differentiated essential competencies (decs)-published in 2010

7/31/2019 Differentiated Essential Competencies (DECs)-Published in 2010

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Differentiated Essential Competencies (DECs)Of Graduates of Texas Nursing Programs

Evidenced by Knowledge, Clinical Judgments, and Behaviors

Vocational (VN)Diploma/Associate Degree (Diploma/ADN)

Baccalaureate Degree (BSN)

The Texas Board of NursingOctober 2010


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DIFFERENTIATED ESSENTIAL COMPETENCIES (DECs)OF GRADUATES OF TEXAS NURSING PROGRAMS

TABLE OF CONTENTSIntroductionExecutive SummaryNursing Program Descriptions and Entry Level Core Competencies

Vocational Nursing ProgramsDiploma/Associate Degree Nursing ProgramsBaccalaureate Degree Nursing Programs

Differentiated Essential CompetenciesMember of the ProfessionProvider of Patient-Centered CarePatient Safety AdvocateMember of the Health Care Team

Appendices

Committee MembersSurvey RespondentsSurvey CollaboratorsAffiliating Agency Responses to SurveyGlossaryReferences


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Agenda Item: 7.2Attachment #4

Introduction

Differentiated Essential Competenciesof Graduates of Texas Nursing Programs

Evidenced by Knowledge, Clinical Judgments, and Behaviors2010

Nursing practice in Texas by licensed nurses flows along a scope of practice continuum based uponeducational preparation from the Licensed Vocational Nurse (LVN) to the doctorally prepared RegisteredNurse (RN). While selected aspects of nursing care may be assigned or delegated by licensed practicingnurses to ancillary persons such as nursing assistants or aides, LVNs and RNs currently form the core inthe roles identified as members of the profession, providers of patient-centered care, patient safetyadvocates, and members of the health care team.

Basic educational preparation for the LVN examination is provided at the vocational level in Texas Board

of Nursing (BON or Board) approved programs in community colleges, hospitals, career schools, and themilitary. Educational preparation for the RN licensure examination may be obtained through Texas BONapproved diploma, associate degree, and baccalaureate degree programs (including generic master=sdegree programs). Each of these programs provides the necessary preparation for practice as aregistered professional nurse. The curricula of each of the nursing programs differ and the outcomes ofthe educational levels dictate a differentiated set of essential competencies of graduates. Thecompetency statements describe progression in expected behaviors across the types of programs fromvocational nursing (VN) to diploma and associate degree nursing (ADN) to baccalaureate degree nursing(BSN). The competencies of each educational level build upon the previous level.

HISTORY AND METHODOLOGYOn January 20, 2000, the then Board of Nurse Examiners (BNE) charged the Advisory Committee onEducation (ACE) to review and revise the original competency document, the Essential Competencies of

Texas Graduates of Education Programs in Nursing(BNE, 1993). The Board of Vocational NurseExaminers (BVNE, later merged with the BNE) conducted a parallel process to survey vocationalprograms for review and revision of the VN competencies and then joined the ACE to finalize the process.

ACE instituted a subcommittee which included six nurses who represented Diploma, ADN, and BSNeducation in addition to Texas League for Nursing (TLN) and Texas Organization of Nurse Executives(TONE) members who represented nursing practice. This subcommittee met August 9, 2000 to begin theprocess of review and revision. The subcommittee analyzed the Essentials of Baccalaureate Education(American Association of Colleges of Nursing, 1998) and the Educational Competencies for Graduates ofAssociate Degree Nursing Programs(National League for Nursing, 2000) and found that the original 14competencies in the Texas document were consistent with these two publications. The subcommitteealso recognized that over the preceding seven years, schools of nursing used the 14 core competenciesin various ways, one of which was to revise course objectives and outcome statements. The reviseddocument was approved in 2002.

At the July 17-18, 2008 meeting of the Texas BON, the Board charged the ACE to review and revise the2002 Differentiated Entry Level Competencies (DELC). This was the first review and revision after themerger of the BVNE and BNE in 2004. Following the methodology used for the 2002 revision, ACEappointed a DELC Work Group to lead the revision process. Members of the DELC Work Grouprepresented VN, Diploma, ADN, and BSN education; vocational and professionalnursing practice; theLicensed Vocational Nurses Association of Texas (LVNAT); the Texas Nurses Association (TNA); and theTexas Organization of Nurse Executives (TONE). Through meetings and telephone conference calls overa period of about 20 months, the work group revised the DELC, changing the title to Differentiated


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Essential Competencies (DECs) and expanding the three roles to four.

The four roles are listed with a brief rationale for the change:

$ Member of the Profession: listed as primary role to focus on the profession$ Provider of Patient-Centered Care: a change in current literature from Aclient@ to Apatient@,

emphasizing patient-centered care

$ Patient Safety Advocate: based upon new concerns about patient safety$ Member of the Health Care Team: relates to the nurse=s participation in the health care

team

The core competencies were increased from 14 in the DELC to 25 in the DECs with an increasing focuson patient safety. All competencies were updated using current literature, national standards, andresearch (e.g., the Quality and Safety Education for Nurses Competencies, the Institute of MedicineReports, the Carnegie Report), and incorporated new focus concepts including safety, advocacy, patient-centered care, evidence-based practice, and informatics. The 25 core competencies fall under the fournursing roles and are further delineated into a series of more specific expected clinical judgments andbehaviors related to each core competency. These more detailed competencies are preceded by thenecessary content (or knowledge) needed as a basis for competency development. The knowledgestatements indicate the student learning needs during the educational experience; the content determines

the subject matter to be taught. The knowledge should provide the tools to the student for critical thinkingand reflection in clinical decision-making for safe, compassionate, and effective patient care. The programof study prepares the students (and graduates) with a knowledge base to make sound clinical judgmentsfor their nursing behaviors and interventions.

The revised competencies were distributed to all Texas BON approved nursing programs for comments inSeptember 2009. ACE members and Board staff presented information about the revised document todeans, directors, and coordinators at meetings of the vocational and professional program directors.Comments and responses were considered as further revisions of the document continued. The reviseddocument was disseminated to affiliating agencies (including long term care, hospitals, and public healthsettings) and other stakeholders during the spring and summer of 2010. The final revision of the DECswas presented to the Board for adoption at the October 2010 meeting. Programs will be expected todevelop a plan for implementation by fall 2011.

COMPETENCIESThe competencies are written to guide nursing programs to meet the approval criteria established by theBON and to ensure that programs prepare graduates to provide safe, competent care to the people ofTexas. A competency is described as Aan expected level of performance that integrates knowledge, skills,abilities, and judgment@ (American Nurses Association, 2008, p. 3).

Competencies were designed to demonstrate the progression of expectations across the types of nursingprograms based upon educational preparation. It is acknowledged that it may be impossible to evaluatestudents abilities on some of the competencies since new graduates will grow from novice to advancedbeginner as they transition into practice (Benner, 1984; National Council of State Boards of Nursing,2006). It is expected that the education should have prepared the graduate with a background todemonstrate these advanced competencies which are italicized and identified by an asterisk in thedocument. All of the competencies may be utilized to develop curriculum.

There may seem to be redundancy in the competencies within the DECs but the redundancy isintentional. The document was designed so that sections related to a specific competency or educationallevel could be separated and could stand alone from the larger document. Most competencies buildacross educational levels and yet some of the competencies are the same across levels. For example, ageneral high level of safety is expected across all levels of nursing practice.

The scope of nursing practice for which the student is being prepared is reflected in the competencies.The scope of practice defines the extent of the provision of care within each level of educational


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preparation. Patients for the LVN are individuals in the context of their families; patients for the diplomagraduate or the ADN are individuals and their families; and patients for the BSN are individuals, families,populations, and communities. Rule 215 lists specific content areas for BSN programs: research,community, and leadership, all of which affect scope of practice.

In addition to the DECs being used for curriculum development, the DECs may also be used in the

practice area to assist employers in developing orientation and internship programs, establishing careerladders, determining entry level competencies, determining job descriptions, and reviewing and revisingpolicies and procedures.

