The American Association of Colleges of Nursing (AACN) publishes Essentials and the National Organization of Nurse Practitioner Faculties issues competencies and these guide faculty in designing nurse practitioner (NP) curricula. The National Council of State Boards of Nursing specifies coursework that must be included in NP curricula. The advantages of evidence-based, peer-reviewed standards are clear: payers, employers, health care institutions, and our patients expect uniform competency among NPs. At the same time, we NPs expect employers, peers, and our patients to understand what it is we do and to tailor their expectations of us to those competencies, which don’t change as we move across state lines or from one health care setting to another. Having our education and training programs meet certain standards helps satisfy those expectations. But, should NP curricula be standardized?
Lisa R. Roberts, DrPH, FNP-BC, is an associate professor at Loma Linda University in Loma Linda, CA, and a primary care NP with a focus on health promotion and prevention. Dr. Roberts also conducts research focusing on interventions to address the needs of vulnerable populations in the United States and internationally.
NP programs are founded on standards from the AACN Essentials as well as criteria laid out by other nursing professional associations. Given this uniform starting point, one would expect that NP educational programs would look uniform. However, faculty also draw on the school’s mission and vision statements to design curriculum, content, and course sequence. Loose interpretation of the standards has resulted in more than 400 curricula across the nation, all with different course titles, objectives, numbers of hours and client encounters, and teaching methods.
Medical schools adopted a standardized curriculum more than 100 years ago. Standardization ensured that students received the same essential education, putting an end to diploma mills and great variance in educational programs that train physicians. That is not to say that there are not qualitative differences between medical schools, but patients have a clear understanding and expectation of physicians’ scope of practice and competencies. NP education, however, does not follow such an approach.
Standardization is not a threat to academic freedom; rather, it is an approach to elevate the educational process and provide better outcomes for patients. Standardization of NP education across all 50 states would bolster the NP scope of practice battle.
Public administration literature suggests that standardization brings efficiency and lowers costs, which in turn should improve outcomes and allow flexibility and interchangeability. Standardization would also bring efficiency to NP programs. Standardization of NP curricula would also allow students to transfer between schools when “life happens,” or simply to fit today’s mobile lifestyle. Standardization benefits the student, who can continue a forward educational trajectory, and benefits the school as well, allowing vacant seats to be filled at any point. By focusing on standardization; competency-based preparation, standardized evaluation measures; and a national credentialing licensing examination, NP patient care will further advance.
What is Your View on This Topic?
Point/Counterpoint offers thought-provoking topics relevant to nurse practitioners in every issue of JNP. Two authors present thoughtful but opposing viewpoints on current subjects, from scope of practice and regulations to work ethics and care practices. Your opinion on these matters is also important, so go to www.npjournal.org or scan the QR code here to register your vote for either side of each topic. Comments or suggestions for future columns should be sent to Department Editor Donald Gardenier at [email protected]
Wendi M. Swanson
Wendi Mortimer Swanson, DNP, FNP-C, is an assistant professor in the College of Graduate Nursing at the Western University of Health Sciences in Pomona, CA. Dr Swanson’s nursing experience includes critical care, family practice, college health, hospice, and academia. Her doctoral work focused on the obesity epidemic and strategies to sustain improved physical activity in college students.
Standardized NP curricula should not be the norm. Colleges and universities are as unique as the communities they serve. Such distinction drives the organization’s mission and vision to influence the surrounding community. NP programs extend the mission to produce multiple community benefits. Identification of community needs prompts assessment and application of suitably matched concepts and skills. Community immersion is dually favorable for student learning and community gains. A rigid curriculum forced to align with the parent organization may appear remote or distant without familiarity. A customized curriculum, rather than a standardized curriculum, offers the best opportunity to represent the culture and character of the college or university and the community.
NP programs should use existing academic and national NP standards to create and deliver programs that best reflect the diverse health care needs of the community and prepare competent practitioners. NP standards are intentionally broad and not limiting. Such breadth offers ample versatility and application across various settings. Graduate faculty are absolutely qualified to develop innovative curricula inclusive of standards within the merits of higher learning. An innovative assignment can simultaneously align to the standard while supporting real-time application. Authentic execution provides experience in an academic environment that is adaptable to the learner. A standardized curriculum stifles innovation and threatens academic freedom.
A standardized curriculum is not only counterproductive, but also a missed opportunity. Standardization would inhibit multiple ways of achieving program outcomes, while recklessly impeding both student centeredness and patient-centeredness. NP education is not an industrial process but is rooted in more than 50 years of successful outcomes. Furthermore, NP education addresses the current needs in healthcare. The current educational approach reflects the epitome of advanced practice nursing: creative problem-solving. Nonstandardized curriculum facilitates the art in nursing and should be fostered.
Published online: November 25, 2017
© 2017 Elsevier Inc. All rights reserved.