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Education Papers & Publications
Nursing Education Papers
The following are NCSBN education papers that have been written and approved since 2002, by the NCSBN Board of Directors and all NCSBN voting members at our Delegate Assembly. The papers are listed in the order they were adopted.
Nancy Spector, PhD, RN
Susan L. Woods, PhD, RN, FAAN
Currently, boards of nursing (BONs) use seven different models for approving nursing programs, and nursing education rules and regulations in BONs are not consistent across jurisdictions. In 2010, the National Council of State Boards of Nursing’s (NCSBN) Board of Directors convened a committee to assess the state of prelicensure nursing program approval in BONs and to make recommendations to the NCSBN’s board based on current and future needs. This article describes the committee’s collaborative engagement with national accreditors and the recommendations that resulted.
Spector, N. & Woods, S.L. (2013). A collaborative model for approval of prelicensure nursing programs. Journal of Nursing Regulation, 3(4), 47-52.
Guidelines for Using Electronic and Social Media: The Regulatory Perspective
Social media can be a very effective way of communicating in nursing, but guidelines for appropriate use by healthcare providers are essential. This article briefly introduces the phenomenon of social media and introduces three actual scenarios where nurses unintentionally violated appropriate use of social media in healthcare. The scenarios are discussed related to social media, career, concerns, and nursing regulation. Incorporating these and other examples with data from board of nursing cases, the nature of complaints against nurses is explored as well as common myths and misunderstandings about using social media platforms. Guidelines for appropriate use by nurses and available resources to inform policy are highlighted. Next steps in social media in nursing should include development of organizational level policies and educational programs on the use of social media.
Spector, N. & Kappel, D. (September, 2012). Guidelines for using electronic and social media: The regulatory perspective" OJIN: The Online Journal of Issues in Nursing. 17(3), Manuscript 1.
The Initiative to Advance Innovations in Nursing Education: Three Years Later
Calls for innovation in nursing education have been prevalent in recent years. In 2009, the Innovations in Education Regulation Committee, convened by the National Council of State Boards of Nursing (NCSBN), worked collaboratively with other stakeholders to identify perceived and real barriers to innovation in nursing education and proposed model rules and statute language that boards of nursing could adapt to foster innovations in their state’s nursing programs. The model language was unanimously adopted by NCSBN’s Member Boards. Since then, NCSBN has conducted three surveys to determine the impact of NCSBN’s initiative as well as the state of innovations in nursing education. Following a review of the committee’s work, this article presents survey data on innovation in nursing education over the last 3 years.
Spector, N & Odom, S. (2012). The initiative to advance innovations in nursing education: Three years later. Journal of Nursing Regulation, 3(2), 40-44.
New Graduate Transition into Practice: Improving Quality and Safety
There is evidence linking improved patient care to standardized transition to practice programs in the areas of safety, competence, and retention. This chapter explores that evidence, presents a standardized model as a solution, and gives examples of transition program models, as well as an overview of NCSBN’s Transition to Practice model.
Spector, N., Ulrich, B.T. & Barnsteiner, J. (2012). New graduate transition into practice: Improving quality and safety. In G. Sherwood & J. Barnsteiner (Eds.), Quality and safety in nursing: A competency approach to improving outcomes (267-287). United Kingdom: Wiley-Blackwell.
Transition to Practice: An Essential Element of Quality and Safety
This chapter describes the importance of transitioning new graduate nurses to practice, and the impact of such transitions on patient care.
Spector, N. (2012). Transition to practice: An essential element of quality and safety. In Amer, Kim, Quality and safety for transformational nursing: Core competencies. New Jersey: Pearson Publishers.
What Nurse Educators Should Consider When Developing Social Media Policies
Social media offers many opportunities to promote student engagement and interactivity; however, student nurses must be instructed in the appropriate use of this tool. It is important for nursing programs to develop sound policies related to social media. This article suggests social media policy guidelines and presents several tools for nurse educators to utilize while implementing their own policies.
Spector, N. (2012). What nurse educators should consider when developing social media policies. Dean’s Notes. 34(1), 1-2.
National Council of State Boards of Nursing's Transition-To-Practice Regulatory Model
This chapter gives an overview of NCSBN’s Transition to Practice model.
Spector, N. & Silvestre, J. (2011). National Council of State Boards of Nursing's transition-to-practice regulatory model. In D. Molinari & A. Bushy (Eds.), Rural nurse: Transition to practice (123-134). New York: Springer.
Quality of Care and Patient Safety: The Evidence for Transition-To-Practice Programs
This chapter reviews the evidence for the need to transition new graduates into competent and safe nurses.
Spector, N. & Silvestre, J. (2011). National Council of State Boards of Nursing's transition-to-practice regulatory model. In D. Molinari & A. Bushy (Eds.), Rural nurse: Transition to practice (34-56). New York: Springer.