EFFECTIVENESS OF THE 2002 DELC AND TRANSITION TO USING THE DECsTexas programs have used the competencies since 1993 and have experienced a statewide NCLEXexamination pass rate above the national average. The DELC could be viewed as a type of corecurriculum for nursing programs in Texas and established the framework for the preparation of safe,competent nursing graduates. The DELC provided guidelines for curriculum development and evaluation,as well as benchmarks for program effectiveness. The new document will continue to provide a commoncore competency statement for all Texas BON approved nursing programs; provide guidelines forcurriculum development, benchmarking, and evaluation; and support the mission of the BON to protectthe public and ensure safe, competent nursing graduates.

VALUES AND ETHICS IN NURSINGThrough the educational process, students are provided the necessary experiences to develop theknowledge, behaviors, and skills expected of practicing nurses. In addition, the clinical judgments of thenurse are guided by various values and beliefs about oneself and society. It is recommended that nursingeducators strive to fostercommitment to the following values and ethical principles believed to beinherent to the nursing profession:

1) Altruism - Concern for the welfare of others seen through caring, commitment, and compassion2) Human Dignity - Belief in the inherent worth and uniqueness of the individual seen throughrespect, empathy, humanness, and trust3) Truth - Faithfulness to fact seen through honesty, accountability, and authenticity4) Justice - Upholding moral and legal principles seen through courage, advocacy, and objectivity

5) Freedom - Capacity to exercise choice seen through openness, self-direction, and self-discipline6) Equality - Having the same rights and privileges seen through acceptance, tolerance, and fairness7) Esthetics - Identifying the qualities of objects, events, and persons that provide satisfaction as seenthrough creativity, sensitivity, and appreciation

Values and beliefs about oneself and society guide the clinical judgments of the nurse. To act as a moralagent and to advocate on behalf of patients, the nurse must be sensitive to ethical issues inherent inhealth care settings and health care policies. Through the educational process, students clarify personaland professional values and develop the knowledge, judgments, behaviors, and skills expected of nursespracticing ethically.

Professional values are enduring beliefs or ideals that guide practitioners and serve as a framework forprofessional decisions and action. These values are the foundation for moral standards of right andwrong, established in accordance with the profession=s norms and traditions. As a practice discipline,nursings fundamental value is caring, growing from altruism -- a concern for the well-being of others.Caring, as a human endeavor, places demands on the character, knowledge, judgments, behaviors, andskills of the nurse. A nurse=s first moral obligation is to be a competent practitioner.

Nursing ethics offer general moral principles and rules to address potential and actual ethical issuesarising within the health care encounter. This system of valued beliefs and behaviors (identified as rights,duties, and obligations as well as good professional character) guides the conduct of nurses.

A code of ethics for nursing embodies the profession=s central values and standards of conduct, reflectingnursings responsibility to society and its collegial solidarity. The code provides the framework for


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Executive Summary

Differentiated Essential Competenciesof Graduates of Texas Nursing Programs

Evidenced by Knowledge, Clinical Judgments, and Behaviors

2010

Background:The Differentiated Essential Competencies (DECs) is the third generation of Texas Board of Nursing(BON or Board) education competencies with differentiation based upon the education outcomes of thethree levels of prelicensure nursing education programs. Previous documents were approved in 2002(Differentiated Entry Level Competencies) and 1993 (Essential Competencies). All revisions weredeveloped within the BON Advisory Committee for Education (ACE) with input from nursing programs,nursing organizations, affiliating agencies, employers, and other stakeholders. The 2010 revisionincorporates concepts from current literature, national standards, and research.

Purpose:The DECs were designed to provide guidance to nursing education programs for curriculum developmentand revision and for effective preparation of graduates who will provide safe, competent, compassionatecare. The DECs outline knowledge, clinical behaviors, and judgments necessary to meet the essentialcompetencies, but it is acknowledged that not all competencies can be evaluated upon graduation. It isintended that the graduate will have received the educational preparation to demonstrate eachcompetency, but it will not be reasonable to evaluate some advanced competencies (italicized andidentified by an asterisk) until the nurse has transitioned into nursing practice.

Definition of Competency:The American Nurses Association (2008) defined a competency as Aan expected level or performancethat integrates knowledge, skills, abilities, and judgment@ (p. 3).

Outline of the DECs:Twenty-five core competencies are categorized under four main nursing roles:$ Member of the Profession

$ Provider of Patient-Centered Care$ Patient Safety Advocate$ Member of the Health Care Team

Each core competency is further developed into specific knowledge areas and clinical judgments andbehaviors based upon the knowledge areas. Redundancy is intentional so that sections of the documentor educational levels can be separated yet remain complete as stand-alone documents.Competencies for each level of educational preparation are presented in a table format. Thecompetencies are differentiated and progressive across the levels, and the scope of practice andexpectations may be compared across the table.

Implications of the DECs:Nursing Education:

$ Guideline and tool for curriculum development and revision$ Tool for benchmarking and evaluation of the program$ Statewide standard to ensure graduates will enter practice as safe and competent nurses

Employers:$ Guide for development of employee orientation and internship programs$ Guide for job descriptions and career ladders$ Information for determining entry level competencies$ Information for reviewing and revising policies and procedures for nursing care


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ESSENTIAL COMPETENCIES OF GRADUATES OF TEXASVOCATIONAL NURSING EDUCATIONAL PROGRAMS

I. Member of the Profession:

A. Function within the nurse=s legal scope of practice and in accordance with the policies andprocedures of the employing health care institution or practice setting.

B. Assume responsibility and accountability for the quality of nursing care provided to patients andtheir families.

C. Contribute to activities that promote the development and practice of vocational nursing.D. Demonstrate responsibility for continued competence in nursing practice, and develop insight

through reflection, self-analysis, self-care, and lifelong learning.

II. Provider of Patient-Centered Care:

A. Use clinical reasoning and established evidence-based policies as the basis for decision makingin nursing practice.

B. Assist in determining the physical and mental health status, needs, and preferences of culturally,ethnically, and socially diverse patients and their families based on interpretation of health-relateddata.

C. Report data to assist in the identification of problems and formulation of goals/ outcomes andpatient-centered plans of care in collaboration with patients, their families, and theinterdisciplinary health care team.

D. Provide safe, compassionate, basic nursing care to assigned patients with predictable health careneeds through a supervised, directed scope of practice.

E. Implement aspects of the plan of care within legal, ethical, and regulatory parameters and inconsideration of patient factors.

F. Identify and report alterations in patient responses to therapeutic interventions in comparison toexpected outcomes.

G. Implement teaching plans for patients and their families with common health problems and well-defined health learning needs.

H. Assist in the coordination of human, information, and materiel resources in providing care forassigned patients and their families.

III. Patient Safety Advocate:

A. Demonstrate knowledge of the Texas Nursing Practice Act and the Texas Board of Nursing Rulesthat emphasize safety, as well as all federal, state, and local government and accreditationorganization safety requirements and standards.

B. Implement measures to promote quality and a safe environment for patients, self, and others.C. Assist in the formulation of goals and outcomes to reduce patient risks.D. Obtain instruction, supervision, or training as needed when implementing nursing procedures or

practices.E. Comply with mandatory reporting requirements of the Texas Nursing Practice Act.

F. Accept and make assignments that take into consideration patient safety and organizationalpolicy.

IV. Member of the Health Care Team:

A. Communicate and collaborate with patients, their families, and the interdisciplinary health careteam to assist in the planning, delivery, and coordination of patient-centered care to assignedpatients.

B. Participate as an advocate in activities that focus on improving the health care of patients andtheir families.


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C. Participate in the identification of patient needs for referral to resources that facilitate continuity ofcare, and ensure confidentiality.

D. Communicate and collaborate in a timely manner with members of the interdisciplinary healthcare team to promote and maintain optimal health status of patients and their families.

E. Communicate patient data using technology to support decision making to improve patient care.

F. Assign nursing care to LVNs or unlicensed personnel based upon an analysis of patient or unitneed.G. Supervise nursing care provided by others for whom the nurse is responsible.

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TEXAS BOARD OF NURSINGDIPLOMA AND ASSOCIATE DEGREE NURSING EDUCATION

Although the programs for Diploma nursing and Associate Degree Nursing (ADN) may vary in themissions and philosophies of the sponsoring institutions, competencies have been identified as common

for graduates of both programs. These competencies are the expectations for entry level into registerednursing practice.

Diploma programs are hospital-based, single purpose schools of nursing that consist of two to three yearsof general education and nursing courses. These programs are based on the missions, values, andpurposes of the governing institutions, and prepare graduates to provide and coordinate health care ofindividuals and their families throughout the life span across the health continuum.

