Curricular content mapping is an essential part of the nurse residency accreditation process. This evidence-based practice demonstrates how your organization’s residency curriculum aligns with accrediting agency standards (Layton, Moore, & Miltner, 2023). However, curricular mapping has benefits that go beyond meeting accreditation standards.

The process for seeking accreditation for a nurse residency program requires full transparency by the program team, documentation, verbalization, and demonstration of all program components and processes, and a thorough analysis of the program by external expert reviewers. Since residency program curricular content is foundational to the program design, it is essential to assess for curricular content gaps, and modify the curricula to meet the knowledge and clinical needs of the residents. It is important to note that content gaps as well as “curricular drift” when content and learning experiences fail to match specified outcomes are inevitable and predictable in health care education (Wilson, et al, 2012). This article discusses strategies for addressing curricular mapping deficiencies for nursing professional development (NPD) practitioners seeking accreditation.

Identifying Gaps and Redundancies in Curricula

Nurse residency program curricula are designed to improve practice readiness in new graduates by building clinical reasoning and practice skills. Curricula scope is broad and, like all clinical education, is predisposed to gaps and redundancies in content and clinical experiences. While the impact of missing content is obvious, redundancies are also problematic because they use time and resources that can be better spent on areas that have inadequate coverage.

Identifying curricular gaps begins with review of agency accreditation standards and creation of a checklist or “map” against which you examine your organization’s curricular content. This map also includes a rating scale to assess how well you cover the topic and helps to ensure appropriate depth of coverage (Layton, Moore, & Miltner, 2023). An identified gap was palliative care training. Using a Likert scale rating of 1-4, with 1 being not covered, 2 being minimally covered, 3 being partial coverage, and 4 fully covered, geropsychiatric care was found to be minimally covered and offered an opportunity for content development. Once you identify any opportunities, you will then conduct a needs assessment to identify learner’s  critical knowledge and skills gaps that may not be evident on the map. This feedback allows you to tailor content around residents’ desire for deeper knowledge, thus increasing confidence in practice.

An example of how the needs assessment serves as a gap analysis and can provide critical feedback was our residents’ requested  additional pharmacology training on geriatric-specific psychiatric medication and pain management. We then analyzed our content to assess the current process and select where, when, and how that need can be addressed. Curricular gaps and redundancies can be categorically divided into didactic (classroom content) and experiential (clinical experiences). Some examples that were uncovered in our program included knowledge and practice gaps in behavioral health, interventional radiology, and wound care.

Strategies for Filling the Gaps

The greatest challenge when addressing curriculum gaps and redundancies is securing appropriate resources. These resources include access to content experts, instructional technology, experienced clinical mentors, and thoughtfully planned encounters in practice settings. Since most organizations face budgetary constraints, securing some of these resources will hinge on your relationship with interprofessional team members and clinical partners (Layton, Moore, & Miltner, 2023).

Cognitive gaps require instructional didactic expertise that focus on building knowledge. The resources may be challenging to acquire. Some considerations are to bring in local content experts. Are there specialty clinic staff and unit-based NPD practitioners available to quickly address a gap in content? For example, when looking to close the gap in geropsychiatric content, our program used the strategy of recruiting local content experts, to provide didactic education. Academic practice partnerships can offer expedient access to subject matter experts, too. A quick phone call to request a pharmacology lecture from a local school of nursing or medicine can provide mutual benefits for learners and faculty. In this collaboration, the learners benefit from content targeted to their needs while the faculty member can use the experience to demonstrate recognition of their expertise, expand their portfolio of presentations, and add to their community service. Don’t forget opportunities to engage retired faculty and staff who add expertise, wisdom, and flexibility.

Effective use of your organization’s learning management system (LMS) is another approach to providing didactic content in a flexible distance-accessible manner. Advanced Cardiac Life Support is an example of a module we assigned for LMS instruction. Guest speakers can also be recorded so that contributions can be expanded beyond a single lecture. Other types of learning objects (videos, readings, case studies) can be carefully curated or produced to expand how the learner accesses and interacts with important content. It is important to note that distance-accessible education require financial considerations. Does the organization pay the learner even if they are accessing the education remotely from home? Consult your organization’s policy for this when designing these learning opportunities.

