Large numbers of expertly prepared nurses are needed to deliver care across the lifespan.Large numbers of expertly prepared nurses are needed to deliver care across the lifespan. This has been noted by several key organizations. There can be no nursing delivery of healthcare without an intelligent and highly educated cadre of new nurses entering the workforce pipeline (WHO, 2020a). The Institute of Medicine (IOM, 2011) noted this in the Future of Nursing: Leading Change, Advancing Health, a landmark report published to highlight the need for a robust nursing workforce to meet the needs of the nation. One of the four key issues addressed in the report focused on the need for better and more robust nursing educational systems to train and promote nurses to work to the top capacity of their licenses.

...there is the need for well-prepared nursing faculty who possess competencies in educational methods...From the United Kingdom (UK) comes yet another acknowledgement of the global importance of well-educated nurses to meet the pressing healthcare needs of individuals. The UK initiative, known as the Nursing Now Campaign (2018-2020), is run in collaboration with the World Health Organization (WHO) and the International Council of Nurses (ICN) (Crisp & Iro, 2018). This campaign seeks to elevate the profession of nursing and have nurses take their rightful places as prominent deliverers of healthcare across the world. For nurses to fulfill their place in healthcare, there is the need for well-prepared nursing faculty who possess competencies in educational methods to train the future global workforce.

Nurse educators and leaders are keenly aware of the unique nursing knowledge base, critical judgement ability, and skill competencies required, although this has not always been completely visible or well understood by the public. But the important issue of having an adequately prepared nursing workforce (i.e., in terms of numbers and skill level) was illustrated even more when the SARS-CoV-2 pandemic spread in January 2020 (Araujo & Garcia-Meza, 2020). This infectious disease has wreaked havoc across the globe, causing COVID-19 illness and highlighting the need for expertly educated nurses to care for acutely ill patients; to engage in public health surveillance, health promotion, disease prevention, culturally competent health education; and to support patients and their families during extreme illness and, for many, death. Without a well-educated workforce, the ability for nurses to care for populations around the globe is and will be severely hampered (WHO, 2020a; WHO, 2020b; Dohrn et al., 2018).

Global Need for Nurses and Nurse Educators

All of these challenges are more severe in low and middle-income countries.The responsibility to educate large numbers of expert nurses is significant. Globally, the numbers of nurses required to meet the current shortage is very large at approximately 5.9 million nurses needed in predominantly lower and middle income countries (WHO, 2020a). Moreover, the preparedness and expectations of nursing graduates will continue to evolve rapidly as a result of social and demographic changes; increasingly complex healthcare needs and chronic conditions; threats of emerging infectious diseases; and environmental and climate related illnesses (WHO, 2020a; WHO, 2020b; IOM, 2011; Keating & DeBoor, 2018).

The capacity of nurse educators to teach effectively is a significant constraint to address this global shortage of nurses (NLN, 2013). Nurse educators are challenged to adequately prepare the next generation of nurses with the knowledge, skills and attitudes to work in a variety of settings (James et al., 2017). These settings may include advanced practice in primary care and disadvantaged communities. Nurses perform population-level disease prevention and health promotion; research; and policy work. All of these challenges are more severe in low and middle-income countries (LMIC). A compounding factor is losing the most capable clinicians and educators to migration to other areas (Trines, 2018).

Nurse educator capacity is a critical success factor for large-scale health improvements.Nurse educator capacity is a critical success factor for large-scale health improvements. Unfortunately, unless nurse educators meet basic capability standards, it is unlikely that the world will have the well-prepared nursing workforce needed to care for the global population, including those most vulnerable, around the world. Without educator proficiency it is unlikely that the profession will be able to achieve its highest potential impact.

The NLN Core Competencies for Nurse Educators

The National League for Nursing (NLN) has outlined eight core competencies for effective nurse educators (NLN, 2005). These NLN core competencies provide an excellent framework to help educators develop into expert faculty (Halstead, 2019). It is essential that educators, especially novices or junior teachers, receive the needed training and support to develop as expert faculty.

Nurse educators often enter their role with significant clinical knowledge but very little training...Nurse educators often enter their role with significant clinical knowledge but very little training to be an exemplary teacher. There is an assumption that a nurse can translate clinical knowledge into an effective educator role, but this is unsupported (Summers, 2017). Nurse educators often have only the vaguest idea of the competencies needed to be effective in this role, if they ever even think in those terms at all. Many novice nurse educators have not ever encountered the eight well-described competencies promulgated by the NLN (2012, 2013).