General education courses, from an accredited college or university, may be required as prerequisites toor offered concurrently with nursing courses. The general education courses provide a foundation incommunication, psychology, human growth and development, and related sciences to support thenursing courses. A Diploma program of study that is completed on or after December 31, 2014, mustentitle a student to receive a degree [Texas Occupation Code 301.157(a-1)].

ADN programs, located in community colleges, senior colleges, and career schools, require a minimum oftwo years of full-time study, integrating a balance between courses in liberal arts; natural, social, andbehavioral sciences; and nursing. Academic associate degrees consist of 60 to 72 credit hours withapproximately half the program requirements in nursing courses.General education courses provide afoundation for nursing content in ADN programs and enable graduates to apply theoretical content andevidence-based findings in the provision of nursing care. The Texas Board of Nursing (BON or Board)approved curriculum includes requirements for didactic instruction and clinical learning experiences infour content areas: medical-surgical, maternal/child health, pediatrics, and mental health nursing.

Nursing courses in Diploma and ADN programs provide opportunities to demonstrate competence in theapplication of nursing knowledge and clinical judgments and behaviors in health care settings. The entrylevel graduate from a Diploma or ADN program integrates knowledge from general education andsciences for the delivery of safe and compassionate care for patients and their families. Nursing content

includes the importance of establishing partnerships with patients and their families in the promotion,prevention, rehabilitation, maintenance, and restoration of health of individuals of all ages. Nursing caresupervision, basicnursing management, and legal/ethical content are imbedded in the curriculum.

All levels of prelicensure nursing education prepare graduates to demonstrate the Differentiated EssentialCompetencies of Graduates of Texas Nursing Programs Evidenced by Knowledge, Clinical Judgments,and Behaviors (DECs). The competencies for each education level are based upon the preparation in theprogram of study.

The Texas BON licenses individuals who pass the National Council Licensure Examination forRegistered Nurses (NCLEX-RN7). Qualified graduates of Diploma and ADN programs typically receivea temporary permit to practice under direct supervision of a registered professional nurse for a 75-dayperiod while awaiting testing and licensure.

The primary role of the entry level graduate of a Diploma or ADN program is to provide direct nursing careto or coordinate care for a limited number of patients in various health care settings. Such patients mayhave complex multiple needs with predictable or unpredictable outcomes.

With additional experience and continuing education, the Diploma or ADN graduate can increase thenumbers of assigned patients, provide independent direct care, supervise health care of patients andtheir families, and receive certification in various specialty areas. Through articulation, graduates maycontinue their education to prepare for expanded roles.


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The entry level competencies of the Diploma and ADN graduate build upon the entry levelcompetencies of the Vocational Nursing (VN) graduate and are listed below:

ESSENTIAL COMPETENCIES OF GRADUATES OF TEXASDIPLOMA AND ASSOCIATE DEGREE NURSING EDUCATION PROGRAMS

I. Member of the Profession:A. Function within the nurse=s legal scope of practice and in accordance with the policies and

procedures of the employing health care institution or practice setting.B. Assume responsibility and accountability for the quality of nursing care provided to patients and

their families.C. Participate in activities that promote the development and practice of professional nursing.D. Demonstrate responsibility for continued competence in nursing practice, and develop insight


II. Provider of Patient-Centered Care:A. Use clinical reasoning and knowledge based on the diploma or associate degree nursing program

of study and evidence-based practice outcomes as a basis for decision making in nursingpractice.

B. Determine the physical and mental health status, needs, and preferences of culturally, ethnically,and socially diverse patients and their families based upon interpretation of comprehensive healthassessment findings compared with evidence-based health data derived from the diploma orassociate degree nursing program of study.

C. Analyze assessment data to identify problems, formulate goals/ outcomes, and develop plans ofcare for patients and their families using information from evidence-based practice incollaboration with patients, their families, and the interdisciplinary health care team.

D. Provide safe, compassionate, comprehensive nursing care to patients and their families through abroad array of health care services.

E. Implement the plan of care for patients and their families within legal, ethical, and regulatory

parameters and in consideration of disease prevention, wellness, and promotion of healthylifestyles.

F. Evaluate and report patient outcomes and responses to therapeutic interventions in comparisonto benchmarks from evidence-based practice, and plan follow-up nursing care.

G. Develop, implement, and evaluate teaching plans for patients and their families to address healthpromotion, maintenance, and restoration.

H. Coordinate human, information, and materiel resources in providing care for patients and theirfamilies.

III. Patient Safety Advocate:A. Demonstrate knowledge of the Texas Nursing Practice Act and the Texas Board of Nursing Rules

that emphasize safety, as well as all federal, state, and local government and accreditationorganization safety requirements and standards.

B. Implement measures to promote quality and a safe environment for patients, self, and others.C. Formulate goals and outcomes using evidence-based data to reduce patient risks.D. Obtain instruction, supervision, or training as needed when implementing nursing procedures or

practices.E. Comply with mandatory reporting requirements of the Texas Nursing Practice Act.F. Accept and make assignments and delegate tasks that take into consideration patient safety and

organizational policy.


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IV. Member of the Health Care Team:A. Coordinate, collaborate, and communicate with patients, their families, and the interdisciplinary

health care team to plan, deliver, and evaluate patient-centered care.B. Serve as a health care advocate in monitoring and promoting quality and access to health care

for patients and their families.C. Refer patients and their families to resources that facilitate continuity of care; health promotion,maintenance, and restoration; and ensure confidentiality.

D. Communicate and collaborate in a timely manner with members of the interdisciplinary healthcare team to promote and maintain optimal health status of patients and their families.

E. Communicate and manage information using technology to support decision making to improvepatient care.

F. Assign and/ or delegate nursing care to other members of the health care team based upon ananalysis of patient or unit need.

G. Supervise nursing care provided by others for whom the nurse is responsible by using evidence-based nursing practice.

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TEXAS BOARD OF NURSINGBACCALAUREATE DEGREE NURSING EDUCATION

Baccalaureate education, offered in college and university settings, provides students with a broadperspective and understanding of nursing; health and healing; the environment; and persons as diverse

individuals, families, populations, and communities. The Baccalaureate Degree Nursing (BSN) programof study integrates approximately 60 hours from liberal arts and natural, social, and behavioral sciencecourses and approximately 60-70 hours of nursing courses. In addition to a liberal arts education thatprovides a solid foundation for the development of clinical judgment skills, baccalaureate educationincludes instruction in community health, public health, research, nursing leadership, and nursingmanagement with preparation in skills and knowledge needed to practice evidence-based nursing (U.S.Department of Health and Human Services, 2008). Baccalaureate education provides a strongfoundation for future critical thinking and problem solving skills with its inclusion of a broad range of basicsciences, behavioral and social management sciences, communication, and data analysis content.Community health nursing, research, and courses that provide depth and breadth in the understandingof leadership, management, health promotion, and care of vulnerable groups are required by the TexasBoard of Nursing (BON or Board) education rules for inclusion in the baccalaureate curriculum, andthese areas of study are generally not addressed in the preceding levels of education. The BSN fromBoard approved nursing programs meets the educational requirements for eligibility to take the NationalCouncil Licensure Examination for Registered Nurses (NCLEX-RN7) as mandated for practice in theState of Texas by the Nursing Practice Act and regulated by the Texas BON.

Baccalaureate graduates synthesize information from various disciplines, think logically, analyze critically,and communicate effectively with patients and other health care professionals. The baccalaureategraduate Auses research findings and other evidence in designing and implementing care that is multi-dimensional, high quality, and cost-effective@ (American Association of Colleges of Nursing, 2008, p. 9).Graduates are expected to demonstrate all the competencies (knowledge, clinical judgments, andbehaviors) of the preceding levels of education, but with greater depth and breadth of application andsynthesis.

Graduates of baccalaureate programs are prepared to provide and direct care for patients, families,populations, and communities experiencing complex and unpredictable health care needs in structured

and unstructured settings. With additional experience and continuing education, BSN graduates are ableto provide care for communities and society within the context of the environment, available resources,and technology.

Qualified graduates of BSN programs typically receive a temporary permit to practice under directsupervision of a registered professional nurse for a 75-day period while awaiting testing and licensure.These graduates routinely begin their careers in structured settings but rapidly move into community-based settings and/ or leadership roles. A BSN degree is the most common requirement for entry intograduate nursing education where nurses may further develop their professional roles to become nurseeducators, researchers, administrators, or advanced practice nurses.

