable populations. Since programs may be at various stages of incorporating the NAM recommendations into nursing education, some programs may have work to comply with these changes. Faculty need to consider what strategies to use to align with the accreditation standards and report recommendations. Table 2 offers some resources and suggestions to help faculty begin making needed changes (National League for Nursing, 2016 Nursing, , 2017 Nursing, and 2019 . Ultimately these changes should positively impact student learning, provide support, and offer diverse experiences that will prepare graduates to address population health and equity issues and hopefully transform nursing education. Interpretive Guidelines III-A The program's faculty are qualified, diverse, and adequate in number to meet program goals. Adequate number of faculty with expertise in social determinants of health, population health, health equality and technological competence to meet program goals. The nursing program exhibits an inclusive organization environment and resources supportive of recruitment, retention, and flourishing of diverse faculty. III-B Preceptors, and other alternative clinical supervisory personnel, are adequate in number, qualified, and prepared for their assigned role and responsibilities in facilitating student learning. Preceptors are oriented to their role and coached in the role by faculty to best facilitate their effectiveness in supporting students' well-being and achievement of expected student learning outcomes. Preceptors are supportive of diverse students and their learning needs. IV-A The institution and program provide student services that are student-centered; culturally responsive; inclusive and readily accessible to all students. There is evidence of ongoing review and revision of the effectiveness of student support services with attention to meeting the needs of diverse learners, supporting inclusivity and empowering students to achieve academic success and professional identify formation in their nursing role. V-C The program's curriculum is sequenced, designed, and implemented to progressively support student achievement of learning outcomes and the acquisition of competencies appropriate for the intended practice role. . . .the curriculum requirements of the program support the development of the professional identity of nurses and respects diversity, equity, and inclusion. V-D The curriculum is up-to-date, dynamic, evidence-based, and reflects current and emerging societal and health care trends and issues, research findings, and contemporary educational practices. The curriculum demonstrates evidence of education based on health care quality, social determinants of health, health equity, population health, and ethical practice. The curriculum demonstrates evidence of education of nurse well-being, resilience, and self-care. Relevant local, regional, national, and international social and health care trends and issues, and workforce needs are addressed as appropriate within the curriculum. V-F The curriculum provides experiential learning that enhances student ability to demonstrate leadership, ethical practice, clinical reasoning and judgment, reflect thoughtfully on one's practice, provide culturally responsive care to diverse and vulnerable populations. The faculty design and implement experiential learning experiences throughout the curriculum. . .that foster acquisition of professional nursing values, encompassing but not limited to, leadership skills, clinical reasoning and judgment, reflective thought, and ethically responsive care to diverse populations. Standards review: Programmatic accreditation practices The future of nursing report 10 years later: Where is nursing and what work remains? Nursing Education Perspectives A vision for integration of the social determinants of health into nursing education curricula United States Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis Social Determinants of Health (SDOH) Plan experiential learning for all students to engage with diverse populations in the community. Encourage civic engagement activities and/or involve students in community-based projects. Provide faculty training about SDOH to prepare them to incorporate SDOH concepts into their courses. Use technology such as telehealth and simulation to provide students with clinical practice experiences incorporating SDOH Incorporate resources that address social determinants of health such as those found at the Institute for Social Determinants of Provide support services such as financial aid, mentoring, study groups, supplemental instruction, tutoring, support groups, stress reduction, culturally sensitive advising, and others. Examine admission practices and ensure they foster a diverse applicant pool and acceptance of diverse students. Develop faculty and staff recruitment and hiring practices that foster diversity of all stakeholders. Gather data about the diversity of students and faculty. Set goals to improve diversity for faculty and students. Consider diversity broadly to include many aspects (race/ ethnicity, sexual identity, ability, economics, gender, age, and others) The NAM report catalyzes the discussions that must occur. Accreditors, like NLN CNEA, are helping to draw attention to these critical concepts. Educators need to ensure the learning and work environments provide these needed changes as the profession moves forward in helping to achieve health equity.