...the academic nurse educator is an advanced specialty role in nursing that is complex in nature.According to the NLN, the academic nurse educator is an advanced specialty role in nursing that is complex in nature. For over 125 years, the NLN has had an historical focus centered on establishing the importance of nursing education and nurse educators. It is the nurse educator who, as a solidly trained professional, is entrusted to develop future nurses into highly trained expert practitioners able to deliver care and healing around the world. The NLN eight core competencies are: (1) facilitate learning; (2) facilitate learner development and socialization; (3) use assessment and evaluation strategies; (4) participate in curriculum design and evaluation of program outcomes; (5) pursue systematic self-evaluation and improvement in the academic nurse educator role; (6) function as a change agent and leader; (7) engage in scholarship of teaching and; (8) function effectively within the organizational environment and academic community. Within the United States (US), nurses engaged in teaching can seek certification in this advanced specialty role. Nurse faculty can receive the credentials of Certified Nurse Educator (CNE), typically after taking review courses, self-studying, and successfully completing the certification exam (NLN).

Nurses International-Open Educational Resources
Within the United States, nurses engaged in teaching can seek certification in this advanced specialty role.The initial project of Nurses International-Open Educational Resources (NI-OERs) began in 2004. It has grown exponentially in the last 15 years with a clear focus on the development of nurse educators and the attainment of nursing education equity in LMIC (Berland et al., 2010). The NI-OERs come at a time when other organizations, such as the United Nations (UN) have focused considerable attention on the best way to view and organize the needs of nations to ensure healthy lives for all citizens. One initiative of the UN, the Sustainable Development Goals (SDGs), is a framework that was proposed in 2015 and provides key focus areas to improve life for all (UN, 2019). The SDG framework outlines 17 key initiatives that focus on improving quality of life for all persons.

The importance of quality nursing education especially in LMIC areas...has the potential for significant progress regarding several of the SDG goals.The importance of quality nursing education especially in LMIC areas, such as Bangladesh, has the potential for significant progress regarding several of the SDG goals. For example, quality nursing education can significantly impact healthcare and universal access (SDG #3), gender equality (SDG #5), and education (SDG #4) in vulnerable areas around the world (Parfitt & Nahar, 2016; UN, 2019). This is significant because many Higher Education Institutes (HEI) in LMIC lack capacity, such as financial assets to purchase learning resources and training equipment. Compounding this, they lack experienced faculty and academic leadership, and even professional development for the educators themselves.

Nurses International (NI) is a 501c3 corporation based in central United States. NI has developed a community-based BSN curriculum with the support of a large network of nurse educator volunteers that include approximately 150 advanced practice educators, researchers, and clinicians. In addition, NI has established relationships with a host of key stakeholders. Promoting nursing education equity through the use of technology is a central tenet of NI’s work. A number of technology developers have taken interest in collaborating with NI to further the innovative use of new teaching platforms.

Promoting nursing education equity through the use of technology is a central tenet...Another strong factor in the success of NI has been the partnership forged with NextGenU.org. NextGenU.org sought to collaborate with NI to complement its work making healthcare education equitable and available to medical students, physicians, and students interested in public health. NI and NextGenU.org have each built repositories of scientifically sound courses freely available to scale-up medical, public health, and nursing education in LMIC. NI and NextGenU.org share information and link to one another’s websites and course offerings.

NI also has initiated strong nursing partnerships with leaders in Bangladesh, Kenya, Egypt, and Guatemala. These partnerships have been built upon establishing increasing levels of trust, diversity, and inclusiveness in the world of nursing education through the free flow of ideas. The sharing of knowledge, technology, and innovative solutions to problems rooted in profound inequities and injustice has brought together many of the strongest and most intelligent nursing minds.

It is expected and encouraged that nurse educators will make culturally appropriate edits to the NI-OERs...With a strong global perspective steeped in the need for social, economic, gender, and educational justice, NI has expanded the NI-OERs and encourages adaptation and use of its resources by global nurse educators in diverse communities. It is expected and encouraged that nurse educators will make culturally appropriate edits to the NI-OERs for use within their specific nursing programs to meet the overall program objectives, and thus the unique needs of their patients and communities.