All levels of prelicensure nursing education prepare graduates to demonstrate the Differentiated EssentialCompetencies of Graduates of Texas Nursing Programs Evidenced by Knowledge, Clinical Judgments,

and Behaviors (DECs). The competencies for each educational level are based upon the preparation inthe program of study.

The entry level competencies of the BSN graduate which build upon the entry level competencies ofthe Diploma or Associate Degree Nursing (ADN) graduate are listed below:


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ESSENTIAL COMPETENCIES OF GRADUATES OF TEXASBACCALAUREATE DEGREE NURSING EDUCATION PROGRAMS

I. Member of the Profession:

A. Function within the nurse=s legal scope of practice and in accordance with the policies andprocedures of the employing health care institution or practice setting.

B. Assume responsibility and accountability for the quality of nursing care provided to patients,families, populations, and communities.

C. Promote the practice of professional nursing through leadership activities and advocacy.D. Demonstrate responsibility for continued competence in nursing practice, and develop insight


II. Provider of Patient-Centered Care:

A. Use clinical reasoning and knowledge based on the baccalaureate degree nursing program ofstudy, evidence-based practice outcomes, and research studies as the basis for decisionmaking and comprehensive patient care.

B. Determine the physical and mental health status, needs, and preferences of culturally,ethnically, and socially diverse patients, families, populations, and communities based uponinterpretation of comprehensive health assessment findings compared with evidence-basedhealth data and a synthesis of knowledge derived from a baccalaureate degree nursingprogram of study.

C. Synthesize comprehensive assessment data to identify problems, formulate goals/ outcomes,and develop plans of care for patients, families, populations, and communities usinginformation from evidence-based practice and published research in collaboration with theabove groups and the interdisciplinary health care team.

D. Provide safe, compassionate, comprehensive nursing care to patients, families, populations,and communities through a broad array of health care services.

E. Implement the plan of care for patients, families, populations, and communities within legal,ethical, and regulatory parameters and in consideration of disease prevention, wellness, andpromotion of healthy lifestyles.

F. Evaluate and report patient, family, population, and community outcomes and responses totherapeutic interventions in comparison to benchmarks from evidence-based practice andresearch findings, and plan follow-up nursing care.

G. Develop, implement, and evaluate teaching plans for patients, families, populations, andcommunities to address health promotion, maintenance, restoration, and population riskreduction.

H. Coordinate human, information, and materiel management resources in providing care forpatients, families, populations, and communities.

III. Patient Safety Advocate:

A. Demonstrate knowledge of the Texas Nursing Practice Act and the Texas Board of NursingRules that emphasize safety, as well as all federal, state, and local government and

accreditation organization safety requirements and standards.B. Implement measures to promote quality and a safe environment for patients, self, and others.C. Formulate goals and outcomes using an evidence-based and theoretical analysis of available

data to reduce patient and community risks.D. Obtain instruction, supervision, or training as needed when implementing nursing procedures

or practices.E. Comply with mandatory reporting requirements of the Texas Nursing Practice Act.F. Accept and make assignments and delegate tasks that take into consideration patient safety

and organizational policy.


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IV. Member of the Health Care Team:

A. Coordinate, collaborate, and communicate with patients, families, populations, communities,and the interdisciplinary health care team to plan, deliver, and evaluate care.

B. Serve as a health care advocate in monitoring and promoting quality and access to health care

for patients, families, populations, and communities.C. Use multiple referral resources for patients, families, populations, and communities,considering cost, confidentiality, effectiveness and efficiency of care, continuity and continuumof care, and health promotion, maintenance, and restoration.

D. Communicate and collaborate in a timely manner with members of the interdisciplinary healthcare team to promote and maintain optimal health status of patients, families, populations, andcommunities.

E. Communicate and manage information using technology to support decision making toimprove patient care and delivery systems.

F. Assign and/ or delegate nursing care to other members of the health care team based upon ananalysis of patient or organizational need.

G. Supervise nursing care provided by others for whom the nurse is responsible by using bestpractices of management, leadership, and evaluation.

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Texas Board of NursingDifferentiated Essential Competencies (DECs)

Vocational Nursing Diploma and Associate Degree Nursing Baccalaureate Degree Nursing

Member of the Profession: I. Member of the Profession: I. Member of the Profession:

A. Function within the nurses legal scope ofractice and in accordance with the policies androcedures of the employing health care institutionr practice setting.

A. Function within the nurses legal scope of practiceand in accordance with the policies and procedures ofthe employing health care institution or practicesetting.

A. Function within the nurses legal scope of pracand in accordance with the policies and procedurethe employing health care institution or practicesetting.

. Assume responsibility and accountability for theuality of nursing care provided to patients and their

amilies.

B. Assume responsibility and accountability for thequality of nursing care provided to patients and theirfamilies.

B. Assume responsibility and accountability for thquality of nursing care provided to patients, familiepopulations, and communities.

C. Contribute to activitiesthat promote theevelopment and practice of vocational nursing.

C. Participate in activities that promote thedevelopment and practice of professional nursing.

C. Promote the practice of professional nursingthrough leadership activities and advocacy.

D. Demonstrate responsibility for continuedompetence in nursing practice, and develop insighthrough reflection, self-analysis, self-care, andfelong learning.

D. Demonstrate responsibility for continuedcompetence in nursing practice, and develop insightthrough reflection, self-analysis, self-care, and lifelonglearning.

D. Demonstrate responsibility for continuedcompetence in nursing practice, and develop insigthrough reflection, self-analysis, self-care, and lifelearning.

. Provider of Patient-Centered Care: II. Provider of Patient-Centered Care: II. Provider of Patient-Centered Care:

A. Use clinical reasoning and established evidence-ased policies as the basis for decision making inursing practice.

A. Use clinical reasoning and knowledge based onthe diploma or associate degree nursing program ofstudy and evidence-based practice outcomes as abasis for decision making in nursing practice.

A. Use clinical reasoning and knowledge based othe baccalaureate degree nursing program of studevidence-based practice outcomes, and researchstudies as the basis for decision making andcomprehensive patient care.

. Assist in determining the physical and mentalealth status, needs, and preferences of culturally,thnically, and socially diverse patients and their

amilies based on interpretation of health-relatedata.

B. Determine the physical and mental health status,needs, and preferences of culturally, ethnically, andsocially diverse patients and their families based uponinterpretation of comprehensive health assessmentfindings compared with evidence-based health dataderived from the diploma or associate degree nursingprogram of study.

B. Determine the physical and mental health statuneeds, and preferences of culturally, ethnically, ansocially diverse patients, families, populations, andcommunities based upon interpretation ofcomprehensive health assessment findings compawith evidence-based health data and a synthesis oknowledge derived from a baccalaureate degreenursing program of study.


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C. Report data to assist in the identification ofroblems and formulation of goals/ outcomes andatient-centered plans of care in collaboration withatients, their families, and the interdisciplinaryealth care team.

C. Analyze assessment data to identify problems,formulate goals/ outcomes, and develop plans of carefor patients and their families using information fromevidence-based practice in collaboration with patients,their families, and the interdisciplinary health careteam.

C. Synthesize comprehensive assessment data tidentify problems, formulate goals/ outcomes, anddevelop plans of care for patients, families,populations, and communities using information frevidence-based practice and published research icollaboration with the above groups and theinterdisciplinary health care team.

D. Provide safe, compassionate, basic nursing careo assigned patients with predictable health careeeds through a supervised, directed scope ofractice.

D. Provide safe, compassionate, comprehensivenursing care to patients and their families through abroad array of health care services.

D. Provide safe, compassionate, comprehensivenursing care to patients, families, populations, andcommunities through a broad array of health careservices.

. Implement aspects of the plan of care withinegal, ethical, and regulatory parameters and inonsideration of patient factors.

E. Implement the plan of care for patients and theirfamilies within legal, ethical, and regulatoryparameters and in consideration of diseaseprevention, wellness, and promotion of healthylifestyles.

E. Implement the plan of care for patients, familiepopulations, and communities within legal, ethicaland regulatory parameters and in consideration ofdisease prevention, wellness, and promotion ofhealthy lifestyles.