Nurses and Social Media: Regulatory Concerns and Guidelines
Social Media possess tremendous potential for strengthening professional relationships and providing valuable information to health care consumers. However, the inappropriate use of social media by nurses is causing concern among educators, employers, and regulators, and nursing organizations are beginning to develop guidelines. When using social media, nurses must protect the patient’s rights to privacy and confidentiality and consider the potential effects of their communications on their patients, their employers, their profession, and themselves. This article describes the professional, ethical, and legal implications of using social media inappropriately and provides guidelines from the National Council of State Boards of Nursing for using them appropriately.
Cronquist & Spector (2011). Nurses and social media: Regulatory concerns and guidelines. Journal of Nursing Regulation, 2(3), 37-40.
Are We Pushing Graduate Nurses Too Fast? Agency for Healthcare Research and Quality Mortality and Morbidity Rounds
How do newly licensed RNs transition from an educational environment to practice to assure safe patient care? This article examines a case study that highlights this issue, and discusses indicators that support a standardized transition to practice program for all newly licensed nurses.
Spector, N. (2011). Are we pushing graduate nurses too fast? Agency for Healthcare Research and Quality Mortality and Morbidity Rounds. Accessed from: http://www.webmm.ahrq.gov/case.aspx?caseID=238.
Use of Simulation in Nursing Education: National Survey Results
While simulation in nursing programs continues to increase, it is important to understand the prevalence of this new technology in nursing education, how this technology is utilized, and how educators are preparing to teach with this educational tool. This article reports on the results of a survey conducted by the National Council of State Boards of Nursing of 11,060 pre-licensure nursing programs in the United States as a means of describing use of simulation.
Hayden, J. (2010). Use of simulation in nursing education: National survey results. Journal of Nursing Regulation, 1(3), 52-57.
A Regulatory Model for Transitioning Newly Licensed Nurses to Practice
This article discusses the importance of developing a national, standardized program, implemented through regulation, for transitioning all newly licensed nursing graduates to practice.
Spector, N. & Echternacht, M. (2010). 2009 update on the National Council of State Boards of Nursing’s regulatory model for transitioning new nurses to practice. JONA’s Healthcare Law, Ethics, and Regulation, 12(1), 12-14.
Evidence-Based Nursing Regulation: A Challenge For Regulators
These are complex times for regulators on nursing boards, particularly in three areas. First, they must stay abreast of emerging practice issues emanating from technological advances, systems thinking, a more diverse patient population living longer with multiple chronic illnesses, and a national focus on patient safety and error prevention. Second, there has been a national call for the transformation of nursing education, and nursing boards are seeing increasing numbers of substandard or fraudulent nursing education programs. This adds to the boards’ workload. Third, disciplinary activity involving nurses has increased during the last 10 years, forcing regulations to stay on their toes regarding disciplinary action and investigation. In this challenging climate, the time is ripe to focus on evidence-based regulation as a strategy for making quality decisions related to regulation.
Spector, N. (2010). Evidence-based nursing regulation: A challenge for regulators. Journal of Nursing Regulation, 1(1), 30-36.
2009 Update on the National Council of State Boards of Nursing’s Regulatory Model for Transitioning New Nurses to Practice
This article outlines the background of NCSBN’s Transition to Practice initiative and the development of the Transition to Practice Model.
Spector, N. & Echternacht, M. (2010). 2009 update on the National Council of State Boards of Nursing’s regulatory model for transitioning new nurses to practice. JONA’s Healthcare Law, Ethics, and Regulation, 12(1), 12-14.
A Transition To Practice Regulatory Model: Changing the Nursing Paradigm
This article discusses the factors that inspired a call for an evidence-based regulatory model for transitioning new nurses to practice, and gives an overview of the Transition to Practice model being developed by NCSBN.
Spector, N. (2009). A transition to practice regulatory model: Changing the nursing paradigm. Dean's notes, 31(2), 1-3.
Approval: National Council of State Boards of Nursing
This chapter takes the reader through the inception and process of professional regulation, highlighting distinctions and overlap between accreditation and approval. Rationale and preparation for site visits are detailed, along with the recently written Model Nursing Practice Act.
Spector, N. (2009). Approval: National Council of State Boards of Nursing. In Caputi, L. (Ed.), Teaching Nursing: The Art and Science, Vol. 3 (2nd ed.). Glen Ellyn, Illinois: College of DuPage Press.
Transition to Practice: Improving Patient Outcomes
Because of the complexities in nursing and healthcare delivery and a national focus on patient safety, there has been a call across nursing organizations and healthcare organizations for more innovation in nursing and healthcare education. The National Council of State Boards of Nursing held an invitational roundtable, involving representatives from nursing education organizations, boards of nursing, the American Nurses Association, and the Robert Wood Johnson Foundation. Topics of discussion included the meaning and implications of innovation in nursing education, perceived barriers to innovation, and the future of innovation. This article summarizes the outcomes of the roundtable’s discussion.