The next section compares or “cross-walks” the eight NLN core competencies for nurse educators with the inputs, processes, and outputs of the Open Educational Resources Project developed by Nurses International (NI-OERs). We explain how the NI-OERs project supports educators to achieve all of the NLN competencies. Widespread use of the NI-OERs is expected to produce the dual benefit of better-prepared nurse educators as well as more capable students who will advance the impact of professional nurses to improve population health in LMIC. A full description of how NI-OERs crosswalk to each of the eight NLN core competencies for nurse educator follows here, and is briefly summarized in the Table.

Table. Crosswalk of NLN Nurse Educator Core Competencies and NI-OER Curriculum

(Christensen & Simmons, 2019; Berland et al., 2010; Nurses International, 2019)

Descriptions of NLN Competencies and Available NI-OERs
Competency 1: Facilitate Learning. This competency is defined as, “Create an environment in classroom, laboratory, and clinical settings that facilitates student learning and the achievement of desired cognitive, affective, and psychomotor outcomes” (NLN, 2020, Competency I). The NI-OERs support this fundamental competency by providing an integrated package of materials for educators. The package is a complete curriculum that includes classroom lectures; teacher references and student learning resources; evaluation materials, (e.g., assignments and exams); checklists for clinical practice; and administrative policies.

At present the OERs are available only in English.In the original development site, all materials were approved by the Bangladesh regulator where they were field-tested (Berland et al., 2010; Lund et al., 2013); they have since been reviewed internally (Ewing, 2013) and scaled for graduate level studies in China, Nepal, UK and the United States. Because scope and context of nursing practice varies widely across the globe, the NI-OERs may require some local adaptation to meet the requirements of the user’s Higher Education Institution and nursing regulatory body. At present the OERs are available only in English. Many countries rely on English-language nursing textbooks as there are few resources available in local languages. For the same reason, further study in nursing often requires proficiency in English.

Competency 2: Facilitate Learner Development and Socialization. This competency specifies that educators are “Responsible for helping students develop as nurses and integrate the values and behaviors expected of those who fulfill that role” (NLN, 2020, Competency II). This can be challenging, especially in countries such as Bangladesh, where nursing is not a respected profession and the quality of work life for nurses has been described as quite low (Akter et al., 2019; Akter, et al., 2018). In addition to formal reference to professional values in most courses, the NI-OERs include case studies that help students explore ethical aspects of routine practice (e.g., truth-telling) as well as more complex dilemmas where resolution is not so obvious.

It is essential that educators exemplify appropriate professional values and behaviors, serving as role models in practice.We recognize that the professionalization process is one of the most challenging components of pre-service nurse education. It is essential that educators exemplify appropriate professional values and behaviors, serving as role models in practice. Therefore, NI is also developing “NI-OER Communities of Practice” or global user-groups for specific topic areas. These groups will serve two purposes. Firstly, they will update course content and contribute open resources, such as case studies or critical thinking exercises, to expand the diversity of material developed for a topic. Secondly, and specific to this competency, members of the user group can mentor junior faculty, particularly in ‘soft skill’ development centered on professional values and behaviors.

Competency 3: Use Assessment and Evaluation Strategies. To demonstrate this competency, educators must “Use a variety of strategies to assess and evaluate student learning in classroom, laboratory and clinical settings, as well as in all domains of learning” (NLN, 2020, Competency III). The NI-OERs provide various assessment tools for theoretical material, including quizzes, vocabulary tests, and mid-term and final exams requiring multiple choice and short answer responses. All of these include a teacher key with suggested answers. In some courses, there are also essay assignments and other projects, although grading rubrics are still under development for many of these.

We recognize that evaluation of practice is a challenging area, even for experienced educators.For laboratory and clinical settings, the NI-OERs provide skills checklists, although these are not yet developed into formal evaluation tools. We recognize that evaluation of practice is a challenging area, even for experienced educators. In addition to the curriculum materials, we have developed an “e-Nurse Educator’s Guide” suitable for novice educators that covers many instructional topics, including guidance on assessment and evaluation.

Competency 4: Participate in Curriculum Design and Evaluation of Program Outcomes. The nurse educator is expected to be “Responsible for formulating program outcomes and designing curricula that reflect contemporary healthcare trends and prepare graduates to function effectively in the health-care environment” (NLN, 2020, Competency IV). The NI-OERs are based on the curriculum requirements of the national nursing regulators in Bangladesh and India. As noted, we expect some local adaptation will be necessary. By providing a coherent framework with expert-developed content, however, we hope to reduce workload in under-resourced settings.