. Identify and report alterations in patientesponses to therapeutic interventions inomparison to expected outcomes.

F. Evaluate and report patient outcomes andresponses to therapeutic interventions in comparisonto benchmarks from evidence-based practice, andplan follow-up nursing care.

F. Evaluate and report patient, family, population,and community outcomes and responses totherapeutic interventions in comparison tobenchmarks from evidence-based practice andresearch findings, and plan follow-up nursing care

G. Implement teaching plans for patients and theiramilies with common health problems and well-efined health learning needs.

G. Develop, implement, and evaluate teaching plansfor patients and their families to address healthpromotion, maintenance, and restoration.

G. Develop, implement, and evaluate teaching plafor patients, families, populations, and communitieaddress health promotion, maintenance, restoratio

and population risk reduction.

H. Assist in the coordination of human, information,nd materiel resources in providing care forssigned patients and their families.

H. Coordinate human, information, and materielresources in providing care for patients and theirfamilies.

H. Coordinate human, information, and materielmanagement resources in providing care for patiefamilies, populations, and communities.


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I. Patient Safety Advocate: III. Patient Safety Advocate: III. Patient Safety Advocate:

A. Demonstrate knowledge of the Texas NursingPractice Act and the Texas Board of Nursing Ruleshat emphasize safety, as well as all federal, state,nd local government and accreditation organizationafety requirements and standards.

A. Demonstrate knowledge of the Texas NursingPractice Act and the Texas Board of Nursing Rulesthat emphasize safety, as well as all federal, state,and local government and accreditation organizationsafety requirements and standards.

A. Demonstrate knowledge of the Texas NursingPractice Act and the Texas Board of Nursing Rulethat emphasize safety, as well as all federal, statelocal government and accreditation organization srequirements and standards.

. Implement measures to promote quality and aafe environment for patients, self, and others.

B. Implement measures to promote quality and asafe environment for patients, self, and others.

B. Implement measures to promote quality and a environment for patients, self, and others.

C. Assist in the formulation of goals and outcomeso reduce patient risks.

C. Formulate goals and outcomes using evidence-based data to reduce patient risks.

C. Formulate goals and outcomes using an evidebased and theoretical analysis of available data toreduce patient and community risks.

D. Obtain instruction, supervision, or training aseeded when implementing nursing procedures orractices.

D. Obtain instruction, supervision, or training asneeded when implementing nursing procedures orpractices.

D. Obtain instruction, supervision, or training asneeded when implementing nursing procedures opractices.

. Comply with mandatory reporting requirements ofhe Texas Nursing Practice Act.

E. Comply with mandatory reporting requirements ofthe Texas Nursing Practice Act.

E. Comply with mandatory reporting requirementsthe Texas Nursing Practice Act.

. Accept and make assignments that take intoonsideration patient safety and organizationalolicy.

F. Accept and make assignments and delegate tasksthat take into consideration patient safety andorganizational policy.

F. Accept and make assignments and delegate tathat take into consideration patient safety andorganizational policy.


V. Member of the Health Care Team: IV. Member of the Health Care Team: IV. Member of the Health Care Team:

A. Communicate and collaborate with patients, theiramilies, and the interdisciplinary health care team tossist in the planning, delivery, and coordination ofatient-centered care to assigned patients.

A. Coordinate, collaborate, and communicate withpatients, their families, and the interdisciplinary healthcare team to plan, deliver, and evaluate patient-centered care.

A. Coordinate, collaborate, and communicate withpatients, families, populations, communities, and tinterdisciplinary health care team to plan, deliver, aevaluate care.


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. Participate as an advocate in activities that focusn improving the health care of patients and their

amilies.

B. Serve as a health care advocate in monitoring andpromoting quality and access to health care forpatients and their families.

B. Serve as a health care advocate in monitoring promoting quality and access to health care forpatients, families, populations, and communities.

C. Participate in the identification of patient needsor referral to resources that facilitate continuity ofare, and ensure confidentiality.

C. Refer patients and their families to resources thatfacilitate continuity of care; health promotion,maintenance, and restoration; and ensureconfidentiality.

C. Use multiple referral resources for patients,families, populations, and communities, considerincost; confidentiality; effectiveness and efficiency ocare; continuity and continuum of care; and healthpromotion, maintenance, and restoration.

D. Communicate and collaborate in a timely mannerwith members of the interdisciplinary health care

eam to promote and maintain optimal health statusf patients and their families.

D. Communicate and collaborate in a timely mannerwith members of the interdisciplinary health care team

to promote and maintain optimal health status ofpatients and their families.

D. Communicate and collaborate in a timely manwith members of the interdisciplinary health care t

to promote and maintain optimal health status ofpatients, families, populations, and communities.

. Communicate patient data using technology toupport decision making to improve patient care.

E. Communicate and manage information usingtechnology to support decision making to improvepatient care.

E. Communicate and manage information usingtechnology to support decision making to improvepatient care and delivery systems.

. Assign nursing care to LVNs or unlicensedersonnel based upon an analysis of patient or uniteed.

F. Assign and/ or delegate nursing care to othermembers of the health care team based upon ananalysis of patient or unit need.

F. Assign and/ or delegate nursing care to othermembers of the health care team based upon ananalysis of patient or organizational need.

G. Supervise nursing care provided by others forwhom the nurse is responsible.

G. Supervise nursing care provided by others forwhom the nurse is responsible by using evidence-based nursing practice.

G. Supervise nursing care provided by others forwhom the nurse is responsible by using best practof management, leadership, and evaluation.


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Member of the Profession

icensed nurse (LVN or RN) who exhibits behaviors that reflect commitment to the growth and development of the role and function of nursingnsistent with state and national regulations and with ethical and professional standards; aspires to improve the discipline of nursing and itsntribution to society; and values self-assessment and the need for lifelong learning.

N Diploma and ADN BSN

A. Function within the nurses legal scope ofpractice and in accordance with the policiesand procedures of the employing health careinstitution or practice setting.

A. Function within the nurses legal scope ofpractice and in accordance with the policies andprocedures of the employing health careinstitution or practice setting.

A. Function within the nurses legal scope ofpractice and in accordance with the policiesand procedures of the employing health careinstitution or practice setting.

Knowledge

1. a. Texas Nursing Practice Act.b. Texas Board of Nursing Rules, PositionStatements, and Guidelines.c. Federal, state, or local laws, rules, andregulations affecting nursing practice.

1. a. Texas Nursing Practice Act.b. Texas Board of Nursing Rules, PositionStatements, and Guidelines.c. Federal, state, or local laws, rules, and regulationsaffecting nursing practice.

1. a. Texas Nursing Practice Act.b. Texas Board of Nursing Rules, PositionStatements, and Guidelines.c. Federal, state, or local laws, rules, andregulations affecting nursing practice.

2. Nursing scope of practice in relation todelegated medical acts and facility policies.

2. Nursing scope of practice in relation to delegatedmedical acts and facility policies.

2. Nursing scope of practice in relation todelegated medical acts and facility policies.

3. Standards and guidelines from professionalorganizations.



4. Facility policies and procedures. 4. Facility policies and procedures. 4. Facility policies and procedures.

Clinical Judgments and Behaviors

1. Function within a directed scope of practice ofthe vocational nurse with appropriate supervision.

1. Function within the scope of practice of theregistered nurse.

1. Function within the scope of practice of theregistered nurse.

2. Assist in determination of predictable healthcare needs of patients to provide individualized,goal-directed nursing care.

2. Use a systematic approach to provideindividualized, goal-directed nursing care to meethealth care needs of patients and their families.

2. Use a systematic approach to provideindividualized, goal-directed nursing care to meehealth care needs of patients, families, populatioand communities.


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3. a. Practice according to facility policies andprocedures and provide input in the development offacility policies and procedures.b. Question orders, policies, and procedures thatmay not be in the patien ts best interest.

3. a. Practice according to facility policies andprocedures and participate in the development offacility policies and procedures.b. Question orders, policies, and procedures that maynot be in the patients best interest.

3. a. Practice according to facility policies andprocedures and participate in the development offacility policies and procedures.b. Question orders, policies, and procedures thamay not be in the patients best interest.

B. Assume responsibility andaccountability for the quality of nursingcare provided to patients and theirfamilies.

B. Assume responsibility and accountability for thequality of nursing care provided to patients and theirfamilies.

B. Assume responsibility and accountability fothe quality of nursing care provided to patientsfamilies, populations, and communities.

