Monday, May 16, 2011

Dean Valderrama's Statement on the Minimum Requirement for a Chief Nursing Officer & Member of the BON

TO ALL NURSES WHO ARE COMMITTED TO THE PASSION 
FOR EXCELLENCE IN NURSING

Position paper on the minimum requirement for a BON and Chief Nursing Officer is a
Master’s degree in Nursing
By

Deogracia M. Valderrama
Dean School of Health Sciences Mapua Institute of Technology
December 2003 to present
May 13, 2011

I am Deogracia M. Valderrama, the current dean of the School of Health Sciences of the Mapua Institute of Technology. Having been in nursing practice and education I would like to give my reaction to the proposed provision on the Amendment of RA 9173. My reactions stem from my experience as Director II for nursing Service at the University of the Philippines-Philippine General Hospital for ten years including my stint in the same position when the position became vacant in 1986 and my almost seven years as dean of the Mapua Institute of Technology School of Health Sciences. I am also giving my comments as the Chair of the PNEA, Inc. the educational arm of the ADPCN as well as the official representative of the association to the committee on amendments of RA 9173.

The amendment proposed is to have master’s degree other than nursing to become a BON
member or Chief of Nursing Service.

I STRONGLY DISAGREE WITH THE AMENDMENT BEING PROPOSED TO INCLUDE MASTERS DEGREE OTHER THAN NURSING FOR THE FOLLOWING REASONS:

Master’s- Degree in Nursing prepared nurses built on the competencies gained in a baccalaureate nursing program by developing a deeper understanding of nursing and the related sciences needed to fully analyze, design, implement, and evaluate nursing care. These nurses are well prepared to provide care to diverse populations and cohorts of patients in clinical and community-based systems. The master’s-prepared nurse integrates findings from the Sciences and the humanities, biopsychosocial fields, genetics, public health, Quality Improvement, health economics, translational science, and organizational sciences for the continual improvement of nursing care at the unit, clinic, home, or program level. Master’s-prepared nursing care reflects a more sophisticated understanding of assessment, problem identification, planning, design of interventions, and evaluation of aggregate outcomes than baccalaureate-prepared nursing care.

Students being prepared for direct care roles will have graduate-level content that builds upon an undergraduate foundation in health assessment, pharmacology, and pathophysiology. Having master’s-prepared graduates with a strong background in these three areas are seen as imperative from the practice perspective. It is recommended that the Master’s curriculum preparing individuals for direct care roles include three separate Graduate-level courses in these three content areas. In addition, the inclusion of these three separate courses facilitates the transition of these master’s program graduates into the DNP advanced-practice registered-nurse programs.

Master’s-prepared nurses understand the intersection between Master’s-prepared nurses understand the intersection between systems science and organizational science in order to serve as integrators within and across systems of care.

According to Nelson et al (2008) in his article on the building blocks of health systems published in the joint Commission Journal in Quality and Patient Safety, care coordination is based on systems science wrote “Care management incorporates an understanding of the clinical and community context, and the research relevant to the needs of the population. Nurses at this level use advanced clinical reasoning for ambiguous and uncertain clinical presentations, and incorporate concerns of family, significant others, and communities into the design and delivery of care.”

Hence, Master’s-in nursing prepared nurses use a variety of theories and frameworks, including nursing and ethical theories in the analysis of clinical problems, illness prevention, and health promotion strategies. knowledge from information sciences, health communication, and health literacy is used to provide care to multiple populations. These nurses are able to address complex cultural issues and design care that responds to the needs of multiple populations, who may have potentially conflicting cultural needs and preferences. As healthcare technology becomes more sophisticated and its use more widespread, Master’s-prepared nurse are able to evaluate when its use is appropriate for diagnostic, educational and therapeutic interventions. Master’s-prepared nurses use improvement science and quality processes to evaluate outcomes of the aggregate of patients, community members, or communities under their care, monitor trends in clinical data, and understand the implications of trends for changing nursing care.

In summary, the master’s-degree program in Nursing (if this degree is obtained from a reputable of higher educational institution of learning) prepares the graduate to:

1. Integrate nursing and related sciences into the delivery of advanced nursing care to diverse populations.

2. Incorporate current and emerging, evidenced based genetic/genomic evidences in providing holistic and advanced nursing care to individuals, families, and communities while accounting for patient values and clinical judgment putting into consideration the patient’s response to illnesses, dysfunctional situations and life phenomenon .

3. Design nursing care for a clinical or community-focused population based on bio-psycho- social ethical and moral, community health, nursing, and organizational sciences.

4. Apply ethical analysis and clinical reasoning to assess, intervene, and evaluate they delivery of advanced nursing care.

