NSG/532 Week 1: Curriculum Foundations and Alignment, sample paper

Where Our Graduates Actually Work: Aligning a Practical Nursing Curriculum's Mission, Outcomes and Courses With a Workforce That Is Mostly in Long-Term Care

[Student Name]

University of Phoenix

NSG/532: Innovative Curriculum Design

Week 1 Assignment

[Instructor Name]

[Date]

The college, the program and its data are a composite written for a model paper.

I coordinate the curriculum for a one-year practical nursing diploma program at a technical college in a largely rural region. We admit 48 students a year into a three-term program that prepares them for the NCLEX-PN and for work as licensed practical nurses. For several years, faculty have sensed that something is off: graduates tell us they felt unprepared for their first jobs, and our first-time licensure pass rate has slipped. This paper tests whether the curriculum's foundations still fit together and still fit the work our graduates do.

The Layers of Curriculum Alignment

A curriculum is aligned when each layer supports the one above it. The mission states whom the program serves and why. Program outcomes state what every graduate will be able to do. Courses and learning activities build those outcomes, and assessments show whether they were achieved. Iwasiw et al. (2020) describe curriculum development as a process in which each decision should be traceable to the program's foundations and to the context in which graduates will practice. A curriculum that is internally consistent can still be misaligned if its foundations no longer match the world its graduates enter.

The Mission

The program's mission, written twelve years ago, states that it "prepares compassionate, competent practical nurses to meet the health care needs of the region's hospitals and communities." The mission names hospitals first, which reflected the job market at the time.

Where Graduates Work

Employment data from graduate follow-up surveys for the past three cohorts, with 118 of 139 graduates responding, tell a different story. Of the respondents, 71% work in long-term care, skilled nursing or assisted living; 12% in home health; 9% in clinics or physician offices; and 8% in hospitals. Regional hospitals have reduced their use of licensed practical nurses on acute units, while long-term care employers report persistent vacancies. The mission's emphasis on hospitals no longer describes the program's graduates.

Program Outcomes

The program has six outcomes, adapted from national competency statements for practical nursing graduates published by the National League for Nursing (2010): promoting human flourishing, making nursing judgments within the practical nurse's scope, developing professional identity, fostering a spirit of inquiry, providing safe care and communicating effectively. The outcomes are sound and do not need to change, but how they are built in the courses needs examination.

The Curriculum Map

I mapped where each outcome is introduced, reinforced and assessed across the program's nine courses and three clinical rotations. Three findings stood out.

First, care of older adults appears in only one course, a four-week unit in the second term, and most clinical hours, 180 of 270, are in acute care settings that now employ few graduates. Content on dementia care, chronic disease management across months, end-of-life care and working with nursing assistants, the daily work of a long-term care nurse, is thin or absent.

Second, the outcome of nursing judgment is introduced in the first term and assessed in the final clinical evaluation, but it is not reinforced in between. Most tests in the middle courses ask students to recall facts rather than to decide what to do.

Third, delegation and supervision of nursing assistants, which long-term care employers name as the skill new practical nurses lack most, is covered in a single lecture.

Licensure Data

The program's first-time NCLEX-PN pass rate has fallen from 90% to 81% over three years, against a state average of 86%. Item analysis reports from the testing service show the weakest performance in areas that require clinical judgment rather than recall. The NCLEX examinations now use items built on a clinical judgment measurement model, and educators have been encouraged to align their teaching with that model (Dickison et al., 2019). Our map shows why our students struggle: the curriculum teaches judgment at the start and tests it at the end but does not practice it in the middle.

Assessments Across the Program

Alignment also depends on how outcomes are assessed. The map showed that written tests account for 70% of course grades in the first two terms, and a review of three course exams found that most items asked students to identify a definition, a normal value or a medication class. Clinical evaluations use a pass-or-fail form with broad criteria such as "provides safe care," which faculty interpret differently. Neither kind of assessment tells faculty whether a student can notice a change in a resident, decide what it means and act within scope. The revision will need assessments that measure the outcomes as written, not only the content that supports them.

Why Alignment Drifts

The misalignment did not come from poor planning. The curriculum was well designed for the conditions of twelve years ago, and it changed piece by piece as faculty retired, textbooks changed and clinical sites came and went. No one compared the whole against the graduates' work again. That pattern is common, and it argues for building a regular review of alignment into the program's evaluation plan, so the next drift is caught earlier.

Summary of Misalignment

The program's outcomes are appropriate, but its mission and courses are misaligned with where graduates work and with how they are now tested. Care of older adults and long-term care practice are under-represented, clinical hours are concentrated in settings that rarely hire graduates, nursing judgment is not reinforced across the program and supervision of nursing assistants is barely taught.

Strengths to Keep

The review also found strengths. Medication administration, rated highest by graduates, is taught well and assessed rigorously, and the program's skills lab is well equipped. Faculty are experienced and committed, and the program's relationships with long-term care employers are strong, since many of them hire our graduates every year and several have offered to host more students if the program changes its clinical schedule. A revision should protect these strengths, keep the skills lab sequence largely intact and avoid rebuilding what already works, which is also a reason to change the curriculum through targeted threads rather than a wholesale redesign.

What the Revision Must Address

The revision will need to update the mission to reflect the program's actual service to long-term care and community settings, redistribute clinical hours toward those settings, thread gerontological content and clinical judgment practice through every term and strengthen supervision and delegation. It will also need to be approved by the college's curriculum committee and the state board of nursing, and supported by employers and faculty, which the next two weeks will address.

Conclusion

Testing the program's foundations against graduate employment and licensure data revealed a curriculum built for a job market that has moved. The outcomes still fit, but the mission, the placement of clinical hours and the threading of clinical judgment do not. The rest of this course will plan a revision that brings the curriculum back into alignment with its graduates' work.

References

Dickison, P., Haerling, K. A., & Lasater, K. (2019). Integrating the National Council of State Boards of Nursing clinical judgment model into nursing educational frameworks. Journal of Nursing Education, 58(2), 72-78. https://doi.org/10.3928/01484834-20190122-03

Iwasiw, C. L., Andrusyszyn, M.-A., & Goldenberg, D. (2020). Curriculum development in nursing education (4th ed.). Jones & Bartlett Learning.

National League for Nursing. (2010). Outcomes and competencies for graduates of practical/vocational, diploma, associate degree, baccalaureate, master's, practice doctorate, and research doctorate programs in nursing.