Knowledge

1. a. Texas Board of Nursing Standards ofPractice.b. National standards of vocational nursingpractice and care.c. National Federation of Licensed PracticalNurses Code of Ethics.d. Advocacy process.

1. a. Texas Board of Nursing Standards of Practice.b. National standards of nursing practice and care.c. American Nurses Association Code of Ethics.d. Models of ethical decision making.e. Advocacy process.

1. a. Texas Board of Nursing Standards of Practicb. National standards of nursing practice and careprocess for the development of standards of nursinpractice and care.c. American Nurses Association Code of Ethics.d. Models of ethical decision making.e. Legislative advocacy process.f. Resources and strategies for access to standardof practice.

2. Legal parameters of vocational nursingpractice and the Texas Nursing Practice Act,including Safe Harbor.

2. a. Legal parameters of nursing practice and the TexasNursing Practice Act, including Safe Harbor.b. Legal principles relative to health care.

2. a. Legal parameters of nursing practice and thTexas Nursing Practice Act, including Safe Harborb. Legal principles and practice theories andprinciples relative to health care.

3. Issues affecting the vocational nurse roleand the delivery of culturally-sensitive care topatients and their families.

3. Issues affecting the registered nurse role and thedelivery of culturally-sensitive care to patients and theirfamilies.

3. Issues affecting the registered nurse role, theBSN role, and the delivery of culturally-sensitive cato patients, families, populations, andcommunities.

4. Continuing competency and professionaldevelopment.

4. Continuing competency and professional development. 4. a. Continuing competency and professionaldevelopment.b. Principles of staff development and learnerbehaviors.

5. Self evaluation, staff evaluation, and peerevaluation processes.

5. Self evaluation, staff evaluation, and peer evaluationprocesses.

5. a. Self evaluation, staff evaluation, and peerevaluation processes.b. Human resource management and performancevaluation processes.

6. Employment setting policies andprocedures.

6. a. Employment setting policies and procedures.b. Methods for the development of policies andprocedures.

6. a. Employment setting policies and proceduresb. Methods for the development of policies andprocedures.c. Role of committees in the development of healt


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care policies and procedures.d. Communication skills in the areas of writing,speaking, and presenting as required to function inleadership positions.

7. a. Professional characteristics and valuessuch as altruism, human dignity, truth, justice,freedom, equality, and esthetics.b. Aspects of professionalism includingattention to appearance and demeanor.c. Communication techniques to maintainprofessional boundaries.

7. a. Professional characteristics and values such asaltruism, human dignity, truth, justice, freedom, equality,and esthetics.b. Aspects of professionalism including attention toappearance and demeanor.c. Communication techniques and management skills tomaintain professional boundaries.

7. a. Professional characteristics and values suchas altruism, human dignity, truth, justice, freedom,equality, and esthetics.b. Aspects of professionalism including attention toappearance and demeanor.c. Communication techniques, management andleadership skills, and role modeling to maintainprofessional boundaries.

8. Principles of quality improvement. 8. Principles of quality improvement and basic outcomemeasurement in health care organizations.

8. Principles and tools of quality improvement andoutcome measurement in systems of care delivery


1. Pass the Nursing JurisprudenceExamination before licensure.

1. Pass the Nursing Jurisprudence Examination beforelicensure.

1. Pass the Nursing Jurisprudence Examinationbefore licensure.

2. a. Provide nursing care within theparameters of vocational nursing knowledge,scope of practice, education, experience, andethical/ legal standards of care.b. Participate in evaluation of careadministered by the interdisciplinary healthcare team.

2. a. Provide nursing care within the parameters ofprofessional nursing knowledge, scope of practice,education, experience, and ethical/ legal standards of care.b. Evaluate care administered by the interdisciplinaryhealth care team.c. Advocate for standards of practice through professionalmemberships.

2. a. Provide nursing care within the parameters oprofessional nursing knowledge, scope of practiceeducation, experience, and ethical/ legal standardsof care.b. Evaluate care administered by theinterdisciplinary health care team.c. Advocate for standards of practice usingprofessional and legislative processes.

3. a. Practice nursing in a caring,nonjudgmental, nondiscriminatory manner.b. Provide culturally sensitive health care topatients and their families.

c. Provide holistic care that addresses theneeds of diverse individuals across thelifespan.

3. a. Practice nursing in a caring, nonjudgmental,nondiscriminatory manner.b. Provide culturally sensitive health care to patients andtheir families.

c. Provide holistic care that addresses the needs ofdiverse individuals across the lifespan.

3. a. Practice nursing in a caring, nonjudgmental,nondiscriminatory manner.b. Provide culturally sensitive health care to patienfamilies, populations, and communities.

c. Provide holistic care that addresses the needs odiverse individuals and populations across thelifespan.d. Advocate for policy development to support caof vulnerable populations and communities.

4. Use performance and self-evaluationprocesses to improve individual nursingpractice and professional growth.

4. a. Use performance and self-evaluation processes toimprove individual nursing practice and professionalgrowth.b. Evaluate the learning needs of self, peers, and othersand intervene to assure quality of care.c. Apply management skills in collaboration with theinterdisciplinary health care team to implement qualitypatient care.

4. a. Use performance and self-evaluationprocesses to improve individual nursing practice anprofessional growth.b. Evaluate the learning needs of self, peers, andothers and intervene to assure quality of care.c. Apply leadership and management concepts anskills in collaboration with the interdisciplinary heacare team to implement quality patient care.


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5. a. Assume accountability for individualnursing practice.b. Follow established evidence-based clinicalpractice guidelines.

5. a. Assume accountability for individual nursing practice.b. Promote accountability for quality nursing practicethrough participation on policy and procedure committees.c. Implement established evidence-based clinical practiceguidelines.

5. a. Assume accountability for individual nursingpractice.b. Promote accountability for quality nursing practthrough participation on policy and procedurecommittees.c. Implement established evidence-based clinicalpractice guidelines.d. Participate in designing systems that supportquality nursing practice.e. Apply research findings and principles of reseato enhance evidence-based practice.

6. a. Follow established policies andprocedures.b. Question orders, policies, and proceduresthat may not be in the patients best interest.c. Use nursing judgment to anticipate andprevent patient harm, including invoking SafeHarbor.

6. a. Follow established policies and procedures.b. Question orders, policies, and procedures that may notbe in the patients best interest.c. Use nursing judgment to anticipate and prevent patientharm, including invoking Safe Harbor.

6. a. Follow established policies and procedures.b. Question orders, policies, and procedures thatmay not be in the patients best interest.c. Use nursing judgment to anticipate and preventpatient harm, including invoking Safe Harbor.

7. Use communication techniques tomaintain professional boundaries in thenurse/ patient relationship.

7. Use communication techniques and management skillsto maintain professional boundaries between patients andindividual health care team members.

7. a. Use communication techniques andmanagement skills to maintain professionalboundaries between patients and individual healthcare team members.b. Use leadership and role modeling skills topromote professional boundaries among themembers of the interdisciplinary team.

8. Comply with professional appearancerequirements according to organizationalstandards and policies.

8. Comply with professional appearance requirementsaccording to organizational standards and policies.

8. Comply with professional appearancerequirements according to organizational standardand policies.

9. Implement principles of qualityimprovement in collaboration with the healthcare team.

9. Collaborate with interdisciplinary team on basicprinciples of quality improvement and outcomemeasurement.

9. Collaborate with interdisciplinary team onprinciples and tools of quality improvement andoutcome measurement in systems of care delivery

C. Contribute to activities that promotethe development and practice ofvocational nursing.

C. Participate in activities that promote thedevelopment and practice of professional nursing.

C. Promote the practice of professional nursinthrough leadership activities and advocacy.

Knowledge

1. Historical evolution of nursing practice. 1. Historical evolution of professional nursing. 1. Links between nursing history and medical,social, political, religious, and cultural influences.

2. Issues affecting the development andpractice of vocational nursing.

2. Issues and trends affecting nursing practice, the nursingprofession, and health care delivery.

2. a. Issues and trends affecting nursing practicethe nursing profession, and health care deliverysystem.b. Inquiry, analysis, and information approaches inaddressing practice issues.


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3. The role of vocational nursingorganizations, regulatory agencies, andhealth care organizations.