Experiential gaps are closed with carefully designed clinical experiences that focus on specific clinical reasoning or practice skills. These can be addressed by increasing the length or number of rotations within the facility and affiliated clinics. Another strategy is to identify potential short-term partnerships with staff members who enjoy teaching trainees. Clinical simulation is another way to obtain experiential learning that builds skills for practice readiness (Powers, et al., 2019). Since simulation technology varies by organization, collaboration with an academic partner, or an expert in simulation can be helpful.

While didactic and experiential gaps are relatively straightforward to address, it is important to note that socialization to organizational and disciplinary values is an important part of the nurse residency program. Strategies to bridge curricular gaps and support the nurse resident are summarized in Table 1.

Table 1. Resources for Bridging Curricular Gaps in Nurse Residency Programs

Curricular Focus	Strategies to Support Resident Development
Cognitive (Didactic/Classroom) — focus is on building knowledge for clinical reasoning	Journal clubs with selected readings provides information and the opportunity to interact with interprofessional team members Multimedia offerings via a learning management system (ex: videos, podcasts, recorded webinars, case presentations) Opportunities to engage with content experts in a variety of formats (ex: classroom, seminar, Q&A sessions, patient rounds)
Psychomotor (Experiential) — focus is on applying knowledge and developing practice skills	Expanded time in a variety of clinical settings Simulated learning experiences Coaching by experts (ex: IV team coaches IV insertion)
Affective (Socialization) – focus is on internalizing organizational and disciplinary values and deepening professional identity	Assignment to preceptors skilled in role-modeling and the socialization process opportunities for self-reflection (ex: journaling, guided conversations, peer-peer interactions) Discussion groups focused on professional identity and core values required of the role. Planned engagement with personnel who demonstrate desired organizational and disciplinary values

Filling the Gaps for Successful Outcomes

Nurse residency programs are resource-intensive and represent a significant investment by the organization. The expected returns on this investment are increased nurse retention, improved clinical reasoning and competence among nurse residents, improved care quality and safety, and better patient outcomes (AACN, 2023). A sound curriculum, with limited gaps and redundancies, helps to ensure these returns. Ensuring the curricula meets the needs of the residents further bridges the gaps. For our program, a strong curricula hinged on engaging experts from multiple disciplines and nursing specialties to help with cognitive and experiential foci. This closed the gaps found rating our curriculum and increased geropsychiatric care content from a rating of 2 to 4 (fully coverage) Curricular mapping, while only one step in the accreditation process, is foundational to establishing and sustaining a comprehensive nurse residency curriculum that meets the needs of the organization and nurse residents.  

References

American Academy of Colleges of Nursing (2023). Vizient/AACN Nurse Residency Program Fact Sheet. www.aacnnursing.org/Portals/42/AcademicNursing/NRP/Nurse-Residency-Program.pdf

Layton, S. S., Moore, R., & Miltner, R. S. (2023). Curriculum mapping post-baccalaureate registered nurse residency curriculum to accrediting agency standards. Journal for Nurses in Professional Development, 39(4): 230-233. https://doi-org.uab.idm.oclc.org/10.1097/NND. 0000000000000999

Powers, S., Claus, N., Jones, A., Lovelace, M., Weaver, K., & Watts, P. (2019). Improving transition to practice: Integration of advanced cardiac life support into a baccalaureate nursing program. Journal of Nursing Education, 58(3): 182-184. https://doi.org/10.3928/01484834-20190221-11

Wilson, E.A., Rudy, D.W., Elam, C., Pfeifle, A., & Straus, R. (2012). Preventing curriculum drift: Sustaining change and building upon innovation. Annals of Behavioral Science and Medical Education, 18(2):23-26. doi: 10.1007/BF03355202.