Spector, N. (October-December 2009). Regulation fosters innovations in nursing education. JONA’s Healthcare Law, Ethics and Regulation. 11(4), 116-119.
Clinical Education and Regulation
This chapter explores in detail the regulatory perspective on clinical education in nursing and why boards of nursing take the position that nursing programs need to provide supervised clinical experiences for their students. Some of the myths about regulatory barriers are dispelled, and some of the differences among boards are discussed. Current issues, such as the regulatory perspective on simulation in prelicensure programs and the use of exit exams are also explored. The importance of the collaboration between education, practice and regulation is integrated throughout.
Spector, N. (2009). Clinical education and regulation. In Valiga, T. & Ard, N. (Eds.),Clinical Nursing Education: Current Reflections. New York: National League for Nursing Press.
Regulatory Recommendations for nursing faculty qualifications
The book addresses the importance of interprofessional collaboration, while this chapter presents interprofessional collaboration from a nursing standpoint. While this may seem counterintuitive, it is understood that each discipline approaches collaboration from its own perspective, and understanding these perspectives is crucial to the success of interprofessional collaboration.
Spector, N. (2009). Interprofessional collaboration: A nursing perspective. In Collaboration across the Disciplines in Health Care. In Freshman, B., Rubino, L. & Reid-Chassiakos, Y. (Eds.), MA: Jones and Bartlett Publishers.
Development of a standardized medication assistant curriculum
The National Council State Boards of Nursing took the position in their 2004 Model Nursing Practice Act and Model Administrative Rules, Article XVIII, Chapter 18, that if jurisdictions use medication assistants, they should be regulated by Boards of Nursing.
Spector, N. & Doherty, M. (2007). Development of a standardized medication assistant curriculum. JONA’s Healthcare Law, Ethics, and Regulation, 9(4), 119-124.
The Importance of Getting Involved: Policy and Governmental Relations at the NCSBN
Nurses make up the largest category of healthcare professionals in the world; their united voice can shape local, state, national and international policy, legislation, and regulation. When nurses know the issues in the health care environment, they can advocate for initiatives that will positively impact their patients and colleagues. Student nurses are at a perfect place in their career development to become aware of professional issues related to policy and government relations.
Hellquist, K. & Spector, N. (2007).The Importance of Getting Involved: Policy and Governmental Relations at the National Council of State Boards of Nursing (NCSBN). Imprint, February/March, 50-53.
A Regulatory Model on Transitioning Nurses from Education to practice
NCSBN data show that most employers reported that new graduates were not prepared to provide safe and effective care. Although educators may argue that employers are expecting too much from new graduates, this evidence supports that the gap between education and practice still exists.
Spector, N. & Li, S. (2007). A Regulatory Model on Transitioning Nurses from Education to Practice. JONA’s Healthcare Law, Ethics, and Regulation, 9(1), 19-22.
A significant role for most state boards of nursing, whose mission is to protect the public, is the approval of nursing education programs in their state. As part of this process, many of the state boards review their schools’ annual pass rates of first-time NCLEX-RN candidates and compare these percentages to state regulations. Schools whose pass rates fall below the state standard risk losing the approval of their state board of nursing.
Spector, N. & Alexander, M. (2006). Exit exams: A regulatory perspective. Journal of Nursing Education, 45(8), 291-292.
Evidence-Based Health Care Seen from Four Points of View
Evidence-based health care (EBHC) and its approach to the practice of medicine has gained considerable acceptance among health care professionals. The Association of American Medical Colleges (AAMC) advocates integration of the principles of evidence-based medicine (EBM) into undergraduate training. Promoted as a tool to further learning by inquiry, to steer clear of opinion-based medicine (Sackett et al., 2000), and to help students at all levels of training to assess conscientiously the current best evidence, an increasing number of medical schools in the United States have incorporated it into their curriculum.
Ghosh, A. K., Stengel, D., Spector, N., Murall, N. & Porzsolt, F. (2006). Evidence-Based Health Care Seen from Four Points of View. In F. Porzsolt & R.M. Kaplan (Eds.), Optimizing health: Improving the value of healthcare delivery. New York: Springer.
Worldviews in collision: Conflict and collaboration across professional lines
The process of providing health services in hospitals is inherently interdisciplinary; many of the challenges to enhancing quality and safety involve the human aspects of this interdisciplinary system. Each of the major disciplines—physicians, nurses, allied health providers, and health administrators—represent qualitatively distinct sets of goals and professional values, influencing not only current behavior but also who chooses these roles in the first place.