If local capacity is limited, nurse educators in LMIC can collaborate with NI team members to update their curricula...If local capacity is limited, nurse educators in LMIC can collaborate with NI team members to update their curricula, making it more relevant for nursing practice in the local setting. Of necessity, evaluation of outcomes at the college or program level is primarily a local task. Looking ahead, we plan to develop guidance within the NI-OERs platform to assist nurse educators with related administrative tasks. This guidance could describe how to establish internal structures (e.g., committees) and processes (e.g., consultation with industry stakeholders or review tools) that could be useful to evaluate program level outcomes.

Competency 5: Function as Change Agent and Leader. This rather general competency states, “Create a preferred future for nursing education and nursing practice” (NLN, 2020, Competency V). This can be interpreted to include educator competency in demonstrating ethical or legal principles, professionalism, management, leadership, and advocacy. All of these topics are formally covered in the NI-OERs in two specific courses, Professional Issues, and Management and Leadership. This content is included informally in clinical courses through case studies and critical thinking exercises.

...it is important to consider the context within which educators practice. Many have received a poor quality education themselves...This competency is, however, aimed toward nurse educators. Reflecting on our experiences of teaching in LMIC settings, it is important to consider the context within which educators practice. Many have received a poor quality education themselves; they may receive no supervisory support and may have no opportunities for professional development. Thus, it is not uncommon to see nurse educators reading to students from the lecture notes they took while they were students in the classroom. The prescribed curriculum is often “junior doctor” content with a limited perspective of modern nursing practice, let alone concepts like reflective practice and transformative learning (Sherwood & Horton-Deutsch, 2012).

In some countries there are very few modern nursing textbooks in the local language.In some countries there are very few modern nursing textbooks in the local language. Therefore, we view the NI-OERs as strategic tools to introduce “preferred future” concepts to nursing students. The NI-OERs may additionally serve as a professional development resource for educators; who access supplementary “Teacher Resources” or who connect with mentors in the NI Community of Practice. There is no obvious short-cut to the hard work of “turning vision to action” (Sherwood & Horton-Deutsch, 2012, p.3) but NI leaders believe that educators can be supported as they assume the role of change agent and leader within an institute.

Competency 6: Pursue Continued Quality Improvement in the Nurse Educator Role. This competency states that nurse educators need to “Recognize that their role is multi-dimensional and that an ongoing commitment to develop and maintain competence in the role is essential” (NLN, 2020, Competency VI). Within this competency, nurse educators must understand the evolving environment, including clinical practice; social conditions; and ethical and professional issues that must be considered in preparing future practitioners. Nurse educators must also be able to look critically at their own pedagogical practice, and that of colleagues, to identify areas for improvement. Thus, continued quality improvement structures and processes can guide the renewal of educational practices that produce a strong learning environment.

Inherent in this competency is the need to engage in professional development for self and colleagues.Inherent in this competency is the need to engage in professional development for self and colleagues. NI has produced a Teacher’s Guide (Nurses International, 2019) to offer direct help for educators as well as suggest approaches for continued professional development. The guide provides an overview and details of further sources for nursing education topics. Of particular relevance to quality improvement, the guide covers faculty development based on self-assessment, peer evaluation, and course evaluation.

Competency 7: Engage in Scholarship. This competency states that “scholarship is an integral component of the faculty role, and that teaching itself is a scholarly activity” (NLN, 2020, Competency VII). NI has adopted the Boyer Model (1990) regarding the development, acquisition, and use of new knowledge, which frames four aspects of scholarship including discovery (i.e., traditional development of new knowledge using research methods), integration (i.e., taking new knowledge and combining findings from different disciplines to view problems in innovative ways), application (i.e., using new knowledge to address and solve real world problems) and teaching (i.e., disseminating new knowledge through exemplary and innovative teaching to students).

NI applies the integration aspect by using open access principles, such as user-friendly content, easy accessibility in different popular formats, flexible copyright policies, and minimal access requirements (Commonwealth of Learning, 2011). In our view, Boyer’s accessible and inclusive approach offers support for junior nurse educators to become active participants in scholarship. NI is working to exemplify its own scholarly contributions, not only by framing the work in a theoretical construct, but also by gathering user data and feedback to use in future evaluation. At present, NI is self-funded and powered almost entirely by a cadre of over 150 volunteers, so the focus is on the dissemination aspect of Boyer’s model.