3. The role of professional nursing organizations,regulatory agencies, and health care organizations.

3. a. The role of professional nursing organizationregulatory agencies, and health care organizationsb. Research related to organizational and societalchange.

4. Factors affecting the public image ofnursing.

4. Strategies to influence the public perception of nursing. 4. Strategies to influence the public perception ofnursing.

5. Distinctions between the evolvingvocational and professional nursing roles.

5. a. The evolving practice roles of professional nursesand their contributions to the profession.b. Types of leadership.c. Political processes to promote professional nursingpractice.

5. a. Evolving leadership roles in the advancemenof the nursing profession; distinction of roles andscopes of practice among nursing and other healthcare professions.b. Theories of leadership.c. Strategies to influence legislative actionprocesses and public policy.


1. Identify historical evolution of nursingpractice and issues affecting thedevelopment and practice of vocationalnursing.

1. Analyze the historical evolution of professional nursingand the application to current issues and trends.

1. Synthesize the links between nursing history anmedical, social, political, religious, and culturalinfluences to promote professional nursing practice

2. Work collegially with members of theinterdisciplinary health care team.

2. Promote collegiality among interdisciplinary health careteam members.

2. Provide leadership in collaboration with theinterdisciplinary health care team.

3. Participate in activities individually or ingroups through organizations that promote apositive image of the vocational nursing role.

3. a. Participate in activities individually or in groupsthrough organizations that promote a positive image of theprofession of nursing.b. Collaborate with nursing colleagues and health careorganizations to promote the profession of nursing.c. Articulate the values and roles of nursing to the public.

3. a. Participate in activities individually or in grouthrough organizations that promote a positive imagof the profession of nursing.b. Collaborate with nursing colleagues and healthcare organizations and with others outside the heacare industry to promote the profession of nursing.c. Articulate the values and roles of nursing to thepublic.d. Communicate with state legislators and

representatives of other regulatory bodies to promoa competent nursing workforce and protection of thpublics safety and welfare.

4. Recognize roles of vocational nursingorganizations, regulatory agencies, andorganizational committees.

4. Recognize roles of professional nursing organizations,regulatory agencies, and organizational committees.

4. Recognize and analyze the impact of professionnursing organizations, regulatory agencies, andorganizational committees upon the nursingprofession and the roles of nurses.

5. Practice within the vocational nursing roleand Scope of Practice.

5. Practice within the professional nursing role and Scopeof Practice.

5. Practice within the professional nursing role andScope of Practice.

6. Serve as a positive role model forstudents, peers, and members of theinterdisciplinary health care team.

6. a. Serve as a positive role model for students, peers,and members of the interdisciplinary health care team.b. Participate in activities that promote consumerawareness of nursings contribution to society.

6. a. Serve as a positive role model for students,peers, and members of the interdisciplinary healthcare team.b. Participate in activities that promote consumerawareness of nursing=s contribution to society.


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D. Demonstrate responsibility for continuedcompetence in nursing practice, and developinsight through reflection, self-analysis, self-care, and lifelong learning.

D. Demonstrate responsibility for continuedcompetence in nursing practice, and developinsight through reflection, self-analysis, self-care, and lifelong learning.

D. Demonstrate responsibility for continuedcompetence in nursing practice, and developinsight through reflection, self-analysis, self-caand lifelong learning.

Knowledge

1. Texas Board of Nursing rules for continuingcompetence.



2. Resources, tools, and processes to assessvocational learning needs.

2. Resources, tools, and processes to assessprofessional learning needs.

2. Resources, tools, and processes to assessprofessional learning needs.

3. Lifelong learning opportunities to facilitatecontinuing competence (e.g., certifications andeducational articulation/ mobility).

3. Lifelong learning opportunities to facilitatecontinuing competence (e.g., certifications andeducational articulation/ mobility).

3. Lifelong learning opportunities to facilitate contincompetence (e.g. certifications and graduateeducation).

4. Changing roles and competencies in vocationalnursing.

4. Changing roles and competencies in professionalnursing.

4. Changing roles and competencies in professionnursing.


1. Participate in educational activities to maintain/improve competency, knowledge, and skills.

1. Participate in educational activities to maintain/improve competence, knowledge, and skills.

1. Participate in educational activities to maintain/improve competence, knowledge, and skills.

*2. Participate in nursing continuing competency

activities to maintain licensure.





3. Use self evaluation, reflection, peer evaluation,and feedback to modify and improve practice.

3. Use self evaluation, reflection, peer evaluation,and feedback to modify and improve practice.

3. Use self evaluation, reflection, peer evaluation, feedback to modify and improve practice.

4. Demonstrate accountability to reassess andestablish new competency when changing practiceareas.



5. Demonstrate commitment to the value oflifelong learning.

5. Demonstrate commitment to the value of lifelonglearning.

5. Demonstrate commitment to the value of lifelonlearning.


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Provider of Patient-Centered Care

icensed nurse (LVN or RN) who, based on educational preparation and scope of practice, accepts responsibility for the quality of nursing care andovides safe, compassionate nursing care using a systematic process of assessment, analysis, planning, intervention, and evaluation that focuses one needs and preferences of patients and their families. The nurse incorporates professional values and ethical principles into nursing practice. Thetients for LVNs and for Diploma and ADN educated RNs include individual patients and their families; the BSN-educated RN is also prepared toovide care to populations and communities.

N Diploma and ADN BSNA. Use clinical reasoning and establishedevidence-based policies as the basis for decisionmaking in nursing practice.

A. Use clinical reasoning and knowledge basedon the diploma or associate degree nursingprogram of study and evidence-based practice

outcomes as a basis for decision making innursing practice.

A. Use clinical reasoning and knowledgebased on the baccalaureate degree nursingprogram of study, evidence-based practice

outcomes, and research studies as the basisfor decision making and comprehensivepatient care.

Knowledge

1. A systematic problem-solving process in the care ofpatients and their families.

1. a. A systematic problem-solving process in thecare of patients and their families based onselected liberal arts and sciences, and evidence-based practice outcomes.b. Conceptual frameworks of nursing practice as ameans of planning careand solving clinicalproblems in care of patients and families.

1. a. A systematic problem-solving process inthe care of patients and families based on theliberal arts, sciences, and evidence-basedpractice outcomes and research studies.b. Conceptual frameworks of nursing practiceas a means of planning careand solving clinicalproblems in care of patients and families.c. Nursing frameworks, theories, and modelsthat relate to managing and evaluating healthcare delivery with consideration of related costsin care of patients, families, populations, andcommunities.

2. a. Priority setting based on patient health statusand individual characteristics.b. Clinical reasoning processes.

2. a. Priority setting based on patient healthstatus and individual characteristics.b. Clinical reasoning processes, systematic clinical

judgment, and best practices.

2. a. Priority setting based on patient healthstatus and individual characteristics.b. Clinical reasoning models, systematic clinical

judgment, research process, and best practices.

3. Application of current literature, available worksetting resources, and evidence-based practice toassist in decision making.

3. Application of current literature and/ or researchfindings and evidence-based practice in improvingpatient care.

3. a. Research utilization and evidence-basedpractice.b. Analysis of reliability, validity, and limitationsof quality of evidence.c. Informed consent for participation inresearch.

4. Resources from scientifically valid sources. 4. Resources for accurate and scientifically validcurrent information.

4. a. Resources for accurate and scientificallyvalid current information.b. Research and evaluation methodologies.


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1. Use problem-solving approach to make decisionsregarding care of assigned patients.

1. Use clinical reasoning and nursing science as abasis for decision making in nursing practice.

1. Use systematic approaches for clinicaldecision making, including nursing research,epidemiology, and political, social, ethical, andlegal processes.

2. a. Organize care for assigned patients based uponproblem-solving and identified priorities.b. Proactively manage priorities in patient care andfollow-up on clinical problems that warrant investigationwith consideration of anticipated risks.

2. a. Organize care based upon problem-solvingand identified priorities.b. Proactively manage priorities in patient care andfollow-up on clinical problems that warrantinvestigation with consideration of anticipated risks.

2. a. Organize care based upon problem-solving and identified priorities.b. Proactively manage priorities in patient careand follow-up on clinical problems that warrantinvestigation with consideration of anticipatedrisks.c. Apply knowledge from genomics,epidemiology, bioterrorism, and currentpopulation demographics in decision making toreduce health risks in communities andvulnerable populations.