Garman, A., Leach, D. & Spector, N. (2006). Worldviews in collision: Conflict and collaboration across professional lines. Journal of Organizational Behavior. 27(7), 1-21.
Since Boards of Nursing are mandated to approve nursing programs, the boards are interested in knowing the evidence-based elements of nursing education that are essential for preparing new nurses for safe entry-level practice.
Spector, N, Li, S., & Kenward, K. (2006). Evidence-Based Nursing Education for Regulation. JONA’s Healthcare Law, Ethics, and Regulation, 8(3), 84-86.
NCSBN takes a stand on clinical prelicensure experiences
Recent discussion at the boards of nursing has focused on whether nursing programs leading to initial licensure can successfully educate nurses with alternative methodologies that take the place of traditional clinical experiences. Programs are asking for education rules addressing faculty qualifications to be waived and are developing programs with only limited clinical experiences with actual patients.
Spector, N. (2006). NCSBN takes a stand on clinical prelicensure experiences. JONA’s Healthcare Law, Ethics, and Regulation, January-March, 8(1), 12-14.
Recognizing the importance of the global perspective in regulation the National Council of State Boards of Nursing (NCSBN) developed as one of its 6 strategic initiatives the following: “Advance NCSBN as a key partner in nursing and healthcare regulation in the U.S. and internationally.” There are several objectives in place to meet this initiative.
Spector, N. and Apple, K. (2005). Global initiatives in regulation at NCSBN, JONA’s Healthcare Law, Ethics, and Regulation, 7(4), 112-113.
Practice can occur across state lines in jurisdictions that participate in the NLC (Nurse Licensure Compact), though states and territories that don’t participate in the NLC require a licensure application for endorsement, This compact allows nurses to have one license in the state of their legal residency and to practice in other compact states, as long as they acknowledge that they are subject to each state’s practice laws and discipline.
Spector, N. and Hellquist, K. (2005). A licensure model that allows for mobility. Imprint, 52(1), 38, 39, and 41.
Focus group on licensed practical nurse scope of practice at NCSBN
The National Council of State Boards of Nursing convened a focus group to discuss the findings of the 2003 Licensed Practical Nurse/Vocational Nurse (LPN/VN) practice analysis and to make recommendations to the NCSBN board of directors.
Spector, N. (2005). Focus group on licensed practical nurse scope of practice at National Council of State Boards of Nursing. JONA’s Healthcare Law, Ethics, and Regulation, January-March, 7(1), 35-37.
A primer: The national council of state boards of nursing nurse licensure compact
The National Council of State Boards of Nursing began exploring the mutual recognition model of nurse licensure. This model, which NCSBN called the Nurse Licensure Compact (NLC), allows a nurse to have one license and to practice in other states as long as that nurse acknowledges that he or she is subject to each state’s practice laws and discipline.
Hellquist, K. and Spector, N. (2004). A primer: The national council of state boards of nursing nurse licensure compact. JONA’s Healthcare Law, Ethics, and Regulation. 6, issue 4 (October-November).
The Sicily Statement on Evidence- Based Health Care
A variety of definitions of evidence-based practice (EBP) exist. However, definitions are in themselves insufficient to explain the underlying processes of EBP and to differentiate between an evidence-based process and evidence-based outcome. There is a need for a clear statement of what Evidence-Based Practice (EBP) means, a description of the skills required to practice in an evidence-based manner and a curriculum that outlines the minimum requirements for training health professionals in EBP. This consensus statement is based on current literature and incorporating the experience of delegates attending the 2003 Conference of Evidence-Based Health Care Teachers and Developers ("Signposting the future of EBHC").
The Sicily Statement on Evidence-Based Health Care. (October, 2004). Attendees at the 2nd International Conference on Evidence-Based Health Care for Teachers and Developers, Palermo, Italy. The Lancet.
This chapter provides the history behind program approval by boards of nursing and compares and contrasts approval with national nursing accreditation. The reader is taken through the board of nursing approval process, step-by-step.
Spector, N. Approval: National Council of State Boards of Nursing (NCSBN). In: Caputi, L. & Englelmann, L. (2004). Teaching Nursing: The Art and Science. Glen Ellyn, IL: College of DuPage Press.
Regulations, Licensure and Policy Breakout Session
The challenge to regulatory boards has always been maintaining the balance between an individual's desire to practice a chosen profession and the board's responsibility to protect the public from unsafe practitioners. Reasonable people can differ in how best to protect the public. And our boards vary in their approaches to a number of issues. I think many regulators recognize that providing access to nursing care is part of protecting the public.
Spector, N. (2004). “Regulations, Licensure and Policy Breakout Session”. In: Proceedings of the National Symposium of Students with Disabilities: Nursing Education and Practice. Chicago: Rush University Press. (Available in January, 2004).