We expect that in most cases the target audience of NI, junior educators in LMIC, will have limited opportunities for high-level scholarship in discovery of new knowledge and integration of knowledge from new disciplines. Many will be educated at the BSN level or with non-nursing Master’s degrees. Most will practice scholarship through the integration, application, and/or teaching aspects of Boyer’s model.

An example of how the NI-OERs support Boyer’s application is the use of course blue-prints that provide a comprehensive overview of an entire semester of content in an easily adaptable format. With this, novice educators can feel confident introducing their own innovative teaching strategies to engage their particular set of learners. Online and mentoring support is provided so that educators’ scholarly efforts (i.e., new teaching methods and tools) can be shared with the global nursing educator community.

Competency 8: Function within the Educational Environment. This competency requires nurse educators to be “knowledgeable about the educational environment within which they practice and recognize how political, institutional, social, and economic forces impact their role” (NLN, 2020, Competency VIII). This competency is marginally supported by the NI-OERs because there is only so much that can be achieved with online resources. As noted, the NI-OERs include not only curriculum materials but also teaching notes and academic and clinical policies designed to download, adapt, and contextualize to meet the needs of the host institution or country. Regarding the cultural norms and institutional practices that affect teaching practice, educators who use the NI-OERs will be most familiar with the expectations, opportunities, and constraints. Our approach at NI is to encourage and support users to download the Teacher Guide (Nurses International, 2019), which provides further context and to participate in the Community of Practice where mentoring advice is available.

Conclusion

The competent nurse educator bridges the gap between current conditions and the potential contribution of nurses to better healthcare.Globally, nurse leaders are working toward the UN Sustainable Development Goals (UN, 2019) to ensure health and prosperity for all. As noted by the authors of the Future of Nursing report (IOM, 2011) and the developers of the Nursing Now Campaign (Crisp & Iro, 2018), there is frequent emphasis on the need for an expertly prepared cadre of global nurse educators to prepare very large numbers of nurses at all levels. The eight NLN core competencies for nurse educators offer valuable insights to nursing faculty who teach in LMIC to prepare nurses to impact these goals.

Without nurse educators who possess the NLN competencies, progress toward the SDGs will be limited. The NLN competencies implicitly recognize the challenge of responding to rapid advances in healthcare knowledge and the workplace implications of disruptive technologies, new forms of service delivery, and rising social expectations of graduate nurses. The competent nurse educator bridges the gap between current conditions and the potential contribution of nurses to better healthcare. The NI-OERs support educators to achieve the NLN core competencies to prepare the health workforce of the future.

Authors

Stacen A. Keating, PhD, MSN, RN
Email: Sk3038@nyu.edu

Stacen A. Keating is a Clinical Assistant Professor at Rory Meyers College of Nursing at New York University in New York City. She teaches public health nursing, applied epidemiology and primary care/ambulatory care nursing. She is engaged with a community of “teaching with technology” scholars at NYU and utilizes design thinking methods to foster critical thinking and innovation with students. Dr. Keating has been on the Nursing Advisory Council of Nurses International since 2014 and also engages in curriculum development and mentoring of junior faculty.

Alex Berland, MSc, RN
Email: aberland@protonmail.com

Alex Berland is President of A. Berland, Inc., Vancouver, Canada. He is a versatile senior executive and consultant with experience leading change in government in the UK and Canada, all sectors of the healthcare industry, education, social services, and community development. Since 2004 he has been founding director of a nurse education project in Bangladesh. He has extensive experience in governance and accountability, quality improvement, and evaluation in higher education and social services.

Kathleen Capone, MS, RN, CNE
Email: kathleen@nursesinternational.org

Kathleen Capone is a nursing professor based in New York. She has developed curricula for global open access and BSN community programs. She has worked globally in Guatemala, Egypt, and China. She is a Certified Nurse Educator.

Miriam J. Chickering, BSN, RN
Email: Miriamchickering@nursesinternational.org

Miriam J. Chickering is CEO of Nurses International, leading a large volunteer team of expert nurse educators and clinicians as they create the world’s first free BSN curriculum. Nurses International’s materials provide support to nursing educators and students in more than 80 countries. Her background includes business strategy, product development, curriculum development, and staff education.