3. Identify and communicate patient physical andmental health care problems encountered in practice.

3. Use knowledge of societal and health trendsand evidence-based outcomes to identify andcommunicate patient physical and mental healthcare problems.

3. Use knowledge of societal and health trendsand current research findings to identify andcommunicate patient physical and mental healthcare problems.

4. Apply relevant, current nursing practice journalarticles to practice and clinical decisions.

4. Apply relevant, current nursing practice journalarticles and evidence-based outcomes fromresearch findings to practice and clinical decisions.

4. Analyze and incorporate researchfindings/studies and evidence-based data into nursingpractice and clinical decisions.

B. Assist in determining the physical and mentalhealth status, needs, and preferences of culturally,ethnically, and socially diverse patients and theirfamilies based on interpretation of health-relateddata.

B. Determine the physical and mental healthstatus, needs, and preferences of culturally,ethnically, and socially diverse patients andtheir families based upon interpretation ofcomprehensive health assessment findingscompared with evidence-based health data

derived from the diploma or associate degreenursing program of study.

B. Determine the physical and mental healthstatus, needs, and preferences of culturally,ethnically, and socially diverse patients,families, populations, and communitiesbased upon interpretation of comprehensivehealth assessment findings compared with

evidence-based health data and a synthesisof knowledge derived from a baccalaureatedegree nursing program of study.

Knowledge

1. Steps of a systematic process in clinical decisionmaking that includes VN scope of practice in focusedassessment, planning, implementation, and evaluation.

1. Steps of a systematic approach, which includesassessment, analysis, planning, implementation,and evaluation.

1. a. Steps of a systematic approach, whichincludes assessment, analysis, planning,implementation, and evaluation.b. Systematic processes, including nursingresearch, epidemiologic, psychosocial, andmanagement.c. Systematic approach to performing acommunity assessment.


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2. Components of focused nursing assessment. 2. Comprehensive nursing assessment ofpatients and their families.

2. Comprehensive nursing assessment ofpatients, families, populations, andcommunities. Analysis of nursing research,epidemiologic, and social data to drawinferences and conclusions.

3. Structured data collection tools and techniques ofassessment of patients including interviewing.

3. Structured and unstructured data collectiontools and techniques of assessment of patientsand their families including interviewing.

3. a. Structured data collection tools andtechniques of assessment of patients includinginterviewing.b. Unstructured data collection tools andtechniques for assessment of patients, families,populations, and communities.c. Components of comprehensive databasesand methods for data collection, healthscreening and case finding.

4. Characteristics, concepts, and processes related topatients, including: gross anatomy; basic physiologyand pathophysiology; psychosocial growth anddevelopment; basic psychopathology; ethicalreasoning; and major cultural and spiritual belief andpractices related to health, illness, birth, death, anddying.

4. Characteristics, concepts, and processesrelated to patients, including: anatomy andphysiology; physical and psychosocial growth anddevelopment; pathophysiology andpsychopathology; ethical reasoning; and culturaland spiritual beliefs and practices related to health,illness, birth, death and dying.

4. Characteristics, concepts, processes, andtheories related to patients including: anatomyand physiology; physical and psychosocialgrowth and development; pathophysiology andpsychopathology; cultural and spiritual beliefsand practices related to health, illness, birth,death and dying; history; research; statistics;humanities; genomics; global health; ethics; andlogical and ethical reasoning.

5. Cultural differences of patients across the lifespan. 5. Cultural differences of patients across thelifespan and major needs of vulnerable patients.

5. Cultural differences and integration of patientneeds across the lifespan into the health caresystem including comprehensive needs ofvulnerable patients, families, populations, andcommunities.

6. Characteristics, concepts, and processes related totransmission of common communicable diseasesncluding individual risk factors and preventive healthpractices.

6. Characteristics, concepts, and processesrelated to disease transmission, risk factors,preventive health practices and their implicationsfor selected populations and community resources.

6. Characteristics, concepts, and processesrelated to communities, including epidemiology,risk factors and preventive health practices andtheir implications for vulnerable populations,resources and resource assessmenttechniques, environmental factors and socialorganizations.

7. Common disease processes, medicationadministration, and other therapies and treatments.

7. Disease processes, pharmacotherapeutics, andother therapies and treatments.

7. Disease processes, pharmacotherapeutics,and other therapies and treatments.

8. Introduction to established approaches that guidenursing practice.

8. Introduction to established theories, models andapproaches that guide nursing practice.

8. Nursing theories, research findings, andinterdisciplinary roles to guide nursing practice.

9. Family processes that impact health. 9. Characteristics, concepts and processesrelated to families, including family development,risk factors, family communication patterns, anddecision making structures. Functional anddysfunctional characteristics of families that impacthealth.

9. Characteristics, concepts and processesrelated to families, including familydevelopment, risk factors, family communicationpatterns, and decision making structures.Functional and dysfunctional characteristics offamilies that impact health.


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10. Application of clinical technology in the delivery ofsafe patient care and documentation.

10. Application of clinical technology and use ofnursing informatics in the delivery of safe patientcare.

10. Application of clinical technology,information management, and use of nursinginformatics in the delivery of safe patient care.

11. Introduction to patients with multiple healthcareproblems.

11. Introduction to complex and multiplehealthcare problems and issues, includingevidence-based complementary health carepractices.

11. Complex and multiple health care problemsand issues, integrating evidence-basedtraditional and complementary healthcarepractices, and population interventions andsolutions.

12. Political, economic, and societal forces affectinghealth of individuals.

12. Political, economic, and societal forcesaffecting the health of individuals and their families.

12. Political, economic, and societal forcesaffecting health care for patients, families,populations, and global communities.


1. Use structured assessment tool to obtain patienthistory. 1. Use structured and unstructured data collectiontools to obtain patient and family history in areas ofphysical, psychiatric/ mental health, spiritual,cultural, familial, occupational, and environmentalinformation, risk factors, and patient resources.

1. a. Use structured and unstructured datacollection tools to obtain patient and familyhistory in areas of physical, psychiatric/ mentalhealth, spiritual, cultural, familial, occupational,environmental information, risk factors, andpatient resources.b. Expand and modify data collection toolsusing evidence-based practice.

2. Perform focused assessment to assist in identifyinghealth status and monitoring change in patients.

2. Perform comprehensive assessment to identifyhealth needs and monitor changes in health statusof patients and families.

2. Perform comprehensive assessment andmonitor changes to include factors impactinghealth status and health needs of patients,families, populations, and communities.

3. Report and document focused patient assessmentdata.

3. a. Validate, report, and documentcomprehensive assessment data for patients andfamilies, including physical and mental healthstatus and needs for patients and their families.

b. Evaluate the use of safe complementary healthcare practices.

3. a. Validate, report, and documentcomprehensive assessment data, includingphysical and mental health status and needs forpatients, families, populations, and

communities.b. Evaluate evidence supporting traditional andcomplementary health care practices beingused by patients, families, populations, andcommunities.

4. Identify predictable and multiple health needs ofpatients and recognize signs of decompensation.

4. Identify complex multiple health needs ofpatients, with consideration of signs and symptomsof decompensation of patients and families.

4. Identify complex multiple health needs ofpatients, with consideration of signs andsymptoms of decompensation of patients andfamilies.

5. Share observations that assist members of thehealth care team in meeting patient needs.

5. Use clinical reasoning to identify patient needsbased upon analysis of health data and evidence-based practice outcomes and communicateobservations.

5. Use clinical reasoning to identify patientneeds based upon analysis of health data,evidence based practice outcomes andresearch findings and communicateobservations.


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6. Assist with health screening. 6. Perform health screening and identifyanticipated physical and mental health risks relatedto lifestyle and activities for prevention.

6. Perform health screening and case finding,and identify links between physical and mentalhealth, lifestyle, prevention, and cost andaccess to healthcare.

7. Differentiate abnormal from normal health data ofpatients.

7. Interpret and analyze health data for underlyingpathophysiological changes in the patient=s status.

7. Interpret and analyze health data of patients,families, populations, and communities includingpathophysiology, genomics and epidemiologicalconsiderations.

8. Recognize healthcare outcomes and report patientstatus.

8. Incorporate multiple determinants of heal

differentiated essential competencies (decs)-published in 2010

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