5. Synthesize evidence for practice to determine application of appropriate interventions across diverse populations.

6. Use quality processes and improvement science to evaluate care and ensure patient safety for individuals and communities.

7. Integrate organizational communication, science, technology and informatics to make changes in the care environment to improve health outcomes.

8. Analyze nursing health history to expand thinking and provide a sense of professional
heritage and identity.

Master’s-level nursing graduates must have been equipped with an expanded level of understanding of nursing and related sciences built on the Essentials of Baccalaureate Education for Professional Nursing Practice. Master’s-prepared nurses have developed a deeper understanding of the nursing profession based on reflective practices and continues to develop their own plans for lifelong learning and professional development.

Nursing-practice interventions include both direct and indirect care components. As a practice discipline, clinical care is the core business of nursing practice whether the graduate is focused on the provision of care to individuals, population-focused care, administration, informatics, education or health policy. Master’s nursing education prepares graduates to implement safe, quality care in a variety of settings and roles. mastery in nursing practice is acquired by the student through a series of applied learning experiences designed to allow the learner to integrate cognitive learning with more than the 30 affective and psychomotor domains of nursing practice. The clinical/practice experiences allow the learner to experiment and acquire competence with new knowledge and skills. These experiences provide the opportunity for delivery of services or programs of wide diversity and focus and may occur in multiple settings including hospitals, community settings, public health departments, primary care practice offices, integrated health care systems and an array of other settings.

The clinical experience is an opportunity to integrate didactic learning, promote innovative thinking, and test new potential solutions to clinical/practice or system issues. Therefore, the development of new skills and practice expectations can be facilitated through the use of creative learning opportunities in diverse settings. These learning opportunities may include experiences in business, industries, and with disciplines that are recognized as innovators in safety, quality, finance, management, or technology.

Through these experiences, the student may develop an appreciation and use the wisdom from other industries and disciplines in nursing practice that can occur through application of knowledge or evidence developed in other industries.

These learning experiences also can occur using simulation designed as a mechanism for verifying early mastery of new levels of practice or designed to create access to data or health care situations that is not readily accessible to the student. These experiences may include simulated mass casualty events, simulated database problems, simulated interpersonal communication scenarios and other new emerging learning technologies. The simulation is an adjunct to the learning that will occur with direct human interface or human experience learning.

The Board of Nursing came up with 11 core competencies which should be achieved by a new graduate nurse in order to pass the Philippine Nursing Licensure Examination. In Article IV of the CHED Memo # 14 Series of 2009, states in Section 5 that “Graduates of Bachelor of Science in Nursing program must be able to apply analytical and critical thinking in the nursing practice. The nurse must be competent in the 11 Key Areas of Responsibility with the respective core competency standards and indicators.” Therefore if the BON is testing the graduates of nursing on the competencies specified by both the BON and CHED then the minimum requirement to become a BON member should be beyond the basic level WHICH IS THE MASTERS DEGREE IN NURSING.

As an addendum to my comments, I would like to recommend that the Hon. Faire look into the vertical articulation when it comes to the ten years of professional experience. As I have indicated in the meeting held at the ADPCN Center for Nursing Development, I mentioned that ten years of professional development should be qualified.

In so far as the Chief nursing officer of a nursing service department is concerned, she should also have a minimum of Master’s degree in nursing and no other degrees for the same reasons mentioned above.

With these reactions, I hope that in the next meetings/dialogues with us the members of Hon Faire’s committee should refrain from using insulting remarks on us who give comments.

References:

American Association of Colleges of Nursing (2011) The Essentials of Master’s Education in Nursing

Advanced Practice Consensus Work Group & National Council of State Boards of Nursing. (2008). Consensus model for regulation of APRNs: Licensure, accreditation, certification, & education. Retrieved August 3, 2010 from http://www.aacn.nche.edu/Education/

Agency for Healthcare Research and Quality. (2009). AHRQ patient safety network Glossary. Retrieved June 20, 2009, http://www.psnet.ahrq.gov/glossary.aspx#J

Agency for Healthcare Research and Quality. (2009). The guide to clinical preventive services 2009: Recommendations of the U.S. Preventive Services task force. Retrieved December 06, 2009, from http://www.ahrq.gov/clinic/USpstfix.htm.

Aiken, L. H, Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Education levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association, 290(12), 1617-1623.

Nelson, E. C., Godfrey, M. M., Batalden, P. B., Berry, S. A., Bothe, A. E., McKinley, K.E. et al. (2008). Clinical microsystems, Part 1. The building blocks of health systems. The Joint Commission Journal on Quality and Patient Safety, 34(7), 367-378.

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